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Reconstructive Surgery of the Rectum, Anus and Perineum pp 399–404Cite as

Managing Adult Anterior Anus and Anovestibular Fistula

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Abstract

This chapter discusses an alternative perspective concerning the management of complex anal fistulae, focusing on anovestibular fistula. There is no single technique for the treatment of all anorectal fistulae. The treatment options must be directed by the surgeon’s experience and judgment. Each of these techniques, including the endorectal advancement flap, formal closure of the internal opening with or without anoplasty, seton deployment and management, ligation of the intersphincteric fistula tract, and the use of fibrin sealants and fistula plugs, should be part of the specialist’s armamentarium.

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References

  1. Parks A. Pathogenesis and treatment of fistula-in-ano. BMJ. 1961;1:463–9.

    Article  PubMed  CAS  Google Scholar 

  2. Isbister WH. A simple method for the management of anorectal abscess. ANZ J Surg. 1987;57:771–4.

    Article  CAS  Google Scholar 

  3. Read DR, Abcarian H. A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum. 1979;22:566–8.

    Article  PubMed  CAS  Google Scholar 

  4. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.

    Article  PubMed  CAS  Google Scholar 

  5. Regadas FS, Murad-Regadas SM, Lima DM, Silva FR, Barreto RG, Souza MH, et al. Anal canal anatomy showed by three-dimensional anorectal ultrasonography. Surg Endosc. 2007;21:2207–11.

    Article  PubMed  Google Scholar 

  6. West RL, Dwarkasing S, Felt-Bersma RJ, Schouten WR, Hop WC, Hussain SM, et al. Hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in evaluating perianal fistulas: agreement and patient preference. Eur J Gastroenterol Hepatol. 2004;16:1319–24.

    Article  PubMed  Google Scholar 

  7. Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB. Endoanal ultrasound-guided surgery for anal fistula. Endoscopy. 2005;37:722–8.

    Article  PubMed  CAS  Google Scholar 

  8. Buchanan GN, Bartram CI, Williams AB, Halligan S, Cohen CR. Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-in-ano. Dis Colon Rectum. 2005;48:141–7.

    Article  PubMed  Google Scholar 

  9. Santoro GA, Fortling B. The advantages of volume rendering in three-dimensional endosonography of the anorectum. Dis Colon Rectum. 2007;50:359–68.

    Article  PubMed  Google Scholar 

  10. Murad-Regadas SM, Regadas FSP, Rodrigues LV, Holanda Ede C, Barreto RG, Oliveira L. The role of 3-dimensional anorectal ultrasonography in the assessment of anterior transsphincteric fistula. Dis Colon Rectum. 2010;53:1035–40.

    Article  PubMed  Google Scholar 

  11. Pinedo MG, Caselli MG, Urrejola SG, Niklitscheck LS, Molina PME, Bellolio RF, Zuñiga DA. Modified loose-seton technique for the treatment of complex anal fistulas. Colorectal Dis. 2012;12:31–313.

    Google Scholar 

  12. Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis. 2010;12:172–8.

    Article  PubMed  CAS  Google Scholar 

  13. Sentovich SM. Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum. 2003;46:498–502.

    Article  PubMed  Google Scholar 

  14. Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Sone JH, et al. Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum. 2000;43:944–9.

    Article  PubMed  CAS  Google Scholar 

  15. Buchanan GN, Bartram CI, Philips RK, Gould SW, Halligan S, Rockall TA, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003;46:1167–74.

    Article  PubMed  Google Scholar 

  16. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum. 2004;47:432–6.

    Article  PubMed  Google Scholar 

  17. Christoforidis D, Etzioni DA, Goldberg SM, Madoff RD, Mellgren A. Treatment of complex anal fistulas with collagen fistula plug. Dis Colon Rectum. 2008;51:1482–7.

    Article  PubMed  Google Scholar 

  18. Ellis CN, Clark S. Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum. 2006;49:1736–40.

    Article  PubMed  Google Scholar 

  19. Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, et al. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007;9:18–50.

    Article  PubMed  Google Scholar 

  20. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006;49:371–6.

    Article  PubMed  Google Scholar 

  21. Aguilar PS, Plasencia G, Hardy TG, Hartmann RF, Stewart WR. Mucosal advancement in the treatment of anal fistula. Dis Colon Rectum. 1985;28:496–8.

    Article  PubMed  CAS  Google Scholar 

  22. Lowry AC, Thorson AG, Rothenberger DA, Goldberg SM. Repair of simple rectovaginal fistulas. Influence of previous repairs. Dis Colon Rectum. 1988;31:676–8.

    Article  PubMed  CAS  Google Scholar 

  23. Kodner IJ, Mazor A, Shemesh EI, Fry RD, Fleshman JW, Birnbaum EH. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas. Surgery. 1993;114:682–90.

