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Anorectal suppurative disease may manifest itself in an acute or a chronic setting. Anal sepsis (abscess) represents the acute manifestation, and anal fistula represents the chronic form of the suppurative process.
In its simplest form, an anal fistula is a communication between an internal opening in the anal canal and an external opening through which an abscess has drained. A fistula and abscess may coexist or be associated with atypical internal openings and multiple tracts that result in a complex suppurative process.
Parks and Gordon classified fistulas into four main subgroups according to the course taken by the main tract: intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Each category can be further subclassified based on associated secondary tracts and other anatomic details.
Symptoms consist of pain, slight fever, and pain on defecation followed by mucopurulent drainage and abatement of the pain. Pruritic symptoms may be present because of skin irritation associated with the chronic discharge. A correct diagnosis is important, through physical examination and the different complementary examinations available (rectoscopy, anorectal ultrasonography, MRI…).
Patients with anorectal fistulas should undergo surgical treatment because they rarely heal spontaneously. In the following presentation we will explain the surgical options that we currently have for this pathology.