Podcast: Phil Tozer – Anal Fistula Part 2

To see our latest courses, or to donate to the St Mark's Hospital Foundation, please visit our channel description for details. Title: Anal Fistula Part 2 Speaker: Phil Tozer Event: St Mark's Podcast Year: 2019 In Part 2 of the anal fistula series, Mr Phil Tozer builds on the foundational principles discussed previously and moves into a detailed exploration of definitive management strategies for complex fistula disease. He begins by emphasising that treatment selection must balance two priorities: achieving durable healing and preserving continence. This dual aim underpins every decision in modern fistula surgery. Mr Tozer reviews the main operative options, starting with seton management, explaining when a draining seton should be maintained, when it can be tightened, and how it supports staged approaches. He then discusses fistulotomy, noting that while it remains highly effective for simple, low tracts, it is inappropriate for high or complex fistulas due to sphincter division risk. The episode focuses on sphincter‑sparing techniques, including LIFT, advancement flaps, and biomaterial‑assisted closure. Mr Tozer outlines the indications, success rates, and limitations of each, stressing the importance of careful patient selection and realistic counselling. He also highlights the role of MRI in surgical planning, the management of recurrent disease, and the need for multidisciplinary collaboration in challenging cases. Overall, Part 2 provides a clear, structured overview of contemporary fistula surgery, offering practical guidance grounded in evidence and specialist experience.