    PubMed  CAS  Google Scholar 

  24. Ozumer G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal vaginal fistulas. Dis Colon Rectum. 1996;39:10–4.

    Article  Google Scholar 

  25. Schouten WR, Zimmerman DD, Briel JW. Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum. 1999;42:1419–23.

    Article  PubMed  CAS  Google Scholar 

  26. Ortiz H, Marzo J. Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg. 2000;87:1680–3.

    Article  PubMed  CAS  Google Scholar 

  27. Mizrahi N, Wexner SD, Zmora O, Da Silva G, Efron J, Weiss EG, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum. 2002;45:1616–21.

    Article  PubMed  Google Scholar 

  28. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum. 2002;45:1622–8.

    Article  PubMed  Google Scholar 

  29. Garcia-Aguilar J, Davey CS, Le CT, Lowry AC, Rothenberger DA. Patient satisfaction after surgical treatment for fistula-in-ano. Dis Colon Rectum. 2000;43:1206–12.

    Article  PubMed  CAS  Google Scholar 

  30. Kreis ME, Jehle EC, Ohlemann M, Becker HD, Starlinger MJ. Functional results after transanal rectal advancement flap repair of trans-sphincteric fistula. Br J Surg. 1998;85:240–2.

    Article  PubMed  CAS  Google Scholar 

  31. Gustafsson UM, Graf W. Excision of anal fistula with closure of the internal opening: functional and manometric results. Dis Colon Rectum. 2002;45:1672–8.

    Article  PubMed  Google Scholar 

  32. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano: the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90:581–6.

    PubMed  Google Scholar 

  33. Rojanasakul A. Intermediate outcome of total anal sphinctersaving technique for fistula-in-ano: the ligation of intersphincteric fistula tract (LIFT) [abstract]. Dis Colon Rectum. 2008;51:694–5.

    Google Scholar 

  34. Alfred KW, Roslani AC, Chittawatanarat K, et al. Short-term outcomes of the ligation of intersphincteric fistula tract (LIFT) procedure for treatment of fistula-in-ano: a single institution experience in Singapore [abstract]. Dis Colon Rectum. 2008;51:696.

    Google Scholar 

  35. Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010;53:43–6.

    Article  PubMed  Google Scholar 

  36. Shanwani A, Nor AM, Amri N. Ligation of intersphincteric fistula tract (LIFT): sphincter saving technique for fistula-in-ano. Dis Colon Rectum. 2010;53:39–42.

    Article  PubMed  CAS  Google Scholar 

  37. Ellis CN. Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the intersphincteric fistula tract (BioLift procedure) for the management of complex anal fistulas. Dis Colon Rectum. 2010;53:1361–4.

    Article  PubMed  Google Scholar 

  38. Scott HJ, Northover JM. Evaluation of surgery for perianal Crohn’s fistulas. Dis Colon Rectum. 1996;39:1039–43.

    Article  PubMed  CAS  Google Scholar 

  39. Michelassi F, Melis M, Rubin M, Hurst BD. Surgical treatment of anorectal complications in Crohn’s disease. Surgery. 2000;128:597–603.

    Article  PubMed  CAS  Google Scholar 

  40. Pearl PK, Andrews JR, Orsay CP, Weisman RI, Prasad ML, Nelson RL, et al. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum. 1993;36:573–9.

    Article  PubMed  CAS  Google Scholar 

  41. Takesue Y, Ohge H, Yokoyama T, Murakami Y, Imamura Y, Sueda T. Long-term results of seton drainage on complex anal fistulae in patients with Crohn’s disease. J Gastroenterol. 2002;37:912–5.

    Article  PubMed  Google Scholar 

  42. Faucheron JL, Saint-Marc O, Guibert L, Parc R. Longterm seton drainage for high anal fistulas in Crohn’s disease-a sphincter-saving operation? Dis Colon Rectum. 1996;39:208–11.

    Article  PubMed  CAS  Google Scholar 

  43. Sangwan YP, Schoetz Jr DJ, Murray JJ, Roberts PL, Coller JA. Perianal Crohn’s disease: results of local surgical treatment. Dis Colon Rectum. 1996;39:529–35.

    Article  PubMed  CAS  Google Scholar 

  44. Hong MK, Craig Lynch A, Bell S, Woods RJ, Keck JO, Johnston MJ, et al. Faecal diversion in the management of perianal Crohn’s disease. Colorectal Dis. 2011;13:171–6.

    Article  PubMed  CAS  Google Scholar 

  45. Rintala RJ, Mildh L, Lindhal H. H-type anorectal malformations: incidence and clinical characteristics. J Pediatr Surg. 1996;31:559–62.

    Article  PubMed  CAS  Google Scholar 

  46. Chatterjee SK. Double termination of the alimentary tract. A second look. J Pediatr Surg. 1980;15:623–7.

    Article  PubMed  CAS  Google Scholar 

  47. Tsuchida Y, Saito S, Honna T, Makino S, Kaneko M, Hazama H. Double termination of the alimentary tract in females: a report of 12 cases and a literature review. J Pediatr Surg. 1984;19:292–6.

