Surgery of cryptoglandular anorectal fistula and abscess. With special reference to complicated infections

In an unselected personal consecutive series of anal fistulous abscesses (n = 253) 21 patients (8%) had a complex fistula, i.e. a translevatoric pelvirectal extension of an ischiorectal track (n = 7), a high intersphincteric fistulous abscess with an intramural or a pelvirectal extension (n = 7), a suprasphincteric fistula (n = 2), an intralevatoric fistulous abscess (n = 5). Treatment procedures were an ischiorectal laying open with translevatoric coring out, an intraluminal laying open into the lower rectum, and partial external sphincter division with seton drainage, respectively, as proposed in the literature. For the posterior levator space abscesses circular laying open into the anal canal lead to healing. In 2 patients with an anterior extension of an intralevatoric and with a suprasphincteric fistulous abscess, respectively, a posterior approach with a transsphincteric longitudinal excision of the diseased anosphincteric tissue was employed, with primary suture of the anorectum and of the sphincters, and with a covering colostomy. The procedure revealed to be useful with respect to exposure, fistula healing, and repair of previously transsected muscle.