(12) classified perianal fistulas as intersphincteric, transsphincteric
, suprasphincteric, and extrasphincteric fistula.
Fibrin glue and transanal rectal advancement flap for high transsphincteric
perianal fistulas; is there any advantage?
(1) Clinically, they are generally divided into four main groups according to the Parks classification: intersphincteric, transsphincteric
, suprasphincteric, and extrasphincteric fistulas.
But, the high cure rate is limited by the fact that laying open a transsphincteric
fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40% .
There were 30 patients with simple transsphincteric
fistulas, and 38 patients who had complex fistulas (branched, with multiple openings, extrasphincteric or suprasphincteric, with collections of fluid in the soft tissues, etc.).
As per the study done by Marks and Ritchie  in a series of 793 patients, the fistulas were divided as intersphincteric (49.5%), transsphincteric
(27.7%), suprasphincteric (6.5%), extrasphincteric (2.9%) and others at 13.4%.
According to Parks, 1976, they are classified as: intersphincteric (60-75%), transsphincteric
, low and high level (15-20%), and suprasphincteric (5%) .
(14, 15) Differentiating between inter- and transsphincteric
fistulas is important for surgical planning and is typically described according to the St.
Different surgical approaches described include transanal, transsphincteric
, and transabdominal; however, there is no general consensus regarding optimal treatment.
Six patients had intersphincteric fistulas and 3 had transsphincteric
Sir Parks in 1976 classified perianal fistulae as intersphincteric, transsphincteric
, suprasphincteric, extrasphincteric, and superficial, according to their relations with the external sphincter .