Highly complex anal fistulas are considered surgically refractory, with many uncertainties in the course of treatment that can affect the cure rate and a high likelihood of recurrence. In fact, issues such as the distribution of the fistula tract and the relationship with the sphincter muscle are involved in a complex diagnostic and treatment process. This includes routine examinations, imaging of the lesion, ultrasonography, and MRI to help understand the interior of the lesion and to help diagnose the distribution of the fistula tract, but a necessary condition for each individualized surgical plan is the ability to remove the patient’s fistula without damaging the patient’s function. The treatment of high-grade complex anal fistulas is currently in clinical use. It is actually a comprehensive treatment, and there is a consensus among the various surgical modalities that functional preservation has become a prerequisite for treatment, of course. The distress caused by high complex anal fistulas is something that many anorectal surgeons will relate to. It is the wish of every specialist to cure anal fistula, but the fact is that the causes of anal fistula are not entirely clear, so basic research and improvement of the procedure are still the direction of the Department of Proctology for decades. It is obvious that unobstructed drainage is a necessary condition for successful fistula and abscess surgery, and that the so-called “minimally invasive” treatment of complex fistulas is inconceivable. This involves the level of the operator, the patient’s cooperation, and the selection criteria, statistical methods, and the rigor of the reported cases. The term “living with fistula” is new and controversial, but it illustrates at least one basic fact of fistula treatment – the intractability of complex fistulas. Most of the clinically reported high-grade complex fistulas have undergone several or even a dozen surgical procedures, but as Professor Ren Donglin says: we should probably give a little time and patience, both to patients and to doctors. Another clinical situation that is just as difficult to treat as complex fistulas is perianorectal abscesses with high and multiple interstitial abscesses, which also do not attract much attention from patients, who often think that a little water infusion will make it go away as easily as ji swellings in other parts of the body. The truth is that surgical measures such as incision and drainage alone are far from the solution, and more than 90% of patients with perirectal multigastric infections eventually develop anal fistulas or high-grade complex anal fistulas, which may require the patient to endure several more surgeries, and some surgeons prefer to give patients high doses of antibiotics rather than easily make such incisions, because “everything If you open it, it will leak. In response to the patient’s lack of understanding of the disease itself, the surgeon needs to do a lot of explaining during the treatment process in order to give him a clear understanding of his disease. The specialist also believes that early treatment, observation and intervention are essential. What is the first-stage treatment of high-grade abscesses and high-grade complex anal fistulas that is carried out clinically? In fact, it is an effort to complete the treatment process that requires multiple surgeries in one stage as much as possible, so that the whole course of treatment can be significantly shortened and less painful. Even so, it is a clear fact that no surgeon may be 100% sure of success in a single visit for a high-grade complex fistula. Therefore, intraoperative and postoperative management to minimize the recurrence rate is the goal of treatment for every case of high abscess and complex anal fistula.