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Dong S, Chen B, Zhang J. Study on the factors influencing the prognosis after perianal abscess surgery. BMC Gastroenterol 2023; 23:334. [PMID: 37759161 PMCID: PMC10537581 DOI: 10.1186/s12876-023-02959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To study the influence of clinical characteristics and diagnosis and treatment methods of perianal abscess on postoperative recurrence or formation of anal fistula to provide a basis for selecting appropriate surgical and inspection methods for clinical treatment of perianal abscess in the future. METHODS The clinical data of 394 patients with perianal abscesses were collected, the influencing factors were investigated, and univariate analysis and multivariate logistic regression analysis were performed to further determine the risk factors affecting the prognosis of perianal abscess. RESULTS The results showed that the rate of preoperative blood routine results in the uncured group was higher (51.16%) than in the cured group (35.61%); the rate of high abscess space in the uncured group (23.26%) was higher than in the cured group (9.11%); the proportion of patients in the uncured group who underwent magnetic resonance imaging (MRI) before surgery (27.90%) was lower than in the cured group (45.30%); the proportion of patients in the uncured group who underwent simple drainage (51.16%) was higher than in the cured group (28.49%). The two groups had significant differences in perineal MRI examination, surgical method, preoperative blood routine, and abscess space (p = 0.030, p = 0.002, p = 0.047 and p = 0.010, respectively). Based on the results of univariate analysis and multivariate logistic regression analysis, the extent of the abscess cavity (OR = 2.544, 95%CI = 1.087-5.954, p = 0.031) and the surgical method (OR = 2.180, 95%CI = 1.091-4.357, p = 0.027) were independent influencing factors for postoperative recurrence of perianal abscess or anal fistula. CONCLUSION Preoperative assessment of the abscess range and precise intraoperative methods to resolve the infection of the abscess glands in the internal mouth can effectively improve the cure rate.
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Affiliation(s)
- Shujiang Dong
- Department of anus-intestines, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 68 Gehu Middle Road, Wujin District, 213000, 213000, Changzhou, China.
| | - Bingxue Chen
- Department of anus-intestines, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 68 Gehu Middle Road, Wujin District, 213000, 213000, Changzhou, China
| | - Jian Zhang
- Department of Medical Imaging, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, 213000, China
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Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study. Tech Coloproctol 2023; 27:145-152. [PMID: 36371771 DOI: 10.1007/s10151-022-02722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Currently, there is no agreement on the best treatment for complex anal fistulas with the least recurrence and lowest complication rate. The aim of this study was to evaluate the long-term recurrence and incontinence after fistulectomy and primary sphincteroplasty (FIPS) in a group of patients with complex perianal fistula. METHODS This prospective observational study was done at the colorectal ward of Taleghani Hospital of Tehran from January 2010 to December 2020. Patients with anal fistula who underwent FIPS were studied. After surgery, patients were evaluated regularly by a colorectal surgeon for fistula recurrence and incontinence. Recurrence was described as a new fistula tract formation after the initial cure and failure of healing in the operation site or any purulent discharge from the fistula tract and openings. In addition, the patient's continence was assessed based on the Wexner score. RESULTS There were 335 patients (66 men and 269 women, mean age 42.74 ± 12.44 years), 191 of them with low fistula and 144 with high fistula. Thirteen patients (3.90%) experienced recurrence (all had a low fistula). Thirty-nine patients (11.64%), 19 patients with high and 20 patients with low fistula, had a Wexner score ≥ 3 during the follow-up. Fifteen patients were lost to follow-up. Male patients (OR = 2.67, 95% CI 0.84, 8.45, p = 0.094, adjusted OR = 4.41, 95% CI 1.05, 18.48, p = 0.042), patients with low fistula (p = 0.001), and recurrent cases had a significantly higher rate of recurrence (OR = 10.38, 95% CI 3.24-33.20 p ≤ 0.001, adjusted OR = 23.36, 95% CI 4.35-125.39, p ≤ 0.001). A significant correlation between body mass index > 35 kg/m2 and incontinence was found (OR = 4.40, 95% CI 1.35, 14.33, p = 0.014). CONCLUSIONS In the present study, an acceptable healing rate and a low percentage of complications following FIPS were seen in patients with complex anal fistula. Randomized clinical trials with appropriate follow-up duration and sample size comparing different surgical methods in these patients are needed to confirm these results.
