ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1566130
Diagnosis and Treatment for Anal Fistula: A Systematic Review of Clinical Practice Guidelines and Consensus Statements
Provisionally accepted
- 1Affiliated People‘s Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- 2Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Background: Anal fistula constitutes a pathological channel originating either from the anal canal or rectum to the skin surrounding the anus, primarily characterized by recurrent pain, purulent discharge, and pruritus. This study aims to compare and standardize the recommendations for the diagnosis and treatment of anal fistula, drawing on contemporary clinical practice guidelines.: A comprehensive search was conducted across multiple databases including PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biological Medicine Database, from their inception through April 1, 2024. The objective was to collate all published guidelines on anal fistula. The quality of the eligible guidelines was appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: The search yielded fifteen guidance documents -comprising nine guidelines and six consensus statements -each offering specific recommendations. Twelve of these documents address screening and diagnosis of anal fistula, while all fifteen discuss various treatment and management strategies. Document analysis highlighted MRI as the predominant diagnostic recommendation. Treatment and management strategies were categorized into four categories: preoperative management, surgical method selection, pharmacological interventions, and postoperative management. Regarding surgical interventions, all guidelines address incision and drainage of fistulas. Most guidelines offer a low recommendation for cutting setons, mainlyattributed to the presence of incontinence. For high--positioned anal fistula, a push-pull flap procedure is recommended, whereas the LIFT procedure is advocated for newly identified, high, and sphincter-penetrating fistulas. Among the 15 guidelines and consensus statements evaluated in this study, more than half demonstrated methodological limitations, with particularly deficient performance in the applicability domain. As a critical determinant of implementation effectiveness, these deficiencies may undermine guidelines' capacity to optimize health outcomes.There is a pressing need for an updated search of potential evidence on the diagnosis and treatment of anal fistula. Effective diagnoses and therapeutic approaches, whether conventional or complementary and alternative medicine, should be thoroughly evaluated and incorporated based on robust evidence.
Keywords: diagnosis, guidelines, anal fistula, therapeutic, Systematic review
Received: 24 Jan 2025; Accepted: 18 Jun 2025.
Copyright: © 2025 Lu, Wang, Wang, Cai, Liang and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rong Shi, Affiliated People‘s Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.