Treatment of Perianal Fistulas in Poland

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A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management.

The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice.

Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form.

Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.

1. Hamalainen KP, Sainio AP: Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum1998; 41: 1357‑61.

2. Toyonaga T, Tanaga Y, Song JF et al.: Comparison of accuracy of physical examination and endoanal ultrasonography for preoperative assessment in patients with acute and chronić anal fistula. Tech Coloproctol 2008; 12: 217‑23.

3. Buchanan GN , Halligan S, Bartram CI et al.: Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 2004; 233: 674‑81.

4. Benjelloun EB, Souiki TE , El Abkari M: Endoanalultrasound in anal fistulas. Is there any influence on postoperative outcome? Tech Coloproctol 2014; 18: 405‑06.

5. Poen AC, Felt-Bersma RJ , Eijsbouts QA et al.: Hydrogen peroxide enhanced transanal ultrasound in the assessment of fistula-in-ano. Dis Colon Rectum 1998; 41: 1147‑52.

6. Ratto C, Grillo E, Parello A: Endoanal ultrasound- guided surgery for anal fistula. Endoscopy 2005; 37: 722‑28.

7. Sudol-Szopinska I, Jakubowski W, Szczepkowski M: Contrast-enhanced endosonography for the diagnosis of anal andanovaginal fistula. J Clin Ultrasound 2002; 30: 145‑50.

8. Santoro GA , Fortling B: The advantages of volume renderingin three-dimensional endosonography of the anorectum. Dis Colon Rectum 2007; 50: 359‑68.

9. West RL , Dwarkasing S, Felt-Bersma RJ et al.: Hydrogen peroxide-enhancedthree-dimensional endoanal ultrasonography andendoanal magnetic resonance imaging in evaluating perianalfistulas: agreement and patient preference. Eur J Gastroenterol Hepatol 2004; 16: 1319‑24.

10. Choen S, Burnett S, Bartram CI et al.: Comparisonbetween anal endosonography and digital examination in theevaluation of anal fistulae. Br J Surg 1991; 78: 445‑47.

11. Schaefer O, Lohrmann C, Langer M: Assessment of analfistulas with high-resolution subtraction MR-fistulography: comparison with surgical findings. J Magn Reson Imaging 2004; 19: 91‑98.

12. Siddiqui MR, Ashrafian H, Tozer P et al.: A diagnosticaccuracy meta-analysis of endoanal ultrasound and MRI forperianal fistula assessment. Dis Colon Rectum 2012; 55: 576‑85.

13. Chapple KS , Spencer JA , Windsor AC et al.: Prognostic value of magnetic resonanceimaging in the management of fistula-in-ano. Dis Colon Rectum 2000; 43: 511‑16.

14. Cox SW , Senagore AJ , Luchtefeld MA et al.: Outcomeafterincision and drainage with fistulotomy for ischiorectal abscess. Am Surg 1997; 63: 686‑89.

15. Davies M, Harris D, Lohana P et al.: The surgical management of fistula-in-ano in a specialistcolorectal unit. Int J Colorectal Dis 2008; 23: 833‑38.

16. Ho KS , Tsang C, Seow-Choen F et al.: Prospective randomized trial comparing ayurvedic cutting seton and fistulotomy for lowfistula-in-ano. Tech Coloproctol 2001; 5: 137‑41.

17. Westerterp M, Volkers NA , Poolman RW et al.: Anal fistulotomy between Scylla and Charybdis. Colorectal Dis 2003; 5: 549‑51.

18. Chang SC, Lin JK : Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study. Int J Colorectal Dis 2003; 18: 111‑15.

19. Cavanaugh M, Hyman N, Osler T: Fecal incontinenceseverity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum 2002; 45: 349‑53.

20. Buchanan GN , Williams AB, Bartram CI et al.: Potential clinical implications of directionof a transsphincteric anal fistula track. Br J Surg 2003; 90: 1250‑55.

21. Ortiiz H, Marzo M, de Miguel M et al.: Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repairfor fistula in ano. Br J Surg 2008; 95: 484‑87.

22. Rojanasakul A, Pattanaarun J, Sahakitrungruang C et al.: Total anal sphincter saving technique forfistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 2007; 90: 581‑86.

23. Bleier JI , Moloo H, Goldberg SM: Ligation of the intersphincteric fistula tract: an effective new technique for complexfistulas. Dis Colon Rectum 2010; 53: 43‑46.

24. Wilson W, Taubert KA , Gewitz T et al.: Prevention of Infective Endocarditis. Guidelines From the American HeartAssociation: A Guideline From the American Heart AssociationRheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and theCouncil on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and OutcomesResearch Interdisciplinary Working Group. Circulation 2007; 16: 1736‑54.

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

Journal Information

CiteScore 2016: 0.29

SCImago Journal Rank (SJR) 2016: 0.166
Source Normalized Impact per Paper (SNIP) 2016: 0.207


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