Perianal Fistül Hastalığının Tanı ve Tedavisi
Özet
Perianal fistül hastalığı perineal bölgede sık görülen bir hastalıktır. Genellikle perineal apse sonrası oluşur. Basit/düşük veya kompleks/yüksek diye ikiye ayrılır. Basit/düşük olan perianal fistül hastalığının tedavisi diğerine göre daha kolaydır. Aynı zamanda postoperatif komplikasyon oranları daha düşüktür. Hastalığın tedavisi yapılabilmekte fakat postoperatif inkontinans cerrahların canını sıkabilmektedir. Tedavide postoperatif inkontinansı göz önüne alarak tedavi seçimi yapılmalıdır. Postoperatif inkontinans olmaması için yıllardır birçok teknik geliştirilmiştir. Yine de geliştirilmeye çalışılmaktadır. Tedavi sürecinde uygulanan yöntem seçiminde perianal fistül hastalığın ne tip olduğu, hastanın maliyet durumu, yaşı, cinsiyeti ve kadında doğurganlık gibi faktörlerin dikkate alındığı bir süreç yaşanmaktadır. Ayrıca bazen nüks olması nedeniyle birkaç kez hasta opere edilebilmektedir. Bu yüzden perianal fistül hastalığı cerrahların çok istekle yanaşmadığı bir hastalıktır. Ama eskiye kıyasla günümüzde yeni gelişen yöntemler sayesinde postoperatif ağrı ve inkontinansın oranı azalmıştır.
Perianal fistula disease is a common disease in the perineal region. It usually occurs after a perineal abscess. It is divided into two as simple/low or complex/high. Simple/low perianal fistula disease is easier to treat than the other. Postoperative complication rates are also lower. The disease can be treated, but postoperative incontinence can be a problem for surgeons. Treatment should be chosen by taking postoperative incontinence into consideration. Many techniques have been developed for years to prevent postoperative incontinence. In the selection of the method applied in the treatment process, there is a process in which factors such as the type of perianal fistula disease, the patient's cost status, age, gender and fertility in women are taken into consideration. In addition, the patient may be operated on several times due to recurrence of the disease. Therefore, perianal fistula disease is a disease that surgeons are not very willing to treat. However, compared to the past, the rate of postoperative pain and incontinence has decreased thanks to new methods.
Referanslar
Włodarczyk M, Włodarczyk J, Sobolewska-Włodarczyk A et al. Current concepts in the pathogenesis of cryptoglandular perianal fistula. Journal of International Medical Research. 2021;49(2). doi:10.1177/0300060520986669
Wang D, Yang G, Qiu J. et al. Risk factors for anal fistula: a case-control study. Tech Coloproctol. 2014;18(7):635-9. doi: 10.1007/s10151-013-1111-y.
Aho Fält U, Zawadzki A, Starck M, et al. Long-term outcome of the Surgisis® (Biodesign® ) anal fistula plug for complex cryptoglandular and Crohn's fistulas. Colorectal Dis. 2021;23(1):178-185. doi: 10.1111/codi.15429.
Sainio P. Fistula in ano in a defined population: Incidence and epidemiology of patients. Ann Chir Gynaecol.1984; 73: 219–224.
Zanotti C, Martinez-Puente C, Pascual et al. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Color Dis. 2007; 22: 1459–62.
Hammond TM, Lunniss PJ. Operative Surgery of the Colon, Rectum and Anus.( Issue 1). CRC Press, Taylor & Francis Group, 6000 Broken Sound Parkway NW, Suite 300, Boca Raton (2016).
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.
Steele SR, Kumar R, Feingold DL. et al. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465-74. doi: 10.1097/DCR.0b013e31823122b3.
Siddiqui MR, Ashrafian H, Tozer P. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012; 55: 576–85.
Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000; 20: 623–35.
Buchanan G, Halligan S, Williams A. et al. Effect ofMRI on clinical outcome of recurrent fistula-in-ano. Lancet 2002; 360: 1661–2.
Liang C, Lu Y, Zhao B. et al. Imaging of anal fistulas: Comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol. 2014;15: 712–23.
West RL, Zimmerman DD, Dwarkasing S. et al. Prospective comparison of hydrogen peroxideenhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum. 2003; 46: 1407–15.
Toyonaga T, Matsushima M, Kiriu T et al. Factors affecting continence after fistulotomy for intersphincteric fistula-inano. Int J Colorectal Dis. 2007; 22: 1071–5.
Bokhari S, Lindsey I. Incontinence following sphincter division for treatment of anal fistula. Colorectal Dis. 2010; 12: 135–9.
Garcés-Albir M, García-Botello SA, Esclapez-Valero P. et al. Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis. 2012; 27: 1109–16.
Parkash S, Lakshmiratan V, Gajendran V. Fistula-in-ano: Treatment by fistulectomy,primary closure and reconstitution. Aust NZJ Surg. 1985; 55: 23–7.
Ratto C, Litta F, Donisi L. et al. Fistulotomy or fistulectomy and primarysphincteroplasty for anal fistula (FIPS): A systemic review. Tech Coloproctol. 2015; 19: 391–400.
Visscher AP, Schuur D, Roos R, et al. Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: Fecal incontinence and impact on quality of life. Dis Colon Rectum. 2015; 58: 533–9.
Schouten WR. Surgery of the Anus, Rectum and Colon. ( Volume 1). CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton ( 2019 ).
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009; 11: 564–71.
Matos D, Lunniss PJ, Phillips RK. Total sphincter conservation in high fistula in ano: Results of a new approach. Br J Surg. 1993; 80: 802–4.
