PMID- 34057576
OWN - NLM
STAT- MEDLINE
DCOM- 20210910
LR  - 20210910
IS  - 1432-1262 (Electronic)
IS  - 0179-1958 (Linking)
VI  - 36
IP  - 10
DP  - 2021 Oct
TI  - Surgery for anal fistulae: state of the art.
PG  - 2071-2079
LID - 10.1007/s00384-021-03917-7 [doi]
AB  - BACKGROUND AND AIM: Anal fistulae (AF) are considered a challenge for colorectal 
      surgeons, as they recur if not properly operated. Being a septic disease, they 
      are correlated with immunodeficiency and surgery may be followed by anal 
      incontinence (AI). The aim of this paper is to suggest a state-of-the-art 
      treatment of AF. METHODS: Pathogenesis, classification, diagnostic tools, 
      intraoperative assessment, and surgeries proposed for AF have been reviewed, 
      together with the results following conventional surgery and innovations aimed at 
      sphincters' preservation. RESULTS: Stress causes immunodepression and favors anal 
      sepsis, and heavy smoking facilitates AF recurrences. Evacuation fistulography, 
      MRI, and transanal ultrasound may help the diagnosis. Fistulotomy allows high 
      cure rate, up to 96.4%, but may cause up to 64% of AI in transsphincteric AF. 
      Fistulectomy with rectal advancement flap is effective in 80% of these cases and 
      avoids AI. Other options are either suturing of AF internal orifice or 
      positioning a cutting seton. Ligation of intersphincteric fistula track (LIFT) is 
      a costless alternative carrying a success of 57-99% with 0-23% AI. Costly 
      innovations, i.e., autologous stem cells, porcine derma sheet (Permacol), 
      video-assisted fistula excision (VAAFT), porcine matrix (PLUG), and laser closure 
      (FiLaC), minimize AI, but may carry AF recurrence. Their grades of recommendation 
      range between 2B and 2C in the Guidelines of the Italian Society of Colorectal 
      Surgery. CONCLUSION: Postoperative incontinence in transsphincteric AF may be 
      minimized by both costless and costly sphincter-saving procedures, the latter 
      carrying higher recurrence rate. The success of surgery may be increased by a 
      different lifestyle.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Pescatori, Mario
AU  - Pescatori M
AD  - Coloproctology Units of Parioli and Cobellis Clinics, Rome and Vallo della 
      Lucania, Italy. ucpclub@virgilio.it.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210531
PL  - Germany
TA  - Int J Colorectal Dis
JT  - International journal of colorectal disease
JID - 8607899
SB  - IM
MH  - Anal Canal
MH  - Animals
MH  - *Fecal Incontinence
MH  - Humans
MH  - Ligation
MH  - *Rectal Fistula/surgery
MH  - Swine
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anal fistulae
OT  - Anal incontinence
OT  - Fistulectomy
OT  - Fistulotomy
OT  - Innovations
EDAT- 2021/06/01 06:00
MHDA- 2021/09/11 06:00
CRDT- 2021/05/31 12:54
PHST- 2021/03/24 00:00 [accepted]
PHST- 2021/06/01 06:00 [pubmed]
PHST- 2021/09/11 06:00 [medline]
PHST- 2021/05/31 12:54 [entrez]
AID - 10.1007/s00384-021-03917-7 [pii]
AID - 10.1007/s00384-021-03917-7 [doi]
PST - ppublish
SO  - Int J Colorectal Dis. 2021 Oct;36(10):2071-2079. doi: 10.1007/s00384-021-03917-7. 
      Epub 2021 May 31.