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Anorectal Abscess and Fistula in Ano

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Fundamentals of Anorectal Surgery

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Abstract

This chapter will cover cryptoglandular anorectal abscess and fistula-in-ano, necrotizing perianal infection, anoperineal infection in neutropenic patients, and fistulizing perianal Crohn’s disease. The topics rectovaginal fistula and perianal Crohn’s disease are covered in separate chapters of this text.

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References

  1. Vasilevsky CA. Anorectal abscess and fistula-in ano. In: Beck DE, editor. Handbook of colorectal surgery. St Louis: Quality Medical Publishing; 1997.

    Google Scholar 

  2. Gordon PH, Nivatvongs S. Principles and practice of surgery for the colon, rectum, and anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999.

    Google Scholar 

  3. Walls EW. Observations on the microscopic anatomy of the human anal canal. Br J Surg. 1958;45:504–12.

    Article  CAS  PubMed  Google Scholar 

  4. Morson BC, Dawson IMP. Gastrointestinal pathology. London: Blackwell Scientific; 1979. p. 715–8.

    Google Scholar 

  5. Lilius HG. Fistula-in-ano, an investigation of human foetal anal ducts and intramuscular glands and a clinical study of 150 patients. Acta Chir Scand Suppl. 1968;383:7–88.

    CAS  PubMed  Google Scholar 

  6. Eisenhammer S. The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet. 1956;103:501–6.

    CAS  PubMed  Google Scholar 

  7. Gosselink MP, van Onkelen RS, Schouten WR. The cryptoglandular theory revisited. Color Dis. 2015;17:1041–3.

    Article  Google Scholar 

  8. Parks AG. Pathogenesis and treatment of fistuila-in-ano. Br Med J. 1961;1:463–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. McElwain JW, MacLean MD, Alexander RM, Hoexter B, Guthrie JF. Anorectal prlblems: experience with primary fistulectomy for anorectal abscess, a report of 1,000 cases. Dis Colon Rectum. 1975;18:646–9.

    Article  CAS  PubMed  Google Scholar 

  10. Ommer A, Herold A, Berg E, Furst A, Schiedeck T, Sailer M. German S3-Guideline: rectovaginal fistula. Ger Med Sci. 2012;10:Doc15.

    PubMed  PubMed Central  Google Scholar 

  11. Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum. 1984;27:593–7.

    Article  CAS  PubMed  Google Scholar 

  12. Read DR, Abcarian H. A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum. 1979;22:566–8.

    Article  CAS  PubMed  Google Scholar 

  13. Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum. 1984;27:126–30.

    Article  CAS  PubMed  Google Scholar 

  14. Wang D, Yang G, Qiu J, et al. Risk factors for anal fistula: a case-control study. Tech Coloproctol. 2014;18:635–9.

    Article  CAS  PubMed  Google Scholar 

  15. Prasad ML, Read DR, Abcarian H. Supralevator abscess: diagnosis and treatment. Dis Colon Rectum. 1981;24:456–61.

    Article  CAS  PubMed  Google Scholar 

  16. Chrabot CM, Prasad ML, Abcarian H. Recurrent anorectal abscesses. Dis Colon Rectum. 1983;26:105–8.

    Article  CAS  PubMed  Google Scholar 

  17. Held D, Khubchandani I, Sheets J, Stasik J, Rosen L, Riether R. Management of anorectal horseshoe abscess and fistula. Dis Colon Rectum. 1986;29:793–7.

    Article  CAS  PubMed  Google Scholar 

  18. Herr CH, Williams JC. Supralevator anorectal abscess presenting as acute low back pain and sciatica. Ann Emerg Med. 1994;23:132–5.

    Article  CAS  PubMed  Google Scholar 

  19. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.

    Article  CAS  Google Scholar 

  20. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011;24:14–21.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sneider EB, Maykel JA. Anal abscess and fistula. Gastroenterol Clin N Am. 2013;42:773–84.

