الناسور الشرجي المعقد عندما لا يحقق العلاج الأولي للحفاظ على العضلة العاصرة الشفاء

References

• 'Complex' anal fistulas are extrasphincteric, suprasphincteric or high transsphincteric fistulas involving greater than 30% of the external anal sphincter (EAS) and intersphincteric fistulas involving greater than 50% of the IAS.
• Rectovaginal fistula, anterior fistula in women, recurrent fistula and fistulas with horseshoe or multiple extensions are also classified as complex fistulas.
• Although the LIFT procedure may not have healed the fistula, it succeeded in downstaging the fistula tract from transsphincteric to intersphincteric, which would qualify for a fistulotomy.
• LAFT can be considered in patients with a high anal fistula.
• Repeated LAFT can be considered in patients following primary failure from the first attempt.
• VAAFT can be considered in the management of complex perianal fistula.
• Fistula plug can be considered in the management of anal fistula.