This chapter follows the one on fistula surgery in the era of evidence-based medicine. The absence of a reliable level of evidence is discussed in Chap.​ 21. At the risk of committing blasphemy, the patients are less interested in the level of evidence than improving their quality of life. The moral compass of the surgeon dealing with fistula patients is to make every attempt to cure this disease. If he/she is capable and experienced, multiple alternatives may have to be resorted to. If the surgeon is not very experienced to deal with complex fistulas, it is better to refer the patient to an experienced surgeon or a center which deals with scores of fistulas every year. In short, the surgeon must tailor the procedure to specific patient and not vice versa. Colostomy should be considered as a last resort but it should not be withheld from the patient whose quality of life can be improved despite persistence of their fistulas.