Chapter 9 222 Referral to a gastrointestinal surgeon is essential when a digital rectal examination is not possible to perform, and when patients fail to respond to conservative measures including PFPT. A tailored approach is reflected in the proposed algorithm. Although more high-quality studies are warranted to determine the effect of PFPT in patients with CAF and implementing these in guidelines, we are convinced that PFPT fills the gap between conservative treatment and surgery.
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