Anal Abscess & Anal Fistula

An anorectal abscess is a pus-filled cavity that develops as a result of acute inflammation. They arise in the area of ​​the rudimentary glands on the dentate line in the anal canal.

Anal fistulas are non-physiological, tunnel-like connections from the anal canal or the distal rectum to the perianal skin.

Anal abscesses and anal fistulas are different stages in the course of the same underlying disease. In most cases, the abscess initiates the disease and is the acute form, while the fistula is usually the second stage and is a chronic inflammation.

Surgical interventions are the first-line treatment for anorectal abscesses.
An anorectal abscess is an urgent indication for surgery because of the dangers of progression into the surrounding structures and – rarely – life-threatening systemic blood poisoning.
Therefore, surgical opening and adequate drainage must be performed immediately after diagnosis.

The fistula in ano is the main indication for an operation. Spontaneous healing is extremely rare and, if you wait and see, there is a risk of an increase in inflammation and, in rare cases, of pelvic floor inflammation. The aim of the operation is to heal the fistula without disturbing the continence. The surgeon must adapt the surgical technique to the respective fistula in the anus. Distal simple fistulas should be cut open and applied, while complex fistulas are usually treated by extirpation and closure of the internal opening. In these cases, a sphincter reconstruction is often necessary. Standard treatments are:

  • Fistelectomy / Fistulotomy (split / cut out)
  • Flap Procedure
  • Fistelectomy with primary sphincter reconstruction

The surgeon’s knowledge should include all procedures to adapt the surgery to the particular fistula.