SPORADICALLY, reports appear in the literature advocating excision and primary closure of anal fistulas. Although immediate postoperative results are good, there have been no reports of large series followed long enough to evaluate adequately such an operative procedure. On the other hand, in a study of 58 recurrent fistulas 72.8 per cent of the patients (42) gave a history of primary suture of the wound at the time of the initial operation. The purpose of this paper is to review the results of operation on 122 anal fistulas over a two year period prior to July 1944 by the technic that was in vogue at the time of Hippocrates.
The basic cause of anal fistula remains in doubt. Although constipation, hard stools, cryptitis and poor hygiene have been incriminated, a careful study of a large series reveals that the majority of patients have no anal symptoms prior to the sudden