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Sarofim M, Ooi K. Reviewing perianal abscess management and recurrence: lessons from a trainee perspective. ANZ J Surg 2022; 92:1781-1783. [PMID: 35485429 PMCID: PMC9543673 DOI: 10.1111/ans.17750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 12/02/2022]
Abstract
Background Perianal abscesses are a common surgical emergency. Due to their perceived ease, drainage is often delegated to junior trainees with varying levels of experience. The purpose of this study is to evaluate the current trend in perianal abscesses management at our institution, and identify factors that predict subsequent fistula formation or abscess recurrence. Methods All acute patients admitted to a major teaching hospital who required surgical drainage of a perianal abscess were analysed over a two‐year period from January 2019 to December 2020. Patient demographics, clinical and laboratory findings were retrospectively reviewed. Proceduralist experience, operative management strategy and recurrence rates (fistula or abscess) were analysed. Results The mean age of patients was 43 years old, and 73% were male. Trainees performed 96% of the procedures. Re‐presentation with a fistula or abscess recurrence requiring further surgery was 31%. Comorbidities of IBD, diabetes, or malignancy were present in one‐third of patients and significantly increased the risk of recurrence (P = 0.01). Searching for a fistula tract was performed in 41% of cases but did not reduce recurrence (P = 0.9). Seton insertion occurred in 10%, and fistulotomy in 2%. Conclusion Perianal abscess drainage at our institution is almost exclusively performed by trainees, the majority of which occurs after‐hours. Patients who present with a fever, inflammatory bowel disease, diabetes mellitus or malignancy are at an increased risk of recurrent abscess or a subsequent fistula after drainage, and input from an experienced surgeon may be of value when considering seton insertion or fistulotomy. Perianal abscess management is primarily done by trainees of varying experience. This retrospective review evaluates current trends at our institution and identify factors that predict abscess recurrence.
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Affiliation(s)
- Mina Sarofim
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Kevin Ooi
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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Ginesi M, Ofshteyn A, Bliggenstorfer J, Bingmer K, Juza R, Stein SL, Steinhagen E. General Surgery Residents' Retention of Knowledge After an Anorectal Skills Workshop. J Surg Res 2022; 274:102-107. [PMID: 35144040 DOI: 10.1016/j.jss.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Studies have demonstrated suboptimal resident exposure to anorectal pathology. A workshop was developed at an academic general surgery residency. This study assesses durability of learning from the workshop. METHODS Thirty-six residents participated in a skills laboratory addressing diagnosis and management of anorectal complaints. The skills laboratory was broken into didactic and hand-on skills stations. Residents completed pre-, post- and 6-mo after workshop assessments to evaluate knowledge and confidence. Knowledge and confidence-based scores pre-, post- and 6-mo after workshop were compared. RESULTS Scores demonstrated retention of information. Knowledge-based question median scores improved from 63.2% pre-workshop to 73.7% post-workshop and 76.3% at 6 mo (P = 0.0005). Median confidence scores improved from 31 pre-workshop to 40 post-workshop, and were stable at 6 mo (P = 0.0001). CONCLUSIONS Knowledge and confidence gained from an anorectal skills workshop was stable or improved at 6 mo. These results suggest that an anorectal curriculum is effective at improving general surgery resident background knowledge and confidence when managing anorectal complaints.
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Affiliation(s)
- Meridith Ginesi
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Jonathan Bliggenstorfer
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Ryan Juza
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio.
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Rosul MV, Patskan BM, Skrypinets YP. OPTIMIZATION OF PARARECTAL FISTULA SURGICAL TREATMENT. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2412-2415. [PMID: 36472270 DOI: 10.36740/wlek202210117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To improve the results of treatment of complex PF by the ligation of the intersphincteric fistula tract (LIFT). PATIENTS AND METHODS Materials and methods: 27 patients with transsphincteric fistulas of the rectum of different complexity have been operated by two methods: by ligature method ("cutting seton") and by the ligation of the intersphincteric fistula tract (LIFT). RESULTS Results: No early complications were noticed in patients who had been applied the technique of fistula ligation in the postoperative period. The pain syndrome was expressed insignificantly. The rehabilitation period was less than 12 days. Having analyzed the long-term results of the observation period lasting up to 26 months, we arrived at the conclusion that the choice of surgical treatment had little effect on the recurrence rate of pararectal fistula (21.4 and 15.38%, respectively). However, one LIFT patient had gas incontinence within 1 year of surgery in contrast to 4 patients who had had a cutting ligature method having anal incontinence for 1 year and 1 patient - during the observation period. CONCLUSION Conclusions: Ligation of the fistula in the intersphincter tract is an effective sphincter-preserving operation, does not require additional equipment and expensive consumables, is characterized by minimal damage to the anal sphincter and a high percentage of closure of PF (84.6%). The recurrence rate does not exceed 15.38%.
