Management of Perianal Fistulas

Treatment Options

For simple, low anal fistulas without proctitis, fistulotomy can be considered with healing rates approaching 100% in carefully selected patients, according to the Journal of Crohn's and Colitis 1
Initial seton placement followed by definitive treatment is recommended for complex perianal fistulas, as stated by the Journal of Crohn's and Colitis 1

Fistulotomy or fistulectomy should be avoided in patients with proctitis due to higher risk of complications and recurrence, as advised by Gastroenterology and the Journal of Crohn's and Colitis 3, 1
Cutting setons can result in high incontinence rates (up to 57%) and should be used with caution, according to the Journal of Crohn's and Colitis 4, 5
Anterior fistulas in female patients should not undergo fistulotomy due to high risk of incontinence, as recommended by the Journal of Crohn's and Colitis 5

Combined medical and surgical approaches offer better outcomes than either approach alone, particularly in complex cases, as suggested by the European Crohn’s and Colitis Organisation 2