Modern management of deep post-anal space abscess and horseshoe fistulas

Deep post-anal space abscesses and horseshoe fistulas are complicated anorectal diseases that can lead to significant morbidity. Surgical intervention is the treatment of choice; however, the anatomical location and natural course of the disease makes management difficult. The goals of care are to eliminate the source of infection, prevent recurrence, and preserve anorectal function. Several different treatment strategies have been described. The modified Hanley procedure is the most commonly utilized technique with low recurrence rates and minimal anorectal dysfunction. Complete resolution of the perianal sepsis followed by definitive repair with standard methods of treating cryptoglandular fistulas is recommended.