2005, Number 3
PDF size: 42.03 Kb.
ABSTRACTIntroduction: The anal abscess and the fistula are considered evolutionary stages of the same illness. In this work the evolution of the abscesses is revised. They are treated with a simple drainage to determine if they develop fistula. Patient and methods: An observational and retrospective study of 147 cases of anal abscesses in a 15 year period (March 89 to February 2004). The patients were treated with simple drainage and local anesthesia. The follow-up average was 4.5 years. Results: 92 cases were superficial abscesses, 35 isquioanals and 20 intersphincterians. All patients subjected to drainage to solve the abscess had recurrence and developed fistula 135 patients (91.8%), of which 84.3% were presented before the 2 years. Twelve patients did not suffer another abscess with a follow-up of 1 and 15 years. The fistula developed from these abscesses were treated in one or two stages. Among these operated, 2 recurrences of fistula occurred (1.5%), and 14 patients presented minor continence disturbances (10.3%). Conclusions: Most of the abscesses develop anal fistula before 2 years after the first crisis. The fistula variety corresponds to the localization of the abscesses.
Hermann G, Desfosses L. Sur la muqueuse de la region clocale du rectum. Comptes-rendu Hebd Acad Scienc 1880; 90: 1301-2.
Lockhart-Mummery JP. Discussion on fistula in ano. Proc R Soc Med 1929; 22: 1331.
Hill MR, Shyrock E, ReBell FG. Role of anal glands in the pathogenesis of anorectal disease. JAMA 1943; 121(10): 742-6.
Eisenhammer S. The internal anal sphincter and the anorectal abscess. Surg Gynec & Obst 1956; 103: 501-6.
Parks AG. Pathogenesis and treatment of fistula in ano. Br Med J 1961; 1: 463-9.
Arnous J, Denis J, du Puy-Montbrun T. Les suppurations anales et périanales (à propos de 6,500 cas). Conc Med 1980; 102: 1715-9.
Denis J, Ganancia R, Puy-Montbrun T. Fistule anale. Proctologie Pratique. 1999. 4éme ed. Masson. Paris.
Goligher J, Ellis M, Pissidis AG. A critique of anal glandular infection in the etiology and treatment of idiopathic anorectal abscesses and fistula. Br J Surg 1976; 54: 977.
Vasilevski CA, Gordon PH. The incidence of recurrent abscesses or fistula in ano following anorectal suppuration. Dis Colon Rectum 1984; 27: 126-30.
Knoefel WT, Hosch SB, Hoyer B et al. Fistula detection in perianal abscess. Prevention or unnecessary trauma? Langebecks Arch Chir Suppl Kongressbd 1997; 114: 545-6.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36: 77-97.
Pérez O, Contador GJ, Azolas C y col. Abscesos anorrectales. Tratamiento y resultados. Rev Ch Cir 1984; 36: 359-63.
McElwain JW, Amaclean MD, Alexander RM et al. Anorectal problems: Experience with primary fistulectomy for anorectal abscess. Dis Colon Rectum 1975; 18: 646.
Seow-Choen F, Leong A, Goh H. Results of a policy of selective immediate fistulotomy for primary annals abscess. Aust NZ J Surg 1993; 63: 485-9.
Schouten WR, Van Vroonhoven TJM. Treatment of anorectal abscess with or without primary fistulectomy. Dis Colon Rectum 1991; 34: 60-3.
García-Aguilar J, Davey CS, Lee CT, Lowry AC, Rothenberger DA. Patient satisfaction after surgical treatment for fistula in ano. Dis Colon Rectum 2000; 43: 1206-12.
Malouf AJ, Buchanan GN, Carapeti EA, Rao S et al. A prospective audit. Of fistula in ano at St. Mark’s Hospital. Colorectal Dis 2002; 4: 13–19.