الفهرس 
Embryology of the anal canalOnly 14 pages are availabe for public view
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Abstract
Introduction: Fistula-in-ano is one of the commonly encountered surgical problems. Different classifications have been put forward which categorize these fistulae into low or high, simple or complex, or according to their anatomy – inter-sphincteric, trans-sphincteric, and supra-sphincteric or extra-sphincteric. Aim of work: The aim of this work was to evaluate the different surgical modalities in treatment of trans sphincteric anal fistula, regarding to early postoperative complications, recurrence and incontinence. Patients and methods: This study comprises a prospective study of 140 patients with transphincteric anal fistula, they were referred to our colorectal surgery unit, Mansoura University Hospital during the period from January 2004 to May 2007. The patients were classified into seven groups (20patients each): Group I: was subjected to laying open the fistula with the use of a seton. Group II: was subjected to seton rerouting. Group III: was subjected to fibrin glue application after complete de-epithelization. Group IV: rectoanal advancing flap (mucosa, submucosa, circula muscle layer). Group V: rectoanal advancing flap (mucosa, submucosa). Group VI: Anocutaneous flap. Group VII: Combined anocutaneous and rectal mucosal advancement flap (H shaped flap). Results: In group I: Fistula recurrence reported in 2 patients (10%) and incontinence occurred in 4 patients (20%), the manometric changes ere significantly decreased in mean resting pressure from 63.75 6.38 to 52.35 8.98 (P < 0.001). In group II: Fistula recurrence reported in 3 patients (15%) and incontinence occur in 2 patients (10%), the manometric changes were significant decrease in mean resting pressure from 64.3 7.47 to 59.05 7.51 (P < 0.001). In group III: Fistula recurrence reported in 7 patients (35%) and there is no change in continence, the manometric changes were significantly decreased in mean resting pressure from 68.1 10.38 to 67.0 10.23 (P < 0.05). In group IV: Fistula recurrence reported in 3 patients (15%) and incontinence occur in 2 patients (10%), the manometric changes significantly decreased in mean resting pressure from 68.4 8.55 to 62.15 7.62 (P < 0.001). In group V: Fistula recurrence reported in 8 patients (40%) and no change in continence, the manometric changes significantly decreased in mean resting pressure from 65.4 8.17 to 63.4 7.38 (P < 0.001). In group VI: Fistula recurrence reported in 7 patients (35%) and incontinence occur in 2 patients (10%), the manometric changes significantly decreased in mean resting pressure from 62.2 6.92 to 60 6.9 (P < 0.05). In group VII: Fistula recurrence reported in 10 patients (50%) and incontinence occurred in 2 patients (10%), the manometric changes significantly decreased in mean resting pressure from 65.0 9.99 to 61.9 9.95 (P < 0.05). Conclusions: Seton fistulectomy is the standard treatment for high anal fistula (primary or recurrent) which provides high rate of cure with little disturbance in incontinence mechanism. Seton rerouting is best applied to high anal fistula (primary or recurrent) without supralevator suppuration, this technique allowing saving the external sphincter or even repair of the previously damage muscle.