    Article  Google Scholar 

  22. Parks AG, Thomson JP. Intersphincteric abscess. Br Med J. 1973;2:537–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Klein JW. Common anal problems. Med Clin North Am. 2014;98:609–23.

    Article  PubMed  Google Scholar 

  24. Garcia-Granero A, Granero-Castro P, Frasson M, et al. Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series. Int J Color Dis. 2014;29:1557–64.

    Article  Google Scholar 

  25. Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease. Br J Surg. 1999;86:360–4.

    Article  CAS  PubMed  Google Scholar 

  26. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001;121:1064–72.

    Article  CAS  PubMed  Google Scholar 

  27. Wise PE, Schwartz DA. The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin N Am. 2012;41:379–91.

    Article  Google Scholar 

  28. Caliste X, Nazir S, Goode T, et al. Sensitivity of computed tomography in detection of perirectal abscess. Am Surg. 2011;77:166–8.

    PubMed  Google Scholar 

  29. Dohan A, Eveno C, Oprea R, Pautrat K, Placé V, Pocard M, Hoeffel C, Boudiaf M, Soyer P. Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience. Eur Radiol. 2014;24(11):2906–15.

    Article  PubMed  Google Scholar 

  30. Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004;233:674–81.

    Article  PubMed  Google Scholar 

  31. Poen AC, Felt-Bersma RJ, Eijsbouts QA, Cuesta MA, Meuwissen SG. Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum. 1998;41:1147–52.

    Article  CAS  PubMed  Google Scholar 

  32. Pomerri F, Dodi G, Pintacuda G, Amadio L, Muzzio PC. Anal endosonography and fistulography for fistula-in-ano. Radiol Med. 2010;115:771–83.

    Article  CAS  PubMed  Google Scholar 

  33. Weisman N, Abbas MA. Prognostic value of endoanal ultrasound for fistula-in-ano: a retrospective analysis. Dis Colon Rectum. 2008;51:1089–92.

    Article  PubMed  Google Scholar 

  34. Bode WE, Ramos R, Page CP. Invasive necrotizing infection secondary to anorectal abscess. Dis Colon Rectum. 1982;25:416–9.

    Article  CAS  PubMed  Google Scholar 

  35. O'Malley GF, Dominici P, Giraldo P, et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Acad Emerg Med. 2009;16:470–3.

    Article  PubMed  Google Scholar 

  36. Perera AP, Howell AM, Sodergren MH, et al. A pilot randomised controlled trial evaluating postoperative packing of the perianal abscess. Langenbeck's Arch Surg. 2015;400:267–71.

    Article  CAS  Google Scholar 

  37. Tonkin DM, Murphy E, Brooke-Smith M, et al. Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum. 2004;47:1510–4.

    Article  PubMed  Google Scholar 

  38. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.

    Article  CAS  PubMed  Google Scholar 

  39. Hanley PH, Ray JE, Pennington EE, Grablowsky OM. Fistula-in-ano: a ten-year follow-up study of horseshoe-abscess fistula-in-ano. Dis Colon Rectum. 1976;19:507–15.

    Article  CAS  PubMed  Google Scholar 

  40. Hanley PH. Conservative surgical correction of horseshoe abscess and fistula. Dis Colon Rectum. 1965;8:364–8.

    Article  CAS  PubMed  Google Scholar 

  41. Browder LK, Sweet S, Kaiser AM. Modified Hanley procedure for management of complex horseshoe fistulae. Tech Coloproctol. 2009;13:301–6.

    Article  CAS  PubMed  Google Scholar 

  42. Ustynoski K, Rosen L, Stasik J, Riether R, Sheets J, Khubchandani IT. Horseshoe abscess fistula. Seton treatment. Dis Colon Rectum. 1990;33:602–5.

    Article  CAS  PubMed  Google Scholar 

  43. Alder AC, Thornton J, McHard K, Buckins L, Barber R, Skinner MA. A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children. J Pediatr Surg. 2011;46:1942–7.

