Anorectal Abscess and Fistula

Abstract

Anorectal abscess and fistula management is a cornerstone of any colorectal surgeon’s practice. Knowledge of anatomic structures and their relationship to each other is imperative to make the correct diagnosis and define the treatment plan. Many studies have demonstrated the value of a good physical exam and the surgeon’s judgment – these cannot be replaced with imaging studies and technology. Anorectal suppuration needs to be promptly managed most commonly with drainage only unless a fistula is identified and the anatomic relationship to the sphincter is clear. Many procedures have been described for the management of anal fistula but fistulotomy remains the most effective. In this chapter we review the current practice of managing anorectal abscess and fistulas.