Fistula-in-Ano

Fistula-in-Ano free pdf ebook was written by on April 22, 2004 consist of 3 page(s). The pdf file is provided by www.mssurg.net and available on pdfpedia since September 10, 2011.

fistula-in-ano: advancement flap repair anal fistula: open tract between anorectum and..with history of anorectal abscess other causes: • • • • • • • congenital fistulas (spina bifida,sacrococcygeal teratoma,..supralevator abscess à high intersphincteric fistula perineal trauma ibd tb stds malignancy presentation: anal discharge preceded...

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Fistula-in-Ano pdf




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Fistula-in-Ano - page 1
FISTULA-IN-ANO: ADVANCEMENT FLAP REPAIR Anal fistula: open tract between anorectum and perineum (vs. sinus) Etiology: cryptoglandular (uncomplicated fistula) (infected anal gland à intersphincteric abscess à rupture into anal canal à tract left) 50-70% with history of anorectal abscess Other causes: congenital fistulas (spina bifida,sacrococcygeal teratoma, dermoid cyst) pelvic sepsis (e.g. appendicitis, salpingitis, diverticulitis, IBD, pelvic neoplasm) à supralevator abscess à high intersphincteric fistula perineal trauma IBD TB STDs malignancy Presentation: anal discharge preceded by pain, swelling, bleeding Treatment Simple, superficial fistula à fistulotomy High fistula à Seton vs. advancement flap Rectal advancement flap: Advantages Low incidence of incontinence Low recurrence rate Less pain (no/small perineal wound) Technique: -identify/cannulate fistula -raise U-shaped mucosal flap +/- fistulectomy, fibrin glue -primary closure of internal os -suture flap 233
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Fistula-in-Ano - page 2
Historical Perspective: 1902: Flap repair of traumatic rectovaginal fistula (Noble, Trans Am Gynecol soc 1902; 27: 363) 1912: First advancement flap for fistula-in-ano (Elting AW, Ann Surg 1912; 56: 774- 52) Current Experience: Author Aquilar et al (1985) Wedell et al (1987) Shemesh et al (1988) Ozuner et al (1996) Vs. Seton: Author Parks and Stitz (1976) Ramanujam et al (1983) Christensen et al (1984) Pearl et al (1993) n 68 45 21 116 Incontinence 17-39% 2% 62% 5% Recurrence NS 2% 0 3% n 189 27 8 19 Recurrence 3 0 1 6 Flatus Fecal Incontinence Incontinence Soiling 13 0 0 3 0 NS 0 0 NS NS NS NS 234
Fistula-in-Ano - page 3
Complications: Incontinence: secondary to sphincter division: *consider patient age, baseline tone inferior rectal nerve injury Recurrence: failure to identify internal os failure to identify lateral &upward extensions Bleeding, cellulitis, constipation/impaction, persistent sinus Anal Fistula and Crohn’s Disease 10-56% incidence Dictum: surgery contraindicated in presence of active rectal disease High incidence of incontinence (50%) Poor/delayed healing Simple fistulas: good/acceptable results Complex/high fistulas: less optimistic (Makowiec et al; Br J Surg 1995; 82: 602-606) 32 patients with Crohn’s, anal fistulas à 36 advancement flap repairs Primary failure = 4/36 Recurrence = 11/36 New fistula = 4/36 235
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