    Article  PubMed  Google Scholar 

  44. Isbister WH. A simple method for the management of anorectal abscess. Aust N Z J Surg. 1987;57:771–4.

    Article  CAS  PubMed  Google Scholar 

  45. Ladd AP, Levy MS, Quilty J. Minimally invasive technique in treatment of complex, subcutaneous abscesses in children. J Pediatr Surg. 2010;45:1562–6.

    Article  PubMed  Google Scholar 

  46. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg. 1997;63:686–9.

    CAS  PubMed  Google Scholar 

  47. Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum. 1997;40:1435–8.

    Article  CAS  PubMed  Google Scholar 

  48. Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial. Dis Colon Rectum. 1991;34:60–3.

    Article  CAS  PubMed  Google Scholar 

  49. Bokhari S, Lindsey I. Incontinence following sphincter division for treatment of anal fistula. Color Dis. 2010;12:e135–9.

    Article  CAS  Google Scholar 

  50. Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010;7:CD006827.

    Google Scholar 

  51. Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med. 1985;14:15–9.

    Article  CAS  PubMed  Google Scholar 

  52. Sozener U, Gedik E, Kessaf Aslar A, et al. Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum. 2011;54:923–9.

    Article  PubMed  Google Scholar 

  53. Seow-En I, Ngu J. Routine operative swab cultures and post-operative antibiotic use for uncomplicated perianal abscesses are unnecessary. ANZ J Surg. 2017;87:356–9.

    Article  PubMed  Google Scholar 

  54. Onaca N, Hirshberg A, Adar R. Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum. 2001;44:1469–73.

    Article  CAS  PubMed  Google Scholar 

  55. Yano T, Asano M, Matsuda Y, Kawakami K, Nakai K, Nonaka M. Prognostic factors for recurrence following the initial drainage of an anorectal abscess. Int J Color Dis. 2010;25:1495–8.

    Article  Google Scholar 

  56. Seow-Choen F, Nicholls RJ. Anal fistula. Br J Surg. 1992;79:197–205.

    Article  CAS  PubMed  Google Scholar 

  57. Mazier WP, Senagore AJ, Schiesel EC. Operative repair of anovaginal and rectovaginal fistulas. Dis Colon Rectum. 1995;38:4–6.

    Article  CAS  PubMed  Google Scholar 

  58. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87:718–28.

    Article  CAS  PubMed  Google Scholar 

  59. Wroblewska M, Kuzaka B, Borkowski T, Kuzaka P, Kawecki D, Radziszewski P. Fournier’s gangrene—current concepts. Pol J Microbiol. 2014;63:267–73.

    PubMed  Google Scholar 

  60. Czymek R, Schmidt A, Eckmann C, et al. Fournier’s gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg. 2009;197:168–76.

    Article  PubMed  Google Scholar 

  61. Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier’s gangrene severity index in a large contemporary series. J Urol. 2008;180:944–8.

    Article  CAS  PubMed  Google Scholar 

  62. Huber P Jr, Kissack AS, Simonton CT. Necrotizing soft-tissue infection from rectal abscess. Dis Colon Rectum. 1983;26:507–11.

    Article  PubMed  Google Scholar 

  63. Bubrick MP, Hitchcock CR. Necrotizing anorectal and perineal infections. Surgery. 1979;86:655–62.

    CAS  PubMed  Google Scholar 

  64. Laucks SS 2nd. Fournier’s gangrene. Surg Clin North Am. 1994;74:1339–52.

    Article  PubMed  Google Scholar 

  65. Yague Romeo D, Angulo Hervias E, Bernal Lafuente C, Marcuello Pena MT, Mayayo Sinues E, Sarria Octavio de Toledo L. Fournier’s gangrene in a 44-year-old woman: CT scan findings. Arch Esp Urol. 2009;62:483–5.

