An anal fistula is an abnormal opening near the anus that arises from a gland in the anus called a crypt. This crypt gets blocked probably by a stool particle and this can give rise to a fistula or an abscess. Often an abscess or a fistula go together and it is difficult to predict which one cam first and it is often difficult to predict which one came first . Often drainage of an abscess can lead to a fistula. It is important to know that a perianal abscess that is drained incorrectly can give rise to a more complex fistula. So if you have a perianal abscess please do have it addressed by a qualified professional. A fistula is an abnormal connection from the inside of the anus to the outside and if it can go to a significant portion of the muscle. How we treat an anal fistula depends on what type of fistula it is. If it is a fistula that is superficial then the best approach is to leave it open and if the fistula goes through a significant approach of muscle then there is some challenge to it as you cannot cut through the muscle as this will make a patient incontinent. So we have different modalities like advancement flap, ligation of intersphincter fistula tract, and tightening seatons to address fistula. certain modalities such as the fibrin glue, fistula plug and awe treatment of fistulas have limited treatments of fistulas and one off the important aspect of fistula treatment is the fistula anatomy, underused that the fistula can come back understand that there is a staged approach to it and to counsel the patient appropriately before undertaking fistula surgery.

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