    Article  PubMed  CAS  Google Scholar 

  48. White JJ, Haller JA, Scott JR, Dorst JP, Kramer SS. N-type anorectal malformations. J Pediatr Surg. 1978;13:631–7.

    Article  PubMed  CAS  Google Scholar 

  49. Heinen FL. The surgical treatment of low anal defects and vestibular fistulas. Semin Pediatr Surg. 1997;6:204–6.

    PubMed  CAS  Google Scholar 

  50. Murphy F, Puri P, Hutson JM, et al. Incidence and frequency of different types and classification of anorectal malformations. In: Holschneider AM, Hutson JM, editors. Anorectal malformations in children. Berlin: Springer; 1996. p. 163–84.

    Google Scholar 

  51. Holschneider AM, Jesch NK, Stragholz E, Pfrommer W. Surgical methods for anorectal malformations from Rehbein to Peña–critical assessment of score systems and proposal for a new classification. Eur J Pediatr Surg. 2002;12:73–82.

    Article  PubMed  CAS  Google Scholar 

  52. Shaaban A, Heise C. Multimedia article. Posterior sagittal anorectoplasty for congenital rectovaginal malformations in the adult. Dis Colon Rectum. 2008;51:1569.

    Article  PubMed  Google Scholar 

  53. Ardelean MA, Bauer J, Schimke C, Ludwikowski B, Schimpl G. Improvement of continence with reoperation in selected patients after surgery for anorectal malformation. Dis Colon Rectum. 2009;52:112–8.

    Article  PubMed  Google Scholar 

  54. Senel E, Akbiyik F, Atayurt H, Tiryaki HT. Urological problems or fecal continence during long-term follow-up of patients with anorectal malformation. Pediatr Surg Int. 2010;26:683–9.

    Article  PubMed  Google Scholar 

  55. Brem H, Guttman FM, Laberge JM, Doody D. Congenital anal fistula with normal anus. J Pediatr Surg. 1989;24:183–5.

    Article  PubMed  CAS  Google Scholar 

  56. Bianchini MA, Fava G, Cortese MG, Vinardi S, Costantino S, Canavese F. A rare anorectal malformation: a very large H-type fistula. Pediatr Surg Int. 2001;17:649–51.

    Article  PubMed  CAS  Google Scholar 

  57. Banu T, Hannan MJ, Hoque M, Aziz MA, Lakhoo K. Anovestibular fistula with normal anus. J Pediatr Surg. 2008;43:526–9.

    Article  PubMed  Google Scholar 

  58. Okada A, Kamata S, Imura K, Fukuzawa M, Kubota A, Yagi M, et al. Anterior sagittal anorectoplasty for vestibular and anovestibular fistula. J Pediatr Surg. 1993;28:279–84.

    Article  Google Scholar 

  59. Kumar V, Chattopdhay A, Vepakomma D, Shenoy D, Bhat P. Anovestibular fistula in adults: a rare presentation. Int Surg. 2005;90:27–9.

    PubMed  Google Scholar 

  60. Jiwane A, Kumar T, Kutumbale R, Bhusare D, Kothari P, Kulkarni B. Perineal canal: an uncommon entity with good prognosis. Indian J Pediatr. 2003;70:667–9.

    Article  PubMed  Google Scholar 

  61. Terzi A, Coskun A, Yildiz F, Coban S, Akinci OF. Anovestibular fistula with imperforate anus in two adults. Ann Saudi Med. 2008;28:472–4.

    Article  PubMed  Google Scholar 

  62. Holschneider AM. Secondary sagittal posterior anorectoplasty. Prog Pediatr Surg. 1990;25:103–17.

    PubMed  CAS  Google Scholar 

  63. Brain AJ, Kiely EM. Posterior sagittal anorectoplasty for reoperation in children with anorectal malformations. Br J Surg. 1989;76:57–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, School of Medicine of the Federal University of Ceara, Fortaleza, Brazil

    F. Sergio P. Regadas M.D., Ph.D. & Sthela Maria Murad-Regadas M.D., Ph.D.

  2. School of Medicine, Clinic Hospital, Federal University of Maranhăo, Fortaleza, Brazil

    Rosilma Gorete Lima Barreto M.D., Ph.D.

Authors
  1. F. Sergio P. Regadas M.D., Ph.D.
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  2. Rosilma Gorete Lima Barreto M.D., Ph.D.
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  3. Sthela Maria Murad-Regadas M.D., Ph.D.
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Corresponding author

Correspondence to F. Sergio P. Regadas M.D., Ph.D. .

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Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

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Regadas, F.S.P., Barreto, R.G.L., Murad-Regadas, S.M. (2013). Managing Adult Anterior Anus and Anovestibular Fistula. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_37

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  • DOI: https://doi.org/10.1007/978-1-84882-413-3_37

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