Simulation of Supralevator Abscesses and Complex Fistulas in Cadavers: Pelvic Dissemination and Drainage Routes.

Autor:	García-Granero A; Hospital Universitario y Politecnico la Fe, Colorectal Surgery Unit, Valencia, Spain., Sancho-Muriel J; Hospital Universitario y Politecnico la Fe, Colorectal Surgery Unit, Valencia, Spain., Sánchez-Guillén L; Hospital Universitario y Politecnico la Fe, Colorectal Surgery Unit, Valencia, Spain., Alvarez Sarrado E; Hospital Universitario y Politecnico la Fe, Colorectal Surgery Unit, Valencia, Spain., Fletcher-Sanfeliu D; Hospital Son Espases, Cardiovascular Surgery Department, Mallorca, Spain., Frasson M; Hospital Universitario y Politecnico la Fe, Colorectal Surgery Unit, Valencia, Spain., A Valverde-Navarro A; Surgical Anatomy Unit, Anatomy and Embryology Department, University of Valencia, Valencia, Spain., Martinez Soriano F; Surgical Anatomy Unit, Anatomy and Embryology Department, University of Valencia, Valencia, Spain.
Jazyk:	angličtina
Zdroj:	Diseases of the colon and rectum [Dis Colon Rectum] 2018 Sep; Vol. 61 (9), pp. 1102-1107.
DOI:	10.1097/DCR.0000000000001136
Abstrakt:	Background: Most perianal abscesses have a cryptoglandular origin, following the pathogenesis described by Parks in 1961. Supralevator abscesses have the most uncommon location. Nevertheless, such pathology results in a high morbidity because of their difficult diagnosis and treatment. Objective: This study aimed to deepen the knowledge of the pathogenesis and management of supralevator abscesses, as well as the complications derived from incorrect treatment, by using simulation in cadavers. Design: This study is an anatomosurgical description of pelvic and perianal zone and simulation of the different types of supralevator abscesses, their correct drainage routes, and secondary complex fistulas due to incorrect drainage. Settings: This dynamic article is based on cadaveric simulation. Patients: Three cadaveric pelvises (2 male and 1 female) were prepared in formalin and sagittally sectioned, and one perineal dissection was performed of a fresh male pelvis. This is an iconographic description of 3 patients treated for supralevator abscesses in our colorectal surgical unit. Main Outcome Measures: The virtual anatomical spaces map out a correct treatment. Results: We reproduced the origin of the different types of supralevator abscesses, as well as their locations and possible drainage pathways, and we determined the definitive treatment of secondary fistulas and their morbidity due to their incorrect drainage. Limitations: The limitations of this study are inherent to anatomical studies without real case intervention. Conclusions: A proper anatomical knowledge of the supralevator abscesses and surgical training by using cadaveric simulations could improve the diagnostic criteria, facilitate the correct decision on surgical drainage pathways, and, thus, decrease postoperative morbidity in patients with this disease.
Databáze:	MEDLINE
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