Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

"Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question,we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer.It would appear that whatever method you adopt in fistula management,there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery).Since,at the moment,reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking,the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease;this knowledge joined to an eclectic attitude of the surgeon,who should be familiar with different types of treatment,is the only guarantee for a satisfactory treatment.As a conclusion,it is worthwhile to remember that adequate initial treatment significantly reduces recurrence,which,when it occurs,is usually due to failure to recognise the tract and primary opening at the initial operation.