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Clin Colon Rectal Surg 2016; 29(01): 043-049
DOI: 10.1055/s-0035-1570392
DOI: 10.1055/s-0035-1570392
Review Article
Management of Complex Anal Fistulas
Weitere Informationen
Publikationsverlauf
Publikationsdatum:
16. Februar 2016 (online)
![](https://www.thieme-connect.de/media/ccrs/201601/lookinside/thumbnails/10-1055-s-0035-1570392_00713-1.jpg)
Abstract
Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data.
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References
- 1 Dudukgian H, Abcarian H. Why do we have so much trouble treating anal fistula?. World J Gastroenterol 2011; 17 (28) 3292-3296
- 2 Parks AG. Pathogenesis and treatment of fistuila-in-ano. BMJ 1961; 1 (5224) 463-469
- 3 Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD ; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 2011; 54 (12) 1465-1474
- 4 Ortega AE, Cologne KG. Classification and treatment of anorectal infections. In: Abcarian H, ed. Anal Fistula Principles and Management. 1st ed. New York: Springer New York; 2014: 17-26
- 5 Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB. Endoanal ultrasound-guided surgery for anal fistula. Endoscopy 2005; 37 (8) 722-728
- 6 Nagendranath C, Saravanan MN, Sridhar C, Varughese M. Peroxide-enhanced endoanal ultrasound in preoperative assessment of complex fistula-in-ano. Tech Coloproctol 2014; 18 (5) 433-438
- 7 Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 2004; 233 (3) 674-681
- 8 Buchanan G, Halligan S, Williams A , et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet 2002; 360 (9346) 1661-1662
- 9 Gage KL, Deshmukh S, Macura KJ, Kamel IR, Zaheer A. MRI of perianal fistulas: bridging the radiological-surgical divide. Abdom Imaging 2013; 38 (5) 1033-1042
- 10 Sahni VA, Ahmad R, Burling D. Which method is best for imaging of perianal fistula?. Abdom Imaging 2008; 33 (1) 26-30
- 11 Sileri P, Cadeddu F, D'Ugo S , et al. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal. BMC Gastroenterol 2011; 11: 120
- 12 Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 1984; 27 (2) 126-130
- 13 McElwain JW, MacLean MD, Alexander RM, Hoexter B, Guthrie JF. Anorectal problems: experience with primary fistulectomy for anorectal abscess, a report of 1,000 cases. Dis Colon Rectum 1975; 18 (8) 646-649
- 14 Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum 1984; 27 (9) 593-597
- 15 Ramanujam PS, Prasad ML, Abcarian H. The role of seton in fistulotomy of the anus. Surg Gynecol Obstet 1983; 157 (5) 419-422
- 16 Mushaya C, Bartlett L, Schulze B, Ho YH. Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage. Am J Surg 2012; 204 (3) 283-289
- 17 Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum 2011; 54 (3) 289-292
- 18 Regelation. Available at: http://en.wikipedia.org/wiki/Regelation . Accessed May 24, 2015
- 19 García-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg 1998; 85 (2) 243-245
- 20 Isbister WH, Al Sanea N. The cutting seton: an experience at King Faisal Specialist Hospital. Dis Colon Rectum 2001; 44 (5) 722-727
- 21 Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 2009; 11 (6) 564-571
- 22 Chuang-Wei C, Chang-Chieh W, Cheng-Wen H, Tsai-Yu L, Chun-Che F, Shu-Wen J. Cutting seton for complex anal fistulas. Surgeon 2008; 6 (3) 185-188
- 23 Kamrava A, Collins JC. A decade of selective use of adjustable cutting seton combined with fistulotomy for anal fistula. Am Surg 2011; 77 (10) 1377-1380
- 24 Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RK. For many high anal fistulas, lay open is still a good option. Tech Coloproctol 2011; 15 (2) 143-150
- 25 Tozer P, Sala S, Cianci V , et al. Fistulotomy in the tertiary setting can achieve high rates of fistula cure with an acceptable risk of deterioration in continence. J Gastrointest Surg 2013; 17 (11) 1960-1965
- 26 Ratto C, Litta F, Parello A, Zaccone G, Donisi L, De Simone V. Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum 2013; 56 (2) 226-233
