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A small percentage of fistulas are complex and very challenging to manage. Management involves an accurate diagnosis and a balance between eradication of the fistula and maintenance of continence. A decision should be made, based on clinical evaluation and anal ultrasound (if available), whether the fistula can be laid open. If it cannot be laid open, a loose seton is placed and the sepsis is allowed to settle. Once the sepsis is quiescent, a definitive repair can be attempted. There are various techniques available including rectal advancement flap, fibrin glue and cutaneous flaps all of which are discussed.<\/jats:p>","DOI":"10.1111\/j.1445-2197.2005.03280.x","type":"journal-article","created":{"date-parts":[[2005,3,1]],"date-time":"2005-03-01T15:15:24Z","timestamp":1109690124000},"page":"64-72","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Anal abscesses and fistulas"],"prefix":"10.1111","volume":"75","author":[{"given":"Matthew J. F. 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