A fistula-in-ano is a granulating track between the anorectum and the perineum. A fistula may consist of primary and secondary tracks. Many fistulas are low lying, consisting of a single straight track from the skin to the anal canal, just passing through the lower fibers of the internal sphincter The majority of such fistulas can, therefore, be managed by simply lying opening the track (fistulotomy), which produces a good prospect of cure and with no impairment of continence. However, the same can not be said for fistulae which pass through the external sphincter. Some of these fistulas are complex, with secondary pararectal or supralevator tracks. Opening such fistulas may be risky and there is growing evidence that even division of a part of the external sphincter leaving the puborectalis undisturbed is associated with considerable impairment of anorectal function[1]. Unless all the secondary tracks are also treated, there is a risk of recurrent sepsis and fistulation.

This highlights the quandary for the surgeons. Possibly in no other field of anorectal surgery is appropriate treatment so critical. The potential for incurring life-long morbidity may be greater than in any other area of large bowel surgery, for example, even partial sphincter division is complicated by perirectal fibrosis and the resulting gutter deformity can rarely be resolved by later reconstructive surgery[1]. Thus fistulas-in-ano have an unenviable reputation for recurrence ad compromised continence. There are few procedures in surgery where the outcome is so greatly influenced by the experience and judgment of the surgeon. For improving our awareness and for better outcome after surgical management of cases with non-specific fistulae-in-ano, I was invited, on behalf of the World Journal of Gastroenterology (WJG) to ask experienced senior colorectal surgeons to report their considerate and views.

The benefits of face to face meetings as a source for exchange of information can not be overlooked but they are limited. Yet, WJG offers 24/7 service on its website and this channel could be used efficiently for exchanging this valuable data. I hope that the readers of the journal will enjoy reading the following manuscripts and that this trial will be repeated.