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A mini-invasive procedure for the treatment of supralevator abscess of cryptoglandular origin by extrasphincteric extension: preliminary results at 1-year follow-up

  • Michele Schiano di VisconteEmail author
  • Gianluca Piccoli
  • Luigi Brusciano
  • Ludovico Docimo
  • Marta Veronese
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Abstract

Aim

The aim of this retrospective study is to evaluate the preliminary results of a mini-invasive procedure for the treatment of supralevator abscesses (SLA) of cryptoglandular origin by extrasphincteric extension.

Method

In this clinical study, an innovative two-stage procedure was tested for the surgical treatment of SLA. As first step and as a preparation for surgery, the interventional radiologist positioned a CT-guided percutaneous perianal guidewire inside the abscess cavity under local anesthesia. As second step, the surgeon performed an abscess incision and drainage around the guidewire, with a complete debridement of all the necrotic tissue. If a complex anal fistula was identified, a loose seton was placed in situ.

Results

Nine patients, comprising 5 men (55%) and 4 women (45%), underwent the above-mentioned two-stage procedure to treat SLA of cryptoglandular origin. Median age was 32 years (range, 25–42 years). A silicone draining seton was placed during the surgical procedure in 5 patients (55%), since a coexisting fistula was also revealed by surgery. A repeat surgery, along with a new drainage procedure, was required in one patient out of nine (11.1%) for a complete wound healing. The complete wound healing was achieved after a median of 30 days (range, 26–38). At the 1-year follow-up, the healing rate was 89%.

Conclusions

The treatment of SLA of cryptoglandular origin by using this innovative two-stage procedure may be a safe and convenient surgical option to effectively decrease the risk of recurrence and anal sphincteric injuries.

Keywords

Supralevator abscess CT scan Drainage Mini-invasive 

Notes

Author contributions

MSdV conceived and designed the study, analyzed and interpreted relevant data, drafted the manuscript. MSdV, GP, LB, LD, and MV acquired the data and critically revised the manuscript. All authors have read and approved the final version of the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration, last amended at the 64th WMA General Assembly, Fortaleza, Brazil, October 2013, or comparable ethical standards. For this type of study, formal consent by the institutional research committee is not required in Italy. Informed consent was obtained from all patients included in this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Colorectal and Pelvic Floor Diseases Center, Department of General Surgery“S. Maria dei Battuti” HospitalConeglianoItaly
  2. 2.Department of Radiology“S. Maria dei Battuti” HospitalConeglianoItaly
  3. 3.Division of General, Mininvasive and Obesity SurgeryUniversity of Study of Campania “Vanvitelli”NaplesItaly

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