Abstrakt

Background: Fistula-in-ano of cryptoglandular origin is a common disease with a maximal incidence within young male people. Incorrect treatment could have adverse effects on quality of live, especially with disturbances of stool continence. Results: The origins of the abscesses and fistulas are in most cases the proctodeal glands in the intersphincteric space. From here the infection or fistulation spreads intersphincteric, ischioanal or supralevatoric. The abscess means to be the acute and fistula the chronic state of the disease. Anamnesis and clinical examination are enough for indicating surgery. Further examinations like endosonography or magnetic resonance tomography (MRT) should be considered in complex abscesses and fistulas. Therapy of anal abscess is primarily surgical. Aim of surgery is a broad drainage of the infection and protecting the anal sphincter structures. An intraoperative search for a fistula should be done carefully. The primary fistulotomy of superficial fistulas should only be done by an experienced surgeon. In doubt or high fistulas, treatment should be considered in a second operation as the case may be with passager placement of a seton. Therapy of anal fistula consists in one of the following operative procedures: lay open, seton drainage, plastic reconstruction with suture of the sphincter, ligation of the intersphincteric gap, or occlusion with biomaterials. The risk of postoperative continence disturbances increases with the thickness of divided sphincter muscle. From that point for all high anal fistulas a sphincter saving procedure should be undertaken. The results of the different techniques with plastic reconstruction are quite similar. Regarding occlusion with biomaterials the healing rate is quite lower.

Autoreninformation

Autoren

• A. Ommer

Abteilungen

• End- und Dickdarm-Zentrum, Essen

Adresse

Dr. med. A. Ommer
End- und Dickdarm-Zentrum Essen
Rüttenscheider Straße 66
D–45130 Essen
Email: [email protected]

Citation