One stage treatment of anal abscesses and fistulas. A clinical appraisal on the basis of two different classifications.

In a five year period 227 patients with anal abscesses and/or fistulas of suspected cryptoglandular origin were observed and treated by one surgeon. In 201 patients the primary opening or the crypt of origin of the abscesses and/or fistulas were identified. These lesions were evaluated according to two classifications [1,2]. The aim was to verify whether primary abscesses and/or fistulas may spontaneously loop all the external sphincters and the puborectalis muscle as reported by Parks et al. [1] or whether the formation of tracks which loop all the striated sphincteric complex (Parks' supra- and extra-sphincteric fistulas) derives exclusively by the incorrect treatment of more superficial lesions, as suggested by Eisenhammer. Not one of the primary suppurative lesions (acute or chronic) looped the striated sphincteric complex (external sphincter-puborectalis muscle). Supra- and extrasphincteric tracks were observed only in the lesions which recurred after previous surgical treatment. The one-stage treatment of primary abscesses and fistulas (fistulotomy drainage or one-stage lay-open) with a few exceptions is a definitive (2% recurrence rate) and safe (4% prolonged impairment of continence rate) procedure.