Complex Perianal Fistulas

2017 ◽  
Author(s):  
Amy L Halverson ◽  
Massarat Zutshi
Keyword(s):  
Anal Sphincter ◽  
Crohn Disease ◽  
Initial Step ◽  
Surrounding Tissue ◽  
Fistula Tract ◽  
Internal Opening ◽  
Adjacent Structures ◽  
Sphincter Complex ◽  
Complex Fistula ◽  
Anal Sphincter Complex

Recurrent fistulas, fistulas with multiple external openings, those involving more than one third of the anal sphincter complex, and fistulas involving adjacent organs are considered complex. Fistulas occurring in the setting of perianal Crohn disease or following pelvic radiation are also considered complex. Evaluation of a fistula includes a detailed history and physical examination. Imaging with ultrasonography helps delineate the course of a fistula relative to adjacent structures as well as identify occult branching of the fistula tract. The initial step in treating fistulas is resolving associated inflammation. When treating fistulas with multiple branching tracts, the portion of the tracts outside the anal sphincter complex should be unroofed, with the goal of transforming the complex fistula into a simpler fistula with a single internal opening. The selection of the most appropriate treatment for a complex fistula depends on the etiology, anatomy, patient comorbidities, and condition of surrounding tissue. Key Words: anal fistula, anovaginal fistula, Crohn disease, fistulotomy, rectourethral fistula

Complex Perianal Fistulas

2017 ◽  
Author(s):  
Amy L Halverson ◽  
Massarat Zutshi
Keyword(s):  
Anal Sphincter ◽  
Crohn Disease ◽  
Initial Step ◽  
Surrounding Tissue ◽  
Fistula Tract ◽  
Internal Opening ◽  
Adjacent Structures ◽  
Sphincter Complex ◽  
Complex Fistula ◽  
Anal Sphincter Complex

Recurrent fistulas, fistulas with multiple external openings, those involving more than one third of the anal sphincter complex, and fistulas involving adjacent organs are considered complex. Fistulas occurring in the setting of perianal Crohn disease or following pelvic radiation are also considered complex. Evaluation of a fistula includes a detailed history and physical examination. Imaging with ultrasonography helps delineate the course of a fistula relative to adjacent structures as well as identify occult branching of the fistula tract. The initial step in treating fistulas is resolving associated inflammation. When treating fistulas with multiple branching tracts, the portion of the tracts outside the anal sphincter complex should be unroofed, with the goal of transforming the complex fistula into a simpler fistula with a single internal opening. The selection of the most appropriate treatment for a complex fistula depends on the etiology, anatomy, patient comorbidities, and condition of surrounding tissue. Key Words: anal fistula, anovaginal fistula, Crohn disease, fistulotomy, rectourethral fistula

scholarly journals Operative strategy for fistula-in-ano without division of the anal sphincter

2013 ◽  
Vol 95 (7) ◽  
pp. 461-467 ◽  
Author(s):  
AKY Fung ◽  
GV Card ◽  
NP Ross ◽  
SR Yule ◽  
EH Aly
Keyword(s):  
Recurrence Rate ◽  
Anal Sphincter ◽  
Faecal Incontinence ◽  
Healing Rate ◽  
Long Term Results ◽  
Fistula Tract ◽  
Operative Strategy ◽  
Perianal Fistulas ◽  
Sphincter Complex ◽  
Anal Sphincter Complex

Introduction The treatment of perianal fistulas is diverse because no single technique is universally effective. Fistulotomy remains the most effective way of eradicating the pathology but it renders the patient at some risk of faecal incontinence, which many patients are reluctant to take. There are no data in the literature to indicate the healing rate of perianal fistulas when using an operative strategy that routinely avoids division of any part of the anal sphincter. The aim of this paper is to present the long-term results with an operative strategy that aims to avoid division of any part of the anal sphincter complex when treating all types of perianal fistulas, thereby minimising/eliminating the risk of postoperative incontinence. Methods We report 54 consecutive cases of anal fistula that presented electively and as an emergency. Patients with known or subsequently diagnosed inflammatory bowel disease or malignancy were excluded from the study. Result Overall, 46 patients (37 male and 9 female) with a median age at presentation of 42 years (range: 19–73 years) were treated by lay-open of the subcutaneous tract of the perianal fistula and insertion of a loose seton for the part of the fistula tract related to the sphincter complex. The types of fistula treated were intersphincteric (89%), transsphincteric (4%) and high suprasphincteric (7%). The median length of time that the seton was left in place was 7 months (range: 1.5–24 months). The healing rate was 86% with a recurrence rate of 19% and a median follow-up duration of 42 months. Conclusions Patients who are reluctant to take any risk of faecal incontinence could be treated using an operative strategy that routinely avoids division of any part of the anal sphincter complex as this has a recurrence rate that compares well with other treatment modalities.

Inflammatory Pseudotumor of the Anal Sphincter Complex: A Case Report

1999 ◽  
Vol 40 (4) ◽  
pp. 733
Author(s):  
Sang Hoon Lee ◽  
So Lyung Jung ◽  
Myeong Im Ahn ◽  
Jee Young Kim ◽  
Young Ha Park
Keyword(s):  
Case Report ◽  
Anal Sphincter ◽  
Inflammatory Pseudotumor ◽  
Sphincter Complex ◽  
Anal Sphincter Complex

Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women

2011 ◽  
Vol 22 (9) ◽  
pp. 1143-1150 ◽  
Author(s):  
Milena M. Weinstein ◽  
Dolores H. Pretorius ◽  
Sung-Ae Jung ◽  
Jennifer J. Wan ◽  
Charles W. Nager ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Sphincter Complex ◽  
Anal Sphincter Complex

scholarly journals The relationship of 3-D translabial ultrasound anal sphincter complex measurements to postpartum anal and fecal incontinence

2015 ◽  
Vol 26 (8) ◽  
pp. 1191-1199 ◽  
Author(s):  
Kate V. Meriwether ◽  
Rebecca J. Hall ◽  
Lawrence M. Leeman ◽  
Laura Migliaccio ◽  
Clifford Qualls ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Translabial Ultrasound ◽  
Sphincter Complex ◽  
Relationship Of ◽  
The Relationship ◽  
Anal Sphincter Complex

Anal Sphincter Complex

2002 ◽  
Vol 45 (2) ◽  
pp. 188-194 ◽  
Author(s):  
Helga Fritsch ◽  
Erich Brenner ◽  
Andreas Lienemann ◽  
Barbara Ludwikowski
Keyword(s):  
Anal Sphincter ◽  
Sphincter Complex ◽  
Anal Sphincter Complex
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