Tesis

Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state...

The Practice Parameters for the Management of Perianal Abscess and Fistula-in-ano from USA(2011) and German guidelines for anal abscess (2012) are based on the evidence and specialists consensus from colorectal field. Standardization of the anal abscess management may simplify the anal fistula treatment. This review is to concepts from other countries and guide the treatment in China.

Perianal fistula is a very unpleasant condition. It is also quite difficult to be solved without recurrence or with complete preservation of sphincter function. This paper summarizes the etiology, classification of fistulas along with the long-term surgical experiences in the approach and the treatment of this condition.

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INTRODUCTION: Management of fistula-in-ano requires understanding of both perianal and rectal anatomy, as well as the surgical approaches available to ensure the highest possible postoperative continence and wound healing. Further, high rates of recurrence with medical management commonly bring these patients under the care of the colorectal surgeon after variable periods of failed conservative management. Novel techniques provide surgeons with tools to treat increasingly complex fistulas with a focus on maintaining sphincteric functionality and limiting recurrence...

BACKGROUND: Imaging modalities such as endoanal ultrasound or MRI can be useful preoperative adjuncts before the appropriate surgical intervention for perianal fistulas. OBJECTIVES: We present a systematic review of published literature comparing endoanal ultrasound with MRI for the assessment of idiopathic and Crohn's perianal fistulas. DESIGN: A meta-analysis was performed to obtain pooled values for specificity and sensitivity. SETTINGS: Electronic databases were searched from January 1970 to October 2010 for published studies...

OBJECTIVE: To evaluate the long-term clinical and manometric results of fistulotomy and sphincter reconstruction for the treatment of complex fistula-in-ano. BACKGROUND: Complex fistula-in-ano is difficult to treat due to the occurrence of postoperative anal incontinence and the high rate of recurrence. METHODS: Seventy patients who were diagnosed with complex fistula-in-ano and underwent fistulotomy and sphincter reconstruction between October 2000 and October 2006 were analyzed in the present study...

PURPOSE: To quantify the longitudinal division of the internal anal sphincter (IAS) and external anal sphincter (EAS) after fistulotomy using three-dimensional endoanal ultrasound (3D-EAUS) and correlate the results with postoperative faecal incontinence. METHODS: A prospective, consecutive study was performed from December 2008 to October 2010. All patients underwent 3D-EAUS before and 8 weeks after surgery. Thirty-six patients with simple perianal fistula were included...

BACKGROUND: Fistula-in-ano is a common medical problem affecting thousands of patients annually. In the past, the options for treatment of fistula-in-ano were limited to fistulotomy and/or seton placement. Current treatment options also include muscle-sparing techniques such as a dermal island flap, endorectal advancement flap, fibrin sealent injection, anal fistula plug, and most recently ligation of the intersphincteric fistula tract (procedure). This study seeks to evaluate types and time trends for treatment of fistula-in-ano...

BACKGROUND: Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair. METHODS: A retrospective review of all complex anal fistulas treated by either a RMAF or a FP at Auckland City Hospital from 2004 to 2008. Comparisons were made in terms of successful healing rates, time to failure and the use of magnetic resonance imaging...

Fistula-in-ano is a difficult problem that physicians have struggled with for centuries. Appropriate treatment is based on 3 central tenets: (1) control of sepsis; (2) closure of the fistula; and (3) maintenance of continence. Treatment options continue to evolve - as a result, it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options. This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures...

Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insiduously in a chronic manner. Management includes control of infection, assessment of the fistulous track in relation to the anal sphincter muscle, and finally, definitive treatment of the fistula. Fistulotomy was the most commonly used mode of management, but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps, fibrin glue, collagen fistula plug, ligation of the intersphincteric fistula track, and stem cells...

Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial...

BACKGROUND: Surgery for anal fistula is often associated with continence disorders due to the transection of sphincter muscles. Extensive knowledge of anal canal anatomy and anal fistula can help prevent this outcome. OBJECTIVE: This study aimed to correlate the anatomical conformation of the anal canal, the fistula track, and the internal opening according to sex and hemicircumference (anterior vs posterior) by use of 3-dimensional ultrasonography. METHODS: One hundred sixty-five patients with fistula were evaluated with 3-dimensional ultrasound and grouped according to sex, fistula type, internal opening, and track position...

The management of anorectal abscess and anal fistula has changed markedly with time. Invasive methods with high resulting rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity. There has been an increase in reports in the medical literature describing the success rates of the varying methods of dealing with this condition. This article reviews the various methods of treatment and evidence supporting their use and explores advances that may lead to new therapies...

PURPOSE: The purpose of this study was to assess the influence of identification of the location of the internal opening of anal fistula on the recurrence rate after surgical treatment in patients with primary transsphincteric anal fistulas. The influence of preoperative rectal ultrasound on the treatment results was studied. METHODS: One hundred thirty-one patients operated in the period February 1992 to July 2005 were analyzed. Endorectal ultrasound (ERUS) was not performed (till February 2004) on 103 out of the 131 patients, while the other 28 received ERUS (from March 2004)...

AIM: To evaluate the effectiveness of three-dimensional endoanal ultrasound (3D-EAUS) in the assessment of anal fistulae with and without H(2)O(2) enhancement. METHODS: Sixty-one patients (37 males, aged 17-74 years) with anal fistulae, which were not simple low types, were evaluated by physical examination and 3D-EAUS with and without enhancement. Fistula classification was determined with each modality and compared to operative findings as the reference standard...

Perianal fistulas, cryptoglandular or Crohn's disease-related, have a tendency to recur. Recurrence usually is owing to missed infection during surgery for cryptoglandular fistulas or insufficient response to medical treatment in Crohn's disease. It is now recognized that preoperative imaging (endoanal ultrasound and magnetic resonance imaging) can help to identify extensions that otherwise would be missed during surgery and therefore prevent recurrence. For medical therapy, the extent of the disease and the presence of abscesses are identified with imaging and therapy response can be monitored...

Endoanal ultrasound is a well-established technique used to evaluate benign anorectal disorders. The technique is easy to perform, has a short learning curve and causes very little discomfort. Reconstruction of 3D images is possible. The clinical indications for endoanal ultrasound in benign anorectal diseases are fecal incontinence and peri-anal fistula. Sphincter defects can be depicted with precision and correlate perfectly with surgical findings. Furthermore, an impression of sphincter atrophy can be established...

BACKGROUND: Several techniques have been described for the management of fistula-in-ano, but all carry their own risks of recurrence and incontinence. Technology has evolved over the past 2 decades that may enable surgeons to deal with this troublesome issue with greater success. This review summarizes the history of fistula-in-ano management, the current techniques available, and describes new technologies. METHODS: Medline searches were performed using the PubMed, Ovid, Embase, Cochrane, and Google Scholar databases to identify articles reporting on fistula-in-ano management using surgery alone, fibrin glues, and fistula plugs...