Cryptoglandular disease encompasses two related entities: anorectal abscess and fistula-in-ano. Anorectal abscess is an infection of the perianal or perirectal region arising most commonly from obstruction of the anal ducts. The various types of anorectal abscess (perianal, ischioanal, intersphincteric, and supralevator) are defined based on their anatomic location. Treatment typically requires incision and drainage of the abscess cavity, which can be performed either at the bedside or in the operating room depending on complexity and extent of the abscess. Approximately one-third to half of patients with anorectal abscess will go on to develop a persistent inflammatory tract between the anal canal and the perianal skin, known as fistula-in-ano. There are multiple surgical options for treatment of fistula-in-ano, all with the general underlying principle that the internal opening must be obliterated to facilitate healing of the tract. Fistulotomy is the traditional and most effective technique for achieving fistula closure, however it is only appropriate for those fistulae with minimal sphincter complex involvement. Alternatives to fistulotomy include setons (either cutting or draining), endorectal advancement flap, anal fistula plug, fibrin glue, and ligation of the intersphincteric fistula tract (LIFT) procedure.
