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Practice Parameters for the Treatment of Perianal Abscess and Fistula-in-Ano  (Revised)

  • Practice Parameters
  • Published:
Diseases of the Colon & Rectum

Abstract

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

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REFERENCES

  1. DJ Cook GH Guyatt A Laupacis DL Sackett (1992) ArticleTitleRules of evidence and clinical recommendations on the use of antithrombotic agents Chest 102 IssueID(Suppl 4) 305S–11S Occurrence Handle1:STN:280:ByyD3cbpslQ%3D Occurrence Handle1395818

    CAS  PubMed  Google Scholar 

  2. DL Sackett (1989) ArticleTitleRules of evidence and clinical recommendations on the use of antithrombotic agents Chest 95 IssueID(Suppl 2) 2S–4S Occurrence Handle1:STN:280:BiaC38%2FivF0%3D Occurrence Handle2914516

    CAS  PubMed  Google Scholar 

  3. Anonymous. Practice parameters for treatment of fistula-in-ano–supporting documentation. The Standards Practice Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1996;39:1363–72

  4. Anonymous. Practice parameters for treatment of fistula-in-ano. The Standards Practice Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1996;39:1361–2

  5. A Parks (1961) ArticleTitlePathogenesis and treatment of fistula-in-ano BMJ 1 463–9

    Google Scholar 

  6. WH Isbister (1987) ArticleTitleA simple method for the management of anorectal abscess ANZ J Surg 57 771–4 Occurrence Handle1:STN:280:BieC3cnitFY%3D

    CAS  Google Scholar 

  7. DR Read H Abcarian (1979) ArticleTitleA prospective survey of 474 patients with anorectal abscess Dis Colon Rectum 22 566–8 Occurrence Handle1:STN:280:Bi%2BC3M3jtVI%3D Occurrence Handle527452

    CAS  PubMed  Google Scholar 

  8. JL Llera RC Levy (1985) ArticleTitleTreatment of cutaneous abscess: a double-blind clinical study Ann Emerg Med 14 15–9 Occurrence Handle1:STN:280:BiqD2s%2Fks1M%3D Occurrence Handle3880635

    CAS  PubMed  Google Scholar 

  9. MP Stewart MR Laing ZH Krukowski (1985) ArticleTitleTreatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial Br J Surg 72 66–7 Occurrence Handle1:STN:280:BiqD1MfktlU%3D Occurrence Handle3881155

    CAS  PubMed  Google Scholar 

  10. J Macfie J Harvey (1977) ArticleTitleThe treatment of acute superficial abscesses: a prospective clinical trial Br J Surg 64 264–6 Occurrence Handle1:STN:280:CSiC2MbgvVI%3D Occurrence Handle322789

    CAS  PubMed  Google Scholar 

  11. AS Dajani KA Taubert W Wilson et al. (1997) ArticleTitlePrevention of bacterial endocarditis. Recommendations by the American Heart Association Circulation 96 358–66 Occurrence Handle1:STN:280:ByiA2sbmsF0%3D Occurrence Handle9236458

    CAS  PubMed  Google Scholar 

  12. AG Parks PH Gordon JD Hardcastle (1976) ArticleTitleA classification of fistula-in-ano Br J Surg 63 1–12 Occurrence Handle1:STN:280:CSmC1crjtlA%3D Occurrence Handle1267867

    CAS  PubMed  Google Scholar 

  13. AG Parks RW Stitz (1976) ArticleTitleThe treatment of high fistula-in-ano Dis Colon Rectum 19 487–99 Occurrence Handle1:STN:280:CSiD3c3ntFw%3D Occurrence Handle964106

    CAS  PubMed  Google Scholar 

  14. IJ Kodner A Mazor EI Shemesh RD Fry JW Fleshman EH Birnbaum (1993) ArticleTitleEndorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas Surgery 114 682–90 Occurrence Handle1:STN:280:ByuD38vlsFU%3D Occurrence Handle8211682

    CAS  PubMed  Google Scholar 

  15. N Mizrahi SD Wexner O Zmora et al. (2002) ArticleTitleEndorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45 1616–21 Occurrence Handle12473884

