الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Fistula-in- ano is a track, lined by granulation tissue that connects deeply in the anal canal or rectum and superficially on the skin around the anus. Perianal fistula is characterized by chronic, purulent, malodorous, ulcerating, sinus tracts in the perianal tissue. The cryptoglandular hypothesis is the most accepted theory in its pathogenesis, also there are some other causes e. g Crohn’s disease, ulcerative colitis, actinomycosis, foreign body, lymphogranuloma venerium and trauma.
In the standard classification of anal fistulae, the fistula is classified into two groups low level fistulae in which the internal opening below the anorectal ring, and high level fistulae in which the internal opening at or above the anorectal ring, but the most widely used classification is that of park’s in which the anal fistulae are clssified into; inter-sphincteric, trans-sphincteric, supra-sphincteric, extra-sphincteric.
Radiological investigation have a role in evaluation of fistula in ano, most primary fistulae can be treated on the basis of clinical examination alone. However, when atypical features are present or when prior surgery has failed, radiological evaluation may be useful.
Pelvic magnatic resonance imaging is accurate in identifying perianal fistula, as it was shown that fistula surgery guided by MRI reduced the recurrence of anal fistula by 75% and therefore, recommended in all patients presenting with recurrent fistula. Performing MRI with contrast allows discrimination of fistulous tracts from adjacent structures.
Surgical strategies to treat anal fistula tend to be guided by their degree of complexity and their underlying aetiology.
Fistulectomy by core out technique is suitable for high anal fistula but not for recurrent or more complex fistula, rerouting method has the benefit of minimal loss of muscle tissue but it is technically difficult and necessitates more than one sitting.
Advancement flap technique has become a popular technique to minimize the incidence of fecal incontinence. The main problem in flap surgery is shrinkage of the flap principally caused by inadequate blood supply, the reason for that might be inadequate dissection, dimension or tention at suture line.
Fibrin glue has the advantage of minimal risk to continence, but it offers a little benefit over other methods in terms of complex fistula healing. The precise role of fibrin glue in the treatment of anal fistula remains unclear due to lack of good quality clinical trials.
High anal fistula, seton fistulotomy provides good results. This method depends on tightening a seton which encircle the striated muscles that lie superficial to the fistula tract. The striated muscle is slowly divided by a process of ischaemic necrosis, this method in remarkably successful in preserving sphincter function
Our study is a prospective observational nonrandomized study of 30 patients with high anal fistula managed by Seton placement, between. Diagnosis: history, physical examination, proctoscopy and Imaging radiology by MRI had been done to all (30) patients Pre operative preparation wasdone out of 30 patients 27 were male and only 3 were females, male to female ratio was 9: 1
Distribution of patients results in our study Intersphincteric 69.5% most common Transsphincteric 26 % Seton(loose type more frequently used as most cases 2ry to perianal abscesses’) 9 cases we used cutting seton (30%) has been taken 8 weeks to cut through 21 loose seton of cases 70 % takes bet 9-12 weeks to be removed intra operatively Incontinence more frequent in cutting than loose but still low overall 3.5% Recurrence also more in cutting overall 7% Suprasphnicteric 10% (3 cases)more prone to incontinence.