This protocol applies to patients with anorectal fistula classified as complex, a category that carries meaningful risk to sphincter function and requires a carefully staged surgical strategy.
Complex anal fistulas include transsphincteric fistulas involving more than 30% of the external sphincter, suprasphincteric fistulas, extrasphincteric fistulas, and horseshoe fistulas. Fistulas occurring in the setting of preexisting fecal incontinence or chronic diarrhea are also classified as complex, as these comorbidities increase the risk of postoperative continence disturbance.
Initial management focuses on controlling local sepsis. The structured approach begins with a specific surgical technique to address the acute septic process — the definitive fistula eradication follows in a planned, staged manner.