PMID- 21876616
OWN - NLM
STAT- MEDLINE
DCOM- 20111206
LR  - 20211020
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 17
IP  - 28
DP  - 2011 Jul 28
TI  - Why do we have so much trouble treating anal fistula?
PG  - 3292-6
LID - 10.3748/wjg.v17.i28.3292 [doi]
AB  - Anal fistula is among the most common illnesses affecting man. Medical literature 
      dating back to 400 BC has discussed this problem. Various causative factors have 
      been proposed throughout the centuries, but it appears that the majority of 
      fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn's disease) result 
      from infection (abscess) in anal glands extending from the intersphincteric plane 
      to various anorectal spaces. The tubular structure of an anal fistula easily 
      yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) 
      in most cases. The problem with this single, yet effective, treatment plan is 
      that depending on the thickness of sphincter muscle the fistula transgresses, the 
      patient will have varying degrees of fecal incontinence from minor to total. In 
      an attempt to preserve continence, various procedures have been proposed to deal 
      with the fistulas. These include: (1) simple drainage (Seton); (2) closure of 
      fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary 
      opening using endorectal or dermal flaps, and more recently; and (4) ligation of 
      intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's 
      disease), a proximal fecal diversion offers a measure of symptomatic relief. The 
      fact remains that an "ideal" procedure for anal fistula remains elusive. The 
      failure of each sphincter-preserving procedure (30%-50% recurrence) often results 
      in multiple operations. In essence, the price of preservation of continence at 
      all cost is multiple and often different operations, prolonged disability and 
      disappointment for the patient and the surgeon. Nevertheless, the surgeon 
      treating anal fistulas on an occasional basis should never hesitate in referring 
      the patient to a specialist. Conversely, an expert colorectal surgeon must be 
      familiar with many different operations in order to selectively tailor an 
      operation to the individual patient.
FAU - Dudukgian, Haig
AU  - Dudukgian H
AD  - Department of Colorectal Surgery, John Stroger Hospital of Cook County, IL 60612, 
      USA.
FAU - Abcarian, Herand
AU  - Abcarian H
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
RN  - 0 (Fibrin Tissue Adhesive)
SB  - IM
MH  - Fibrin Tissue Adhesive/therapeutic use
MH  - Humans
MH  - Ligation
MH  - Rectal Fistula/pathology/*surgery
MH  - Surgical Flaps
MH  - Treatment Outcome
PMC - PMC3160532
OTO - NOTNLM
OT  - Abscess
OT  - Anal fistula plug
OT  - Dermal advancement flap
OT  - Endorectal flap
OT  - Fibrin sealant
OT  - Fistula
OT  - Ligation of intersphincteric fistula tract procedure
EDAT- 2011/08/31 06:00
MHDA- 2011/12/13 00:00
PMCR- 2011/07/28
CRDT- 2011/08/31 06:00
PHST- 2010/09/13 00:00 [received]
PHST- 2011/02/15 00:00 [revised]
PHST- 2011/02/22 00:00 [accepted]
PHST- 2011/08/31 06:00 [entrez]
PHST- 2011/08/31 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
PHST- 2011/07/28 00:00 [pmc-release]
AID - 10.3748/wjg.v17.i28.3292 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2011 Jul 28;17(28):3292-6. doi: 10.3748/wjg.v17.i28.3292.