- 27 Perez F, Arroyo A, Serrano P, Candela F, Sanchez A, Calpena R. Fistulotomy with primary sphincter reconstruction in the management of complex fistula-in-ano: prospective study of clinical and manometric results. J Am Coll Surg 2005; 200 (6) 897-903
- 28 Arroyo A, Pérez-Legaz J, Moya P , et al. Fistulotomy and sphincter reconstruction in the treatment of complex fistula-in-ano: long-term clinical and manometric results. Ann Surg 2012; 255 (5) 935-939
- 29 Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglandular or Crohn's fistula-in-ano. Dis Colon Rectum 2010; 53 (4) 486-495
- 30 van Onkelen RS, Gosselink MP, Schouten WR. Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract?. Dis Colon Rectum 2012; 55 (2) 163-166
- 31 Schouten WR, Zimmerman DD, Briel JW. Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum 1999; 42 (11) 1419-1422 , discussion 1422–1423
- 32 Ortíz H, Marzo J. Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg 2000; 87 (12) 1680-1683
- 33 Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 2002; 45 (12) 1622-1628
- 34 Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg 2003; 90 (3) 351-354
- 35 van Koperen PJ, Wind J, Bemelman WA, Bakx R, Reitsma JB, Slors JF. Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 2008; 51 (10) 1475-1481
- 36 Mitalas LE, Gosselink MP, Zimmerman DD, Schouten WR. Repeat transanal advancement flap repair: impact on the overall healing rate of high transsphincteric fistulas and on fecal continence. Dis Colon Rectum 2007; 50 (10) 1508-1511
- 37 van Koperen PJ, Wind J, Bemelman WA, Slors JF. Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage?. Int J Colorectal Dis 2008; 23 (7) 697-701
- 38 Ellis CN, Clark S. Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum 2006; 49 (11) 1736-1740
- 39 Makowiec F, Jehle EC, Becker HD, Starlinger M. Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease. Br J Surg 1995; 82 (5) 603-606
- 40 Mizrahi N, Wexner SD, Zmora O , et al. Endorectal advancement flap: are there predictors of failure?. Dis Colon Rectum 2002; 45 (12) 1616-1621
- 41 Farid M, Youssef M, El Nakeeb A, Fikry A, El Awady S, Morshed M. Comparative study of the house advancement flap, rhomboid flap, and y-v anoplasty in treatment of anal stenosis: a prospective randomized study. Dis Colon Rectum 2010; 53 (5) 790-797
- 42 Del Pino A, Nelson RL, Pearl RK, Abcarian H. Island flap anoplasty for treatment of transsphincteric fistula-in-ano. Dis Colon Rectum 1996; 39 (2) 224-226
- 43 Ellis CN, Clark S. Effect of tobacco smoking on advancement flap repair of complex anal fistulas. Dis Colon Rectum 2007; 50 (4) 459-463
- 44 Nelson RL, Cintron J, Abcarian H. Dermal island-flap anoplasty for transsphincteric fistula-in-ano: assessment of treatment failures. Dis Colon Rectum 2000; 43 (5) 681-684
- 45 Sungurtekin U, Sungurtekin H, Kabay B , et al. Anocutaneous V-Y advancement flap for the treatment of complex perianal fistula. Dis Colon Rectum 2004; 47 (12) 2178-2183
- 46 Hossack T, Solomon MJ, Young JM. Ano-cutaneous flap repair for complex and recurrent supra-sphincteric anal fistula. Colorectal Dis 2005; 7 (2) 187-192
- 47 Singer M, Cintron J. New techniques in the treatment of common perianal diseases: stapled hemorrhoidopexy, botulinum toxin, and fibrin sealant. Surg Clin North Am 2006; 86 (4) 937-967
- 48 Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum 2004; 47 (4) 432-436
- 49 Singer M, Cintron J, Nelson R , et al. Treatment of fistulas-in-ano with fibrin sealant in combination with intra-adhesive antibiotics and/or surgical closure of the internal fistula opening. Dis Colon Rectum 2005; 48 (4) 799-808
- 50 Zmora O, Neufeld D, Ziv Y , et al. Prospective, multicenter evaluation of highly concentrated fibrin glue in the treatment of complex cryptogenic perianal fistulas. Dis Colon Rectum 2005; 48 (12) 2167-2172
- 51 Witte ME, Klaase JM, Gerritsen JJ, Kummer EW. Fibrin glue treatment for simple and complex anal fistulas. Hepatogastroenterology 2007; 54 (76) 1071-1073