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Lalou L, Archer L, Lim P, Kretzmer L, Elhassan AM, Awodiya A, Seretis C. Auditing the Routine Microbiological Examination of Pus Swabs From Uncomplicated Perianal Abscesses: Clinical Necessity or Old Habit? Gastroenterology Res 2020; 13:114-116. [PMID: 32655728 PMCID: PMC7331855 DOI: 10.14740/gr1279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022] Open
Abstract
Background Obtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management. Methods We reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano. Results A total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-in-ano. Conclusions We do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.
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Affiliation(s)
- Lida Lalou
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Lucy Archer
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Paul Lim
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Leo Kretzmer
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Ali Mohammed Elhassan
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Afolabi Awodiya
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
| | - Charalampos Seretis
- Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, West Midlands, UK
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Ofshteyn A, Terry M, Bingmer K, Stein SL, Steinhagen E. General surgery resident experience with anorectal surgery. Am J Surg 2019; 219:993-997. [PMID: 31445669 DOI: 10.1016/j.amjsurg.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have suggested that general surgery residents graduate with suboptimal anorectal experience. However, competence in anorectal procedures is an important part of general surgery training. METHODS ACGME general surgery resident case logs from 1999 to 2017 were reviewed. Mean number of anorectal procedures were evaluated, comparing Period 1 (1999-2008) and Period 2 (2009-2017). RESULTS Between 1999 and 2017, the mean number of all anorectal procedures performed by each general surgery resident has increased from 25.9 to 32.4 (by 25%). Between Period 1 and 2, mean numbers of total anorectal procedures, abscess drainage, fistula repair, hemorrhoidectomy, prolapse repair, other anorectal procedures all increased (p ≤ 0.01). Mean numbers of sphincterotomy/sphincteroplasty and other procedures for fecal incontinence significantly decreased (p ≤ 0.01). CONCLUSIONS General surgery residents have gained more experience in some anorectal procedures over time. The required number of procedures to establish competence is not well defined and should be formally evaluated.
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Affiliation(s)
- Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Morgan Terry
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA.
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Vander Mijnsbrugge GJH, Felt-Bersma RJF, Ho DKF, Molenaar CBH. Perianal fistulas and the lift procedure: results, predictive factors for success, and long-term results with subsequent treatment. Tech Coloproctol 2019; 23:639-647. [PMID: 31317361 PMCID: PMC6692447 DOI: 10.1007/s10151-019-02023-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
Background Treatment of a perianal fistula is difficult due to the risk of fecal incontinence and recurrence. The ligation of intersphincteric tract (LIFT) procedure is a sphincter-saving procedure associated with success rates ranging from 57 to 94%. The aim of our study was to find predictors for a favorable outcome of the LIFT procedure, evaluation of postoperative fecal incontinence, quality of life, and subsequent treatment with long-term follow-up. Methods This study was performed in patients who underwent LIFT between 2013 and 2015 at our institution. Their medical data were retrieved from the electronic patient files. The fistula characteristics were described by physical examination, three-dimensional endoanal ultrasound, and perioperative evaluation. Recurrence rate, postoperative fecal incontinence, and quality of life were assessed with the Patient-Reported Outcome Measurement (PROM). Thirty-two months later, long-term follow-up including subsequent procedures was evaluated. Results Forty-five patients [17 men, mean age 40 years (range 24–67 years)] were included. In 41 (84%) patients, the fistula was classified as complex; 32 (71%) were referrals with a history of previous fistula surgery. The initial success rate was 18 (40%). Only the height of the internal fistula opening (≥ 15 mm p < 0.03) was associated with recurrence. The LIFT procedure did not affect the occurrence of fecal incontinence or soiling. Recurrence showed a trend with a lower PROM (p = 0.07). Twenty-four months later, further surgery leads to cure in 34 (75%), asymptomatic fistulas in 7 (16%), and persisting active fistulas in 4 (9%) patients. Conclusions Initial LIFT had a success rate of 40% and with subsequent surgical treatment 75%. Recurrence after LIFT is related to the height of the internal fistula opening and is associated with diminished quality of life. Continence was not affected by initial LIFT.
