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We used our findings and those reported in the literature to construct a modified risk factor scoring system based on patient's physical status, major comorbidities, perifistular soft tissue condition, and nutritional status and an algorithm for managing TCF based on the patients' fistula size and modified risk factor scores. Conclusions In conclusion, we were able to review our cases and those of other studies to create a risk scoring system and a decision algorithm that we believe will help optimize patient-directed surgical management
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