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Diseases of the Colon and Rectum Dec 2016
Topics: Disease Management; Female; Fissure in Ano; Humans; Rectal Fistula; Rectovaginal Fistula
PubMed: 27824697
DOI: 10.1097/DCR.0000000000000733 -
BMC Medical Imaging Sep 2023Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and... (Review)
Review
BACKGROUND
Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy.
METHODS
A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded.
RESULTS
Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed.
CONCLUSION
High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
Topics: Humans; Male; Infant; Anorectal Malformations; Retrospective Studies; Colostomy; Rectal Fistula; Magnetic Resonance Imaging
PubMed: 37749545
DOI: 10.1186/s12880-023-01105-3 -
Techniques in Coloproctology Oct 2022Video-assisted anal fistula treatment (VAAFT) has gained increasing acceptance as a sphincter-sparing procedure for treating complex anorectal fistulas (CAF), but no... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Video-assisted anal fistula treatment (VAAFT) has gained increasing acceptance as a sphincter-sparing procedure for treating complex anorectal fistulas (CAF), but no unequivocal conclusions can yet be drawn regarding its ultimate effectiveness. We reviewed the literature and performed a meta-analysis to evaluate the efficacy and safety of VAAFT in CAF patients.
METHODS
The study protocol was registered with the PROSPERO database (CRD42021279085). A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases up to June 2021 with no restriction on language based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the keywords video-assisted surgery, video-assisted anal fistula treatment, and complex anorectal fistula to identify relevant studies.
RESULTS
Fourteen trials (7 prospective and 7 retrospective) with a total of 1201 patients (mean age 43.5 years) were included. The median follow-up duration was 16.5(8-48) months. Pooled analysis showed that the rates of success, recurrence and postoperative complication across the studies were 83% (95% CI 81-85%, I = 37.9%), 16% (95% CI 14-18%, I = 4.8%), 11% (95% CI 7-15%, I = 72.1%), respectively. The postoperative Jorge-Wexner score used to assess the level of anal incontinence was 1.09 (95% CI, 0.9-1.27, I = 74.6%). The internal opening detection rate was 97.6% (95% CI 96.1-99.6%, I = 48.2%). Recurrence rates varied according to the closure method of internal opening from 21.4% after using staplers, 18.7% after suturing, to 23.5% after advancement flap. The hospital stay was 3.15 days (95% CI 2.96-3.35, I = 49.7%). Subgroup analysis indicated that the risk of heterogeneity in the urine retention group was higher compared with that of the overall group and that retrospective studies may be the source of heterogeneity for postoperative anal incontinence. r . Sensitivity analysis confirmed the stability of the pooled results. Begg's and Egger's tests showed no evidence of publication bias.
CONCLUSIONS
According to the available evidence, VAAFT may be a valuable alternative to fistulotomy or seton in treating CAF and has the additional long-term benefits of reducing anal incontinence and surgical morbidity, permitting earlier healing and accelerated rehabilitation.
Topics: Adult; Anal Canal; Fecal Incontinence; Humans; Organ Sparing Treatments; Prospective Studies; Rectal Fistula; Retrospective Studies; Treatment Outcome; Video-Assisted Surgery
PubMed: 35347492
DOI: 10.1007/s10151-022-02614-z -
Journal of the National Medical... Nov 1988The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of... (Review)
Review
The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of the more common classifications of fistula-in-ano presented. The different methods of treating each are discussed, and some of the common complications of the procedure are listed. A true understanding of the disease process and anatomy is needed before treatment of fistulous abscesses is begun, but, with it, successful outcomes will occur in most cases.
Topics: Abscess; Anus Diseases; Female; Humans; Male; Rectal Diseases; Rectal Fistula
PubMed: 3074175
DOI: No ID Found -
Primary Care Mar 1999Anorectal abscesses and fistulas are seen commonly in the primary care practice. An abscess forms as the result of obstruction of an anal gland, with resulting... (Review)
Review
Anorectal abscesses and fistulas are seen commonly in the primary care practice. An abscess forms as the result of obstruction of an anal gland, with resulting retrograde infection. An anal fistula simply represents the chronic phase of a perianal abscess. The history generally is diagnostic, and special studies usually are not required. Treatment is surgical, with good results.
Topics: Abscess; Drainage; Female; HIV Infections; Humans; Rectal Diseases; Rectal Fistula; Rectovaginal Fistula
PubMed: 9922295
DOI: 10.1016/s0095-4543(05)70102-0 -
Clinics in Gastroenterology Sep 1975
Comparative Study
Topics: Abscess; Anal Canal; Crohn Disease; Female; Humans; Male; Postoperative Care; Rectal Fistula; Rectum
PubMed: 1183066
DOI: No ID Found -
FP Essentials Apr 2014Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most... (Review)
Review
Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening.
Topics: Family Practice; Fissure in Ano; Humans; Laxatives; Rectal Fistula; Risk Factors
PubMed: 24742084
DOI: No ID Found -
Surgical Technology International 2008Anorectal abscesses and fistulas are common maladies that are usually readily diagnosed and effectively treated. However, complex fistulous disease challenges even the... (Review)
Review
Anorectal abscesses and fistulas are common maladies that are usually readily diagnosed and effectively treated. However, complex fistulous disease challenges even the most expert of surgical specialists. The management options in this subset of patients are suboptimal, with treatment often requiring multiple procedures, putting the patient at risk for continued symptoms and fecal incontinence. In this chapter, the clinical aspects of perianal suppurative disease are discussed and an attempt is made to deal with many of the more challenging aspects of patient management.
Topics: Combined Modality Therapy; Digestive System Surgical Procedures; Drainage; Humans; Proctitis; Rectal Fistula; Sepsis
PubMed: 18802894
DOI: No ID Found -
The Surgical Clinics of North America Dec 2002Anorectal abscess and fistula are intimately connected in anatomy, etiology, and morbidity. They have been extensively described, but only sparingly studied in... (Review)
Review
Anorectal abscess and fistula are intimately connected in anatomy, etiology, and morbidity. They have been extensively described, but only sparingly studied in randomized controlled trials. These trials, covering such issues as primary suture of abscess, whether or not to perform a fistulotomy at the time of abscess drainage, and comparison of fistulotomy and fistulectomy, are the focus of this article. Important gaps in our knowledge and subjects for new trials are also discussed.
Topics: Abscess; Clinical Competence; Digestive System Surgical Procedures; Humans; Rectal Diseases; Rectal Fistula
PubMed: 12516844
DOI: 10.1016/s0039-6109(02)00063-4 -
BMC Pediatrics Jun 2021Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study...
BACKGROUND
Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics.
METHODS
Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001-2020.
RESULTS
The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other.
CONCLUSIONS
Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60-70%.
Topics: Anal Canal; Anorectal Malformations; Child; Humans; Infant, Newborn; Male; Plastic Surgery Procedures; Rectum; Retrospective Studies; Urinary Fistula
PubMed: 34134660
DOI: 10.1186/s12887-021-02761-6