[Anal fistula disease : Anatomical foundations and surgical procedures]

Perianal abscess and cryptoglandular fistula disease is among the most common proctological disorders and requires an in-depth knowledge of anorectal anatomy, particularly the relevant abscess spaces and fistula tracts, for precise diagnosis and successful treatment. The pathogenesis is attributed to an infection of the proctodeal glands within the anal sphincter apparatus. While immediate abscess drainage is the top priority in acute situations and fistula exposure by probing should not be forced to avoid a via falsa, definitive fistula treatment depends on the complexity of the fistula. The gold standard for fistula treatment includes fistulotomy, fistula excision (possibly with sphincter reconstruction) and advanced flap surgery. Success rates in experienced hands exceed 80%. Alternative procedures have been developed, particularly for sphincter preservation, with varying success rates.