Die chirurgische Behandlung des anorektalen Abszesses

Treatment of anorectal suppuration includes timely and sufficient surgery. So later complications like fistula-in-ano can be ruled out. In this prospective study the data of 324 patients who had been operated because of an anorectal suppuration were examined. 38,6% of these abscesses were located in the perianal tissue, 34.6% in the intersphincter space, 19,4% in the ischiorectal fossa and 7,4% in the supralevator space. Only in 25,6% patients who were operated an anal fistula was proved. In ischiorectal abscesses we found fistula-in-ano within 47,6% of the patients, in most cases trans- and suprasphincteric fistulas. 62.1% of these patients did not need further interventions. Sixteen of 45 intraoperative diagnosed trans- and suprasphincteric fistulas did not need further operative interventions (35.6%). At 7.7% later diagnosed fistulas had to be treated operatively. 9.6% of the patients developed a new suppuration. The renunciation of an intensive primary fistula search doesnt lead to a higher persisting fistula formation. From this aspect a further exploration should be renounced in the first operation. Of course superficial fistulas can be cured in the same meeting. From this point a drainage cutting-seton should be viewed very critically. Postoperativ diagnosed high anal fistulas can be treated after fading of acute infection with continent fistulectomy.