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A method of active outstripping incisions with special reference to the localization of the primary anaerobic focus and possible pathways of the spreading of purulent exudate is proposed on the basis of experiences with surgical treatment of 14 patients with acute anaerobic paraproctitis and investigations of topographical-anatomical localization of cellular spaces in the pararectal area.

The experience with operative treatment of 974 patients with chronic paraproctitis has been summarized. After the operations for intrasphincter fistula, 1% of the patients developed a disease recurrence, 0.5%--incompetence of the anal sphincter; for transsphincteric fistula--2.6 and 1.9%, respectively, for extrasphincteric fistula--5.7 and 5.2%. A fistula excision into the intestinal lumen is an operation of choice in intra- and transsphincteric fistula. In extrasphincteric fistula, fistula excision, plastic transfer of mucosa for closure of its internal opening with preservation of the anal sphincter should be performed. In presence of the extensive scars and purulent leaks, a ligature should be added to fistula excision.