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Perianal Sepsis and Fistula

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Benign Anorectal Disorders

Abstract

Anal fistula and anal sepsis are the part of spectrum of anorectal suppurative diseases. The abscess represents the acute inflammatory event, whereas the fistula is representative of the chronic process. A perianal abscess (also known as anorectal abscess or anal sepsis) is an infection of the soft tissues surrounding the anal canal with formation of a discrete abscess cavity. A fistula-in-ano is a hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin through which an abscess has been drained or has spontaneously ruptured. In some fistulas, there may be only an internal opening leading to a blind tract. Symptoms generally affect quality of life significantly and range from minor discomfort and drainage with resultant hygienic problems to distressing sepsis. Treating an abscess is relatively straightforward. However, eradicating anorectal fistulas is challenging and often frustrating for both the surgeon and the patient. The lack of any standard surgical procedure and heterogeneity of anorectal fistula warrants the surgeon to use his “judgment” more than in most colorectal diseases.

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Bibliography

  • 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):935–9.

    Article  PubMed  Google Scholar 

  • Beets Tan RG, Beets GL, van Der Hoop AG, et al. Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology. 2001;218:75.

    Article  CAS  PubMed  Google Scholar 

  • Benjelloun EB, Jarrar A, El Rhazi K, et al. Acute abscess with fistula: long-term results justify drainage and fistulotomy. Updates Surg. 2013;65(3):207–11.

    Article  CAS  PubMed  Google Scholar 

  • Brook I, Frazier EH. The aerobic and anaerobic bacteriology of perirectal abscess. J Clin Microbiol. 1997;35:2974–6.

    PubMed Central  CAS  PubMed  Google Scholar 

  • Cariati A. Fistulotomy or seton in anal fistula: a decisional algorithm. Updates Surg. 2013;65(3):201–5.

    Article  PubMed  Google Scholar 

  • Champagne BJ, O’Connor LM, Ferguson M, et al. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006;49(12):1817–21.

    Article  PubMed  Google Scholar 

  • Choen S, Burnett S, Bartram CI, et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. Br J Surg. 1991;78:445–7.

    Article  CAS  PubMed  Google Scholar 

  • Cirocco WC, Reilly JC. Challenging the predictive accuracy of Goodsall’s rule for anal fistula. Dis Colon Rectum. 1992;35:537.

    Article  CAS  PubMed  Google Scholar 

  • Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. 1997;96:358–66.

    Article  CAS  PubMed  Google Scholar 

  • 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):1361–4.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Faucheron J, Saint-Marc O, Guibert L, Parc R. Long-term seton drainage for high anal fistulas in Crohnʼs disease-A sphincter-saving operation?. Diseases of the Colon & Rectum. 1996;39(2):208–211.

    Article  CAS  Google Scholar 

  • Fazio VW. Complex anal fistulae. Gastroenterol Clin North Am. 1987;16:93.

    CAS  PubMed  Google Scholar 

  • Frudinger A, Halligan S, Bartram CI, et al. Female anal sphincter: age-related differences in asymptomaticm volunteers with high frequency endoanal US. Radiology. 2002;224:417–23.

    Article  PubMed  Google Scholar 

  • Garcia-Olmo D, Herreros D, Pascual I, et al. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum. 2009;52(1):79–86.

    Article  PubMed  Google Scholar 

  • Gordon PH, Nivatvongs S. Principles and practice of surgery for the colon, rectum and anus. Quality Medical Publishing; New York. 1999. p. 241–283

    Google Scholar 

  • Grace RH, Harper IA, Thompson RG. Anorectal sepsis: microbiology in relation to fistula-in-ano. Br J Surg. 1982;69:401–3.

    Article  CAS  PubMed  Google Scholar 

  • Halligan S, Stoker J. Imaging of fistula in ano 1. Radiology. 2006;239:18–33.

    Article  PubMed  Google Scholar 

  • Hamadani AB, Haigh PI, Liu IA, et al. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Dis Colon Rectum. 2009;52:217–21.

    Article  PubMed  Google Scholar 

  • Hammond TM, Grahn MF, Lunniss PJ. Fibrin glue in the management of anal fistulae. Colorectal Dis. 2004;6(5):308–19.

