[Anal fistulae and abscesses: diagnostic and therapeutic aspects, excepting Crohn's disease]

Anal fistulae are an often neglected and underevaluated disease. They are painful and invalidating. Surgeons must be aware of the pathophysiological aspects to achieve successful treatment. The anatomical classification is established to better understand anal anatomy and physiology of anal abscessess and fistulae. The Diagnosis of a perianal abscess is usually easy except in case of deep abscess. Clinical signs of chronic fisula may be misleading. Modern imaging (MRI and endoscopic ultrasonography) may be useful to detail the fistular anatomy in difficult cases. Several operative procedures have been proposed to treat anal fistulae and abscesses. Besides old procedures such as fistulotomy, cutting or draining, seton, we can also mention recently proposed preservative sphincter surgery. This new concept is believed to improve wound healing and decrease functional deficiency. Particularly, the rectal flap seems to be attractive but its superiority has not been proven with a randomized trial. So far, our preference goes to the well-known procedures such as prolonged seton drainage and/or slow cutting seton.