These lesions are too deep to be treated under local anaesthesia; therefore caudal, loco-regional or general anaesthesia is required. A radial incision is made in the perianal tissue and continued into the ischiorectal space. If the internal opening is clearly identified and if the underlying fistulous tract may be catheterised easily, a seton drainage should be placed. A probe should never be introduced forcefully to avoid creation of a false tract. After gentle curet-tage, the wounds are loosely packed with a mesh dressing for 24-48 h. A perianal fistula with a pelvic abscess extending from the anal canal should never be drained into the rectum as it could result in an extra-sphincteric fistula which is a much more complex problem to treat.
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