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  Executive Summary Postoperative anal fistula recurrence (AFR) remains one of the most significant challenges in colorectal surgery, with reported rates reaching as high as 40%. Recurrence leads to substantial medical and economic burdens, potentially compromising anal sphincter function and patient quality of life. This document synthesizes findings from an international, evidence-based Delphi consultation survey and associated expert commentaries to identify the critical risk factors for AFR across three domains: patient-related, fistula-related, and surgery-related. A consensus reached by an international panel of surgical specialists identifies 14 core risk factors . The most critical factors include inflammatory bowel disease (IBD), undetected internal openings, and the presence of recurrent or complex fistula structures (such as horseshoe extensions). The findings underscore the necessity of accurate preoperative assessment —utilizing detailed clinical examinations and me...

  Executive Summary The surgical management of fistula-in-ano remains a significant clinical challenge, balancing the need for permanent eradication of suppuration with the preservation of fecal continence. This briefing document synthesizes findings from a long-term study of 279 patients to identify the primary drivers of surgical failure and postoperative morbidity. The study reveals an overall recurrence rate of 7.2% and a postoperative continence deterioration rate of 12.2% . The most critical takeaways are: Identification of the Internal Opening (IO): Failure to locate the IO during surgery is a primary , statistically significant risk factor for recurrence. Preoperative Continence Status: The strongest predictor of postoperative incontinence is the existence of preoperative incontinence. Fistula Complexity: Complex fistulae (CF), particularly suprasphincteric and extrasphincteric types , significantly increase the risk for both recurrence and incontinence. Surgical Techniq...