Aim: The aim of this prospective, nonrandomized, observational study was to present our results in operative treatment of complex anal fistulas using video-assisted anal fistula treatment (VAAFT) procedure with a curative intent in 2 years follow-up period. Materials and Methods: Between March 2016 and March 2018, 73 patients underwent the VAAFT procedure. Postoperative follow-up was 2 years, up to March 2020. Only patients with complex cryptoglandular anal fistulas were included. All patients were referred for magnetic resonance imaging of the pelvis. Fecal incontinence severity index score was used to assess any continence disturbance prior operation and postoperatively. Result: Primary healing occurred in 52 cases (71.23%) after first operation. From 21 patients who had recurrence or who had persisting disease, 16 patients accepted reoperation with second VAAFT procedure and additionally 10 patients achieved healing. From a total number of 73 patients who were included in study healing ultimately occurred in 62 cases (84.93%). In the first operation internal opening was identified in 47 cases (64.38%) and was closed with mattress suture, rectal advancement flap or ligation of intersphincteric fistula tract technique depending on its extent and type of fistula. Median primary healing rate was 6 weeks. There were no serious intra- or postoperative complications. None of the patients reported any type of continence disturbance. Discussion: VAAFT has been shown to offer good rates of healing, low morbidities, possibilities of multiple attempts in case of first failure and this series adds to the literature.

Anal fistulas are still a huge challenge for surgeons because of their high incidence, high recurrence rate, prolonged healing time and possible complications such as fecal incontinence. Even though many surgical options have been described, we still do not have the standardized procedure. Patients who suffered from this problem have a low quality of life because of constant anal pain and soiling from anal tracts. Aside from cryptoglandular etiology, fistulas associated with Crohn’s disease are separate entity that requires a multidisciplinary approach. This chapter will be an overview of modern approaches in anal fistula treatment regardless of etiology with special consideration on how to avoid adverse outcomes and to improve patients’ quality of life.

Background/Objectives: MicroRNAs (miRNAs) regulate gene expression and are proposed as biomarkers in colorectal cancer (CRC). This study evaluated miR-185-5p, miR-141-5p, and miR-21-5p expression in CRC tissues; their association with tumor location, histopathology, and clinical outcomes; and the suitability of miR-16-5p and miR-151a-3p as housekeeping controls. Previous reports suggest tumor-suppressive roles for miR-185 and miR-141 and an oncogenic function for miR-21, though findings remain inconsistent. Methods: Paired tumor and adjacent normal tissues from 70 CRC patients were analyzed. RNA was extracted from FFPE samples, and miRNA expression quantified by RT-qPCR. Relative expression values were normalized to miR-151a-3p. Tumor–normal differences, localization effects, and associations with clinicopathological and outcome variables were assessed using repeated-measures ANOVA and non-parametric tests. Results: miR-185-5p and miR-141-5p were significantly reduced in tumors compared with normal mucosa while miR-21-5p was upregulated. miR-16-5p showed higher expression in normal tissue, indicating its instability and unsuitability as a housekeeping control. A modest but significant localization effect was observed for miR-185, while other miRNAs were minimally influenced by location. Baseline asymmetry between non-tumor samples, observed for miR-185-5p, further indicated sidedness effects. None of the miRNAs were associated with stage, histological type, grade, invasion, immune infiltration, progression, or five-year survival. Conclusions: miR-185-5p, miR-141-5p, and miR-21-5p show robust tumor–normal differences, supporting their diagnostic potential, while miR-16-5p is unsuitable as a housekeeper. Modest but significant localization effect was observed for miR-185 in right-sided tumors. None showed prognostic value in stage I–III CRC. Larger, location-stratified studies are warranted.

Main function of rectum and anal canal is to maintain fecal continence and allow defecation at an appropriate time and place. When patient has the unintentional loss of stool and inability to control bowel movements in socially acceptable situations, we talk about fecal incontinence (FI). This condition leads to distress and social difficulties for affected individuals. Different causes including neurological disorders, gastrointestinal diseases, and pelvic floor dysfunction can lead to FI. The condition is classified into different types: passive incontinence, where individuals are unaware of stool passage, and urge incontinence, characterized by a sudden, strong urge to defecate that cannot be controlled. Diagnosis typically involves a thorough medical history and physical examination and may include imaging studies (transrectal ultrasound and MRI defecography) or anorectal manometry to assess muscle function and rectal sensation. Management strategies range from dietary modifications and pelvic floor exercises to pharmacological treatment and surgical interventions.

Aim: This study aimed to evaluate whether implantation of an autologous skin graft in the intersphincteric space, as part of the ASGIIFT procedure, improves the primary healing of complex transsphincteric cryptoglandular anal fistulas. Methods: A prospective observational IDEAL stage 2a study was conducted at a tertiary referral centre for minimally invasive colorectal surgery and proctology in Croatia between September 2021 and January 2023, with an 18‐month follow‐up. Preoperative pelvic MRI was performed in all cases, and 40 adult patients who met the inclusion criteria were included in the study. The primary outcome was the postoperative primary healing rate which was defined clinically. Secondary outcomes included postoperative continence disturbance, postoperative pain, time of healing and other postoperative complications (Wexner score and VAS – Visual Analogue Scale were used). The ASGIIFT procedure includes all standard steps of the LIFT technique (ligation of the intersphincteric fistula tract), with the addition of a pre‐prepared autologous dermal graft placed into the intersphincteric space. The study was approved by the institutional ethics committee. Results: Primary clinical healing was achieved in 35 patients (87.5%) within a median of 4 weeks postoperatively (range 3–6 weeks). Five initially unhealed patients showed conversion from transsphincteric to intersphincteric fistula during the follow‐up period and were subsequently treated by fistulotomy without complications. No patient experienced worsening continence, and no serious postoperative complications occurred. Conclusion: ASGIIFT appears to be a safe and feasible technique for treating transsphincteric anal fistulas, showing promising early results in this single‐centre IDEAL 2a study. Further prospective comparative studies are warranted to validate these initial findings.