Comments on the Article, “Selected Techniques of Anal Fistula Surgery from Antiquity Through the Early 20th Century”

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I read with interest the article, “ Selected Techniques of Anal Fistula Surgery from Antiquity Through the Early 20th Century” by Ortega et al in the June 2017 issue of Diseases of the Colon & Rectum.1 It is a comprehensive article but fails to mention the contributions of Arabs and Muslims to the field of proctology. One particular physician was Al-Razi or Rhazes (865–925), who made significant contributions to the surgery of anal fistula, among other anorectal diseases.
He was the first to fully describe the relationship of the extent of muscle division to incontinence. “Regarding transverse fistula in the anus, if they are close to the anal opening, the danger is less. That is because the entire muscle will not go with it, only a piece, and thus its function will not disappear entirely. If they are far away from the anal opening, the danger is great because the entire muscle is cut and bowel incontinence results.”2 Therefore, he recommended incision for low fistula and ligation, and curettage with cauterization for high anal fistula.3
He gave a detailed description of the technical aspects of fistulotomy: “Introduce the rough probe into the sinus and insert the index finger in the anal canal to reach the end of the probe. If you see it takes a large part of the muscle, do not cut the sphincter muscle and guide the rough probe through the fistula tract and scrape it several times until it bleeds and pack the fistula tract with a wick immersed in verdigris. Repeat scraping it until the fistula tract shrinks in size. Then, fill it with extract of frankin and aloe vera.
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