The surgical management of fistula-in-ano in a specialist colorectal unit

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.

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“…The sex ratio is 2-3 men per woman. The average age of onset is between 20 and 50 years [5][6][7][8][9][10][11].…”

Section: Epidemiologymentioning

confidence: 99%

“…The technique of fistulotomy varies depending on the height of sphincter encompassed by the fistulous tract: • A low intersphincteric or trans-sphincteric can usually be immediately laid open (one-stage fistulotomy) without risk to continence [5,7,8,10,11,13,[23][24][25][26][27].…”

Section: Fistulotomymentioning

confidence: 99%

Cryptoglandular anal fistula

Parades

Zeitoun

Atienza

2010

Journal of Visceral Surgery

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“…Foram 97 fistulotomias realizadas em 74 pacientes, portanto, uma média de 1,31 fistulotomias por paciente. O número encontrado no presente estudo é semelhante ao encontrado na literatura 19,20 . 20 .…”

Section: Tabela 7 -unclassified

Análise das complicações tardias em operações anorretais: experiência de um serviço de referência em coloproctologia

Steckert

Sartor

Miranda

et al. 2010

Rev bras. colo-proctol.

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RESUMO: Introdução: as operações anorretais correspondem a 80% do movimento do coloproctologista. O índice de complicações tardias após estas operações é indefinido, e varia de acordo com o tipo de operação INTRODUÇÃOAs doenças anorretais são comuns na população geral. Estima-se que cerca de 5% da população adulta nos Estados Unidos é afetada por tais doenças 1 . Estas podem, em algumas situações, serem tratadas de forma conservadora. Todavia, o procedimento cirúrgico é necessário em vários casos selecionados. Dentre os principais tipos de tratamento cirúrgico descritos, salientam-se as operações para tratamento das hemorróidas, fissuras, fístulas e abscessos perianais 2 . As operações anorretais correspondem a cerca de 80% do total do movimento cirúrgico na especialidade de coloproctologia 2 . O porte dos procedimentos cirúrgicos anorretais é semelhante, independentemente da doença de base. O tempo operatório, materiais utilizados e cuidados de anestesia são equivalentes.

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“…3 It is a distressing condition for patients and can be surgically challenging. 4 There are various classifications of fistula in ano but the simplest and the most widely used one is the Park's classification. In 1976, Sir Alan Parks classified fistula in ano depending on the relationship of the tract to the anal sphincter muscle.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of ligation of intersphincteric fistula tract (LIFT) in the management of fistulas in ano

Rohit

Jain²,

Pandey

2017

Int Surg J

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Background: Fistula in ano is an abnormal connection between the epithelized surface of anal canal and usually the perianal skin. It is a benign treatable lesion of rectum and anal canal. Crypto glandular infection accounts for about ninety percent of the cases. The estimated prevalence of an anal fistula is 12 to 28/1000000 of the population per year with male to female ratio 1.8:1. Ligation of intersphincteric fistula tract is a new sphincter saving method with good result in the management of anal fistula. The aim of study was to evaluate the effectiveness and functional outcomes of the ligation of intersphinteric fistula tract (LIFT).Methods: This prospective study includes sixteen patients who were operated for fistulas in ano at Bundelkhand Medical College and Associated Hospital, Sagar from January 2015 to June 2017. Patients above the age of 20 years, proved cases of fistulas in ano without co-morbid conditions and no previous surgical intervention were included in the study. Patients presenting with fistulas from another source such as crohn’s disease, tuberculosis, anal cancer and recurrent fistulas were excluded. A detailed history, clinical presentation, digital rectal examination, anal ultrasound and routine investigations were done in all cases.Results: In the present study most of the patients were male and presents with perianal discharge. The diagnosis is made by clinical history, per rectal examination and anal ultrasonography. All the sixteen patients with fistula in ano underwent ligation of intersphincteric fistula tract (LIFT). The patients were followed for a period of three months. Most of the cases (87.5%) healed within 4-6 weeks. The recurrence of fistula occurs in four cases (25%). Recurrence is due to infection and technical error in the procedures. There were no deaths in the study.Conclusions: The LIFT technique proved to be safe and effective in the treatment of fistula in ano.

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The surgical management of fistula-in-ano in a specialist colorectal unit

Cited by 49 publications

References 20 publications

Cryptoglandular anal fistula

Cryptoglandular anal fistula

Análise das complicações tardias em operações anorretais: experiência de um serviço de referência em coloproctologia

Effectiveness of ligation of intersphincteric fistula tract (LIFT) in the management of fistulas in ano

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