Our Summary

This research paper presents new guidelines for the treatment of a medical condition called cryptoglandular anal fistula, which is a kind of abnormal connection between the inside of the anus and the skin around it. The guidelines were developed by a group of medical experts from the European Society of Coloproctology (a group of doctors who specialize in diseases of the colon and rectum).

The process for creating these guidelines was in six stages. First, they decided what the guidelines would cover, which in this case is how to diagnose and treat this condition in adult patients. Secondly, they put together a team of experts who specialize in this area, along with some patients to give their perspective.

Next, they came up with a list of 250 questions about the condition and its treatment, and picked the 45 most important ones to include in the guidelines. They then decided what outcomes were most important to consider in the treatment, such as whether the fistula healed, whether it came back, and whether the patient had any pain or incontinence.

After that, they searched through medical literature to find the most up-to-date and reliable information on the subject. They used this information to draft the guidelines, which were then reviewed and revised by the team.

The final guidelines include 42 recommendations on the diagnosis and treatment of this condition. These guidelines represent the most current and comprehensive advice for treating cryptoglandular anal fistula, and will be useful for healthcare providers and patients.

FAQs

  1. What is a cryptoglandular anal fistula and who has developed new guidelines for its treatment?
  2. What was the process for creating these new guidelines for the treatment of cryptoglandular anal fistula?
  3. What does the final guidelines for the treatment of cryptoglandular anal fistula include and who would find them useful?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions closely to promote healing and prevent complications. This may include keeping the surgical area clean and dry, taking prescribed medications as directed, and avoiding activities that could strain the area. It is also important to attend follow-up appointments with your healthcare provider to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended for anal fistula surgery are those who have cryptoglandular anal fistulas that are causing symptoms such as pain, swelling, or discharge. Other factors that may indicate the need for surgery include recurrent or complex fistulas, fistulas that are not responding to conservative treatments, or fistulas that are associated with other conditions such as Crohn’s disease.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider in order to determine if surgery is the best course of action for their individual situation. Surgery for anal fistulas is generally safe and effective, and can help alleviate symptoms and improve quality of life for patients.

Timeline

Before anal fistula surgery, a patient may experience symptoms such as pain, swelling, discharge, and difficulty sitting or walking. They may also undergo diagnostic tests such as a physical examination, a digital rectal exam, and possibly an MRI or ultrasound to determine the extent of the fistula.

After anal fistula surgery, the patient may experience some pain and discomfort, as well as drainage of fluid or blood from the surgical site. They will likely be prescribed pain medication and possibly antibiotics to prevent infection. The patient will need to follow post-operative care instructions, such as keeping the area clean and dry, avoiding strenuous activity, and possibly changing their diet to promote healing.

Over the following weeks and months, the patient will have follow-up appointments with their healthcare provider to monitor the healing process and ensure that the fistula does not recur. It may take several weeks to months for the fistula to fully heal, depending on the complexity of the surgery and the individual’s overall health. With proper care and follow-up, most patients can expect a successful outcome and relief from their symptoms.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery include:

  1. What is an anal fistula and why do I need surgery to treat it?
  2. What are the risks and benefits of anal fistula surgery?
  3. How long will the surgery take and what is the recovery time?
  4. Will I need to stay in the hospital after the surgery?
  5. What type of anesthesia will be used during the surgery?
  6. What can I expect in terms of pain and discomfort after the surgery?
  7. Will I have any restrictions or limitations on activities after the surgery?
  8. What is the success rate of anal fistula surgery and what are the chances of the fistula coming back?
  9. Are there any potential complications or side effects of the surgery that I should be aware of?
  10. Are there any alternative treatments to surgery for anal fistulas that I should consider?
  11. How often will I need follow-up appointments after the surgery?
  12. What can I do to help prevent future anal fistulas from developing after the surgery?

Reference

Authors: Reza L, Gottgens K, Kleijnen J, Breukink S, Ambe PC, Aigner F, Aytac E, Bislenghi G, Nordholm-Carstensen A, Elfeki H, Gallo G, Grossi U, Gulcu B, Iqbal N, Jimenez-Rodriguez R, Leventoglu S, Lisi G, Litta F, Lung P, Millan M, Ozturk E, Sackitey C, Shalaby M, Stijns J, Tozer P, Zimmerman D. Journal: Colorectal Dis. 2024 Jan;26(1):145-196. doi: 10.1111/codi.16741. Epub 2023 Dec 5. PMID: 38050857