Reoperation in recurrent complex anal fistula

This chapter discusses the range of surgical options now available for the management of patients with recurrent fistulae-in-ano. The management of these patients has become its own super-specialty in which the colorectal surgeon needs to understand the array of imaging modalities available to achieve a successful result. This is possibly best backed by an approach of the surgeon actually performing his or her own ultrasonography to achieve the desired outcome; this should be supplemented by secondary reconstructive procedures for the effects ensuing from destructive perirectal sepsis. These will include delayed sphincter repair, advancement anoplasty, rectovaginal fistula management, and perineoplasty. The imaging of these patients needs to address all of these secondary destructive effects.

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