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Der Chirurg; Zeitschrift Fur Alle... Apr 2019Anal fistulas are a common anorectal disease and are frequently associated with a perianal abscess. The etiology is based on a cryptoglandular infection in the... (Review)
Review
Anal fistulas are a common anorectal disease and are frequently associated with a perianal abscess. The etiology is based on a cryptoglandular infection in the intersphincteric space. Surgery remains the only definitive therapy. The primary goal of definitive fistula surgery is healing; however, success of fistula surgery is influenced by a variety of factors including the surgeon's experience, type of fistula, involvement of sphincter muscles, type of surgical procedure and patient-related factors. For the surgical treatment of a complex anal fistula, a variety of operative procedures have been described including fistulectomy with sphincterotomy, different flap procedures (e.g. mucosal flap and advancement flap) and finally so-called sphincter-preserving techniques, such as LIFT (ligation of intersphincteric fistula tract), VAAFT (video-assisted anal fistula treatment), the use of plugs of collagen or fibrin glue sealants as well as laser procedures or the clip. In the search for suitable quality indicators in anal fistula surgery there is a conflict between healing and preservation of continence. If potential quality indicators are identified the principles of anal fistula surgery must be adhered to and the appropriate selection of patients and procedures is of crucial importance to achieve high healing rates without compromising continence or inducing surgical revision due to abscesses or recurrence. Based on the available literature and guidelines, in the assessment of quality indicators considerable differences exist with respect to patient selection, etiology of anal fistulas and length of follow-up. Heterogeneity of treatment protocols lead to difficulties in a definitive assessment of which surgical treatment is the best option for complex anal fistulas.
Topics: Anal Canal; Anus Diseases; Fibrin Tissue Adhesive; Humans; Ligation; Quality Indicators, Health Care; Rectal Fistula; Treatment Outcome
PubMed: 30683947
DOI: 10.1007/s00104-019-0794-7 -
Diseases of the Colon and Rectum Jul 2023
Topics: Humans; Constriction, Pathologic; Surgical Flaps; Anus Diseases; Digestive System Surgical Procedures; Anal Canal
PubMed: 37027211
DOI: 10.1097/DCR.0000000000002484 -
Alimentary Pharmacology & Therapeutics Apr 2020The management of Crohn's disease patients with perianal lesions and anti-TNF failure is challenging. (Observational Study)
Observational Study
BACKGROUND
The management of Crohn's disease patients with perianal lesions and anti-TNF failure is challenging.
AIMS
To assess the effectiveness of vedolizumab in perianal Crohn's disease and the predictors of success in a real-life cohort.
METHODS
We conducted a nationwide multicentre cohort study in patients with perianal Crohn's disease who received vedolizumab. In patients with active perianal Crohn's disease, the success of vedolizumab was defined by clinical success (no draining fistula at clinical examination and no anal ulcers for primary lesions) at 6 months without medical or surgical treatment for perianal Crohn's disease. Logistic regression analyses were performed to identify predictors of success. In patients with inactive perianal Crohn's disease, recurrence was defined by the occurrence of lesions and/or the need for medical or surgical treatments.
RESULTS
One hundred and fifty-one patients were included. Among them 102 patients had active perianal disease, 33 (32.4%) males, mean age 39.8 years, mean Crohn's disease duration 14.6 years; 101 (99%) had received at least one anti-TNF. The median follow-up time was 52 weeks. Sixty-eight per cent of patients discontinued therapy after a median time of 33 weeks. Vedolizumab success was reached in 23/102 (22.5%). Among patients with setons at initiation, 9/61(15%) had a successful removal. In multivariable analysis, factors associated with success were the number of prior biologic agents (≥3, odds ratio, OR: 0.20, 95% CI 0.04-0.98) and no antibiotics at initiation (OR: 4.76, 95% CI 1.25-18.19). In 49 patients with inactive perianal Crohn's disease, perianal disease recurred in 15/49 (30.6%), 11/49 (22.4%) needed dedicated treatments. Median time to recurrence was 22 weeks.
CONCLUSIONS
We identified a low rate of success of vedolizumab in patients with active perianal Crohn's disease, and nearly one third of patients with inactive perianal Crohn's disease had perianal recurrence. Further evaluation is warranted in prospective studies.
Topics: Adult; Animals; Antibodies, Monoclonal, Humanized; Anus Diseases; Cohort Studies; Crohn Disease; Female; France; Humans; Male; Middle Aged; Perianal Glands; Rectal Fistula; Recurrence; Treatment Outcome; Young Adult
PubMed: 32080886
DOI: 10.1111/apt.15665 -
Der Hautarzt; Zeitschrift Fur... Jun 2015Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists... (Review)
Review
Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.
