Diagnóstico y tratamiento de las fístulas anorrectales complejas

doi:10.1016/S0009-739X(04)78953-8

Cirugía Española

Volume 76, Issue 3, 2004, Pages 142-148

https://doi.org/10.1016/S0009-739X(04)78953-8 Get rights and content

Resumen

La fístula de ano (FA) es una entidad con una alta incidencia. La mayoría es simple y su tratamiento quirúrgico altamente resolutivo. Sin embargo, hay un grupo de fístulas con unas características que las convierten en complejas, tanto desde el punto de vista de su diagnóstico como de su tratamiento.

Se revisa la metodología de estudio y tratamiento de las FA complejas y se analizan los métodos diagnósticos, entre los que destacan la utilidad de la anamnesis y exploración física, y las dos principales técnicas de imagen: la ecografía endorrectal y la resonancia magnética. A continuación se detallan las diferentes técnicas potencialmente utilizables en el tratamiento de la fístula compleja, haciendo especial hincapié en la puesta a plano, el colgajo endorrectal de avance, y la utilización de sedales y cola de fibrina.

Se expone el algoritmo terapéutico utilizado por los autores en el tratamiento de las fístulas anales complejas

The incidence of anal fistula is high. Most anal fistulas are simple and surgical treatment has a high success rate. However, because of their characteristics, the diagnosis and treatment of some fistulas is complex.

The methodology of the study and treatment of complex anal fistulas is reviewed. Diagnostic methods are analyzed, especially the utility of history-taking and physical examination, and the two main imaging techniques, endorectal ultrasonography and magnetic resonance imaging. The various techniques that could potentially be used in the treatment of complex fistulas are also described with special emphasis on the lay open technique, endorectal advancement flap, and the use of setons and fibrin glue.

The therapeutic algorithm used by the authors in the treatment of complex anal fistulas is described.

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Cited by (2)

Approach to the current situation of proctology in andalusia (Spain): Results of a community survey
2006, Cirugia Espanola
La proctología ha adquirido tal complejidad que requiere una capacitación específica, así como la creación de grupos especializados. En Andalucía hay proctólogos en toda la red sanitaria pública. Resulta imprescindible medir el nivel de calidad ofrecido en los diferentes procesos, con el fin de poder mejorarlos. Nuestro objetivo es conocer los medios disponibles y cómo se está llevando a cabo el manejo de estos pacientes para poder aplicar las mejoras.
Estudio descriptivo, multicéntrico y transversal sobre el estado de la proctología en los servicios de cirugía general en 25 hospitales de Andalucía (20 públicos y 5 privados). Se empleó una encuesta que reflejaba generalidades del hospital, pruebas disponibles y tratamientos empleados.
En el 65,38% hay una unidad de coloproctología. Hay consulta monográfica sólo en el 38,46%. Disponen de manometría y ecografía endoanal el 50 y el 58%, respectivamente. El tratamiento de hemorroides es predominantemente con hemorroidectomía (92,30%). El tratamiento médico y la esfinterotomía son los más empleados en la fisura, y la dilatación anal aún se practica en el 30,76%. El sedal se utiliza en el 92,30%, así como la fistulotomía (88,46%) para tratar la fístula. El tratamiento del sinus es la exéresis en bloque y cierre primario (54,16%). Respecto a las enfermedades del suelo pelviano, entre el 30 y el 44% reconocen que la experiencia es escasa.
Aunque existe una gran voluntad de avanzar y alcanzar un nivel científico adecuado, debemos corregir multitud de gestos que han quedado obsoletos. Herramientas como la evidencia científica, la gestión de la información y la evaluación mediante la comparación con estándares, se debe incluirlas con diligencia en nuestra práctica clínica.
Proctology has acquired such complexity that it requires a specific qualification, as well as the creation of specialized groups. In Andalusia there are proctologists throughout the public health system. Measurement of the quality of the distinct processes is essential. The aim of the present study was to determine the resources available, as well as to identify the management of these patients, with a view to identifying areas requiring improvement.
A descriptive, multicenter, cross sectional study of the current situation of proctology in general surgery services in 25 hospitals in Andalusia (20 public and 5 private) was performed. A survey was used to identify the general characteristics of the hospital, the tests available, and the treatments used.
A total of 65.38% of the hospitals have a coloproctology unit, while a drop-in outpatient clinic is available in only 38.46%. Manometry and anal endosonography are available in 50% and 58%, respectively. Treatment of hemorrhoids is predominantly hemorrhoidectomy (92.30%). Medical treatment and sphincterotomy are the most widely used treatments for anal fissure, and anal dilation is still performed in 30.76%. Seton is used in 92.30%, as well as fistulotomy (88.46%), to treat fistula. The most frequent treatment of sinus is en-bloc resection and primary closure (54.16%). Between 30% and 44% report little experience of pelvic floor disorders.
Although there is a willingness to achieve progress and reach an adequate scientific level, a multitude of obsolete practices should be corrected. Tools such as scientific evidence, information management and evaluation by means of comparison with standards should be diligently included in our clinical practice.
Non-surgical management of rectovaginal fistula: A case report
2015, Ginecologia y Obstetricia de Mexico

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Diagnóstico y tratamiento de las fístulas anorrectales complejasDiagnosis and treatment of complex anorectal fistulas

Resumen

Surg Clin North Am

Pathogenesis and treatment of fistula-in-ano

BMJ

Fistulas in ano: endoanal ultrasonographic assessment assists decision making for surgery

Gut

Anal endosonography in the evaluation of perianal sepsis and fistula in ano

Br J Surg

Anal endosonography for recurrent anal fistulas. Image enhancement with Hydrogen Peroxide

Dis Colon Rectum

Hydrogen peroxide-enhanced transanal ultrasound in the assessment of fistula-in-ano

Dis Colon Rectum

Peroxide-enhanced anal endosonography: technique, image interpretation, and clinical applications

Radiographics

Ultrasound study of anal fistulas with hydrogen peroxide enhancement

Dis Colon Rectum

Pre-operative assessment of anal fistulas using endoanal US

Colorectal Dis

MR imaging classification of perianal fistulas and its implications for patient management

FRCS Radiographics

Magnetic resonance imaging of fistula-in-ano

Dis Colon Rectum

Endoanal coil in MR imaging of anal fistulas

AJR

Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap

Dis Colon Rectum

Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study

Int J Colorectal Dis

Principles and practice of surgery for the colon, rectum, and anus. St. Louis

Fibrin glue for anal fistulas: long-term results

Dis Colon Rectum