    Article  PubMed  Google Scholar 

  66. Kara E, Muezzinoglu T, Temeltas G, et al. Evaluation of risk factors and severity of a life threatening surgical emergency: Fournier’s gangrene (a report of 15 cases). Acta Chir Belg. 2009;109:191–7.

    Article  CAS  PubMed  Google Scholar 

  67. Kovalcik PJ, Jones J. Necrotizing perineal infections. Am Surg. 1983;49:163–6.

    CAS  PubMed  Google Scholar 

  68. Abcarian H, Eftaiha M. Floating free-standing anus. A complication of massive anorectal infection. Dis Colon Rectum. 1983;26:516–21.

    Article  CAS  PubMed  Google Scholar 

  69. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44:705–10.

    Article  CAS  PubMed  Google Scholar 

  70. Cuccia G, Mucciardi G, Morgia G, et al. Vacuum-assisted closure for the treatment of Fournier’s gangrene. Urol Int. 2009;82:426–31.

    Article  PubMed  Google Scholar 

  71. Yang BL, Lin Q, Chen HJ, et al. Perianal necrotizing fasciitis treated with a loose-seton technique. Color Dis. 2012;14:e422–4.

    Article  CAS  Google Scholar 

  72. Lucca M, Unger HD, Devenny AM. Treatment of Fournier’s gangrene with adjunctive hyperbaric oxygen therapy. Am J Emerg Med. 1990;8:385–7.

    Article  CAS  PubMed  Google Scholar 

  73. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154:89–92.

    Article  CAS  PubMed  Google Scholar 

  74. Baker B, Al-Salman M, Daoud F. Management of acute perianal sepsis in neutropenic patients with hematological malignancy. Tech Coloproctol. 2014;18:327–33.

    Article  CAS  PubMed  Google Scholar 

  75. Barnes SG, Sattler FR, Ballard JO. Perirectal infections in acute leukemia. Improved survival after incision and debridement. Ann Intern Med. 1984;100:515–8.

    Article  CAS  PubMed  Google Scholar 

  76. Vanhueverzwyn R, Delannoy A, Michaux JL, Dive C. Anal lesions in hematologic diseases. Dis Colon Rectum. 1980;23:310–2.

    Article  CAS  PubMed  Google Scholar 

  77. Morcos B, Amarin R, Abu Sba A, Al-Ramahi R, Abu Alrub Z, Salhab M. Contemporary management of perianal conditions in febrile neutropenic patients. Eur J Surg Oncol. 2013;39:404–7.

    Article  CAS  PubMed  Google Scholar 

  78. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:427–31.

    Article  PubMed  Google Scholar 

  79. Musa MB, Katakkar SB, Khaliq A. Anorectal and perianal complications of hematologic malignant neoplasms. Can J Surg. 1975;18:579–83.

    CAS  PubMed  Google Scholar 

  80. Plumb AA, Halligan S, Bhatnagar G, Taylor SA. Perianal sepsis in hematologic malignancy: MR imaging appearances and distinction from cryptoglandular infection in immunocompetent patients. Radiology. 2015;276:147–55.

    Article  PubMed  Google Scholar 

  81. Sehdev MK, Dowling MD Jr, Seal SH, Stearns MW Jr. Perianal and anorectal complications in leukemia. Cancer. 1973;31:149–52.

    Article  CAS  PubMed  Google Scholar 

  82. Glenn J, Cotton D, Wesley R, Pizzo P. Anorectal infections in patients with malignant diseases. Rev Infect Dis. 1988;10:42–52.

    Article  CAS  PubMed  Google Scholar 

  83. Badgwell BD, Chang GJ, Rodriguez-Bigas MA, et al. Management and outcomes of anorectal infection in the cancer patient. Ann Surg Oncol. 2009;16:2752–8.

    Article  PubMed  Google Scholar 

  84. Levi JA, Schimpff SC, Slawson RG, Wiernik PH. Evaluation of radiotherapy for localized inflammatory skin and perianal lesions in adult leukemia: a prospectively randomized double blind study. Cancer Treat Rep. 1977;61:1301–5.

