A Review of the Anatomy of Anal Glands Relevant to Cryptoglandular Fistulas; Are We on the Right Track?

Abstract

Purpose: Anal fistulae are relatively common, quite symptomatic, and sometimes difficult to repair. Multiple procedures are used to treat patients with anal fistulae, and healing rates vary considerably, both between different procedures and between different centers doing the same procedure. Some of this variability in approach and outcomes may be due to different understandings of anal gland anatomy and its role in anal sepsis. This is a review of the anatomy of the anal glands and their relationship to anal sepsis in the light of current techniques for repair.

Methods: A search of the English language literature was performed looking for articles related to the anatomy of the anal glands. Reports that placed anatomy in the context of cryptoglandular sepsis were selected.

Results: Seven articles fulfilled the criteria; in addition to the original articles that described anatomy in isolation. Anal glands number from 2 to 11 and are merocrine secretory glands that drain into an anal crypt. They are mostly submucosal and lie caudally from the crypt. A varying proportion of glands traverse the internal anal sphincter. These are surrounded by a lymphocytic infiltrate and can have dilated segments. The anatomy suggests that some people are born with sepsis-prone glands and that issues with their passage through the internal sphincter may potentiate that sepsis.

Conclusion: This review suggests that the correct focus of repair should be on the infected gland itself, as it passes through the internal sphincter.