Anal fistulae and abscesses: diagnostic and therapeutic aspects, exceptingCrohn's disease

Anal fistulae are an often neglected and underevaluated disease. They are p ainful and invalidating. Surgeons must be aware of the pathophysiological a spects to achieve successful treatment. The anatomical classification is es tablished to better understand anal anatomy and physiology of anal abscesse ss and fistulae. The Diagnosis of a perianal abscess is usually easy except in case of deep abscess. Clinical signs of chronic fistula may be misleadi ng. Modern imaging (MRI and endoscopic ultrasonography) may be useful to de tail the fistular anatomy in difficult cases. Several operative procedures have been proposed to treat anal fistulae and abscesses. Besides old proced ures such as fistulotomy, cutting or draining, seton we can also mention re cently proposed preservative sphincter surgery. This new concept is believe d to improve wound healing and decrease functional deficiency. Particularly , the rectal flap seems to be attractive but its superiority has not been p roven with a randomized trial. So far, our preference goes to the well-know n procedures such as prolonged seton drainage and/or slow cutting seton.