Topics: Anus Diseases; Anus Neoplasms; Delayed Diagnosis; Diagnosis, Differential; Eczema; Female; Humans; Male; Pruritus Ani; Self Medication
PubMed: 25874442
DOI: 10.1007/s00105-015-3618-9 -
Surgery Today Mar 2023Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including...
PURPOSE
Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease.
METHODS
We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion.
RESULTS
After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03).
CONCLUSION
Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
Topics: Humans; Crohn Disease; Anus Diseases; Retrospective Studies; Surgical Stomas; Ileostomy; Postoperative Complications
PubMed: 35867163
DOI: 10.1007/s00595-022-02556-x -
Journal of Visceral Surgery Apr 2015
Topics: Anus Diseases; Colonic Diseases; Colorectal Surgery; Education, Medical, Continuing; France; Gastroenterology; Humans; Rectal Diseases
PubMed: 25280597
DOI: 10.1016/j.jviscsurg.2014.07.010 -
Der Hautarzt; Zeitschrift Fur... Jun 2015Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which... (Review)
Review
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which may lead to severe functional and psychological impairment. Patients often suffer for many years before the right diagnosis is finally made. HS/AI is still a therapeutic challenge. Conservative therapies play a role in mild stages of the disease; however they do not result in healing. Therapy of choice associated with the lowest recurrence rate is a radical wide excision of involved skin.
Topics: Anus Diseases; Hidradenitis; Hidradenitis Suppurativa; Humans; Recurrence; Risk Factors; Treatment Outcome
PubMed: 25877488
DOI: 10.1007/s00105-015-3616-y -
Drugs Jan 2018Perianal localization of Crohn's disease involves significant morbidity, affects quality of life and results in an increased use of healthcare resources. Medical and... (Review)
Review
Perianal localization of Crohn's disease involves significant morbidity, affects quality of life and results in an increased use of healthcare resources. Medical and surgical therapies contribute to its management. The objective of this review is to address the current understanding in the management of perianal Crohn's disease, with the main focus in reviewing pharmacological therapies, including stem cells. In complex fistulas, once local sepsis has been controlled by surgical drainage and/or antibiotics, anti-TNF drugs (infliximab, adalimumab) are the first-line therapy, with or without associated immunomodulators. Combining surgery and anti-TNF therapy has additional benefits for healing. However, response is inadequate in up to half of cases. A possible role of new biological drugs in this context (vedolizumab, ustekinumab) is an area of ongoing investigation, as is the local application of autologous or allogeneic mesenchymal stem cells. These are non-hematopoietic multipotent cells with anti-inflammatory and immunomodulatory properties, the use of which may successfully treat refractory patients, and seem to be a promising and safe alternative to achieving fistula healing in Crohn's disease, without known systemic effects.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Anus Diseases; Combined Modality Therapy; Crohn Disease; Female; Humans; Immunologic Factors; Mesenchymal Stem Cell Transplantation; Tumor Necrosis Factor-alpha
PubMed: 29139091
DOI: 10.1007/s40265-017-0842-x -
Der Hautarzt; Zeitschrift Fur... Jun 2015Patients with anal complaints require a high level of sensitivity of the involved healthcare professionals. A large variety of different pathological changes lead to... (Review)
Review
Patients with anal complaints require a high level of sensitivity of the involved healthcare professionals. A large variety of different pathological changes lead to very similar clinical symptoms. A carefully guided history interview is able to target in many cases the underlying condition. Treatment should not be performed before definite exclusion of any malignant disease. However, patients most of all blame hemorrhoids for any anal physical discomfort and visit the physician with high expectations in treatment of their supposed disease. The following summary ranks anal diseases by frequency considering their clinical appearance and delimitation and provides an overview of symptoms associated with hemorrhoids.
Topics: Anus Diseases; Anus Neoplasms; Cooperative Behavior; Diagnosis, Differential; Fibroma; Fissure in Ano; Hemorrhoids; Humans; Interdisciplinary Communication; Rectal Fistula
PubMed: 25862524
DOI: 10.1007/s00105-015-3617-x -
The American Surgeon Jun 2023Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the...
BACKGROUND
Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer.
METHODS
We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient.
RESULTS
Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn's disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms.
CONCLUSIONS
A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn's disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.
Topics: Humans; Abscess; Anus Neoplasms; Crohn Disease; Retrospective Studies; Rectal Neoplasms; Anus Diseases; Rectal Diseases; Rectal Fistula; Sepsis
PubMed: 35621130
DOI: 10.1177/00031348221101481