coloproctology

, 33:295

S3-Leitlinie: Kryptoglanduläre Analfisteln

AWMF-Registriernummer: 088/003
  • A. Ommer
  • A. Herold
  • E. Berg
  • S. Farke
  • A. Fürst
  • F. Hetzer
  • A. Köhler
  • S. Post
  • R. Ruppert
  • M. Sailer
  • T. Schiedeck
  • B. Strittmatter
  • B.H. Lenhard
  • W. Bader
  • J.E. Gschwend
  • H. Krammer
  • E. Stange
Leitlinien

Zusammenfassung

Hintergrund

Kryptoglanduläre Analfisteln sind mit 2 auf 10.000 Einwohner/Jahr eine häufige Erkrankung mit einem Häufigkeitsgipfel bei jungen männlichen Erwachsenen. Die fehlerhafte Behandlung kann zu einer Beeinträchtigung der Lebensqualität, insbesondere durch Beeinträchtigung der Stuhlkontinenz führen.

Methode

Es wurde eine systematische Literaturrecherche durchgeführt.

Ergebnis

Relevante randomisierte Studien sind selten, so dass der Evidenzlevel insgesamt niedrig ist. Die Klassifikation der Analfisteln orientiert sich nach der Beziehung des Fistelgangs zum Schließmuskel. Für die Operationsindikation sind Anamnese und klinische Untersuchung ausreichend. Zusätzlich sollte intraoperativ eine Sondierung und/oder Anfärbung des Fistelgangs erfolgen. Endosonographie und Magnetresonanztomographie (MRT) sind in ihrer Aussage gleichwertig und können bei komplexen Fisteln als ergänzende Untersuchungen eingesetzt werden.

Als Therapie der Analfistel stehen folgende operative Verfahren zur Verfügung: Fistelspaltung, Fadendrainage, plastische Rekonstruktion mit Sphinkternaht sowie Okklusion mit Biomaterialien. Eine Spaltung sollte nur bei oberflächlichen Fisteln erfolgen. Die Gefahr der postoperativen Kontinenzstörung steigt mit der Menge des durchtrennten Sphinkteranteils. Bei allen hohen Analfisteln soll ein Schließmuskel schonendes Verfahren zur Anwendung kommen. Die Ergebnisse der verschiedenen Techniken zur plastischen Rekonstruktion in Bezug auf Heilungs- und Inkontinenzraten sind weitgehend identisch. Für die Okklusion mit Biomaterialien ist insgesamt eine geringere Heilungsrate zu konstatieren.

Schlussfolgerung

In dieser S3-Leitlinie werden erstmals im deutschen Raum evidenzbasierte Richtlinien für die Diagnostik und Therapie der kryptoglandulären Analfisteln zusammengestellt.

Schlüsselwörter

Analfistel Stuhlinkontinenz Operative Verfahren Diagnostik Literaturrecherche 

S3 guidelines: cryptoglandular anal fistulas

German Association of Scientific Medical Societies (AWMF) registry number: 088/003

Abstract

Background

With an incidence of 2 in 10,000/year, fistula-in-ano of cryptoglandular origin is a common disease, affecting predominantly young males. Incorrect treatment can adversely effect quality of life, particularly in terms of stool continence.

Methods

A systematic review of the literature has been undertaken.

Results

Since relevant randomized studies are scant, the level of evidence is low. The classification of anal fistulas depends on the relation between fistula channel and anal sphincter. Anamnesis and clinical examination are sufficient to establish the indication for surgery. In addition, an intraoperative probe and/or staining of the fistula channel should be performed. Endoanal ultrasound and magnetic resonance tomography are similar in predictive value. These modalities may be able to provide additional information in complex fistulas.

The treatment of anal fistulas consists of one of the following surgical procedures: lay-open technique, seton drainage, plastic reconstruction with suture of the sphincter or occlusion with biomaterials. The lay-open technique should only be performed in superficial fistulas. The risk of impaired postoperative continence increases with the thickness of the divided sphincter muscle. A sphincter-saving procedure should be undertaken for all high anal fistulas. The results of the different techniques using plastic reconstruction are largely comparable. A lower healing rate is seen with occlusion using biomaterials.

Conclusion

This clinical S3 guideline provides instructions for the diagnosis and treatment of cryptoglandular fistula-in-ano for the first time in Germany.

Keywords

Fistula-in-ano Stool incontinence Surgical treatment Diagnostic Review 

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© Urban & Vogel, Muenchen 2011

Authors and Affiliations

  • A. Ommer
    • 1
  • A. Herold
    • 1
  • E. Berg
    • 1
  • S. Farke
    • 1
  • A. Fürst
    • 1
  • F. Hetzer
    • 1
  • A. Köhler
    • 1
  • S. Post
    • 1
  • R. Ruppert
    • 1
  • M. Sailer
    • 1
  • T. Schiedeck
    • 1
  • B. Strittmatter
    • 1
  • B.H. Lenhard
    • 1
  • W. Bader
    • 1
  • J.E. Gschwend
    • 1
  • H. Krammer
    • 1
  • E. Stange
    • 1
  1. 1.End- und Dickdarmpraxis EssenEssenDeutschland

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