ReviewWorld journal of gastroenterology2022
Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas.
Review in World journal of gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
11 citing papers in PubMed, 18 citations in OpenAlex.
- Levator ani involvement in perianal fistulas: MRI-based insights into complex anatomy.Abdominal radiology (New York) · 2026Article
- Case report of combined application of three sphincter-preserving approaches in complex perianal fistula.Journal of surgical case reports · 2026Article
- A 34-Year-Old Man With a Traumatic Penetrating Injury of the Buttock and Occult Retained Foreign Body Resulting in a High Anal Fistula Managed by Trans-Sphincteric Surgery.The American journal of case reports · 2026Article
- Outcomes of Draining Seton Insertion Followed by Ligation of the Intersphincteric Fistula Tract Versus Cutting Seton Insertion for Anal Fistula: A 5-Year Retrospective Cohort Study.Middle East journal of digestive diseases · 2025Article
- Process to determine the level of the primary internal opening of anal fistula on magnetic resonance imaging.Annals of coloproctology · 2025Article
- Clinical application of the intersphincteric approach with internal incision combined with counter- drainage for deep perianal abscess.BMC gastroenterology · 2025Article
- Evaluation of the RIFER procedure in treating high intersphincteric anal fistulas.Frontiers in medicine · 2025Article
- Surgeon oriented reporting template for magnetic resonance imaging and endoanal ultrasound of anal fistulas enhances surgical decision-making.World journal of radiology · 2024Article
- Recent advances in the diagnosis and treatment of complex anal fistula.Annals of coloproctology · 2024Review
- Preoperative Assessment of Perianal Fistulas with Combined Magnetic Resonance and Tridimensional Endoanal Ultrasound: A Prospective Study.Diagnostics (Basel, Switzerland) · 2023Article
- TROPIS (Transanal Opening of Intersphincteric Space) Procedure for the Treatment of Horseshoe Anal Fistulas.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.