Almughamsi Asim M, Elhassan Yasir Hassan
Department of Surgery, College of Medicine, Taibah University, Madinah, Saudi Arabia.
Department of Basic Medical Science, College of Medicine, Taibah University, Madinah, Saudi Arabia.
Surg Today. 2025 Apr;55(4):457-474. doi: 10.1007/s00595-025-02995-2. Epub 2025 Jan 31.
Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92-97% for simple fistulas versus 40-95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50-60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.
肛瘘仍然是结直肠手术中最具挑战性的病症之一，成功治疗需要精确的解剖学知识。这篇全面综述综合了有关肛瘘发生发展及治疗的解剖学基础的现有证据，特别聚焦于隐窝腺假说及其临床意义。对近期文献的系统分析考察了解剖结构与肛瘘形成、分类系统、诊断方式及治疗方法之间的关系。该综述表明，解剖学因素从根本上影响治疗效果，现代成像技术在描绘肛瘘解剖结构方面的准确率高达98%。主要研究结果显示，手术成功率因解剖结构的复杂程度而有显著差异：使用保留括约肌技术时，简单肛瘘的成功率为92%-97%，而复杂肛瘘的成功率为40%-95%。包括间充质干细胞在内的新兴微创方法和再生疗法在复杂病例中显示出有前景的结果，治愈率为50%-60%。对于克罗恩病相关肛瘘和直肠阴道瘘等复杂病例，需要特殊考虑。本综述为外科医生提供了一个基于解剖学因素选择最佳治疗策略的循证框架，强调在实现完全根除肛瘘的同时保留肛门括约肌功能的重要性。整合先进成像技术、手术技术和新兴疗法为改善患者治疗效果提供了新的可能性。本综述旨在弥合解剖学知识与实际手术应用之间的差距，加强临床决策，并改善肛瘘治疗中的患者治疗效果。