- 52 Buchanan GN, Bartram CI, Phillips RK , et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum 2003; 46 (9) 1167-1174
- 53 Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 2006; 49 (3) 371-376
- 54 Champagne BJ, O'Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum 2006; 49 (12) 1817-1821
- 55 Lewis R, Lunniss PJ, Hammond TM. Novel biological strategies in the management of anal fistula. Colorectal Dis 2012; 14 (12) 1445-1455
- 56 Ortiz H, Marzo J, Ciga MA, Oteiza F, Armendáriz P, de Miguel M. Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano. Br J Surg 2009; 96 (6) 608-612
- 57 Ellis CN, Rostas JW, Greiner FG. Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas. Dis Colon Rectum 2010; 53 (5) 798-802
- 58 Adamina M, Ross T, Guenin MO , et al. Anal fistula plug: a prospective evaluation of success, continence and quality of life in the treatment of complex fistulae. Colorectal Dis 2014; 16 (7) 547-554
- 59 Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum 2008; 51 (6) 838-843
- 60 Stamos MJ, Snyder M, Robb BW , et al. Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas. Dis Colon Rectum 2015; 58 (3) 344-351
- 61 Heydari A, Attinà GM, Merolla E, Piccoli M, Fazlalizadeh R, Melotti G. Bioabsorbable synthetic plug in the treatment of anal fistulas. Dis Colon Rectum 2013; 56 (6) 774-779
- 62 Matos D, Lunniss PJ, Phillips RK. Total sphincter conservation in high fistula in ano: results of a new approach. Br J Surg 1993; 80 (6) 802-804
- 63 Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 2007; 90 (3) 581-586
- 64 Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery?. Dis Colon Rectum 2012; 55 (11) 1173-1178
- 65 Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 2013; 56 (3) 343-347
- 66 Yassin NA, Hammond TM, Lunniss PJ, Phillips RK. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis 2013; 15 (5) 527-535
- 67 Alasari S, Kim NK. Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol 2014; 18 (1) 13-22
- 68 Madbouly KM, El Shazly W, Abbas KS, Hussein AM. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum 2014; 57 (10) 1202-1208
- 69 Madbouly KM, El Shazly W, Abbas KS, Hussein AM. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum 2014; 57 (10) 1202-1208
- 70 Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N. Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum 2013; 56 (7) 898-902
- 71 Gingold DS, Murrell ZA, Fleshner PR. A prospective evaluation of the ligation of the intersphincteric tract procedure for complex anal fistula in patients with Crohn's disease. Ann Surg 2014; 260 (6) 1057-1061
- 72 Tan KK, Alsuwaigh R, Tan AM , et al. To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula?. Dis Colon Rectum 2012; 55 (12) 1273-1277
- 73 Ellis CN. Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the intersphincteric fistula tract (BioLIFT procedure) for the management of complex anal fistulas. Dis Colon Rectum 2010; 53 (10) 1361-1364
- 74 van Onkelen RS, Gosselink MP, Schouten WR. Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract?. Dis Colon Rectum 2012; 55 (2) 163-166
- 75 Han JG, Yi BQ, Wang ZJ , et al. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano. Colorectal Dis 2013; 15 (5) 582-586
- 76 FiLaC [video online]. Available at: https://www.youtube.com/watch?v=8M-k0zEx1jo . Accessed May 24, 2015
- 77 Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M. Fistula-tract Laser Closure (FiLaC™): long-term results and new operative strategies. Tech Coloproctol 2015; 19 (8) 449-453
- 78 Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 2011; 15 (4) 417-422
- 79 Kochhar G, Saha S, Andley M , et al. Video-assisted anal fistula treatment. JSLS 2014; 18 (3) e2014.00127 . doi:10.4293/JSLS.2014.00127
- 80 Gaertner WB, Witt J, Madoff RD, Mellgren A, Finne CO, Spencer MP. Ileal pouch fistulas after restorative proctocolectomy: management and outcomes. Tech Coloproctol 2014; 18 (11) 1061-1066