    PubMed  Google Scholar 

  16. O Kronborg (1985) ArticleTitleTo lay open or excise a fistula-in-ano: a randomized trial Br J Surg 72 970 Occurrence Handle1:STN:280:BimC3cvptFA%3D Occurrence Handle3910159

    CAS  PubMed  Google Scholar 

  17. CA Vasilevsky PH Gordon (1984) ArticleTitleThe incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration Dis Colon Rectum 27 126–30 Occurrence Handle1:STN:280:BiuC3s7ksFM%3D Occurrence Handle6697831

    CAS  PubMed  Google Scholar 

  18. WF Tets Particlevan HC Kuijpers (1994) ArticleTitleContinence disorders after anal fistulotomy Dis Colon Rectum 37 1194–7 Occurrence Handle7995143

    PubMed  Google Scholar 

  19. YH Ho M Tan AF Leong F Seow-Choen (1998) ArticleTitleMarsupialization of fistulotomy wounds improves healing: a randomized controlled trial Br J Surg 85 105–7 Occurrence Handle1:STN:280:DyaK1c7itl2nug%3D%3D Occurrence Handle9462396

    CAS  PubMed  Google Scholar 

  20. ME Abel YS Chiu TR Russell PA Volpe (1993) ArticleTitleAutologous fibrin glue in the treatment of rectovaginal and complex fistulas Dis Colon Rectum 36 447–9 Occurrence Handle1:STN:280:ByyB2crmtVA%3D Occurrence Handle8482163

    CAS  PubMed  Google Scholar 

  21. GN Buchanan CI Bartram RK Phillips et al. (2003) ArticleTitleEfficacy of fibrin sealant in the management of complex anal fistula: a prospective trial Dis Colon Rectum 46 1167–74 Occurrence Handle12972959

    PubMed  Google Scholar 

  22. JR Cintron JJ Park CP Orsay et al. (2000) ArticleTitleRepair of fistulas-in-ano using fibrin adhesive: long-term follow-up Dis Colon Rectum 43 944–50 Occurrence Handle1:STN:280:DC%2BD3czmsFKisg%3D%3D Occurrence Handle10910240

    CAS  PubMed  Google Scholar 

  23. I Lindsey MM Smilgin-Humphreys C Cunningham NJ Mortensen BD George (2002) ArticleTitleA randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula Dis Colon Rectum 45 1608–15 Occurrence Handle12473883

    PubMed  Google Scholar 

  24. L Patrlj B Kocman M Martinac et al. (2000) ArticleTitleFibrin glue-antibiotic mixture in the treatment of anal fistulae: experience with 69 cases Dig Surg 17 77–80 Occurrence Handle1:STN:280:DC%2BD3c7ovVSrtQ%3D%3D Occurrence Handle10720836

    CAS  PubMed  Google Scholar 

  25. KS Venkatesh P Ramanujam (1999) ArticleTitleFibrin glue application in the treatment of recurrent anorectal fistulas Dis Colon Rectum 42 1136–9 Occurrence Handle1:STN:280:DyaK1MvisVyksw%3D%3D Occurrence Handle10496552

    CAS  PubMed  Google Scholar 

  26. O Zmora N Mizrahi N Rotholtz et al. (2003) ArticleTitleFibrin glue sealing in the treatment of perineal fistulas Dis Colon Rectum 46 584–9 Occurrence Handle12792432

    PubMed  Google Scholar 

  27. C Ratto E Gentile M Merico et al. (2000) ArticleTitleHow can the assessment of fistula-in-ano be improved? Dis Colon Rectum 43 1375–82 Occurrence Handle1:STN:280:DC%2BD3crgtl2ltg%3D%3D Occurrence Handle11052514

    CAS  PubMed  Google Scholar 

  28. P Orsoni M Barthet F Portier M Panuel A Desjeux JC Grimaud (1999) ArticleTitleProspective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease Br J Surg 86 360–4 Occurrence Handle1:STN:280:DyaK1M3hsF2lsA%3D%3D Occurrence Handle10201779

    CAS  PubMed  Google Scholar 

  29. DA Schwartz MJ Wiersema KM Dudiak et al. (2001) ArticleTitleA comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas Gastroenterology 121 1064–72 Occurrence Handle1:STN:280:DC%2BD3Mnkt1Crsg%3D%3D Occurrence Handle11677197

