Anal Fistula the management of convoluted anal fistula remains a test for specialists and a baffling issue for patients. Treatment expects to cure the condition, with seepage of the related contaminated organ abscess and annihilation of the fistula tract. The greater part of perianal diseases are either idiopathic or crypto-glandular in inception. All techniques for fistula repair depend on the disposal of the fistula interior opening to the anal gland. Anorectal abscess and the fistula that it may bring about, are long-term processes, initially portrayed toward the start of the recorded medical history, as a component of the ''Corpus Hippocraticum'' in a treatise termed ''On Fistulae''.
The notable reasons for a typical/confused abscess and fistula, including inflammatory bowel disease, contagious disease, mycobacterial contamination, neoplasm and injury. Fistulas, auxiliary to these procedures are named complex and require the utilization of nonstandard systems for management. The most regular giving grumblings of patients a anal fistula are swelling, agony and release. The previous two manifestations are normally connected with a abscess, when the outside or optional opening has shut or has neglected to create Anal fistula may be mistaken for suppurative hidradenitis and pilonidal sinus and the specialist should be mindful so as to make the right determination.
The advancement of rectal flap technique would be appealing with less sphincter muscle to be divided. Avoidance of contour defects, experiencing less pain due to the absence of a perineal wound and a faster healing process are the AMF (advancement mucosal flap) advantages. A few types of setons used are the Ayurveda-medicated thread, braided sutures, thread, rubber band, Penrose drains, and cable tie seton, Seton material should be non-absorbable, from non-slippage material, comfortable and least irritant for the patient and equally effective in causing focal reaction in the track, leading to fibrosis. Sphincter-sparing procedures are the standard treatment of anal fistula.
In a cohort study,54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10–53] months. Median Crohn’s Disease Activity Index at baseline was 81 [45–135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59–4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively