PMID- 33860363
OWN - NLM
STAT- MEDLINE
DCOM- 20210521
LR  - 20210527
IS  - 1128-045X (Electronic)
IS  - 1123-6337 (Print)
IS  - 1123-6337 (Linking)
VI  - 25
IP  - 6
DP  - 2021 Jun
TI  - Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in 
      the Netherlands.
PG  - 709-719
LID - 10.1007/s10151-021-02446-3 [doi]
AB  - BACKGROUND: Management of cryptoglandular fistula-in-ano (FIA) can be 
      challenging. Despite Dutch and international guidelines determining optimal 
      therapy is still quite difficult. The aim of this study was to report current 
      practices in the management of cryptoglandular FIA among gastrointestinal 
      surgeons in the Netherlands. METHODS: Dutch surgeons and residents who are 
      treating FIA regularly were sent a survey invitation by email. The survey was 
      available online from September 19 to December 1 2019. The questionnaire 
      consisted of 28 questions concerning diagnostic and surgical techniques in the 
      treatment of intersphincteric and transsphincteric FIA. RESULTS: In total, 147 
      (43%) surgeons responded and completed the survey. Magnetic resonance imaging was 
      the preferred diagnostic imaging modality (97%) followed by the endo-anal 
      ultrasound (12%). In case of a high FIA, 86% used a non-cutting seton. Most 
      respondents removed a seton between 6 weeks and 3 months (n = 84, 58%). 
      Fistulotomy was the procedure of preference in low transsphincteric (86%) and low 
      intersphincteric FIA (92%). Mucosal advancement flap (MAF) and ligation of 
      intersphincteric fistula tract (LIFT), with 78% and 46%, respectively, were the 
      procedures that were applied most often in high transsphincteric FIA. In high 
      intersphincteric FIA 67% performed a MAF and 33% a fistulotomy. Thirty-three 
      percent of all respondents stated that they habitually closed the internal 
      fistula opening, half of them used a Z-plasty. For debridement of the fistula 
      tract the preferred method was curettage (78%). CONCLUSIONS: Dutch 
      gastrointestinal surgeons use various techniques in the management of FIA. Novel 
      promising techniques should be investigated adequately in sufficient large trials 
      to increase consensus. A core outcome measurement and a prospective international 
      database would help in comparing results. Until then, treatment should be 
      adjusted to the individual patient, governed by fistula characteristics and 
      patient choice.
FAU - Dekker, L
AU  - Dekker L
AUID- ORCID: 0000-0001-8092-7196
AD  - Department of Surgery, Amsterdam University Medical Center, Location AMC, 
      Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. l.dekker22@amsterdamumc.nl.
AD  - Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands. 
      l.dekker22@amsterdamumc.nl.
FAU - Zimmerman, D D E
AU  - Zimmerman DDE
AUID- ORCID: 0000-0002-0393-9350
AD  - Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands.
FAU - Smeenk, R M
AU  - Smeenk RM
AD  - Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.
FAU - Schouten, R
AU  - Schouten R
AD  - Department of Surgery, Flevoziekenhuis, Almere, The Netherlands.
FAU - Han-Geurts, I J M
AU  - Han-Geurts IJM
AD  - Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20210415
PL  - Italy
TA  - Tech Coloproctol
JT  - Techniques in coloproctology
JID - 9613614
SB  - IM
MH  - Anal Canal
MH  - Humans
MH  - Ligation
MH  - Netherlands
MH  - Prospective Studies
MH  - *Rectal Fistula/surgery
MH  - Recurrence
MH  - *Surgeons
MH  - Treatment Outcome
PMC - PMC8124037
OTO - NOTNLM
OT  - Anal fistula
OT  - Diagnostic
OT  - Fistula in ano
OT  - Perianal fistula
OT  - Surgical
OT  - Survey
OT  - Therapy
COIS- The authors declare that they have no conflict of interest.
EDAT- 2021/04/17 06:00
MHDA- 2021/05/22 06:00
PMCR- 2021/04/15
CRDT- 2021/04/16 06:46
PHST- 2020/08/18 00:00 [received]
PHST- 2021/04/01 00:00 [accepted]
PHST- 2021/04/17 06:00 [pubmed]
PHST- 2021/05/22 06:00 [medline]
PHST- 2021/04/16 06:46 [entrez]
PHST- 2021/04/15 00:00 [pmc-release]
AID - 10.1007/s10151-021-02446-3 [pii]
AID - 2446 [pii]
AID - 10.1007/s10151-021-02446-3 [doi]
PST - ppublish
SO  - Tech Coloproctol. 2021 Jun;25(6):709-719. doi: 10.1007/s10151-021-02446-3. Epub 
      2021 Apr 15.