    Article  CAS  PubMed  Google Scholar 

  • Henrichsen S, Christiansen J. Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study. Br J Surg. 1986;73:371–2.

    Article  CAS  PubMed  Google Scholar 

  • Herreros MD, Garcia-Arranz M, Guadalajara H, et al. Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation. Dis Colon Rectum. 2012;55(7):762–72.

    Article  CAS  PubMed  Google Scholar 

  • Isbister WH. A simple method for the management of anorectal abscess. Aust N Z J Surg. 1987;57:771–4.

    Article  CAS  PubMed  Google Scholar 

  • Jacob TJ, Perakath B, Keighley MR. Surgical intervention for anorectalfistula. Cochrane Database Syst Rev. 2010; (5):CD006319.

    Google Scholar 

  • Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54(12):1537–41.

    Article  PubMed  Google Scholar 

  • Johnson E, Gaw JU, Armstrong DN. Role of anorectal fistuloscopy in evaluating complex anorectal fistulas. Dis Colon Rectum. 2005;48:631.

    Google Scholar 

  • Jones J, Tremaine W. Evaluation of perianal fistulas in patients with crohn’s disease. MedGenMed. 2005;7(2):16.

    PubMed Central  PubMed  Google Scholar 

  • Kuijpers HC, Schulpen T. Fistulography for fistula-in-ano: is it useful? Dis Colon Rectum. 1985;28:103–4.

    Article  CAS  PubMed  Google Scholar 

  • Law PJ, Bartram CI. Anal endosonography: technique and normal anatomy. Gastrointest Radiol. 1989;14(1):349–535.

    Article  CAS  PubMed  Google Scholar 

  • Leng Q, Jin HY. Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: a meta-analysis. World J Gastrointest Surg. 2012;27(4(11)):256–61.

    Article  Google Scholar 

  • Lim CH, Shin HK, Kang WH, et al. The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses. J Korean Soc Coloproctol. 2012;28(6):309–14.

    Article  PubMed Central  PubMed  Google Scholar 

  • Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med. 1985;14:15–9.

    Article  CAS  PubMed  Google Scholar 

  • Loungnarath R, Dietz DW, Mutch MG, et al. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum. 2004;47(4):432–6.

    Article  PubMed  Google Scholar 

  • Lunniss PJ, Armstrong P, Barker PG, et al. Magnetic resonance imaging of anal fistulae. Lancet. 1992;340:394–6.

    Article  CAS  PubMed  Google Scholar 

  • Macfie J, Harvey J. The treatment of acute superficial abscesses: a prospective clinical trial. Br J Surg. 1977;64:264–6.

    Article  CAS  PubMed  Google Scholar 

  • Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010;(7):CD006827.

    Google Scholar 

  • Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2012;16(1):111.

    Article  PubMed Central  Google Scholar 

  • Mitalas L, Gosselink M, Zimmerman D, Schouten R. Repeat Transanal Advancement Flap Repair: Impact on the Overall Healing Rate of High Transsphincteric Fistulas and on Fecal Continence. Diseases of the Colon & Rectum. 2007;50(10):1508–1511.

    Article  Google Scholar 

  • Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum. 2002;45(12):1616–21.

    Article  PubMed  Google Scholar 

  • Nelson R. Anorectal abscess fistula: what do we know? Surg Clin North Am. 2002;82(6):1139–51.

    Article  PubMed  Google Scholar 

  • Ommer A, Herold A, Joos A, et al. Fistula plug in the treatment of high anal fistulas–initial results from a German multicenter-study. Ger Med Sci. 2012;10:13.

    Google Scholar 

  • O’Riordan JM, Datta I, Johnston C, Baxter NN. A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum. 2012;55(3):351–8.

    Article  PubMed  Google Scholar 

  • Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Surg. 1976;63:1.

    Article  CAS  PubMed  Google Scholar 

  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of patients with Crohn’s disease. N Engl J Med. 1999;340:1398–405.

    Article  CAS  PubMed  Google Scholar 

  • Quah HM, Tang CL, Eu KW, et al. Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula. Int J Colorectal Dis. 2006;21(6):602–9.