Rojanasakul A, Pattanaarun J, Sahakitrungruang C. et al. Total anal sphincter saving technique for fistula-in-ano: The ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007; 90: 581–6.
Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006; 49: 371–6.
Köckerling F, Alam NN, Narang SK. et al. Treatment of fistulain- ano with fistula plug: A review with special consideration of the technique. Frontiers in Surgery 2015; 2:55.
Narang SK, Jones C, Alam NN. et al. Delayed absorbable synthetic plug (GORE® BIO-A®) for the treatment of fistula-in-ano: A systematic review. Colorectal Dis. 2016; 18: 37–44.
Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015; 21: 12–20.
Meinero P, Mori L, Gasloli G. Videoassisted anal fistula treatment: A new concept of treating anal fistulas. Dis Colon Rectum. 2014; 57: 354–9.
Herreros MD, Garcia-Arranz M, Guadalajara H, et al. Autologous expanded adiposederived stem cells for the treatment of complex cryptoglandular perianal fistulas: A phase III randomized clinical trial and long-term evaluation. Dis Colon Rectum. 2012; 55: 762–72.
Referanslar
Włodarczyk M, Włodarczyk J, Sobolewska-Włodarczyk A et al. Current concepts in the pathogenesis of cryptoglandular perianal fistula. Journal of International Medical Research. 2021;49(2). doi:10.1177/0300060520986669
Wang D, Yang G, Qiu J. et al. Risk factors for anal fistula: a case-control study. Tech Coloproctol. 2014;18(7):635-9. doi: 10.1007/s10151-013-1111-y.
Aho Fält U, Zawadzki A, Starck M, et al. Long-term outcome of the Surgisis® (Biodesign® ) anal fistula plug for complex cryptoglandular and Crohn's fistulas. Colorectal Dis. 2021;23(1):178-185. doi: 10.1111/codi.15429.
Sainio P. Fistula in ano in a defined population: Incidence and epidemiology of patients. Ann Chir Gynaecol.1984; 73: 219–224.
Zanotti C, Martinez-Puente C, Pascual et al. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Color Dis. 2007; 22: 1459–62.
Hammond TM, Lunniss PJ. Operative Surgery of the Colon, Rectum and Anus.( Issue 1). CRC Press, Taylor & Francis Group, 6000 Broken Sound Parkway NW, Suite 300, Boca Raton (2016).
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.
Steele SR, Kumar R, Feingold DL. et al. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465-74. doi: 10.1097/DCR.0b013e31823122b3.
Siddiqui MR, Ashrafian H, Tozer P. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012; 55: 576–85.
Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000; 20: 623–35.
Buchanan G, Halligan S, Williams A. et al. Effect ofMRI on clinical outcome of recurrent fistula-in-ano. Lancet 2002; 360: 1661–2.
Liang C, Lu Y, Zhao B. et al. Imaging of anal fistulas: Comparison of computed tomographic fistulography and magnetic resonance imaging. Korean J Radiol. 2014;15: 712–23.
West RL, Zimmerman DD, Dwarkasing S. et al. Prospective comparison of hydrogen peroxideenhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum. 2003; 46: 1407–15.
Toyonaga T, Matsushima M, Kiriu T et al. Factors affecting continence after fistulotomy for intersphincteric fistula-inano. Int J Colorectal Dis. 2007; 22: 1071–5.
Bokhari S, Lindsey I. Incontinence following sphincter division for treatment of anal fistula. Colorectal Dis. 2010; 12: 135–9.
Garcés-Albir M, García-Botello SA, Esclapez-Valero P. et al. Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis. 2012; 27: 1109–16.
Parkash S, Lakshmiratan V, Gajendran V. Fistula-in-ano: Treatment by fistulectomy,primary closure and reconstitution. Aust NZJ Surg. 1985; 55: 23–7.
Ratto C, Litta F, Donisi L. et al. Fistulotomy or fistulectomy and primarysphincteroplasty for anal fistula (FIPS): A systemic review. Tech Coloproctol. 2015; 19: 391–400.
Visscher AP, Schuur D, Roos R, et al. Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: Fecal incontinence and impact on quality of life. Dis Colon Rectum. 2015; 58: 533–9.
Schouten WR. Surgery of the Anus, Rectum and Colon. ( Volume 1). CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton ( 2019 ).
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009; 11: 564–71.
Matos D, Lunniss PJ, Phillips RK. Total sphincter conservation in high fistula in ano: Results of a new approach. Br J Surg. 1993; 80: 802–4.
Rojanasakul A, Pattanaarun J, Sahakitrungruang C. et al. Total anal sphincter saving technique for fistula-in-ano: The ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007; 90: 581–6.
Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006; 49: 371–6.
Köckerling F, Alam NN, Narang SK. et al. Treatment of fistulain- ano with fistula plug: A review with special consideration of the technique. Frontiers in Surgery 2015; 2:55.
Narang SK, Jones C, Alam NN. et al. Delayed absorbable synthetic plug (GORE® BIO-A®) for the treatment of fistula-in-ano: A systematic review. Colorectal Dis. 2016; 18: 37–44.
Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015; 21: 12–20.
Meinero P, Mori L, Gasloli G. Videoassisted anal fistula treatment: A new concept of treating anal fistulas. Dis Colon Rectum. 2014; 57: 354–9.
Herreros MD, Garcia-Arranz M, Guadalajara H, et al. Autologous expanded adiposederived stem cells for the treatment of complex cryptoglandular perianal fistulas: A phase III randomized clinical trial and long-term evaluation. Dis Colon Rectum. 2012; 55: 762–72.