    CAS  PubMed  Google Scholar 

  85. Hall JF, Bordeianou L, Hyman N, et al. Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 2014;57:1304–8.

    Article  PubMed  Google Scholar 

  86. Hyman N, O'Brien S, Osler T. Outcomes after fistulotomy: results of a prospective, multicenter regional study. Dis Colon Rectum. 2009;52:2022–7.

    Article  PubMed  Google Scholar 

  87. Fazio VW. Complex anal fistulae. Gastroenterol Clin N Am. 1987;16:93–114.

    CAS  Google Scholar 

  88. Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum. 2002;45:1616–21.

    Article  PubMed  Google Scholar 

  89. Kondylis PD, Shalabi A, Kondylis LA, Reilly JC. Male cryptoglandular fistula surgery outcomes: a retrospective analysis. Am J Surg. 2009;197:325–30.

    Article  PubMed  Google Scholar 

  90. Sangwan YP, Rosen L, Riether RD, Stasik JJ, Sheets JA, Khubchandani IT. Is simple fistula-in-ano simple? Dis Colon Rectum. 1994;37:885–9.

    Article  CAS  PubMed  Google Scholar 

  91. Zmora O, Neufeld D, Ziv Y, et al. Prospective, multicenter evaluation of highly concentrated fibrin glue in the treatment of complex cryptogenic perianal fistulas. Dis Colon Rectum. 2005;48:2167–72.

    Article  PubMed  Google Scholar 

  92. Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54:1465–74.

    Article  PubMed  Google Scholar 

  93. Cirocco WC, Reilly JC. Challenging the predictive accuracy of Goodsall’s rule for anal fistulas. Dis Colon Rectum. 1992;35:537–42.

    Article  CAS  PubMed  Google Scholar 

  94. Roig JV, Jordan J, Garcia-Armengol J, Esclapez P, Solana A. Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum. 2009;52:1462–9.

    Article  PubMed  Google Scholar 

  95. Buchanan G, Halligan S, Williams A, et al. Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet. 2002;360:1661–2.

    Article  PubMed  Google Scholar 

  96. Makowiec F, Laniado M, Jehle EC, Claussen CD, Starlinger M. Magnetic resonance imaging in perianal Crohn’s disease. Inflamm Bowel Dis. 1995;1:256–65.

    Article  CAS  PubMed  Google Scholar 

  97. Ratto C, Litta F, Parello A, Donisi L, Zaccone G, De Simone V. Gore Bio-A(R) Fistula Plug: a new sphincter-sparing procedure for complex anal fistula. Color Dis. 2012;14:e264–9.

    Article  CAS  Google Scholar 

  98. Maconi G, Ardizzone S, Greco S, Radice E, Bezzio C, Bianchi Porro G. Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn’s disease. Am J Gastroenterol. 2007;102:2214–9.

    Article  PubMed  Google Scholar 

  99. Maconi G, Tonolini M, Monteleone M, et al. Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohn’s disease. Inflamm Bowel Dis. 2013;19:2737–43.

    Article  PubMed  Google Scholar 

  100. Nevler A, Beer-Gabel M, Lebedyev A, et al. Transperineal ultrasonography in perianal Crohn’s disease and recurrent cryptogenic fistula-in-ano. Color Dis. 2013;15:1011–8.

    Article  CAS  Google Scholar 

  101. Plaikner M, Loizides A, Peer S, et al. Transperineal ultrasonography as a complementary diagnostic tool in identifying acute perianal sepsis. Tech Coloproctol. 2014;18:165–71.

    Article  CAS  PubMed  Google Scholar 

  102. Siddiqui MR, Ashrafian H, Tozer P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576–85.

    Article  PubMed  Google Scholar 

  103. Weisman RI, Orsay CP, Pearl RK, Abcarian H. The role of fistulography in fistula-in-ano. Report of five cases. Dis Colon Rectum. 1991;34:181–4.

