Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92–97% for simple fistulas versus 40–95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50–60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.

Objectives Fistula-in-ano is a common condition that negatively affects the quality of life of its sufferers. A high anal fistula poses a significant challenge for surgeons due to its proximity to the anorectal ring and the potential risk of incontinence rather than recurrence. Many modalities have been used in a justified search for a satisfactory cure for the condition, but the seton remains a mainstay of surgical treatment. Therefore, the rationale of this study is to assess the outcome of treating a high anal fistula using the cutting seton technique in a hospital in Al Madinah, Saudi Arabia. The evaluation is intended through a retrospective analysis of patients' outcomes, comparing its effectiveness to similar articles. Methods This is a retrospective study that includes 50 patients with high anal fistulas who were treated with a cutting seton at the National Guard Hospital over a four-year period (2019-2022). Information obtained from medical records included clinical and demographic data. The data collected during the study was compiled and statistically analyzed using the SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). A p-value of <0.05 was considered statistically significant. Results A total of 50 patients with high anal fistula treated with a cutting seton were included: 82% were males and 18% were females, with 66% below 45 years of age. Approximately 92% had inter-sphincteric fistulas, and only 28% had a recurrent fistula. Almost all patients (98%) had an MRI done before surgery. Around 70% of patients were completely cured, 26% had minor complications, 8% of the operated patients experienced mild incontinence, and only one recurrence (2%). Conclusion The cutting seton is still a valid modality in treating patients with a high anal fistula, as it is considerably safe, effective, and yields good outcomes. Standard preoperative assessment and thorough surgical techniques are cornerstones for achieving a satisfactory outcome.

Background: Rapid advances in dental medicine necessitate a shift from traditional educational paradigms to competency-based education (CBE), which emphasizes the acquisition of specific clinical and professional skills. Aim: This study examines the implementation and effectiveness of CBE in Sudanese dental schools by comparing four curriculum models—discipline-based, hybrid, integrated, and community-based. Methods: A convergent parallel mixed-method design was employed to collect quantitative data through structured surveys and qualitative data via semi-structured interviews with students, faculty, and dental practitioners. Descriptive statistical analyses and thematic analyses were used to assess competency achievement across eight domains and to evaluate stakeholder perceptions. Results: Quantitative findings revealed robust competency attainment in the knowledge base domain, while practice management skills were significantly lacking across several models. Notably, the integrated curriculum at Ribat University achieved high scores in both communication and practice management, contrasting with gaps observed in discipline-based and hybrid models. Qualitative insights underscored the need for improved management training and stronger interdisciplinary integration. Conclusions: CBE frameworks in Sudanese dental education effectively foster essential competencies; however, targeted curricular enhancements—particularly in practice management—are required to better prepare graduates for contemporary dental practice.

Background: Reversal of Hartmann's procedure is a complex surgery with potential complications. This case report describes a rare and severe complication following an attempted reversal. Case presentation: A 53-year-old male who had undergone a Hartmann's procedure for non-metastatic sigmoid colon cancer presented with bowel obstruction 10 days after attempted reversal surgery at another hospital. Imaging studies suggested an entero-colic fistula. Emergency laparotomy revealed dense adhesions and multiple bowel injuries. The procedure was terminated, and controlled fistulae were created. Management and outcome: The patient required two months of intensive care. A subsequent surgery excised the fistulae and restored intestinal continuity, leaving the patient with an end colostomy and approximately 120 cm of ileum. Conclusion: This case highlights the potential risks of Hartmann's reversal and emphasizes the importance of proper patient selection, timing, and surgical expertise. It underscores the need for thorough preoperative evaluation and preparation when attempting such complex surgeries. Highlights:

Introduction: Research is a vital component of surgical training, enhancing academic skills and career opportunities. This study aimed to assess the research involvement of surgical residents in Saudi Arabia and identify key predictors, barriers, and motivations. Methodology: A cross-sectional study was conducted among 297 surgical residents between December 2021 and September 2023 using a structured online questionnaire. Data were analyzed with SPSS. Results: Overall, 51.2% of residents published at least one paper during residency. Prior research experience in medical school significantly predicted publication during residency (P = 0.012). In logistic regression, residents in gynecology had lower odds of publication compared to general surgery (OR 0.58, P < 0.05). The main motivation for research was fellowship acquisition (63.3%). The leading barriers were lack of time (67.0%) and work-related stress (50.0%). Conclusion: Early research engagement in medical school strongly predicts future productivity during residency, while time constraints and stress remain major obstacles. Our findings suggest that residency programs could enhance research output by providing structured mentorship, allocating protected research time, and encouraging early exposure to research activities.