Integrating traditional Chinese medicine with modern surgery: A comprehensive approach to complex anal fistula

Complex anal fistula remains a formidable clinical challenge due to its intricate anatomy, high recurrence rates, and risk of functional impairment. Conventional surgical approaches, including fistulotomy, seton placement, and sphincter-sparing procedures such as ligation of intersphincteric fistula tract or video-assisted anal fistula treatment, provide variable outcomes and are often associated with delayed wound healing or incontinence. Recently, the integration of traditional Chinese medicine (TCM) into surgical management has gained attention for its potential to enhance wound repair, modulate inflammatory responses, and reduce postoperative recurrence. TCM modalities - including herbal formulations, topical applications, and acupuncture - not only accelerate granulation tissue formation but also regulate immune homeostasis by influencing pathways such as phosphatidylinositol 3-kinase/protein kinase B, hypoxia-inducible factor-1, and ransforming growth factor-β/mothers against decapentaplegic homolog. Clinical evidence suggests that combining syndrome differentiation-based TCM therapies with surgical interventions achieves synergistic effects, improving healing rates and preserving anorectal function. In this editorial, we comment on the article by Liu et al published in the recent issue of the World Journal of Gastrointestinal Surgery . This editorial synthesizes current surgical strategies and highlights the emerging role of TCM in complex anal fistula treatment, emphasizing the importance of individualized, multidisciplinary approaches. By bridging modern surgical precision with traditional holistic regulation, integrative therapy holds promise for advancing patient outcomes and establishing new standards in anorectal surgery.