Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	125604
DOI	10.4240/wjgs.125604
Country	China

Category	Surgery
Manuscript Type	Minireviews
Article Title	Hypoxia-biofilm-immunometabolism axis in cryptoglandular anal fistula: An integrated pathophysiological and therapeutic paradigm
Manuscript Source	Unsolicited Manuscript
All Author List	Chuang Wu, Ling-Yi Tang, Yun-Lin Jiang and Zhen-Yi Wang
Funding Agency and Grant Number	Funding Agency Grant Number Scientific Research Project of Shanghai Municipal Health Commission No. 202540035
Corresponding Author	Zhen-Yi Wang, MD, PhD, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, China. wangzhenyi@shyueyanghospital.com
Key Words	Cryptoglandular anal fistula; Pathophysiology; Hypoxia; Biofilm; Immunometabolism; Intersphincteric space; Postoperative care
Core Tip	Cryptoglandular anal fistula may arise as an adaptive mechanism that limits sepsis but becomes locked into a self-sustaining “hypoxia-biofilm microenvironment” within the intersphincteric space. This review integrates biofilm biology, immunometabolic reprogramming (Warburg effect), and hypoxia-inducible factor-1α-driven fibrosis into a unified paradigm, proposing that treatment must disrupt all three pillars of this vicious cycle.
Citation	Wu C, Tang LY, Jiang YL, Wang ZY. Hypoxia-biofilm-immunometabolism axis in cryptoglandular anal fistula: An integrated pathophysiological and therapeutic paradigm. World J Gastrointest Surg 2026; In press DOI: https://doi.org/10.4240/wjgs.125604
PDF	125604-in-press.pdf

Received	2026-07-23 08:08
Peer-Review Started	2026-07-23 08:08
First Decision by Editorial Office Director
Return for Revision	2026-08-10 06:28
Revised	2026-08-19 15:35
Publication Fee Transferred	2026-09-13 10:11
Second Decision by Editor	2026-10-26 07:15
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-10-26 09:55
Articles in Press	2026-10-26 09:55
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9366 (online)
Open Access	This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Copyright	©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com