Anorectal fistulae

Abstract

The configuration of perianal sepsis and the relationship of abscesses or fistulae with internal and external sphincters are the most important factors influencing the results of surgical management. Preoperative identification of all loculate purulent areas, and definition of the anatomy of the primary fistulous tract, secondary extensions, and the internal opening play an important role in adequate planning of the operative approach, in order to ensure complete drainage of abscesses, prevent early recurrence after surgical treatment, and minimize iatrogenic damage of sphincters and the risk of minor or major degrees of incontinence. In this chapter, the accuracy and reliability of endoanal ultrasonography and magnetic resonance imaging in the evaluation of perianal abscesses and fistulae will be discussed. The indications for and results of different forms of treatment (fistulotomy, fistulectomy, anal flap, seton positioning, fibrin glue injection, fistula plug) will also be presented and discussed. © 2010 Springer-Verlag Milan.