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Pilonidalsinus und Analfistel

Indikationen und Methoden der chirurgischen Therapien

Pilonidal sinus and anal fistula

Indications and methods of surgical therapy

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Zusammenfassung

Fisteln im Analbereich werden unterteilt in Pilonidalfisteln in der Rima ani und Analfisteln als Verbindung zwischen Anus und perianaler Haut. Bei der Pilonidalfistel erfolgt bei unkompliziertem Befund nach Abheilung akuter Abszesse die minimalinvasive Fistelexzision in Lokalanästhesie. Konservative Therapiekonzepte sowie die radikale Exzision mit offener Wundbehandlung haben sich nicht bewährt. Bei ausgeprägtem, großem Befund erfolgt eine weite Exzision mit plastischer Deckung mittels Limberg-Lappen. Bei der Analfistel muss unterschieden werden zwischen subkutanen und tiefen intersphinktären Fisteln ohne Sphinkterbeteiligung einerseits und hohen intersphinktären, transsphinktären, suprasphinktären und extrasphinktären Fisteln andererseits. Erstere können mit geringer Morbidität und hoher Heilungsrate fistulotomiert werden. Bei der zweiten Gruppe besteht ein erhebliches Inkontinenz- und Rezidivrisiko. Ohne Inkontinenzrisiko, bei allerdings hohem Rezidivrisiko, kann die Fistel mittels „Anal Fistula Plug“ verschlossen werden. Bei Versagen dieser Therapie bietet sich eine Fistulektomie mit Verschluss der inneren Fistelöffnung durch einen anorektalen Verschiebelappen an.

Abstract

Proctologic fistulas are divided into pilonidal sinuses affecting the anal cleft and fistula in ano as tracts between the anus and perianal skin. An uncomplicated finding of a pilonidal sinus is treated by minimally invasive excision of the fistula tract using local anesthesia and acute abscesses must be drained prior to excision. Conservative approaches as well as radical excision are no longer recommended. In complicated situations a wide excision with plastic closure by a Limberg flap is the treatment of choice. Fistula in ano must be differentiated into subcutaneous and deep intersphincteral fistulas with no involvement of the anal sphincter and high intersphincteral transphincteral, suprasphincteral and extrasphincteral fistulas. Fistulas in the first group are candidates for fistulotomy with a low risk of incontinence and a high healing rate but the latter group has an increased risk of incontinence and fistula recurrence. Fistulas can be closed by an anal fistula plug without risk of incontinence but with a high risk of recurrence. In the case of recurrence a fistulectomy with closure of the internal opening and an anorectal advancement flap is performed.

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Correspondence to PD Dr. D. Hahnloser.

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Steinemann, D., Dindo, D., Soll, C. et al. Pilonidalsinus und Analfistel. Gastroenterologe 5, 308–317 (2010). https://doi.org/10.1007/s11377-010-0399-7

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Schlüsselwörter

  • Pilonidalfistel
  • Sakraldermoid
  • Analfistel
  • Fistulotomie
  • Fistulektomie

Keywords

  • Pilonidal sinus
  • Sacral dermoid
  • Fistula in ano
  • Fistulotomy
  • Fistulectomy