    Article  CAS  PubMed  Google Scholar 

  • Ramanujam PS, Prasad ML, Abcarian H, et al. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum. 1984;27(9):593–7.

    Article  CAS  PubMed  Google Scholar 

  • Ratto C, Litta F, Parello A, et al. Gore Bio-A® Fistula Plug: a new sphincter-sparing procedure for complex anal fistula. Colorectal Dis. 2012;14(5):e264–9.

    Article  CAS  PubMed  Google Scholar 

  • Ratto C, Litta F, Parello A. Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum. 2013;56(2):226–33.

    Article  PubMed  Google Scholar 

  • Read DR, Abcarian H. A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum. 1979;22:566–8.

    Article  CAS  PubMed  Google Scholar 

  • Rojanasakul A, Pattanaarun J, et al. Total anal sphincter saving technique for fistula-in-ano; The ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90(3):581–6.

    PubMed  Google Scholar 

  • Schwandner O. Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Tech Coloproctol. 2013;17(2):221–5.

    Article  CAS  PubMed  Google Scholar 

  • Schwandner O, Stadler F, Dietl O, et al. Initial experience on efficacy in closure of cryptoglandular and Crohn’s transsphincteric fistulas by the use of the anal fistula plug. Int J Colorectal Dis. 2008;23(3):319–24.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001;135:906–18.

    Article  CAS  PubMed  Google Scholar 

  • Sheikh P, Baazka A. Management of fistula in ano- the current evidence. Indian J Surg. 2014;76(6):482–6.

    Article  PubMed  Google Scholar 

  • Sirikurnpiboon S, Burin A, Jivapaisarnpong P. Ligation of intersphincteric fistula tract and its modification: results from treatment of complex fistula. World J Gastrointest Surg. 2013;5(4):123–8.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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):1622–8.

    Article  PubMed  Google Scholar 

  • Spencer JA, Chapple K, Wilson D, et al. Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol. 1998;171:403–6.

    Article  CAS  PubMed  Google Scholar 

  • Stewart MP, Laing MR, Krukowski ZH. Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial. Br J Surg. 1985;72:66–7.

    Article  CAS  PubMed  Google Scholar 

  • Sultan AH, Kamm MA, Hudson CN, et al. Anal sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–11.

    Article  CAS  PubMed  Google Scholar 

  • Takayuki T, Makoto M, Yoshiaki T, et al. Evidence based treatment strategy of anorectal sepsis and anal fistula. Nippon Doncho Konmonbyo Gakki Zasshi. 2008;61(7):364–77.

    Article  Google Scholar 

  • Tan KK, Lee PJ. Early experience of reinforcing the ligation of the intersphincteric fistula tract procedure with a bioprosthetic graft (BioLIFT) for anal fistula. ANZ J Surg. 2013;84(4):280–3.

    Article  PubMed  Google Scholar 

  • Tan KK, Tan IJ, Lim FS, et al. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum. 2011;54(11):1368–72.

    Article  PubMed  Google Scholar 

  • 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;17:1960–5.

    Article  CAS  PubMed  Google Scholar 

  • 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):163–6.

    Article  PubMed  Google Scholar 

  • Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum. 1984;27:126–30.

    Article  CAS  PubMed  Google Scholar 

  • Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis. 2010;12(3):172–8.

    Article  CAS  PubMed  Google Scholar 

  • 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):1173–8.

    Article  PubMed  Google Scholar 

  • Whiteford MH, Kilkenny J, Hyman N, et al. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum. 2005;48:1337–42.

    Article  PubMed  Google Scholar 

  • Yeung JM, Simpson JA, Tang SW, et al. Fibrin glue for the treatment of fistulae in ano-a method worth sticking to? Colorectal Dis. 2010;12(4):363–6.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Parvez Sheikh MS, FICS, FAIS .

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Sheikh, P., Bajaj, P. (2016). Perianal Sepsis and Fistula. In: Chowdri, N., Parray, F. (eds) Benign Anorectal Disorders. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2589-8_5

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  • DOI: https://doi.org/10.1007/978-81-322-2589-8_5

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