- Emily J Bubbers: St. Peter's Hospital, Helena, Montana.
- Kyle G Cologne: Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data.