Reverse “Y” Shape Fistula - a Paricularity in the Evolution of Postanal Space Abscesses

Horseshoe fistula, with an incidence of less than 3% of the total perianal fistulas, is an atypical lesion not included in the classification of Parks. Its specificity is given by the anatomical features of the postanal space, respectively the presence of the anococcygeal ligament. This type of perineal fistula has a particular tract in shape of a reverse „Y”. We present the cases of 12 patient diagnosed with posterior horseshoe fistula with deep postanal space abscess surgically treated during 2013-2017. The study is retrospective and observative and it includes the history of the disease, the diagnostic methods, the surgical procedures performed and the postoperative evolution. As far as we are concerned, we based our approach on the advancement flap literature data, as well as on the role of the anococcygeal ligament in the pathology of this lesion type. After optimal control of the purulent collection from the postanal space and after the remission of local inflammatory phenomena, a correct advancement flap technique succeeds most often to resolve the septic area of the crypt of origin. We believe that current standards on the functional outcomes of these types of lesions require techniques that avoid the slow elastic cutting of the sphincter, minimizing the risk of incontinence. Keywords: postanal space abscess; anococcygeal ligament; horseshoe fistula; advancement flap