Intersphincteric Exploration With Ligation of Intersphincteric Fistula Tract or Attempted Closure of Internal Opening for Acute Anorectal Abscesses
| Autor: | Liu Huimin, Krit Pongpirul, Nitikun Booning, Chucheep Sahakitrungruang, Arun Rojanasakul |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Anal Canal Intersphincteric fistula 03 medical and health sciences 0302 clinical medicine Humans Rectal Fistula Medicine Ligation Aged Retrospective Studies Gynecology Wound Closure Techniques business.industry Gastroenterology General Medicine Middle Aged Thailand Abscess Rectal Diseases Treatment Outcome 030220 oncology & carcinogenesis Acute Disease Drainage Feasibility Studies Female 030211 gastroenterology & hepatology business |
| Zdroj: | Diseases of the Colon & Rectum. 64:438-445 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001867 |
| Popis: | Background Acute anorectal abscesses of cryptoglandular origin are commonly managed by incision and drainage, which results in fistula development in up to 73% of cases, requiring subsequent definitive fistula surgery. However, given that fistula tracts may already be present at the initial presentation, primary closure of the tract as secondary prevention of fistula formation, using ligation of intersphincteric fistula tract, may be useful. Objective This study aims to examine the feasibility and outcomes of performing intersphincteric exploration with ligation of intersphincteric fistula tract or attempted closure of internal opening for acute anorectal abscesses. Design This is a retrospective study of patients with acute anorectal cryptoglandular abscesses who underwent surgery between January 2014 and December 2016. Settings The patients were treated at a tertiary referral center in Thailand. Patients Eighty-six patients with acute anorectal abscesses without previous surgery were included. Interventions Intersphincteric dissection was performed. Further surgical intervention was dependent on the intersphincteric findings. Main outcome measure The main outcome measure was the 90-day healed rate. Results Of the 86 patients, 3 had low intersphincteric abscesses, 26 had low transsphincteric abscesses, 25 had anterior high transsphincteric abscesses, 27 had posterior high transsphincteric abscesses, and 5 had high intersphincteric abscesses. Ligation of intersphincteric fistula tract was successfully performed in 66 patients with an identifiable intersphincteric tract. Intersphincteric exploration with attempted closure of the internal opening was performed in the remaining 20 patients. The success rates were 86% and 70%. Unidentified internal opening and intersphincteric pathology were risk factors for nonhealing. No patients reported fecal incontinence postoperatively. Limitations The limitation of this study is its retrospective nature and that all operations were performed by a single surgeon; therefore, the results may vary according to the individual surgeon's expertise. Conclusions Fistula tract formation was found in most cases of acute anorectal abscesses. Definitive surgery using this strategy provides promising results. See Video Abstract at http://links.lww.com/DCR/B451. Exploracin interesfintrica con ligadura del trayecto en la fstula interesfintrica o intento de cierre del orificio interno en abscesos anorrectales agudos ANTECEDENTES:Los abscesos anorrectales agudos de origen criptoglandular, comunmente se manejan mediante incision y drenaje, lo que resulta en el desarrollo de una fistula hasta en un 73% de los casos, requiriendo posteriormente cirugia definitiva de la fistula. Sin embargo, dado que los trayectos de la fistula ya pueden estar inicialmente presentes, puede ser util el cierre primario del trayecto, como prevencion secundaria en la formacion de la fistula, mediante la ligadura del trayecto de la fistula interesfinterica.OBJETIVO:El estudio tiene como objetivo, examinar la viabilidad y los resultados en realizar exploracion interesfinterica, con ligadura del trayecto de fistula interesfinterica o intento de cierre del orificio interno para abscesos anorrectales agudos.DISENO:Se trata de un estudio retrospectivo de pacientes con abscesos criptoglandulares anorrectales agudos, que fueron operados entre enero de 2014 y diciembre de 2016.AJUSTES:Los pacientes fueron tratados en un centro de referencia terciario en Tailandia.PACIENTES:Se incluyeron 86 pacientes con abscesos anorrectales agudos, sin cirugia previa.INTERVENCIONES:Se realizo diseccion interesfinterica. La intervencion quirurgica adicional dependio de los hallazgos interesfintericos.PRINCIPALES MEDIDAS DE RESULTADO:La principal medida de resultado, fue la tasa de cicatrizacion a 90 dias.RESULTADOS:De los 86 pacientes, hubo 3 abscesos interesfintericos bajos, 26 abscesos transesfintericos bajos, 25 abscesos transesfintericos anteriores altos, 27 abscesos transesfintericos posteriores altos y 5 abscesos interesfintericos altos. La ligadura del tracto de la fistula interesfinterica, con tracto interesfinterico identificable, se realizo con exito en 66 pacientes. Se realizo exploracion interesfinterica, con intento de cierre del orificio interno en los 20 pacientes restantes. Las tasas de exito fueron 86% y 70% respectivamente. Orificio interno no identificado y patologia interesfinterica, fueron factores de riesgo para la falta de cicatrizacion. Ningun paciente reporto incontinencia fecal posoperatoria.LIMITACIONES:La limitacion de este estudio, es su naturaleza retrospectiva y que todas las operaciones fueron realizadas por un solo cirujano, por lo tanto, los resultados pueden variar segun la experiencia de cada cirujano.CONCLUSIONES:En la mayoria de los casos de abscesos anorrectales agudos, se encontro formacion de trayectos fistulosos. La cirugia definitiva con esta estrategia, proporciona resultados prometedores. Consulte Video Resumen en http://links.lww.com/DCR/B451. |
| Databáze: | OpenAIRE |
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