How is an abscess treated?

The pus is drained from the abscess cavity by making an opening through the overlying skin. This may be done under local anaesthesia in the consulting rooms. A large abscess may require wider drainage, under general anaesthesia. Hospital admission is needed for such a procedure. Antibiotics may be used to control the spread of the infection, but antibiotics alone will not cure an abscess. Drainage of the pus is always necessary.

How is a fistula treated?

Surgery is needed to cure a fistula. The course of the track between the anus and the skin has to be identified and exposed. This track may be treated in one of two ways according to its complexity.

Fistulotomy opens the track to the skin’s surface along the length of the track allowing the open wound to heal slowly. Some sphincter muscle may be divided.

Seton drainage and fistula repair is used for more complex fistulas involving the sphincter muscles. Firstly a seton (a loop of flexible material) is placed along the track under anaesthetic and a definitive repair to close the opening through the sphincter muscle is done. These are more complex operations. Most commonly this is either done by raising a flap of the lining of the bowel to close over the inside opening (an advancement flap) or tieing off the track in between the two sphincter muscles (Ligation of Intersphincteric Fistula tract –LIFT procedure).