Practice Parameters for the Treatment of Perianal Abscess and Fistula-in-Ano (Revised)

Abstract

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Incontinence rates after cutting seton treatment for anal fistula

“…This conclusion is similar to the recommendations of the Association of Coloproctologists of Great Britain and Northern Ireland (ACPGBI) that a cutting seton should be used as the primary treatment only for a low transsphincteric fistula or as the secondary treatment for a low intrasphincteric fistula [24]. Whiteford et al [32] found that complex fistulas may be treated with a cutting seton. They defined a fistula as complex under the following circumstances: as complex primary track crossing 30-50% of the external sphincter (high-transsphincteric, suprasphincteric and extrasphincteric), anterior track in a female, multiple tracks, recurrent fistula, pre-existing incontinence, previous local irradiation, Crohn's disease.…”

Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn's fistula

“…An internal pocket in the fistula tract remaining unhealed after infliximab treatment was suggested to be the predominant reason for recurrence [13,14]. To reach a better clinical outcome, combination treatment with infliximab and surgical intervention is highly recommended for management of Crohn's fistulae [15]. Nonetheless, even this strategy does not result in a satisfactory healing for many patients.…”

Minimally Invasive Surgical Technique in the Management of Perianal Fistulas Using the Surgisis® AFP Material

“…Another practical division considers simple and complex fistulas. Complex fistulas connected with an increased postoperative incontinence rate include the following: high transsphincteric (comprising >1/3 of the EAS diameter), suprasphincteric, retrosphincteric, rectovaginal, and horseshoe fistulas, anterior fistulas in female patients, and fistulas coexisting with Leśniowski-Crohn's or post-radiation diseases (9).…”