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Journal of Visceral Surgery Apr 2015The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible... (Review)
Review
The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.
Topics: Abscess; Anus Diseases; Emergencies; Humans; Ligation; Rectal Fistula; Suction; Surgical Flaps; Treatment Outcome
PubMed: 25261376
DOI: 10.1016/j.jviscsurg.2014.07.008 -
Ugeskrift For Laeger Sep 2021Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge... (Review)
Review
Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge of anal anatomy and imaging with MRI or endoanal sonography is crucial to classify AF as simple or complex depending on risk of anal incontinence after fistulotomy as summarised in this review. Fistulotomy has healing rates of > 90%, risks incontinence, and the procedure is reserved for simple fistulas. Complex AF are treated with a draining seton and then with sphincter-saving procedures which have long-term healing rates of about 50%.
Topics: Anal Canal; Fecal Incontinence; Humans; Magnetic Resonance Imaging; Rectal Fistula; Treatment Outcome
PubMed: 34498577
DOI: No ID Found -
BMC Surgery Sep 2022Isolated iliac artery aneurysms are rare and difficult to diagnose. It is more common in males. It can be asymptomatic at diagnosis or can present with frank rupture, or...
BACKGROUND
Isolated iliac artery aneurysms are rare and difficult to diagnose. It is more common in males. It can be asymptomatic at diagnosis or can present with frank rupture, or symptoms caused by compression on nearby organs.
CASE PRESENTATION
A 44 years old male was diagnosed with rectosigmoid adenocarcinoma and underwent low anterior resection. One year after the surgery, he presented with fistula between the rectal stump and left iliac artery that was managed by stenting.
CONCLUSION
A fistula between the rectal stump and the left iliac artery is very rare. There are several treatment options for ilio-rectal fistula but no conclusive specific treatment.
Topics: Adult; Humans; Iliac Artery; Male; Rectal Fistula; Rupture; Tomography, X-Ray Computed
PubMed: 36104778
DOI: 10.1186/s12893-022-01776-9 -
Journal of Visceral Surgery Apr 2015Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of... (Review)
Review
Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of postoperative incontinence. Different methods have been proposed to overcome the need for dividing part or all of the sphincter, so-called "sphincter saving techniques" (SST), such as flap advancement, intrafistular injection of glue, or the insertion of a bio-prosthesis (collagen plug). However, the success rate of SSTs is lower than that of fistulotomy. Ligation of the Intersphincteric Fistula Tract (LIFT) is one of the most recent SSTs. It aims to ligate and transect the fistula by an approach through the intersphincteric space. The methodological quality of most published studies has been only average, but several studies have reported attractive success rates of 70 to 95% without postoperative incontinence. Other techniques such as endo-anal clip or injection of autologous stem cells are still anecdotal.
Topics: Anal Canal; Evidence-Based Medicine; Fecal Incontinence; Fibrin Tissue Adhesive; Humans; Ligation; Organ Sparing Treatments; Quality of Life; Rectal Fistula; Surgical Flaps; Tissue Adhesives; Treatment Outcome
PubMed: 25280598
DOI: 10.1016/j.jviscsurg.2014.08.002 -
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 -
Techniques in Coloproctology Apr 2021Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause... (Review)
Review
BACKGROUND
Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques.
METHODS
A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies.
RESULTS
The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients' quality of life and satisfaction.
CONCLUSIONS
Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.
Topics: Anal Canal; Fecal Incontinence; Humans; Organ Sparing Treatments; Quality of Life; Rectal Fistula; Treatment Outcome
PubMed: 33387100
DOI: 10.1007/s10151-020-02385-5 -
World Journal of Gastroenterology Oct 2014Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a... (Review)
Review
Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.
