**9. Conclusions**

Revisiting the anatomy and pathogenesis facilitates us to understand the natural patterns of anorectal abscess and fistula. With this new idea, we are able to classify and stratify this disease according to level of complexity and sphincter involvement, thus selecting the appropriate tool to manage it. Definitive treatment in acute abscess stage is feasible if the principles are followed. Surgical options and strategies should be carefully selected to suite each pattern, while adhering to the principles of surgical treatment. Challenges in managing cryptoglandular fistula-in-ano are summarized in Appendix (**Table 6**). The proposed solution is carefully selected from the current review of evidence and the experience of a high-volume tertiary centre.