    CAS  PubMed  Google Scholar 

  30. PS Aguilar G Plasencia TG Hardy SuffixJr RF Hartmann WR Stewart (1985) ArticleTitleMucosal advancement in the treatment of anal fistula Dis Colon Rectum 28 496–8 Occurrence Handle1:STN:280:BiqB2MnotFA%3D Occurrence Handle4017809

    CAS  PubMed  Google Scholar 

  31. T Sonoda T Hull MR Piedmonte VW Fazio (2002) ArticleTitleOutcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap Dis Colon Rectum 45 1622–8 Occurrence Handle12473885

    PubMed  Google Scholar 

  32. G Ozuner TL Hull J Cartmill VW Fazio (1996) ArticleTitleLong-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas Dis Colon Rectum 39 10–4 Occurrence Handle1:STN:280:BymC1c7jt1M%3D Occurrence Handle8601343

    CAS  PubMed  Google Scholar 

  33. AC Lowry AG Thorson DA Rothenberger SM Goldberg (1988) ArticleTitleRepair of simple rectovaginal fistulas. Influence of previous repairs Dis Colon Rectum 31 676–8 Occurrence Handle1:STN:280:BiaD3cvktFA%3D Occurrence Handle3168676

    CAS  PubMed  Google Scholar 

  34. WR Schouten DD Zimmerman JW Briel (1999) ArticleTitleTransanal advancement flap repair of transsphincteric fistulas Dis Colon Rectum 42 1419–23 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyjtw%3D%3D Occurrence Handle10566529

    CAS  PubMed  Google Scholar 

  35. H Ortiz J Marzo (2000) ArticleTitleEndorectal flap advancement repair and fistulectomy for high trans-sphincteric and supra-sphincteric fistulas Br J Surg 87 1680–3 Occurrence Handle1:STN:280:DC%2BD3M%2FnvFeruw%3D%3D Occurrence Handle11122184

    CAS  PubMed  Google Scholar 

  36. UM Gustafsson W Graf (2002) ArticleTitleExcision of anal fistula with closure of the internal opening: functional and manometric results Dis Colon Rectum 45 1672–8 Occurrence Handle12473893

    PubMed  Google Scholar 

  37. ME Kreis EC Jehle M Ohlemann HD Becker MJ Starlinger (1998) ArticleTitleFunctional results after transanal rectal advancement flap repair of trans-sphincteric fistula Br J Surg 85 240–2 Occurrence Handle1:STN:280:DyaK1c7mt1CntQ%3D%3D Occurrence Handle9501825

    CAS  PubMed  Google Scholar 

  38. J Garcia-Aguilar CS Davey CT Le AC Lowry DA Rothenberger (2000) ArticleTitlePatient satisfaction after surgical treatment for fistula-in-ano Dis Colon Rectum 43 1206–12 Occurrence Handle1:STN:280:DC%2BD3cvltVGjsg%3D%3D Occurrence Handle11005484

    CAS  PubMed  Google Scholar 

  39. JG Williams CA MacLeod DA Rothenberger SM Goldberg (1991) ArticleTitleSeton treatment of high anal fistulae Br J Surg 78 1159–61 Occurrence Handle1:STN:280:By2D28bltlU%3D Occurrence Handle1958973

    CAS  PubMed  Google Scholar 

  40. J Garcia-Aguilar C Belmonte DW Wong SM Goldberg RD Madoff (1998) ArticleTitleCutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula Br J Surg 85 243–5 Occurrence Handle1:STN:280:DyaK1c7mt1Cnug%3D%3D Occurrence Handle9501826

    CAS  PubMed  Google Scholar 

  41. RK Pearl JR Andrews CP Orsay et al. (1993) ArticleTitleRole of the seton in the management of anorectal fistulas Dis Colon Rectum 36 573–9 Occurrence Handle1:STN:280:ByyB2s3mtFw%3D Occurrence Handle8500375

    CAS  PubMed  Google Scholar 

  42. WH Isbister N Sanea ParticleAl (2001) ArticleTitleThe cutting seton: an experience at King Faisal Specialist Hospital Dis Colon Rectum 44 722–7 Occurrence Handle1:STN:280:DC%2BD3M3msVehuw%3D%3D Occurrence Handle11357036

