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Review
. 2011 Dec;25(12):675-80.
doi: 10.1155/2011/931316.

Update on anal fistulae: surgical perspectives for the gastroenterologist

Helena Tabry  1 , Paul A Farrands
Affiliations
Review

Update on anal fistulae: surgical perspectives for the gastroenterologist

Helena Tabry et al. Can J Gastroenterol. 2011 Dec.

Abstract
in English, French

Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term 'cryptoglandular' is given to abscesses arising from the anal glands.For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgical treatments include setons, fibrin glue, collagen plugs and flaps to cover the internal fistula opening. These have achieved varying degrees of success, as will be discussed. The present review also discusses anal fistulae in light of much recently published literature. Currently, anal fistulae remain challenging and require specialist expertise; however, new treatment options are on the horizon.

Les fistules anales sont courantes et débilitantes. Elles se caractérisent par une douleur marquée et des écoulements. Elles se forment après une infection à proximité du canal anal ou comme événement primaire découlant d’un abcès dans l’abdomen, qui se fistulise dans le vagin ou la peau périanale. Le terme « cryptoglandulaire » est attribué aux abcès provenant des glandes anales.

Pendant de nombreuses années, le traitement de choix consistait à ouvrir la fistule, mais s’associait à des risques d’incontinence, dont les conséquences avaient un potentiel dévastateur. Les autres traitements chirurgicaux incluent les sétons, la colle à la fibrine, les bouchons de collagène et des lambeaux pour couvrir les ouvertures fistulaires internes. On démontrera que ces traitements obtiennent un succès variable. La présente analyse traite également des fistules anales à la lumière de publications beaucoup plus récentes. Les fistules anales demeurent un défi et exigent des compétences spécialisées, mais de nouvelles possibilités thérapeutiques s’annoncent.

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Figures

Figure 1)
Figure 1)
Perianal abscesses. Image reproduced with permission of Elsevier Ltd. Images from Surgery of the Colon, Rectum and Anus, Fielding LP, Goldberg SM, eds. Oxford: Butterworth-Heinemann Ltd, 1993. Copyright Elsevier
Figure 2)
Figure 2)
Fistulae and ischiorectal abscess arising from a cryptoglandular abscess. Image reproduced with permission of Elsevier Ltd. Images from Surgery of the Colon, Rectum and Anus, Fielding LP, Goldberg SM, eds. Oxford: Butterworth-Heinemann Ltd, 1993. Copyright Elsevier
Figure 3)
Figure 3)
Fistula classification. A Low fistula not involving muscle. B Intersphincteric fistula. C Trans-sphincteric fistula. D Supersphincteric fistulae. E Extrasphincteric fistula. Image reproduced with permission from Medscape.com, 2010 (www.medscape.com/viewarticle/503224). Copyright Medscape
See this image and copyright information in PMC

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