ASCRS Ch13 — Cryptoglandular Abscess and Fistula

Citation: Johnson EK, Bernier G. "Cryptoglandular Abscess and Fistula." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG;

2022. pp. 249–268 (PDF pp. 258–277 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Third chapter of Part II ("Anorectal Disease") — Chapter 12 preceded it.

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Thirteenth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers two stages of cryptoglandular disease: anorectal abscess (epidemiology, cryptoglandular pathophysiology, classification by anatomic space — perianal, ischiorectal, intersphincteric, supralevator, horseshoe — diagnosis, treatment by drainage route, post-drainage care/antibiotics) and anal fistula/fistula-in-ano (Parks classification, Goodsall's rule, preoperative imaging modalities, treatment strategy overview, fistulotomy, setons — draining/cutting/loose-as-definitive — fibrin glue, fistula plug, endorectal advancement flap, LIFT and its variants, and novel therapies: FiLaC, VAAFT, fistulotomy with primary sphincter reconstruction, stem cell therapy, OTSC Proctology clip).

Key content

Split into two new dedicated condition pages, mirroring the Ch12 fissure/stenosis split: Anorectal Abscess and Anal Fistula. Closes an open item explicitly flagged since ASCRS Ch01 - Anatomy and Embryology (which had set up the anal gland/crypt and perianal/ intersphincteric/submucous/ischioanal potential-space anatomy but deferred cryptoglandular abscess/ fistula coverage to this chapter). Minor cross-links added to Colorectal Anatomy & Embryology (open-item closure), Crohn Disease (extrasphincteric/ Crohn's fistulas explicitly out of this chapter's scope — pointer to that page's existing fuller content), and Fecal Incontinence (fistulotomy/cutting seton as iatrogenic sphincter-defect causes).

Limitations

• Textbook chapter, not primary literature; cited trial/meta-analysis figures are the chapter authors' synthesis, not independently re-verified.
• Novel fistula therapies (FiLaC, VAAFT, stem cell therapy, OTSC Proctology) are explicitly presented as early-evidence/evolving areas, with wide, inconsistent success-rate ranges across studies (e.g. FiLaC 33–82%, fistula plug 24–94%).
• Extrasphincteric and Crohn's-related fistula management is explicitly out of this chapter's scope — readers needing that content are directed elsewhere (per the chapter itself, to "another chapter," i.e. ASCRS Ch47, not yet ingested).
• Anal-fistula persistence-after-abscess rate (~30–35%) and abscess-classification percentages come from specific single-institution case series, not necessarily generalizable.

Relevance

Thirteenth entry in the ASCRS ingest. Adds two genuinely new condition pages, both substantial given cryptoglandular disease's central place in colorectal anorectal practice. Chapter 14 continues Part II with "Rectourethral and Complex Fistulas."