    Article  CAS  PubMed  Google Scholar 

  104. Abramowitz L, Soudan D, Souffran M, et al. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Color Dis. 2016;18:279–85.

    Article  CAS  Google Scholar 

  105. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum. 1996;39:723–9.

    Article  CAS  PubMed  Google Scholar 

  106. Davies M, Harris D, Lohana P, et al. The surgical management of fistula-in-ano in a specialist colorectal unit. Int J Color Dis. 2008;23:833–8.

    Article  CAS  Google Scholar 

  107. Jordan J, Roig JV, Garcia-Armengol J, Garcia-Granero E, Solana A, Lledo S. Risk factors for recurrence and incontinence after anal fistula surgery. Color Dis. 2010;12:254–60.

    Article  CAS  Google Scholar 

  108. van Koperen PJ, Wind J, Bemelman WA, Slors JF. Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage? Int J Color Dis. 2008;23:697–701.

    Article  Google Scholar 

  109. van Tets WF, Kuijpers HC. Continence disorders after anal fistulotomy. Dis Colon Rectum. 1994;37:1194–7.

    Article  PubMed  Google Scholar 

  110. Ho YH, Tan M, Leong AF, Seow-Choen F. Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial. Br J Surg. 1998;85:105–7.

    Article  CAS  PubMed  Google Scholar 

  111. Pescatori M, Ayabaca SM, Cafaro D, Iannello A, Magrini S. Marsupialization of fistulotomy and fistulectomy wounds improves healing and decreases bleeding: a randomized controlled trial. Color Dis. 2006;8:11–4.

    Article  CAS  Google Scholar 

  112. Jain BK, Vaibhaw K, Garg PK, Gupta S, Mohanty D. Comparison of a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula: a randomized, controlled pilot trial. J Korean Soc Coloproctol. 2012;28:78–82.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Gottgens KW, Janssen PT, Heemskerk J, et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Color Dis. 2015;30:213–9.

    Article  CAS  Google Scholar 

  114. Kelly ME, Heneghan HM, McDermott FD, et al. The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol. 2014;18:915–9.

    Article  CAS  PubMed  Google Scholar 

  115. Patton V, Chen CM, Lubowski D. Long-term results of the cutting seton for high anal fistula. ANZ J Surg. 2015;85:720–7.

    Article  PubMed  Google Scholar 

  116. Rosen DR, Kaiser AM. Definitive seton management for transsphincteric fistula-in-ano: harm or charm? Color Dis. 2016;18:488–95.

    Article  CAS  Google Scholar 

  117. Tan KK, Alsuwaigh R, Tan AM, et al. To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? Dis Colon Rectum. 2012;55:1273–7.

    Article  PubMed  Google Scholar 

  118. Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54:1537–41.

    Article  PubMed  Google Scholar 

  119. Mitalas LE, Dwarkasing RS, Verhaaren R, Zimmerman DD, Schouten WR. Is the outcome of transanal advancement flap repair affected by the complexity of high transsphincteric fistulas? Dis Colon Rectum. 2011;54:857–62.

    Article  PubMed  Google Scholar 

  120. Schouten WR, Zimmerman DD, Briel JW. Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum. 1999;42:1419–22. discussion 22–3.

    Article  CAS  PubMed  Google Scholar 

  121. Madbouly KM, El Shazly W, Abbas KS, Hussein AM. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum. 2014;57:1202–8.

    Article  PubMed  Google Scholar 

  122. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45:1622–8.

    Article  PubMed  Google Scholar 

  123. Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum. 2010;53:486–95.

    Article  PubMed  Google Scholar 

  124. Goos M, Manegold P, Gruneberger M, Thomusch O, Ruf G. Long-term results after endoanal advancement flap repair for fistulas-in-ano. How important is the aetiology? Int J Color Dis. 2015;30:413–9.

