الفهرس 
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Abstract
SUMMARY
T
he word fistula comes directly from its Latin counterpart which means “pipe”. In medical terminology, a fistula translates to an abnormal connection between a set of organs or vessels that do not normally connect e.g. the connection between the distal alimentary tract and the integument. For years, it has been accepted that the abnormal communication of the lower gastrointestinal system with the perianal region is due to a cryptoglandular infection. It is believed that the anal crypts become blocked by inspissated debris or stool. As a result, an infection develops at the anal glands, which extends in a path of least resistance, forming an abscess in the intersphincteric space leading to the development of a fistula in about one third of patients. However, this explanation does not take into account fistulas caused by Crohn’s disease, tuberculosis, lymphogranuloma venereum, and actinomycosis, first reported by Swinton in 1964.
Perianal fistula disease has significant implications for the patient’s quality of life as a sequelae range from minor pain and social hygienic embarrassment to frank sepsis.
The treatment of anal fistula has challenged physicians and healers for millennia. References to fistulous disease and use of both fistulotomy and setons can be found in the writings of Hippocrates, dating from 400 BC.
In management of perianal fistula Surgery is the mainstay of therapy with the aim of draining local infection eradicating the fistulous tract and prevention recurrence while preserving native sphincter function.
Patients with horseshoe fistula usually undergo multiple drainage and unsuccessful fistula surgery before they reach to get a definitive diagnosis and treatment. The patients of horseshoe fistula are usually advice surgery for their problems. There are several operation like fistulotomy, cutting seton, fibrin glue injection, fistula plug and endorectal advancement flap.
It was found that all these procedures are just temporary solutions as invariably the fistula recurs. Besides, a lot of complications can occur due to surgery like urinary retention, bleeding, thrombosed pile, and fecal impaction, incontinence of stool, anal stenosis and delayed wounds healing. Treatment of horseshoe fistula by fecal diversion alone did not resolve horseshoe fistula. Horseshoe fistula is one of the most complex and potentially morbid conditions faced in a modern anorectal surgery.