Topics: Anal Canal; Crohn Disease; Digestive System Surgical Procedures; Fecal Incontinence; Gastrointestinal Agents; Humans; Patient Care Team; Predictive Value of Tests; Rectal Fistula; Risk Factors; Treatment Outcome; Wound Healing
PubMed: 25309057
DOI: 10.3748/wjg.v20.i37.13205 -
Techniques in Coloproctology Sep 2017Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the... (Review)
Review
BACKGROUND
Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn's disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP). They report a consensus on the management of perianal Crohn's disease lesions, including fistulas, ulceration and anorectal stenosis and propose an appropriate treatment strategy, as well as sphincter-preserving and multidisciplinary management.
METHODOLOGY
A panel of French gastroenterologists and colorectal surgeons with expertise in inflammatory bowel diseases reviewed the literature in order to provide practical management pathways for perianal CD. Analysis of the literature was made according to the recommendations of the Haute Autorité de Santé (HAS) to establish a level of proof for each publication and then to propose a rank of recommendation. When lack of factual data precluded ranking according to the HAS, proposals based on expert opinion were written. Therefore, once all the authors agreed on a consensual statement, it was then submitted to all the members of the SNFCP. As initial literature review stopped in December 2014, more recent European or international guidelines have been published since and were included in the analysis.
RESULTS
MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn's disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn's disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn's disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical-surgical cooperation.
Topics: Adult; Anal Canal; Anus Neoplasms; Combined Modality Therapy; Consensus; Crohn Disease; Digestive System Surgical Procedures; Drainage; Female; France; Gastrointestinal Agents; Humans; Male; Perineum; Practice Guidelines as Topic; Rectal Fistula; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 28929282
DOI: 10.1007/s10151-017-1684-y -
Journal of Visceral Surgery Aug 2010Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a... (Review)
Review
Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.
Topics: Abscess; Anti-Bacterial Agents; Drainage; Fecal Incontinence; Fibrin Tissue Adhesive; Postoperative Complications; Randomized Controlled Trials as Topic; Rectal Fistula; Risk Factors; Sepsis; Surgical Flaps; Surgical Instruments
PubMed: 20822966
DOI: 10.1016/j.jviscsurg.2010.07.007 -
Annals of the Royal College of Surgeons... Nov 2022Acute supralevator abscess (SLA) is an uncommon and complicated form of anorectal sepsis. Its correct management is crucial to avoid complex iatrogenic fistula... (Review)
Review
INTRODUCTION
Acute supralevator abscess (SLA) is an uncommon and complicated form of anorectal sepsis. Its correct management is crucial to avoid complex iatrogenic fistula formation. A comprehensive review of the literature was conducted to determine the incidence of SLA and the surgical outcome with particular reference to the direction of drainage.
METHODS
A search of Medline, PubMed and the Cochrane Library was performed to identify all studies reporting surgical drainage of SLA.
FINDINGS
A total of 19 studies were identified, including 563 patients. The only two prospective studies reported an incidence of SLA of 10% and 3% in 68 and 100 patients, respectively, with anorectal sepsis. In 17 retrospective studies, the incidence ranged from 0% to 28%. Magnetic resonance imaging (MRI) was performed routinely in only one study. The surgical anatomical classification of the abscess was described in six studies diagnosed at surgery. The direction of surgical drainage whether 'inwards' (into the lumen) or 'outwards' (into the ischioanal fossa) was stated in only six studies. In two of these, the direction of drainage was contradictory to the recommendation made by Parks . Recurrent sepsis was reported in eight studies and ranged from 0% to 53%.
CONCLUSIONS
Detailed and prospective data on acute SLA are lacking. Its real incidence is unclear and it is not possible to analyse surgical outcomes conclusively according to different direction of drainage. The routine use of MRI in complicated anorectal sepsis would specify the surgical anatomy of SLA before any drainage is carried out.
Topics: Humans; Abscess; Rectal Fistula; Prospective Studies; Retrospective Studies; Drainage; Sepsis
PubMed: 35133205
DOI: 10.1308/rcsann.2021.0257