    Article  Google Scholar 

  125. Jones IT, Fazio VW, Jagelman DG. The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum. 1987;30:919–23.

    Article  CAS  PubMed  Google Scholar 

  126. Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol. 2011;11:61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Zimmerman DD, Briel JW, Gosselink MP, Schouten WR. Anocutaneous advancement flap repair of transsphincteric fistulas. Dis Colon Rectum. 2001;44:1474–80.

    Article  CAS  PubMed  Google Scholar 

  128. van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG. Staged mucosal advancement flap versus staged fibrin sealant in the treatment of complex perianal fistulas. Gastroenterol Res Pract. 2011;2011:186350.

    PubMed  PubMed Central  Google Scholar 

  129. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thail. 2007;90:581–6.

    Google Scholar 

  130. Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol. 2014;18:685–91.

    Article  CAS  PubMed  Google Scholar 

  131. Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol. 2009;13:237–40.

    Article  CAS  PubMed  Google Scholar 

  132. Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum. 2013;56:343–7.

    Article  PubMed  Google Scholar 

  133. Shanwani A, Nor AM, Amri N. Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum. 2010;53:39–42.

    Article  CAS  PubMed  Google Scholar 

  134. Sirany AM, Nygaard RM, Morken JJ. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results. Dis Colon Rectum. 2015;58:604–12.

    Article  PubMed  Google Scholar 

  135. Alasari S, Kim NK. Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol. 2014;18:13–22.

    Article  CAS  PubMed  Google Scholar 

  136. Vergara-Fernandez O, Espino-Urbina LA. Ligation of intersphincteric fistula tract: what is the evidence in a review? World J Gastroenterol. 2013;19:6805–13.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Zirak-Schmidt S, Perdawood SK. Management of anal fistula by ligation of the intersphincteric fistula tract—a systematic review. Dan Med J. 2014;61:A4977.

    PubMed  Google Scholar 

  138. Han JG, Wang ZJ, Zheng Y, et al. Ligation of intersphincteric fistula tract vs ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug procedure in patients with transsphincteric anal fistula: early results of a multicenter prospective randomized trial. Ann Surg. 2016;264:917–22.

    Article  PubMed  Google Scholar 

  139. Champagne BJ, O'Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006;49:1817–21.

    Article  PubMed  Google Scholar 

  140. Ellis CN. Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ. 2007;64:36–40.

    Article  PubMed  Google Scholar 

  141. Adamina M, Hoch JS, Burnstein MJ. To plug or not to plug: a cost-effectiveness analysis for complex anal fistula. Surgery. 2010;147:72–8.

    Article  PubMed  Google Scholar 

  142. Christoforidis D, Pieh MC, Madoff RD, Mellgren AF. Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study. Dis Colon Rectum. 2009;52:18–22.

    Article  PubMed  Google Scholar 

  143. El-Gazzaz G, Zutshi M, Hull T. A retrospective review of chronic anal fistulae treated by anal fistulae plug. Color Dis. 2010;12:442–7.

    Article  CAS  Google Scholar 

  144. Kleif J, Hagen K, Wille-Jorgensen P. Acceptable results using plug for the treatment of complex anal fistulas. Dan Med Bull. 2011;58:A4254.

    PubMed  Google Scholar 

  145. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009;52:248–52.

    Article  PubMed  Google Scholar 

  146. Christoforidis D, Etzioni DA, Goldberg SM, Madoff RD, Mellgren A. Treatment of complex anal fistulas with the collagen fistula plug. Dis Colon Rectum. 2008;51:1482–7.

    Article  PubMed  Google Scholar 

  147. Schwandner T, Roblick MH, Kierer W, Brom A, Padberg W, Hirschburger M. Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum. 2009;52:1578–83.

    Article  PubMed  Google Scholar 

  148. Stamos MJ, Snyder M, Robb BW, et al. Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas. Dis Colon Rectum. 2015;58:344–51.

    Article  PubMed  Google Scholar 

  149. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum. 2004;47:432–6.

