title: Cryptoglandular anal fistulas.
abstract: BACKGROUND
  Cryptoglandular anal fistula arises in 2 per 10 000 persons per year and is most common in young men. Improper treatment can result in fecal incontinence and thus in impaired quality of life.
  
  
  METHODS
  This S3 guideline is based on a systematic review of the pertinent literature.
  
  
  RESULTS
  The level of evidence for treatment is low, because relevant randomized trials are scarce. Anal fistulae are classified according to the relation of the fistula channel to the sphincter. The indication for treatment is established by the clinical history and physical examination. During surgery, the fistula should be probed and/or dyed. Endo-anal ultrasonography and magnetic resonance imaging are of roughly the same diagnostic value and may be useful as additional studies for complex fistulae. Surgical treatment is with one of the following operations: laying open, seton drainage, plastic surgical reconstruction with suturing of the sphincter, and occlusion with biomaterials. Only superficial fistulae should be laid open. The risk of postoperative incontinence is directly related to the thickness of sphincter muscle that is divided. All high anal fistulae should be treated with a sphincter-saving procedure. The various plastic surgical reconstructive procedures all yield roughly the same results. Occlusion with biomaterials yields a lower cure rate.
  
  
  CONCLUSIONS
  This is the first German S3 guideline for the treatment of cryptoglandular anal fistula. It includes recommendations for the diagnostic evaluation and treatment of this clinical entity.
authors: End- und Dickdarmpraxis Essen, Germany. aommer@online.de
authors: Andreas
authors: A
authors: Ommer
authors: Alexander
authors: A
authors: Herold
authors: Eugen
authors: E
authors: Berg
authors: Alois
authors: A
authors: Fürst
authors: Marco
authors: M
authors: Sailer
authors: Thomas
authors: T
authors: Schiedeck
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D059351:Organ Sparing Treatments / Q000379:methods*; D012003:Rectal Fistula / Q000175:diagnosis* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*