Emerging Concepts in Classification of Anal Fistulae

Rojanasakul, Arun; Tsang, Charles B.

doi:10.1007/978-3-030-40862-6_80

Cited by 2 publications

(20 citation statements)

References 16 publications

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“…However, other view states that the vertical portion of the levator ani's striated muscles around the anorectal ring is the puborectalis muscle, interchangeably known as the deep external sphincter [7]. This is supported by previous study by Shafik in 1975 confirming that puborectalis muscle and deep external sphincter are actually fused and functions as a single loop termed the top loop [9].…”

Section: Several Updates In Anorectal Anatomy Are Summarized Belowmentioning

confidence: 92%

“…Anorectal musculature, fascias and spaces are constant. Therefore, the natural patterns of anal fistula should also follow a constant pattern [7].…”

Section: Revisiting the Pathogenesis Of Cryptoglandular Infectionmentioning

confidence: 99%

“…Quoting Kurihara et al in 2006, 'To be able to successfully treat cryptoglandular anorectal abscesses and fistulas, we need to understand the exact anatomy and extension course' [8]. Secondly, as mentioned before, we need to understand that infection will spread along the least resistant plane, along the planes of anorectal muscles and fascia to reach the respective anorectal spaces [7].…”

Section: Relevant Updates In Anorectal Anatomymentioning

confidence: 99%

“…There are 3 components of external sphincters, subcutaneous, superficial and deep external sphincters, whereas puborectalis is a component of the levator ani [1,2]. Recent publications suggest that puborectalis is also known to be the same entity as deep external sphincter [7,9]. Perianal space and Ishio-rectal fossa were described by Parks as the 2 most common spaces for abscess formation [1].…”

Section: Review Of Relevant Anorectal Anatomymentioning

confidence: 99%

“…Internal sphincter circular muscles and longitudinal muscle layer are fused together, and the intersphincteric plane is a potential space between the longitudinal layer and the fascia of striated muscle external sphincters [4,7] (see Figure 1a and b).…”

Section: Several Updates In Anorectal Anatomy Are Summarized Belowmentioning

confidence: 99%

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Understanding New Ideas in Cryptoglandular Fistula-in-Ano

Voon¹

2023

Current Topics in Colorectal Surgery

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Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.

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Section: Several Updates In Anorectal Anatomy Are Summarized Belowmentioning

confidence: 92%

“…Anorectal musculature, fascias and spaces are constant. Therefore, the natural patterns of anal fistula should also follow a constant pattern [7].…”

Section: Revisiting the Pathogenesis Of Cryptoglandular Infectionmentioning

confidence: 99%

Section: Relevant Updates In Anorectal Anatomymentioning

confidence: 99%