A New Concept for the Surgical Anatomy of Posterior Deep Complex Fistulas

Kurihara, Hiroyuki; Kanai, Takashi; Ishikawa, Toru; Ozawa, Kotaro; Kanatake, Y.; Kanai, Shinichiro; Hashiguchi, Yojiro

doi:10.1007/s10350-006-0736-6

Cited by 40 publications

(4 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conventional methods such as fistulotomy and setons were associated with high postoperative morbidity, incontinence, and recurrence. The importance of the intersphincteric space being the focus of sepsis in complex fistulas was emphasized by Kurihara et al [4] and Zhang et al [7]. Newer modalities like AFP, VAAFT, OTSC clip, fibrin glue, and the fistula-tract laser closure (FiLaC) device fail to address this source of sepsis, resulting in failure of fistula closure.…”

Section: Discussionmentioning

confidence: 99%

“…It is now recognized that the intersphincteric space is more commonly involved in the development of complex fistula in ano than the deep postanal space, as described by Courtney [3]. This concept has led to new advances in the treatment of complex fistula in ano [4]. To treat sepsis in the deep intersphincteric space, there must be adequate drainage of the intersphincteric space, followed by curettage of the external tract to ensure proper wound healing.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results

et al. 2023

View full text Add to dashboard Cite

Purpose: Many methods have been used to treat complex fistulas, but no single technique has been considered standard. Damage to the sphincter may sometimes be unavoidable, and incontinence may be an important cause of morbidity. This study aimed to validate the results of transanal opening of the intersphincteric space (TROPIS), as a technique that avoids damaging the anal sphincter, in patients with complex fistula in ano. Methods: A prospective study was conducted among 35 consecutive patients with complex fistula in ano. After a preoperative magnetic resonance fistulogram, TROPIS was performed in all patients. The St. Mark's incontinence score was assessed preoperatively and postoperatively at 3 months. Results: The tracts were intersphincteric in 16 patients, transsphincteric in 10, extrasphincteric in 2, and horseshoe in 3. Four patients had recurrent tracts (3 transsphincteric and 1 intersphincteric). A defined follow-up schedule was used. Curettage was done if postoperative pus drainage from the wound was noted. The fistula healed in 29 patients (82.86%) following TROPIS. The remaining 6 patients received curettage, with healing in 3 (overall healing rate, 91.4%). Patients who received curettage were followed for 3 months, and the outcome was labeled as healed or failed. The mean preoperative incontinence score was 0. One patient developed incontinence to gas postoperatively in week 2, but there was no significant change in the scores at 3 months postoperatively. The mean postoperative incontinence score was 0.02. Conclusion: TROPIS is an effective method for the treatment of complex fistula in ano, with minimal risk for incontinence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Although these methods focus on closing the internal opening or ligating the tract in intersphincteric plane, the failure after these procedures were probably due to inadequate drainage of secondary extensions of the primary fistula track in the intersphincteric space 10 . Studies 11,12 had found that most posterior high complex fistulas were associated with a primary or secondary lesion in the posterior deep space 12 , namely deep posterior intersphincteric space (DPIS) 12 .…”

Section: Discussionmentioning

confidence: 99%

Cutting seton versus decompression and drainage seton in the treatment of high complex anal fistula: a randomized controlled trial

Zhi

Jia

et al. 2022

Sci Rep

View full text Add to dashboard Cite

This study aimed to compare the efficacy between decompression and drainage seton (DADS) and cutting seton (CS) in the treatment of high complex anal fistula. Patients were randomly assigned 1:1 to DADS or CS group. The primary outcome was the rate of wound healing. Second outcomes included time taken to return to work, postoperative pain, the severity of fecal incontinence and other complications. A total of 120 patients with a mean age of 39 years were included. There was no significant difference in the rate of complete wound healing at 1 year. The mean time taken to return to work was 5 ± 2 days in DADS group, shorter than CS group (10 ± 3, p < 0.001). Mean vaizey incontinence score and the post-operation pain in DADS group was significantly lower than CS group. No significant difference was found between two groups in the incidence of complications. DADS is as effective as Cutting seton for the treatment of high complex anal fistula but is associated with less postoperative pain and better sphincter function preserving.

show abstract

“…A wider field of vision makes it easier to confirm the muscle structures associated with continence. The origin of the infection has long been considered to be located in the posterior extrasphincteric space [ 3 , 14 ], but a new concept has emerged illustrating an intersphincteric space to be the origin [ 15 , 16 ]. Advances in radiologic imaging such as magnetic resonance imaging may have helped facilitate the introduction of this new concept.…”

Section: Discussionmentioning

confidence: 99%

Two-stage Complete Deroofing Fistulotomy Approach for Horseshoe Fistula: Successful Surgery Leaving Continence Intact

Usui¹,

Ishiyama²,

Nishio³

et al. 2021

Ann Coloproctol

View full text Add to dashboard Cite

Purpose: Surgery of the horseshoe fistula is challenging due to its complex configuration and sphincter muscle involvement. Complete deroofing fistulotomy for horseshoe fistula is highly curative with the eradication of all fistulous lesions but has been discredited for its high incontinence rate. It was replaced with the more conservative Hanley’s procedure leaving the lateral tracts intact, despite its issue of recurrence. Our study aimed to report the outcomes of a procedure dividing complete deroofing fistulotomy for horseshoe fistula into 2 stages to avoid impairment of sphincter function.Methods: We retrospectively reviewed 139 patients who underwent surgery for horseshoe fistula using the 2-stage complete deroofing fistulotomy method between 2014 and 2017. The first surgery deroofed the lateral tracts with an arch-like incision severing the anococcygeal ligament. The primary lesion was also drained and curetted. A seton was placed in the primary tract which was laid open in the second surgery after the lateral wound had partially healed.Results: Recurrence was observed in 12 patients. All were superficial recurrences except for 1, in which recurrence was confirmed in the primary lesion. Those with blind intersphincteric upward extensions had a significantly higher recurrence rate. Furthermore, patients who resided far from the hospital and could not make visits for frequent wound inspections also had a significantly higher recurrence rate. No patient had any continence issues at the end of the follow-up period.Conclusion: Managing horseshoe fistula with the 2-stage deroofing fistulotomy approach allows for eradication of the fistula tract without compromising anal sphincter function.

show abstract

A New Concept for the Surgical Anatomy of Posterior Deep Complex Fistulas

Abstract: Recognition of the posterior deep space, the septum of the ischiorectal fossa, the inferior levator space, and the clinical ischiorectal space may be crucial for effective surgical management of posterior complex fistula.

Cited by 40 publications

References 9 publications

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results

Cutting seton versus decompression and drainage seton in the treatment of high complex anal fistula: a randomized controlled trial

Two-stage Complete Deroofing Fistulotomy Approach for Horseshoe Fistula: Successful Surgery Leaving Continence Intact

Contact Info

Product

Resources

About