PMID- 30683947
OWN - NLM
STAT- MEDLINE
DCOM- 20190429
LR  - 20200225
IS  - 1433-0385 (Electronic)
IS  - 0009-4722 (Linking)
VI  - 90
IP  - 4
DP  - 2019 Apr
TI  - [Quality indicators in the treatment of anal fistulas].
PG  - 270-278
LID - 10.1007/s00104-019-0794-7 [doi]
AB  - Anal fistulas are a common anorectal disease and are frequently associated with a 
      perianal abscess. The etiology is based on a cryptoglandular infection in the 
      intersphincteric space. Surgery remains the only definitive therapy. The primary 
      goal of definitive fistula surgery is healing; however, success of fistula 
      surgery is influenced by a variety of factors including the surgeon's experience, 
      type of fistula, involvement of sphincter muscles, type of surgical procedure and 
      patient-related factors. For the surgical treatment of a complex anal fistula, 
      a variety of operative procedures have been described including fistulectomy with 
      sphincterotomy, different flap procedures (e.g. mucosal flap and advancement 
      flap) and finally so-called sphincter-preserving techniques, such as LIFT 
      (ligation of intersphincteric fistula tract), VAAFT (video-assisted anal fistula 
      treatment), the use of plugs of collagen or fibrin glue sealants as well as laser 
      procedures or the clip. In the search for suitable quality indicators in anal 
      fistula surgery there is a conflict between healing and preservation of 
      continence. If potential quality indicators are identified the principles of anal 
      fistula surgery must be adhered to and the appropriate selection of patients and 
      procedures is of crucial importance to achieve high healing rates without 
      compromising continence or inducing surgical revision due to abscesses or 
      recurrence. Based on the available literature and guidelines, in the assessment 
      of quality indicators considerable differences exist with respect to patient 
      selection, etiology of anal fistulas and length of follow-up. Heterogeneity of 
      treatment protocols lead to difficulties in a definitive assessment of which 
      surgical treatment is the best option for complex anal fistulas.
FAU - Schwandner, O
AU  - Schwandner O
AD  - Abteilung fur Proktologie, Krankenhaus Barmherzige Bruder Regensburg, Prufeninger 
      Str. 86, 93049, Regensburg, Deutschland. 
      oliver.schwandner@barmherzige-regensburg.de.
LA  - ger
PT  - Journal Article
PT  - Review
TT  - Qualitatsindikatoren bei der Therapie der Analfisteln.
PL  - Germany
TA  - Chirurg
JT  - Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen
JID - 16140410R
RN  - 0 (Fibrin Tissue Adhesive)
SB  - IM
MH  - Anal Canal
MH  - *Anus Diseases/surgery
MH  - Fibrin Tissue Adhesive
MH  - Humans
MH  - Ligation
MH  - *Quality Indicators, Health Care
MH  - *Rectal Fistula/surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Continence
OT  - Fistulectomy
OT  - Healing
OT  - Quality indicator
OT  - Recurrence
EDAT- 2019/01/27 06:00
MHDA- 2019/04/30 06:00
CRDT- 2019/01/27 06:00
PHST- 2019/01/27 06:00 [pubmed]
PHST- 2019/04/30 06:00 [medline]
PHST- 2019/01/27 06:00 [entrez]
AID - 10.1007/s00104-019-0794-7 [pii]
AID - 10.1007/s00104-019-0794-7 [doi]
PST - ppublish
SO  - Chirurg. 2019 Apr;90(4):270-278. doi: 10.1007/s00104-019-0794-7.