La fistule anale cryptoglandulaire

Cryptoglandular anal fistula is the most frequently occurring form of perianal sepsis. Characteristically, it has an endoanal primary opening, a fistula track and an abscess and/or a secondary purulent opening. Antibiotic therapy is not curative. Treatment of an abscess is required urgently and, when possible, consists of incising it under local anaesthesia. The fistula track may be treated afterwards in the aim of drying up the suppuration without disturbing anal continence. It usually makes use of fistulotomy techniques the modalities of which depend on the position of the opening of the fistula tract within the anus. They are effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence. This explains the increasing interest in sphincter preserving techniques, notably using advancement of a covering flap of rectal mucosa, the injection of fibrin glue and the plug procedure. However, results of these procedures are not yet good enough and must be improved.