German S3 guidelines: anal abscess and fistula (second revised version)

Area of Science:

• Colorectal surgery
• Gastroenterology

Background:

• Anal abscess and fistula are common conditions, particularly in young men.
• Cryptoglandular origins are typical, arising from intersphincteric proctodeal glands.

Purpose of the Study:

• To provide updated, evidence-based guidelines for the diagnosis and treatment of anal abscess and fistula.
• To consolidate current best practices based on a systematic literature review.

Main Methods:

• Systematic review of pertinent literature.
• Revision and update of the German S3 guidelines for anal abscess and fistula.

Main Results:

• Diagnosis is often established through patient history and clinical examination; advanced imaging (endosonography, MRI) is reserved for complex cases.
• Surgical goals for abscesses include complete drainage while preserving sphincter function to reduce recurrence and fistula formation.
• Anal fistula treatment options range from fistulotomy for superficial cases to sphincter-saving procedures (seton drainage, flap repair, LIFT) and biomaterial occlusion for complex or high fistulas.

Conclusions:

• The updated guidelines offer comprehensive instructions for the management of anal abscess and fistula.
• Emphasis is placed on appropriate surgical techniques to optimize outcomes and minimize complications like incontinence.