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Affiliation(s)
| | - R J F Felt-Bersma
- Proctos Kliniek, Bilthoven, The Netherlands. .,Department of Gastroenterology and Hepatology, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - D K F Ho
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Mascagni D, Pironi D, Pontone S, Tonda M, Eberspacher C, Panarese A, Miscusi G, Grimaldi G, Catania A, Santoro A, Filippini A, Sorrenti S. Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient. Aging Clin Exp Res 2017; 29:101-108. [PMID: 27830517 DOI: 10.1007/s40520-016-0652-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Perianal fistula is a complex and frequent disease. At present, no treatment nor technique has shown an absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between faecal continence preservation and disease eradication. Rarely concomitant perianal abscess and fistula are treated at the same time, and often time to complete recovery is long. AIMS The aim of this study was to evaluate the possibility of treating the abscess and the fistula tract in one procedure with total fistulectomy, sphincteroplasty and an almost complete closure of the residual cavity, thus reducing the healing time in older patients. METHODS A non-randomized single-centre series of 86 patients from 2007 to 2012 with low-medium trans-sphincteric perianal fistula (< 30% of external sphincter involvement) with or without synchronous perianal abscess were treated with total fistulectomy, sphincteroplasty and closure of the residual cavity technique. RESULTS Success rate was 97.7% with a healing time of 4 weeks; overall morbidity was 16.2%; recurrence rate was 2.3%; no major alterations of continence were observed. DISCUSSION Fistulectomy, sphincteroplasty and closure of the residual cavity are associated with a low rate of recurrence and good faecal continence preservation in older patients. This technique can be safely used even with a concomitant perianal abscess, with reduction in healing time and in the number of surgical procedures needed. CONCLUSIONS Total fistulectomy with sphincteroplasty and partial closure of the residual cavity, as described, is a safe procedure but has to be performed by dedicated colorectal surgeons.
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Affiliation(s)
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University, Rome, Italy.
| | - Stefano Pontone
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Maya Tonda
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | | | | | | | | | - Antonio Catania
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Sapienza University, Rome, Italy
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Visscher AP, Schuur D, Slooff RAE, Meijerink WJHJ, Deen-Molenaar CBH, Felt-Bersma RJF. Predictive factors for recurrence of cryptoglandular fistulae characterized by preoperative three-dimensional endoanal ultrasound. Colorectal Dis 2016; 18:503-9. [PMID: 26558554 DOI: 10.1111/codi.13211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/06/2015] [Indexed: 02/08/2023]
Abstract
AIM Precise information regarding the location of an anal fistula and its relationship to adjacent structures is necessary for selecting the best surgical strategy. Retrospective and cross-sectional studies were performed to determine predictive factors for recurrence of anal fistula from preoperative examination by three-dimensional endoanal ultrasound (3D-EAUS). METHOD Patients in our tertiary centre and in a private centre specialized in proctology undergoing preoperative 3D-EAUS for cryptoglandular anal fistulae between 2002 and 2012 were included. A questionnaire was sent in September 2013 to assess the patient's condition with regard to recurrence. Variables checked for association with recurrence were gender, type of centre, previous fistula surgery, secondary track formation and classification of the fistula. RESULTS There were 143 patients of whom 96 had a low fistula treated by fistulotomy, 28 a high fistula treated by fistulectomy and 19 a high fistula treated by fistulectomy combined with a mucosal advancement flap. The median duration of follow-up was 26 (2-118) months. The fistula recurred in 40 (27%) patients. Independent risk factors included the presence of secondary track formation [hazard ratio 2.4 (95% CI 1.2-51), P = 0.016] and previous fistula surgery [hazard ratio 1.2 (95% CI 1.0-4.6), P = 0.041]. Agreement between the 3D-EAUS examination and the evaluation under anaesthesia regarding the site of the internal opening, classification of the fistula and the presence of secondary tracks was 97%, 98% and 78%. CONCLUSION The identification of secondary tracks by preoperative 3D-EAUS examination was the strongest independent risk factor for recurrence. This stresses the importance of preoperative 3D-EAUS in mapping the pathological anatomy of the fistula and a thorough search for secondary track formation during surgery.
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Affiliation(s)
- A P Visscher
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - D Schuur
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - R A E Slooff
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
| | - W J H J Meijerink
- Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - R J F Felt-Bersma
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands
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Abstract
Anal fistulae management is a balance of effective healing and the risk of incontinence from sphincter division. This review examines the heterogeneity in the literature of treatment options and the difficulties this presents for surgical training and decision making.
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Affiliation(s)
- J Phillips
- Surgical Registrar (ST7) in the Department of General Surgery, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Riding of Yorkshire HU16 5JQ
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Li HS, Chen Q. Recent progress in surgical management of perianal abscess. Shijie Huaren Xiaohua Zazhi 2012; 20:580-584. [DOI: 10.11569/wcjd.v20.i7.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perianal abscess is one of the common rectal diseases. Surgical management is still the most effective way. Surgical methods have roughly experienced three phases of landmark development: initially simple incision/drainage combined with surgery for the second time when fistula-in-ano is formed, followed by primary curative incision, and finally sphincter-preserving surgery, which reinforces the importance of protecting the function of the anus. The use of these surgical methods not only reduces the recurrence of abscess and the incidence of anal fistula, but also protects the fine function and integrity of the anus, greatly reducing the pain in patients and raising their quality of lives.
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