Skin Sparing Fistulectomy with Primary Sphincters Repair by Special Sutures for Management of High Perianal Fistula

Abstract Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

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Study the Role of Loose versus cutting of Seton in Treatment of High Perianal fistula in a District Hospital of Health Insurance

QJM ◽

10.1093/qjmed/hcaa050.024 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M S Abdelhameed ◽

I M H Elghazawy ◽

E A Elsayed

Keyword(s):

Anal Fistula ◽

Low Cost ◽

Perianal Fistula ◽

Dentate Line ◽

Internal Opening ◽

Fistula In Ano ◽

One Year ◽

Definition Of ◽

A Prospective Study ◽

High Perianal Fistula

Abstract 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 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. 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 30 patients in ELNile hospital in one Year 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 30 patients mean age was 42.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 27 patients, incontinence occurred in 3 patients and recurrence occurred in 3 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.

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Multiple setons in the treatment of high perianal fistula

British Journal of Surgery ◽

10.1002/bjs.1800810149 ◽

1994 ◽

Vol 81 (1) ◽

pp. 136-137 ◽

Cited By ~ 8

Author(s):

D. Garcíaolmo ◽

P. Vázquez Aragón ◽

J. López Fando

Keyword(s):

Perianal Fistula ◽

High Perianal Fistula

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Fistulectomy and primary repair of wound and anal sphincter by Lasheen's sutures for high perianal fistula

10.5348/s05-2015-7-oa-4 ◽

2020 ◽

Keyword(s):

Anal Sphincter ◽

Primary Repair ◽

Perianal Fistula ◽

High Perianal Fistula

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Adenocarcinoma Developing at the Level of a Chronic Perianal Fistula by Cell Implantation from a Proximal Rectal Cancer

Medicina Moderna - Modern Medicine ◽

10.31689/rmm.2020.27.2.133 ◽

2020 ◽

Vol 27 (2) ◽

pp. 133-138

Author(s):

Lucian Sorin ANDREI ◽

◽

Adriana ANDREI ◽

Radu Sorin POPISTEANU ◽

Gabriel BECHEANU ◽

...

Keyword(s):

Rectal Cancer ◽

Perianal Fistula ◽

Cell Implantation

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Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Cancers ◽

10.3390/cancers13061445 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1445

Author(s):

Andromachi Kotsafti ◽

Melania Scarpa ◽

Imerio Angriman ◽

Ignazio Castagliuolo ◽

Antonino Caruso

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Hpv Vaccination ◽

Perianal Fistula ◽

Hpv Infection ◽

Poor Quality ◽

Colorectal Disease ◽

Small Series ◽

Chron's Disease

Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

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Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1722356 ◽

2021 ◽

Author(s):

Ashraf Talaat Youssef

Keyword(s):

Digital Rectal Examination ◽

Perianal Fistula ◽

Final Diagnosis ◽

Abscess Formation ◽

Study Group ◽

Potential Space ◽

Anal Glands ◽

Ultrasound Study ◽

Perianal Sepsis

Abstract Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging. Objective The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management. Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results. Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches. Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.

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