thesis
Identification of factors affecting the outcome of transanal advancement flap repair for high transsphincteric fistulas
- Publication date
- 11 November 2009
- Publisher
- A fistula is defined as an abnormal communication between two epithelium lined surfaces.
Perianal fistulas are abnormal communications between the anal canal and the perianal skin.
Perianal fistulas have been treated since ancient times. Probably the first to describe the
diagnosis and treatment of anal fistula was Sushruta around 600 BC. Around 430 BC,
Hippocrates (460-370 BC) described perianal fistulas in more detail. It is remarkable that
some of his guidelines carry worldwide popularity up to today. The estimated incidence of
perianal fistulas varies between 0.86 and 2.32 per 10,000/year. There is a male
predominance with a reported male-to-female-ratio varying from 2:1 to 5:1 2. The
maximum incidence is between the third and fifth decades of life . Perianal fistulas account
for a substantial discomfort and morbidity to the patient and although many fistulas are easily
recognized and treated, others can be complex and difficult to treat.