Anal Fistula and Abscess

This volume comprehensively describes the anatomy, pathophysiology, diagnostics, and modalities of treatment of one of the most complex and debated clinical conditions in coloproctology: anal fistulas and abscesses. It also debates current controversies and presents the best approaches based on the authors’ clinical expertise. Providing an in-depth understanding of the anal canal anatomy and surrounding area, it enables readers to manage anal sepsis and avoid excessive damage, in particular to the anal sphincters. Further, the book presents insights into the pathophysiological processes (in cryptoglandular and Crohn’s disease) causing abscess and fistula, which have a significant impact on the management of these conditions. It also discusses diagnostic assessments crucial for selecting the optimal surgical technique and offers guidance on the timing. Lastly, it assesses the pros and contras of the various surgical procedures, evaluating the possible outcome in terms of both therapeutic success and detrimental effects on the anorectal functions. As such it is a valuable resource for all physicians involved in the management of anal fistulas and abscesses (coloproctologists, general surgeons, gastroenterologists, radiologists). 

Prof. Carlo Ratto was born in Naples, Italy, on July 6, 1962. He completed his graduation in medicine and surgery at the Catholic University of Rome in 1987 and specialized in emergency surgery at the Catholic University of Rome in 1992. He is a colorectal surgeon, experienced in clinical and scientific research, training and educational support, and innovations in coloproctology. His clinical practice concerns particularly the colo-recto-anal disorders and diseases. He was coordinator of several scientific projects, with publication of results in prestigious scientific journals. He has been editor of books on different topics in coloproctology. He was Scientific Director and Member of Board of numerous training and master courses, meetings, and congresses. Prof. Ratto is an active member of the most prestigious scientific societies in coloproctology. He was frequently involved, as invited speaker, in a number of national and international congresses and meetings, and he hasalso performed “live surgery.” He is active member of – American Society of Colon and Rectal Surgeons (ASCRS), Fellow – European Society of Coloproctology (ESCP) – International Anal Neoplasia Society (IANS) Prof. Ratto was/is member of the several committees of the ASCRS. Prof. Ratto is member of the editorial board of several scientific journals.

Dr. Angelo Parello was born in Agrigento, Italy, on October 17, 1980. He graduated with honors in medicine and surgery from the Catholic University of Rome in 2004. From 2004 to 2010, he was resident in general surgery at the Catholic University of Rome, which he attended with particular interest directed to diagnosis and treatment of coloproctological diseases. His clinical practice is mainly directed to diagnosis and treatment of colo-rectal-anal diseases, and he is an expert in performing both anorectal and pelvic floor diagnostics tests (e.g., anorectal manometry and endoanal and transrectal ultrasound) and treatment (e.g., transanal hemorrhoidal Doppler-guided dearterialization for hemorrhoidal disease, and sacral neuromodulation for fecal incontinence and constipation). Dr. Parello collaborated in the development of a novel minimally invasive surgical approach to treat fecal incontinence – THD implant Gatekeeper and SphinKeeper. He was teacher and tutor in many national and international courses conducted in Italy and other European countries. Dr. Parello is author of several scientific publications in international journals and author of several book chapters, and has presented his research result

Dr. Francesco Litta was born in Matera on April 25, 1983. He graduated with honors in medicine and surgery from the Catholic University of Rome in 2008. He is a specialist in general surgery. Dr. Litta is a consultant surgeon in the Proctology Unit at the Foundation University Hospital “A. Gemelli,” IRCCS, Rome, Italy. His clinical practice focuses mainly on the diagnosis and treatment ofdisease of the colon and the rectum, and all proctological diseases. He is involved in anorectal physiology testing, with particular interest in the evaluation of benign and malignant disease by means of the anorectal manometry, three-dimensional endoanal ultrasound, and the high-resolution anoscopy. His research activity is mainly based on the evaluation and treatment of patients affected by anal fistula, fecal incontinence, constipation, hemorrhoidal disease, xii About the Editors obstructed defecation syndrome, and inflammatory bowel diseases, with studies concerning pathophysiology and surgical treatment by means of traditional and new minimally invasive therapeutic options. Dr. Litta is author of several scientific publications in international journals and author of several book chapters, and has presented his research results at national and international scientific conferences. He is teacher in a series of national and international courses on the management of coloproctological diseases. Dr. Litta is active member of the European Society of Coloproctology (ESCP), and member of the Guidelines Committee on the diagnosis and treatment of cryptoglandular perianal fistula, on behalf of this Society.

Dr. Veronica De Simone was born in Avellino, Italy, on January 4, 1987. She graduated with honors in medicine and surgery from the Catholic University of Rome in 2011 (110/110 cum laude). She completed her training in general surgery at the Catholic University of Rome (2012–2017). She works in the Proctology Unit at the Foundation University Hospital “A. Gemelli,” Rome, Italy. Her clinical practice concerns the diagnosis and treatment of benign and malignant colorectal and anal diseases. She developed a particular expertise in the diagnosis and management of anal and perianal HPV-related disease, performing anal cancer screening and second-level diagnostic tests (high resolution anoscopy) in high-risk population (HIV+, transplant recipients, and inflammatory bowel diseases). She is expert in performing anorectal diagnostics tests (e.g., anorectal manometry, and endoanal and transrectal ultrasound), in particular for the diagnostic evaluation of patients affected by fecal incontinence, obstructed defecation, and anal fistula and abscess. She is also involved in multidisciplinary team for the diagnosis, treatment, and follow-up of patients affected by rectal and anal cancer. Her research activity is mainly based on the evaluation and treatment of patients affected by fecal incontinence, anal HPV-related diseases, and anorectal dysfunctional outcomes after rectal resection surgery. About the Editors xiii She is author of several scientific publications in international journals and has presented her research results at national and international scientific conferences. She is teacher in a series of national and international courses on the diagnosis and treatment of colorectal diseases.

Dr. Paola Campennì was born in Vibo Valentia, Italy, on January 17, 1984. She graduated with honors in medicine and surgery from the University of Rome “La Sapienza” in October 2008 with an experimental research about transanal endoscopic microsurgery for rectal cancer. She worked as resident in the Digestive Surgery Unit at the University of Udine, and she focused on colorectal diseases and minimally invasive surgery at the University of Milan. In May 2015, she concluded her surgical training with honors and published her degree thesis. From 2016 to 2019, she worked at Humanitas Research Hospital, Rozzano (MI), as colorectal surgeon and at Humanitas University as clinical tutor for medicine and surgery students (course of SimulationLab: patients management). She is now a staff surgeon in the Proctology Unit at the Foundation University Hospital “A. Gemelli,” Rome, Italy, and consultant proctologist at Mater Olbia Hospital, Olbia, Italy. She is mainly dedicated to treatment of: – Proctological diseases (hemorrhoidal disease, anal fissure, anal fistula, anorectal abscess, proctitis, HPV infection, and anorectal dysplasia/cancer) – Chronic inflammatory bowel diseases (Crohn disease and ulcerative colitis) – Pelvic Disorders (complete rectal prolapse, internal intussusception, rectocele, obstructed defecation syndrome, and fecal incontinence) She routinely performs endoanal and transrectal ultrasound, anorectal manometry, and high-resolution anoscopy, and she is actively involved in the conservative treatment of fecal incontinence by the adoption of percutaneous tibial nerve stimulation (PTNS). xiv About the Editors She is author of several papers concerning functional disorders and rectal cancer. She is one of the founders of the Young Group of Italian Society of Colorectal Surgery (SICCR-Y), secretary from 2017 to 2019, and promoter of numerous multicenter studies.