Sisa SCG, Fretes RI, Melo AI

Language: Spanish
References: 8
Page: 52-55
PDF size: 217.80 Kb.

ABSTRACT

Introduction: anorectal fistula is abnormal communication between the anorectum and the skin, or adjacent tissues or organs. The term "intramural" refers to an intersphincteric fistula without an external orifice with a cord path generally identifiable by digital rectal examination and which originates as a consequence of an intersphincteric abscess manifested by rectal pain, fever and perineum normal on inspection. The present study seeks to analyze the incidence and results of the treatment of this condition in patients operated between 2017 and 2022 at the Hospital de Clinicas de Asunción, Paraguay. Objectives: to determine the incidence and distribution of intramural fistulas in the operated population, as well as to evaluate the effectiveness of the treatment applied. Materials and methods: a retrospective analysis of the medical records of the 133 patients operated on between 2017 and 2022 was carried out. Evaluation of treatment effectiveness was based on the rate of fistula recurrence. Results: 35% of the patients were women. Fistulas were classified according to their location as low transsphincteric (46%), intersphincteric fistulas (35%), high transsphincteric (16%) and suprasphincterics (3%). Rectal intramural fistulas accounted for 22% of the intersphincters and 8% of the total. These patients were diagnosed by clinical and endorectal ultrasound. The treatment performed in the operated cases consisted of fistulotomy, and to date, no recurrences have been reported. Conclusions: fistulotomy was shown to be an effective treatment for the management of intramural fistulas, with favorable results without recurrences. The importance of knowledge and diagnosis of this entity in the abscess stage for early and prophylactic treatment is emphasized, reducing the probability of fistula formation.

REFERENCES

1. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011; 54 (12): 1465-1474.

2. Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK. Perianal abscess. BMJ. 2017; 356: j475.

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

4. Sugrue J, Nordenstam J, Abcarian H, Bartholomew A, Schwartz JL, Mellgren A et al. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctology. 2017; 21 (6): 425-432.

5. Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB. The ASCRS Textbook of Colon and Rectal Surgery [Internet]. Springer International Publishing; 2021. Disponible en: https://books.google.com.py/books?id=IBVQEAAAQBAJ

6. Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctology. 2020; 24 (2): 127-143.

7. Zbar AP. David Henry Goodsall: reassessment of the rule. Tech Coloproctology. 2009; 13 (3): 185-188.

8. Varsamis N, Kosmidis C, Chatzimavroudis G, Sapalidis K, Efthymiadis C, Kiouti FA et al. Perianal fistulas: A review with emphasis on preoperative imaging. Adv Med Sci. 2022; 67 (1): 114-122.