The use of biologics in anal fistulas

The management of anal fistulas is often challenging. Simple fistulotomy is ideal for intersphincteric tracts and low transsphincteric fistulas that incorporate a small amount of the sphincter muscles. More complex fistulas require a sphincter-sparing approach. The general goal of the numerous established procedures for the treatment of anal fistulas is to eliminate the fistula tract with the lowest rate of recurrence while preserving sphincter function. As such, the use of biologic materials in this cohort of fistulas has gained popularity over the years because they are resistant to infection, have limited foreign body reaction, and are repeatable without compromising fecal continence. Short- and long-term results are variable and will be discussed further in this article. There are also novel strategies using biologic materials that warrant consideration and further study.