Guideline Addresses Anorectal Abscess; Anal, Rectovaginal Fistulas


WEDNESDAY, Aug. 10, 2022 — In clinical practice guidelines issued by the American Society of Colon and Rectal Surgeons and published in the August issue of Diseases of the Colon & Rectum, updated recommendations are presented for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula.

After reviewing the literature, Wolfgang B. Gaertner, M.D., from the University of Minnesota in Minneapolis, and colleagues included three new and six updated recommendations in the new guidelines. A new recommendation is that a combination of surgical and medical approaches is recommended for the typical management of anorectal fistula associated with Crohn disease (strong recommendation based on moderate-quality evidence). Among the updated recommendations, the anal fistula plug and fibrin glue are relatively ineffective treatments for fistula-in-ano (strong recommendation based on moderate-quality evidence). For fistula-in-ano associated with Crohn disease, endorectal advancement flaps and the LIFT procedure may be used for treatment (strong recommendation based on moderate-quality evidence). In its entirety, the updated guideline contains 25 recommendations.

“The ultimate judgment regarding the propriety of any specific procedure must be made by the physician considering all the circumstances presented by the individual patient,” the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical device industries.

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