Can the external anal sphincter be preserved in the treatment of trans-sphincteric fistula-in-ano?

Thomson, J. P. S.; Ross, A. H. McL.

doi:10.1007/bf01644991

Cited by 73 publications

(44 citation statements)

References 13 publications

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“…There is nevertheless a risk of rendering the patient incontinent when the anal sphincter is divided. [4][5][6] Insertion of a loose seton, 7 to prevent abscess formation, may be used as bridge to definitive surgery or to control the fistula over the long term; however, this is often associated with a chronic discharge, 8 which may itself affect QOL. Should the loose seton be removed, the fistula rarely heals spontaneously.…”

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confidence: 99%

Quality of life with anal fistula

Owen

Buchanan

Schizas

et al. 2016

annals

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INTRODUCTION Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. METHODS Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. RESULTS Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. CONCLUSIONS Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

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confidence: 99%

Quality of life with anal fistula

Owen

Buchanan

Schizas

et al. 2016

annals

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“…Treatment options of anal fistula include fistulotomy, seton placement, endorectal advancement flap, dermal island flap, fistula plug, fibrin injection and ligation of the intersphincteric fistula tract. 5 Surgical treatment of anal fistula depends on the amount of sphincter involvement and internal and external anal sphincters preservation for continence maintenance 6 .…”

Section: Resultsmentioning

confidence: 99%

Use of Seton in Management of High Variety of Anal Fistula

Abbasi

2017

Anwer Khan Mod Med Coll J

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Background: Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula.Objectives: Evaluation the efficacy and safety of seton as surgical management of high anal fistula.Methods: This is a prospective study done on 57 patients in BIRDEM hospital and some other clinic of Dhaka city in 3 years period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were-successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction.Result: Among 57 patients mean age was 38.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 51 patients, incontinence occurred in 2 patients and recurrence occurred in 4 patients. Conclusion:Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.Key Words: Anal canal, fistula, surgery, seton ABSTRACT result in an abscess between the internal and external sphincters, which in turn can spread to other parts of the perianal region. Infection can then track in many directions from this focus in the intersphincteric plane 3 . When the track reaches the skin or another epithelialized surface then a fistula is formed. Anal fistula were classified on the basis of its relationship to the sphincters. The definition of high or low describes the height of the track as it traverses the sphincter muscles and not the position of the internal opening which is almost without exception at the dentate line. More accurately according to parks classification fistula in ano can

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“…This work focusing in particular on the structure of the external anal sphincter (EAS) as a triple interconnected system of U-shaped loops which sequentially compresses opposing anal segments [5] proposes a mechanism of single-loop continence from any of these parts following partial EAS division during fistulectomy [6,7]. The transition of this anatomical sphincteric disposition into a physiological mechanistic approach to continence historically has always been challenged [8], although endoanal magnetic resonance imaging has proven a coronal interplay of the subcutaneous, intermediate and deep EAS components [9,10] originally described by Goligher et al.…”

Section: Introductionmentioning

confidence: 99%

Anorectal morphology and function: analysis of the Shafik legacy

Zbar

Guo

Pescatori³

2008

Tech Coloproctol

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Following the untimely death of Professor Ahmed Shafik, the authors decided to analyse his published work on the anatomy and physiology of the anorectal area, reconciling this body of data with current imaging and physiological techniques. All available papers as indexed by PubMed pertaining to the anorectal area were obtained and reviewed. The anatomical data was compared with historical representations and current new imaging modalities. The original 'triple-loop' theory of the anatomical disposition of the external anal sphincter has been confirmed by coronal and coronally reconstructed imaging modalities. There is variance between the Shafik and other descriptions of the anatomy of the longitudinal muscle and its importance in the definition of perianal spaces which are important in the spread of perirectal sepsis and in intersphincteric rectal dissection. Current dynamic defaecography would suggest a more complex levator plate function in squeeze and straining than that originally suggested by Shafik as a primary defaecatory role for the levator muscle. The body of work by Professor Shafik has reorganized our understanding of the external anal sphincter and the function of the levator during defaecation. Future studies should assess anatomical and physiological variances using new technology in health and in specific disease states.

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Can the external anal sphincter be preserved in the treatment of trans-sphincteric fistula-in-ano?

Cited by 73 publications

References 13 publications

Quality of life with anal fistula

Quality of life with anal fistula

Use of Seton in Management of High Variety of Anal Fistula

Anorectal morphology and function: analysis of the Shafik legacy

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