Fistulotomy or seton in anal fistula: a decisional algorithm

详细信息    查看全文

• 作者：Andrea Cariati (1)
  
• 关键词：Anal fistulas ; Cutting seton ; Fistulotomy ; Anal sphincters ; Anal incontinence
• 刊名：Updates in Surgery
• 出版年：2013
• 出版时间：September 2013
• 年：2013
• 卷：65
• 期：3
• 页码：201-205
• 全文大小：137KB
• 参考文献：1. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis 22:1459-462 CrossRef
  2. Nelson R (2002) Anorectal abscess fistula: what do we know? Surg Clin North Am 82:1139-151 v–vi CrossRef
  3. Sainio P (1984) Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 73:219-24
  4. Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum 27(9):593-97 CrossRef
  5. Scoma JA, Salvati EP, Rubin RJ (1974) Incidence of fistulas subsequent to anal abscesses. Dis Colon Rectum 17(3):357-59 CrossRef
  6. Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27(2):126-30 CrossRef
  7. Oliver I, Lavueva FJ, Piorez VF et al (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula tract treatment. Int J Colorectal Dis 18(2):107-10
  8. Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H (2012) Evolution of treatment of fistula in ano. World J Surg 36:2162-167 CrossRef
  9. Zbar AP, Khikin M (2012) Should we care about the internal anal sphincter? Dis Colon Rectum 55:105-08 CrossRef
  10. Zbar AP, Ramesh J, Beer-Gabel M, Salazar R, Pescatori M (2003) Conventional cutting vs internal anal sphincter-preserving seton for high trans-sphincteric fistula: a prospective randomized manometric and clinical trial. Tech Coloproctol 7:89-4 CrossRef
  11. Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RKS (2011) For many high anal fistulas, lay open is still a good option. Tech Coloproctol 15:143-50 CrossRef
  12. Cariati A, Piromalli E, Copello F, Torelli I (2012) Anal stretch for chronic anal fissure: an old operation that stood the test of time. Langenbecks Arch Surg. doi:10.1007/s00423-012-0969-x
  13. Chuang-Wei C, Chang-Chieh W, Cheng-Wen H, Tsai-Yu L, Chun-Che F, Shu-Wen J (2008) Cutting seton for complex anal fistulas. Surgeon 3:185-88 CrossRef
  14. McCourtney JS, Finlay IG (1996) Cutting seton without preliminary internal sphincterotomy in management of complex high fistula-in-ano. Dis Colon Rectum 39:55-8 CrossRef
  15. Vial M, Parés D, Pera M, Grande L (2010) Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 12:172-78 CrossRef
  16. García-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD (1998) Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg 85:243-45 CrossRef
  17. Pearl RK, Andrews JR, Orsay CP et al (1997) Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 36:573-79 CrossRef
  18. H?m?l?inen KJ, Sainio AP (1997) Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 40:1443-446 CrossRef
  19. Christensen A, Nilas L, Christiansen J (1986) Treatment of trans-sphinteric anal fistula by the seton technique. Dis Colon Rectum 29:454-55 CrossRef
  20. Ritchie RD, Sackier JM, Hodde JP (2009) Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 11:564-71 CrossRef
  21. Parks AG, Stitz RW (1976) The treatment of high fistula-in-ano. Dis Colon Rectum 19:487-99 CrossRef
  22. Van Tets WF, Kuijpers JH (1995) Seton treatment of perianal fistula with high anal or rectal opening. Br J Surg 82:895-97 CrossRef
  23. Lasheen AE (2004) Partial fistulectomy and fistular wall flap for the treatment of high perianal fistulas. Surg Today 34:977-80 CrossRef
  24. Jivapaisarnpong P (2009) Core out fistulectomy, anal sphincter reconstruction and primary repair of internal opening in the treatment of complex anal fistula. J Med Assoc Thai 92:638-42
  25. Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M (2010) Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. Int J Surg 8:321-25 CrossRef
  26. Malik AI, Nelson RL, Tou S. (2010) Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database of systematic reviews 7:CD 006827. doi:10.1002/14651858.CD006827.pub2
  
• 作者单位：Andrea Cariati (1)
  
  1. General Surgery, San Martino, IST Hospital, Via Fratelli Coda 67/5 a, 16166, Genoa, Italy
  

文摘

Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6?%), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9?%) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50?%). Healing rates have been of 100?% and healing times ranged from 1 to 6?months in 97?% of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5?%) for 4-?months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5?%) and four with trans-sphincteric fistula (4/137) (3?%). Our algorithm permitted us to reduce to 20?% sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula.