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Practice Guideline
. 2011 Oct;108(42):707-13.
doi: 10.3238/arztebl.2011.0707. Epub 2011 Oct 21.

Cryptoglandular anal fistulas

Andreas Ommer  1 , Alexander Herold, Eugen Berg, Alois Fürst, Marco Sailer, Thomas Schiedeck; German Society for General and Visceral Surgery
Affiliations
Practice Guideline

Cryptoglandular anal fistulas

Andreas Ommer et al. Dtsch Arztebl Int. 2011 Oct.

Abstract

Background: Cryptoglandular anal fistula arises in 2 per 10 000 persons per year and is most common in young men. Improper treatment can result in fecal incontinence and thus in impaired quality of life.

Method: This S3 guideline is based on a systematic review of the pertinent literature.

Results: The level of evidence for treatment is low, because relevant randomized trials are scarce. Anal fistulae are classified according to the relation of the fistula channel to the sphincter. The indication for treatment is established by the clinical history and physical examination. During surgery, the fistula should be probed and/or dyed. Endo-anal ultrasonography and magnetic resonance imaging are of roughly the same diagnostic value and may be useful as additional studies for complex fistulae. Surgical treatment is with one of the following operations: laying open, seton drainage, plastic surgical reconstruction with suturing of the sphincter, and occlusion with biomaterials. Only superficial fistulae should be laid open. The risk of postoperative incontinence is directly related to the thickness of sphincter muscle that is divided. All high anal fistulae should be treated with a sphincter-saving procedure. The various plastic surgical reconstructive procedures all yield roughly the same results. Occlusion with biomaterials yields a lower cure rate.

Conclusion: This is the first German S3 guideline for the treatment of cryptoglandular anal fistula. It includes recommendations for the diagnostic evaluation and treatment of this clinical entity.

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Figures

Figure 1
Figure 1
Flow chart of literature review
Figure 2
Figure 2
Classification of anal fistulas
See this image and copyright information in PMC

References

    1. Zanotti C, Martinez-Puente C, Pascual I, et al. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis. 2007;22:1459–1462. - PubMed
    1. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219–224. - PubMed
    1. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12. - PubMed
    1. Becker A, Koltun L, Sayfan J. Simple clinical examination predicts complexity of perianal fistula. Colorectal Dis. 2006;8:601–604. - PubMed
    1. Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology. 2001;121:1064–1072. - PubMed

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