Abstract
In a five year period 227 patients with anal abscesses and/or fistulas of suspected cryptoglandular origin were observed and treated by one surgeon. In 201 patients the primary opening or the crypt of origin of the abscesses and/or fistulas were identified. These lesions were evaluated according to two classifications [1, 2]. The aim was to verify whether primary abscesses and/or fistulas may spontaneously loop all the external sphincters and the puborectalis muscle as reported by Parks et al. [1] or whether the formation of tracks which loop all the striated sphincteric complex (Parks' supra- and extrasphincteric fistulas) derives exclusively by the incorrect treatment of more superficial lesions, as suggested by Eisenhammer. Not one of the primary suppurative lesions (acute or chronic) looped the striated sphincteric complex (external sphincter-puborectalis muscle). Supra-and extrasphincteric tracks were observed only in the lesions which recurred after previous surgical treatment. The one-stage treatment of primary abscesses and fistulas (fistulotomy drainage or one-stage lay-open) with a few exceptions is a definitive (2% recurrence rate) and safe (4% prolonged impairment of continence rate) procedure.
Résumé
Durant une période de 5 ans 227 malades ayant un abcés et/ou une fistule d'origine crypto-glandulaire suspectée ont été observés et traités par un chirurgien. Chez 201 malades, l'orifice primaire ou la crypte d'origine de l'abcés et/ou de la fistule furent identifiés. Les lésions ont été évaluées selon deux classifications [1, 2]. Le but fût de vérifier si un abcés primaire et/ou une fistule peut spontanément avoir un siège suprasphinctérien comme rapporté par Parks et coll. [1] ou si la formation de trajet supra ou extra-sphinctérien provient uniquement d'un traitement incorrect de lésions plus superficielles comme cela est suggéré par Eisenhammer. Aucune des lésions suppurées primaires (aiguës ou chroniques) n'encerclait le complexe musculaire sphinctérien strié (sphincter externe et muscle pubo-rectal). Des fistules supra et extra-sphinctériennes fûrent observées uniquement au cours de lésions qui récidivaient après un premier traitement chirurgical. Le traitement en un temps des abcés et des fistules primaires (fistulotomie-drainage et mise à plat en un temps) est, à peu d'exception près, définitif (2% de récurrence) et sûr (4% de défaut prolongé de la continence).
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References
Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula in ano. Br J Surg 63:1–12
Eisenhammer S (1978) The final evaluation and classification of surgical treatment of the primary anorectal cryptoglandular intermuscular (intersphincteric) fistulous abscess and fistula. Dis Col Rect 21:237–254
McElwain JW, Alexander RM, Maclean MD (1966) Primary fistulectomy for anorectal abscess: clinical study of 500 cases. Dis Col Rect 9:181–185
Waggener HU (1969) Immediate fistulotomy in the treatment of perianal abscess. Surg Clin North Am 49:1227–1233
Lockhart-Mummery JP (1975) Treatment of abscess. In: Symposium on anorectal problems. Dis Col Rect 18:650–651
Gabriel WB (1963) Principles and practice of rectal surgery, 5 edn. Charles C Thomas, Springfield, III.
Bennet RC (1962) A review of the result of orthodox treatment for anal fistulae. Proc R Soc Med 55:756
Hill JR (1967) Fistulas and fistulous abscess in the anorectal region: personal experience in management. Dis Col Rect 10:421
Prasad ML, Read DR, Abcarian H (1981) Supralevator abscess. Dis Col Rect 24:456–461
Parks AG, Stitz RW (1976) The treatment of high fistula in ano. Dis Col Rect 19:487–499
Scoma JA, Salvati EP, Rubin RJ (1974) Incidence of fistulas subsequent to anal abscesses. Dis Col Rect 17:357–359
Hanley PH (1978) Anorectal abscess fistula. Surg Clin North Am 58:487–503
Hanley PH (1978) Rubber band seton in the management of abscess-anal fistula. Ann Surg 187:435–437
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Fucini, C. One stage treatment of anal abscesses and fistulas. Int J Colorect Dis 6, 12–16 (1991). https://doi.org/10.1007/BF00703954
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DOI: https://doi.org/10.1007/BF00703954