[Anorectal fistulas]

Most anal fistulae appear to originate in a proctodaeal gland, the gland penetrates only a part of the spincter muscles. Therefore the fistulous track passes merely through a part of the spincters. The best treatment is to lay open the fistulous main track, this is sometimes difficult. The wound will heal and the scar will become part of the anal verge. The smallest part of preserved sphincter muscles saves the anorectal continence in most cases. Exteriorisation of the internal fistula opening by plastic procedures is not so safe but sometimes unavoidable, for example with perineal fistulae of women or in pelvirectal fistulae. These are always iatrogen.