Perirectal fascia splits the supraelevator space in perirectal medial, containing fat and pararectal lateral, including connective tissue and ureters.
A better signal-to-noise ratio can be used to allow decreasing imaging time and maximize spatial resolution with a better chance of characterization of perianal fistulas.
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However, because of the probable recurrence with these procedures these patients often need multiple interventions.
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Other surgical options are represented by a rectal mucosal advancement flap or a curvilinear flap made with mucosa, submucosa, and sometimes the muscle may be considered when sphincter function could be lost by fistulotomy.