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Why do we have so much trouble treating anal fistula?

World Journal of Gastroenterology 2011年第28期17卷 3292-3296页

作者： Haig Dudukgian Herand Abcarian Department of Colorectal Surgery John Stroger Hospital of Cook County Department of Surgery University of Illinois Chicago

Anal fistula is among the most common illnesses affecting *** literature dating back to 400 BC has discussed this *** causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (***,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal *** tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most *** 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 *** an attempt to preserve continence,various procedures have been proposed to deal with the *** 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 (***’s disease),a proximal fecal diversion offers a measure of symptom-atic *** fact remains that an "ideal" procedure for anal fistula remains *** failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple *** 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 ***,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a ***,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

关键词： fistula Abscess Fibrin sealant Anal fistula plug Dermal advancement flap Endorectal flap ligation of intersphincteric fistula tract procedure

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