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The review presents the domestic and foreign scientists' data on modern principles and trends in the surgical treatment of anal abscesses. The problem is urgent due to the high incidence of anal abscess in clinical practice, which is about 40% of the total number of patients hospitalized in the coloproctological hospital. The preservation of muscular structures of the anal sphincter during surgery plays an important role in the treatment of anal abscess, allowing to reduce the percentage of unsatisfactory results of treatment and to improve the patients' quality of life in the postoperative period. Different approaches to the surgical treatment of anal abscesses in different surgical schools are considered in the review. We analyzed the operational access options depending on the forms of anal sepsis. One-stage or multi-stage treatment of rectal fistula complicated by purulent process was evaluated. The advantages and disadvantages of the loose seton for preparing patients to sphincter-preserving stage of treatment in delayed order are revealed. However, there is still a number of problems that has been not completely solved. These include the feasibility of conducting the loose seton during the treatment of the anal abscess, demonstrating the advantages of one-stage or two-stage methods of surgical treatment, etc. For each of these problems, additional randomized trials are needed to justify a particular approach. Choosing the right way of surgical treatment will allow to prevent anal muscle damage and reduce the frequency of fecal incontinence.

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