    CAS  PubMed  Google Scholar 

  43. A Dziki M Bartos (1998) ArticleTitleSeton treatment of anal fistula: experience with a new modification Eur J Surg 164 543–8 Occurrence Handle1:STN:280:DyaK1czmt1ejtg%3D%3D Occurrence Handle9696978

    CAS  PubMed  Google Scholar 

  44. KP Hamalainen AP Sainio (1997) ArticleTitleCutting seton for anal fistulas: high risk of minor control defects Dis Colon Rectum 40 1443–7 Occurrence Handle1:STN:280:DyaK1c%2FmvFyksA%3D%3D Occurrence Handle9407983

    CAS  PubMed  Google Scholar 

  45. WF Tets ParticleVan JH Kuijpers (1995) ArticleTitleSeton treatment of perianal fistula with high anal or rectal opening Br J Surg 82 895–7 Occurrence Handle7648099

    PubMed  Google Scholar 

  46. HJ Scott JM Northover (1996) ArticleTitleEvaluation of surgery for perianal Crohn’s fistulas Dis Colon Rectum 39 1039–43 Occurrence Handle1:STN:280:BymA1M%2FmvVc%3D Occurrence Handle8797656

    CAS  PubMed  Google Scholar 

  47. SJ McClane JL Rombeau (2001) ArticleTitleAnorectal Crohn’s disease Surg Clin North Am 81 169–83 Occurrence Handle1:STN:280:DC%2BD3M7jsFGmug%3D%3D Occurrence Handle11218163

    CAS  PubMed  Google Scholar 

  48. JL Faucheron O Saint-Marc L Guibert R Parc (1996) ArticleTitleLong-term seton drainage for high anal fistulas in Crohn’s disease–a sphincter-saving operation? Dis Colon Rectum 39 208–11 Occurrence Handle1:STN:280:BymB38zntlE%3D Occurrence Handle8620789

    CAS  PubMed  Google Scholar 

  49. F Michelassi M Melis M Rubin RD Hurst (2000) ArticleTitleSurgical treatment of anorectal complications in Crohn’s disease Surgery 128 597–603 Occurrence Handle1:STN:280:DC%2BD3M%2Fhsl2ntw%3D%3D Occurrence Handle11015093

    CAS  PubMed  Google Scholar 

  50. YP Sangwan DJ Schoetz SuffixJr JJ Murray PL Roberts JA Coller (1996) ArticleTitlePerianal Crohn’s disease: results of local surgical treatment Dis Colon Rectum 39 529–35 Occurrence Handle1:STN:280:BymB3czmvVU%3D Occurrence Handle8620803

    CAS  PubMed  Google Scholar 

  51. JG Williams DA Rothenberger FD Nemer SM Goldberg (1991) ArticleTitleFistula-in-ano in Crohn’s disease: results of aggressive surgical treatment Dis Colon Rectum 34 378–84 Occurrence Handle1:STN:280:By6B3Mrps1U%3D Occurrence Handle2022142

    CAS  PubMed  Google Scholar 

  52. RD Fry EI Shemesh IJ Kodner A Timmcke (1989) ArticleTitleTechniques and results in the management of anal and perianal Crohn’s disease Surg Gynecol Obstet 168 42–8 Occurrence Handle1:STN:280:BiaD2szgtFE%3D Occurrence Handle2909131

    CAS  PubMed  Google Scholar 

  53. RA White TE Eisenstat RJ Rubin EP Salvati (1990) ArticleTitleSeton management of complex anorectal fistulas in patients with Crohn’s disease Dis Colon Rectum 33 587–9 Occurrence Handle1:STN:280:By%2BB1MfntlE%3D Occurrence Handle1694476

    CAS  PubMed  Google Scholar 

  54. DH Levien J Surrell WP Mazier (1989) ArticleTitleSurgical treatment of anorectal fistula in patients with Crohn’s disease Surg Gynecol Obstet 169 133–6 Occurrence Handle1:STN:280:BiaA3s3mtFE%3D Occurrence Handle2756461