    Article  PubMed  Google Scholar 

  150. Adams T, Yang J, Kondylis LA, Kondylis PD. Long-term outlook after successful fibrin glue ablation of cryptoglandular transsphincteric fistula-in-ano. Dis Colon Rectum. 2008;51:1488–90.

    Article  PubMed  Google Scholar 

  151. Haim N, Neufeld D, Ziv Y, et al. Long-term results of fibrin glue treatment for cryptogenic perianal fistulas: a multicenter study. Dis Colon Rectum. 2011;54:1279–83.

    Article  PubMed  Google Scholar 

  152. Sentovich SM. Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum. 2003;46:498–502.

    Article  PubMed  Google Scholar 

  153. Swinscoe MT, Ventakasubramaniam AK, Jayne DG. Fibrin glue for fistula-in-ano: the evidence reviewed. Tech Coloproctol. 2005;9:89–94.

    Article  CAS  PubMed  Google Scholar 

  154. Yeung JM, Simpson JA, Tang SW, Armitage NC, Maxwell-Armstrong C. Fibrin glue for the treatment of fistulae in ano—a method worth sticking to? Color Dis. 2010;12:363–6.

    Article  CAS  Google Scholar 

  155. Buchanan GN, Bartram CI, Phillips RK, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003;46:1167–74.

    Article  PubMed  Google Scholar 

  156. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum. 2002;45:1608–15.

    Article  PubMed  Google Scholar 

  157. Cintron JR, Park JJ, Orsay CP, et al. Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum. 2000;43:944–9. discussion 9–50.

    Article  CAS  PubMed  Google Scholar 

  158. Altomare DF, Greco VJ, Tricomi N, et al. Seton or glue for trans-sphincteric anal fistulae: a prospective randomized crossover clinical trial. Color Dis. 2011;13:82–6.

    Article  CAS  Google Scholar 

  159. Zmora O, Mizrahi N, Rotholtz N, Pikarsky AJ, Weiss EG, Nogueras JJ, Wexner SD. Fibrin glue sealing in the treatment of perineal fistulas. Dis Colon Rectum. 2003;46(5):584–9.

    Article  Google Scholar 

  160. Cadeddu F, Salis F, Lisi G, Ciangola I, Milito G. Complex anal fistula remains a challenge for colorectal surgeon. Int J Color Dis. 2015;30:595–603.

    Article  CAS  Google Scholar 

  161. Panés J, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016;388(10051):1281–90.

    Article  PubMed  Google Scholar 

  162. Panes J, et al. Long-term efficacy and safety of stem cell therapy (Cx601) for complex perianal fistulas in patients with Crohn’s disease. Gastroenterology. 2018;154(5):1334–42.e4.

    Google Scholar 

  163. Molendijk I, et al. Allogeneic bone marrow-derived mesenchymal stromal cells promote healing of refractory perianal fistulas in patients with Crohn’s disease. Gastroenterology. 2015;149(4):918–27.e6.

    Article  PubMed  Google Scholar 

  164. Garcia-Olmo D, et al. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum. 2009;52(1):79–86.

    Article  PubMed  Google Scholar 

  165. Lightner A, et al. A systematic review and meta-analysis of mesenchymal stem cell injections for the treatment of perianal Crohn’s disease: progress made and future directions. Dis Colon Rectum. 2018;61(5):629–40.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Colorado, Aurora, CO, USA

    Jon D. Vogel

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada

    Carol-Ann Vasilevsky

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  1. Jon D. Vogel
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  2. Carol-Ann Vasilevsky
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Correspondence to Jon D. Vogel .

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Editors and Affiliations

  1. Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    David E. Beck

  2. Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    Scott R. Steele

  3. Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

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Vogel, J.D., Vasilevsky, CA. (2019). Anorectal Abscess and Fistula in Ano. In: Beck, D., Steele, S., Wexner, S. (eds) Fundamentals of Anorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-65966-4_10

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