title: Fistula-in-ano: when to cut, tie, plug, or sew.
abstract: BACKGROUND
  Management of fistula-in-ano requires understanding of both perianal and rectal anatomy, as well as the surgical approaches available to ensure the highest possible postoperative continence and wound healing. Further, high rates of recurrence with medical management commonly bring these patients under the care of the colorectal surgeon after variable periods of failed conservative management. Novel techniques provide surgeons with tools to treat increasingly complex fistulas with a focus on maintaining sphincteric functionality and limiting recurrence.
  
  
  METHODS
  This manuscript presents our practice, including perioperative decision making regarding surgical approach, in managing patients with fistula-in-ano.
  
  
  CONCLUSIONS
  Familiarity with these techniques prepares the general surgeon and colorectal surgeon to improve wound healing and functional outcomes in these patients, especially with complex disease involving the external and internal anal sphincters.
authors: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors: Robert
authors: R
authors: Beaulieu
authors: David
authors: D
authors: Bonekamp
authors: Corinne
authors: C
authors: Sandone
authors: Susan
authors: S
authors: Gearhart
mesh_terms: D017577:Cutaneous Fistula / Q000601:surgery*; D004322:Drainage; D006801:Humans; D008279:Magnetic Resonance Imaging; D012003:Rectal Fistula / Q000601:surgery*; D013524:Surgical Flaps; D013537:Sutures; D058106:Wound Closure Techniques