ABSTRACT
Anal fistulae are chronic pathological connections between the anal canal and the skin of the perineum or buttocks, which do not heal spontaneously. They usually pass through a variable proportion of the anal sphincter complex. They are subject to either persistent discharge or recurrent episodes of painful abscess formation, eased by either spontaneous drainage or repeated hospital admissions for surgical drainage. Failure of adequate and sustained drainage may lead to a more complicated situation, as secondary tracks and abscesses develop. The majority of anal fistulae can be managed, without significant compromise to anal sphincter function, by a conventional approach, but a substantial minority can present a major challenge to both patient and surgeon. Indeed, in the concluding remarks of his address to the Royal Society of Medicine in 1929, Mr JP Lockhart Mummery stated, ‘Probably more reputations have been damaged by the unsuccessful treatment of cases of fistula than by excision of the rectum or gastroenterostomy.’ The difficulty resides in the balance between eradication of the pathology and preservation of function (continence). Over the last 30 years, efforts have been increasingly directed towards sphincter preservation, but almost certainly at the expense of long-term surgical cure. The contribution of Sir Alan Parks to the etiology, classification, and principles of management of anal fistulae remains highly pertinent today. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429100932/76c97e6a-a85e-4c07-8d0b-d32156ce347e/content/fig2_10_1.tif" xmlns:xlink="https://www.w3.org/1999/xlink"/>
