{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:29:35Z","timestamp":1790839775697,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,2,24]],"date-time":"2012-02-24T00:00:00Z","timestamp":1330041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fistula\u2010in\u2010ano is a common medical problem affecting thousands of patients annually. In the past, the options for treatment of fistula\u2010in\u2010ano were limited to fistulotomy and\/or seton placement. Current treatment options also include muscle\u2010sparing techniques such as a dermal island flap, endorectal advancement flap, fibrin sealent injection, anal fistula plug, and most recently ligation of the intersphincteric fistula tract (procedure). This study seeks to evaluate types and time trends for treatment of fistula\u2010in\u2010ano.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review from 1975 to 2009 was performed. Data were collected and sorted into 5\u2010year increments for type and time trends of treatment. Fistulotomy and partial fistulotomy were grouped as cutting procedures. Seton placement, fibrin sealant, dermal flap, endorectal flap, and fistula plug were grouped as noncutting procedures. Statistical analysis was performed for each time period to determine trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With institutional review board approval, the records of 2,267 fistula operations available for analysis were included. Most of the patients were men (74 vs. 26%). Cutting procedures comprised 66.6% (<jats:italic>n<\/jats:italic> = 1510) of all procedures. Noncutting procedures were utilized in 33.4% (<jats:italic>n<\/jats:italic> = 757), including Seton placement alone 370 (16.3%), fibrin sealant 168 (7.4%), dermal or endorectal flap 147 (6.5%), and fistula plug 72 (3.2%). The distribution of operations grouped in 5\u2010year intervals is as follows: 1975\u20131979, 78 cutting and one noncutting; 1980\u20131984, 170 cutting and 10\u00a0noncutting; 1985\u20131989, 54 cutting and five noncutting; 1990\u20131994, 37 cutting and six noncutting; 1995\u20131999, 367 cutting and 167\u00a0noncutting; 2000\u20132004, 514 cutting and 283\u00a0noncutting; 2005\u20132009, 290 cutting and 285\u00a0noncutting. The percentage of cutting and noncutting procedures significantly differed over time, with cutting procedures decreasing and noncutting procedures increasing proportionally (\u03c7<jats:sup>2<\/jats:sup> linear\u2010by\u2010linear association, <jats:italic>p<\/jats:italic> &lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fistula\u2010in\u2010ano remains a common complex disease process. Its treatment has evolved to include a variety of noncutting techniques in addition to traditional fistulotomy. With the advent of more sphincter\u2010sparing techniques, the number of patients undergoing fistulotomy should continue to decrease over time. Surgeons should become familiar with various surgical techniques so the treatment can be tailored to the patient.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-012-1480-9","type":"journal-article","created":{"date-parts":[[2012,2,23]],"date-time":"2012-02-23T19:46:31Z","timestamp":1330026391000},"page":"1162-1167","source":"Crossref","is-referenced-by-count":68,"title":["Evolution of Treatment of Fistula in Ano"],"prefix":"10.1002","volume":"36","author":[{"given":"J.","family":"Blumetti","sequence":"first","affiliation":[{"name":"Stroger Hospital of Cook County Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Abcarian","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine University of Illinois at Chicago 840 South Wood Street 60612 Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Quinteros","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine University of Illinois at Chicago 840 South Wood Street 60612 Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Stroger Hospital of Cook County Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine University of Illinois at Chicago 840 South Wood Street 60612 Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Abcarian","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine University of Illinois at Chicago 840 South Wood Street 60612 Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,2,24]]},"reference":[{"key":"e_1_2_7_2_2","first-page":"419","article-title":"The role of seton in fistulotomy of the anus","volume":"157","author":"Ramanujam PS","year":"1983","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02587008"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02553848"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02554093"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02235039"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02068080"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02234135"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010003\u20100076\u20108"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02586982"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181f2e9cd"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02237048"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02553995"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181b72378"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02616977"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02554037"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02257781"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106181\u20105"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02049864"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02070710"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02561583"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050079"},{"key":"e_1_2_7_23_2","first-page":"682","article-title":"Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas","volume":"114","author":"Kodner IJ","year":"1993","journal-title":"Surgery"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181ce8b01"},{"key":"e_1_2_7_25_2","first-page":"681","volume":"43","author":"Nelson RL","year":"2000","journal-title":"Dermal island\u2010flap anoplasty for transsphincteric fistula\u2010in\u2010ano: assessment of treatment failures"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106708\u20109"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20100898\u2010z"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106589\u2010y"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181a8fbb7"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010005\u20100288\u20101"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01423.x"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181d43b7d"},{"key":"e_1_2_7_33_2","first-page":"1584","article-title":"Anal fistula plug in high fistula\u2010in\u2010ano: an early Saudi experience","volume":"52","author":"Zubaidi A","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181d972a9"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010009\u20100523\u20101"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010011\u20100769\u20102"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-012-1480-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-012-1480-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-012-1480-9","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T03:16:45Z","timestamp":1704943005000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-012-1480-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,2,24]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2012,5]]}},"alternative-id":["10.1007\/s00268-012-1480-9"],"URL":"https:\/\/doi.org\/10.1007\/s00268-012-1480-9","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,2,24]]}}}