    CAS  PubMed  Google Scholar 

  55. CG Marks JK Ritchie HE Lockhart-Mummery (1981) ArticleTitleAnal fistulas in Crohn’s disease Br J Surg 68 525–7 Occurrence Handle1:STN:280:Bi2D3c7ivFY%3D Occurrence Handle7272665

    CAS  PubMed  Google Scholar 

  56. N Sohn BI Korelitz MA Weinstein (1980) ArticleTitleAnorectal Crohn’s disease: definitive surgery for fistulas and recurrent abscesses Am J Surg 139 394–7 Occurrence Handle1:STN:280:Bi%2BC2M7js1Y%3D Occurrence Handle7362011

    CAS  PubMed  Google Scholar 

  57. LM Dongen Particlevan EJ Lubbers (1986) ArticleTitlePerianal fistulas in patients with Crohn’s disease Arch Surg 121 1187–90 Occurrence Handle3767650

    PubMed  Google Scholar 

  58. Y Takesue H Ohge T Yokoyama Y Murakami Y Imamura T Sueda (2002) ArticleTitleLong-term results of seton drainage on complex anal fistulae in patients with Crohn’s disease J Gastroenterol 37 912–5 Occurrence Handle12483246

    PubMed  Google Scholar 

  59. F Makowiec EC Jehle HD Becker M Starlinger (1995) ArticleTitleClinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease Br J Surg 82 603–6 Occurrence Handle1:STN:280:ByqA3sfms1A%3D Occurrence Handle7613925

    CAS  PubMed  Google Scholar 

  60. IT Jones VW Fazio DG Jagelman (1987) ArticleTitleThe use of transanal rectal advancement flaps in the management of fistulas involving the anorectum Dis Colon Rectum 30 919–23 Occurrence Handle1:STN:280:BieD1c7psFE%3D Occurrence Handle3691261

    CAS  PubMed  Google Scholar 

  61. TL Hull VW Fazio (1997) ArticleTitleSurgical approaches to low anovaginal fistula in Crohn’s disease Am J Surg 173 95–8 Occurrence Handle1:STN:280:ByiB38fivFc%3D Occurrence Handle9074371

    CAS  PubMed  Google Scholar 

  62. JS Joo EG Weiss JJ Nogueras SD Wexner (1998) ArticleTitleEndorectal advancement flap in perianal Crohn’s disease Am Surg 64 147–50 Occurrence Handle1:STN:280:DyaK1c7ks1ejug%3D%3D Occurrence Handle9486887

    CAS  PubMed  Google Scholar 

  63. N Hyman (1999) ArticleTitleEndoanal advancement flap repair for complex anorectal fistulas Am J Surg 178 337–40 Occurrence Handle1:STN:280:DC%2BD3c%2Flt1Ckug%3D%3D Occurrence Handle10587195

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. The American Society of Colon and Rectal Surgeons

    Mark H. Whiteford M.D., John Kilkenny III M.D., Neil Hyman M.D., W. Donald Buie M.D., Jeffrey Cohen M.D., Charles Orsay M.D., Gary Dunn M.D., W. Brian Perry M.D., C. Neal Ellis M.D., Jan Rakinic M.D., Sharon Gregorcyk M.D., Paul Shellito M.D., Richard Nelson M.D., Joe J. Tjandra M.D. & Graham Newstead M.D.

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  1. Mark H. Whiteford M.D.
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  2. John Kilkenny III M.D.
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  3. Neil Hyman M.D.
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  4. W. Donald Buie M.D.
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  5. Jeffrey Cohen M.D.
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  6. Charles Orsay M.D.
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  7. Gary Dunn M.D.
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  8. W. Brian Perry M.D.
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  9. C. Neal Ellis M.D.
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  11. Sharon Gregorcyk M.D.
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Prepared by The Standards Practice Task Force

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Correspondence to Neil Hyman M.D..

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Prepared by The Standards Practice Task Force ., Whiteford, M., Kilkenny, J. et al. Practice Parameters for the Treatment of Perianal Abscess and Fistula-in-Ano  (Revised). Dis Colon Rectum 48, 1337–1342 (2005). https://doi.org/10.1007/s10350-005-0055-3

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  • DOI: https://doi.org/10.1007/s10350-005-0055-3

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