Download Citation on ResearchGate | Fistule anale cryptogénétique: définition, épidémiologie, bactériologie, physiopathologie | Les suppurations forment un. Request PDF on ResearchGate | La fistule anale cryptoglandulaire | Cryptoglandular anal fistula is the most frequently occurring form of perianal sepsis. 22 sept. Les infections au niveau anal peuvent se manifester par un abcès, qui va ensuite , avec la propagation de l’infection, créer une fistule.
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Fistulae-in-ano remain a major problem for the colorectal surgeon.
Fisgule they do not threaten life they are a major cause of morbidity. Low fistulae inter-sphincteric and low trans-sphincteric can be treated with anqle fistulotomy with a high cure rate and minimal effect on sphincter function.
The problem arises when the fistula tract is higher and fistulotomy is not an option without risk of compromise to ano-rectal function. This has led to a variety of measures for the treatment of such fistulae, all of which try to eradicate the sepsis and fistula tract but preserving as much external sphincter as possible. Options which have been used include setons tight and loosere-routing of the fistula tract, fibrin glue, and core fistulectomy with a flap advancement.
All these methods have been reviewed recently in a position statement on fistulae in ano Williams A further method has been introduced in recent years and, if successful, offers a chance of cure of the fistula but without division of the external anal sphincter.
Fistule anale et Surgisis – Service de chirurgie générale et digestive Hôpital Saint-Antoine
This new procedure is to use a tapered fibrin plug which is placed into the fistula tract once the acute septic episode has settled. The tapered shape of the plug is to ensure that the plug remains in place, closing the internal opening, and encouraging in-growth of host tissue over months. The plug is comprised of lyophilised porcine intestinal submucosa and once the fistula has been drained with a loose seton the plug is rehydrated and inserted through the tract such that the wider end sits at the internal opening.
The internal part is sutured firmly to the internal sphincter whilst the external aale is not secured.
The external wound is left open to allow free drainage of any fluid. Postoperatively the patient is told to rest for two weeks and to avoid strenuous exercise.
In the communication from the original authors Champagne full bowel preparation was performed and antibiotic prophylactic cover was with metronidazole. The first communication of this technique was from Atlanta Johnson and reported on 25 patients, 10 of whom had fibrin glue closure and 15 the fibrin plug.
The final paper from this group Champagne gave the results from the use of the fibrin plug in 46 patients. Whilst encouraging, others have been unable to match these results and the long term success remains unknown.
It would be interesting to see sequential MR imaging in these patients.
De l’abcès à la fistule anale
They make the point that little is lost by attempting to treat the fistula with a fibrin plug. Our own experience has been combined with that of colleagues in Aarhus and was presented in abstract form at the recent meeting of the European Society of Coloproctolgy in Malta.
In conclusion, this new technique shows some promise but there are details of the procedure which, if not followed, may lead to early extrusion of the fibrin plug. The fact that no muscle is divided is clearly an advantage but the true value of this technique over other, more established procedures, will need further experience. Unfortunately there are few randomised trials in the field of fistula surgery but this perhaps is one area that requires either a trial or, at the very least, a comprehensive audit of experience.
Trois de ces patients avaient une maladie de Crohn, et trois avaient une fistule ano-vulvaire. Fistule anale et Surgisis Fistulae-in-ano remain a major problem for the colorectal surgeon.
Dis Colon Rectum ; Efficacy of anal fistula plug vs. The treatment of anal fistula: Anal fistula plug for closure of difficult anorectal fistula: