Complex Cryptogladular Anal Fistulas – Sphincter Save Operations
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 8
Abstract
Cryptoglandular anal fistula is usually an indication for surgery. The aim of surgical fistula treatment is to eliminate fistula, preserve sphincter function – continence, and prevent of abscess and/or fistula recurrence. The surgical treatment of the cryptoglandular anal fistulas is challenging. The most important concern in surgical fistula therapy is the risk of incontinence. Preoperative assessment of sphincter function, fistula primary, secondary opening, track and its relation to anal sphincter is necessary. A superficial fistula, eg. low transsphincteric and intersphincteric, can be treated by fistulotomy and lay-open technique (healing by second intention). Fistulotomy leads to high efficacy but higher rates of postoperative incontinence. Bigger amount of sphincter in “complex” fistulas, eg. high transsphincteric, suprashincteric and anterior (especially in woman) requires sphincter save surgical procedures such as: advancement flaps (mucosal, full thickness rectal or anodermal), direct closure of the primary opening, fistulectomy and direct primary reconstruction of the sphincter muscle. Often, stepwise operation manner with a loose seton inserted through transsphincterical fistula portion is employed. Sphincter save procedures results in low postoperative incontinence, but higher recurrence rate. Despite initial optimism fibrin glue and anal fistula plug procedures, with increasing follow up evaluation, have low success rates.
Authors and Affiliations
Paweł Grochowicz
Keywords
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