Key Concepts

• Anorectal abscess should be treated with surgical drainage, not antibiotic therapy.
• At least one-third of cryptoglandular abscesses will progress to fistula.
• Anal fistula in the typical patient should be evaluated with examination under anesthesia. Subsequent management will be dictated by anatomic findings in the operating room.
• Priorities of management are control of sepsis, maintenance of continence, and cure without recurrence, generally in that order.
• While there are many new and emerging methods of treatment, the surgeon should be critical of the published literature and base their informed consent discussion on their observed results over time. Most studies would indicate that at least 12 months of follow-up is required to determine success.