The initial approach to anorectal abscesses: Fistulotomy is safe and reduces the chance of recurrences

被引:22
作者
Knoefel, WT [1 ]
Hosch, SB [1 ]
Hoyer, B [1 ]
Izbicki, JR [1 ]
机构
[1] Univ Hamburg, Dept Surg, D-20246 Hamburg, Germany
关键词
anorectal abscess; anorectal fistula; fistulotomy;
D O I
10.1159/000018847
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims: Anorectal abscesses are most frequently based on a coexistent fistula in ano. Whether these should be searched for and excised initially or not remains controversial. Our aim was to determine which approach has less recurrences and carries a lower risk of continence disorders. Methods: 158 patients with an anorectal abscess or anal fistula were identified in our institution over a period of 75 consecutive months. The records and follow-up questionnaires of 131 patients were evaluable. The mean follow-up period was 40 (range 3-78) months. Results: When fistulotomy was performed at the time of draining the abscess, the recurrence rate could be reduced, in comparison to incision and drainage alone, from 34 to 4% (p = 0.007). In the group of patients undergoing surgery for a recurrence, the recurrence rate could even be reduced from 67 to 0% (p = 0.03) by simultaneous fistulotomy. A total of 4 of the 131 patients (3%) developed incontinence of liquid stool and flatus, but no incontinence of solid stool occurred. Incontinence did only occur a fer recurrent disease. Conclusions: The number of recurrences requiring surgery can be significantly reduced by initial fistulotomy, The risk to develop incontinence increases with recurrent anorectal disease, not with careful fistulotomy. Copyright (C) 2000 S. Karger AG, Basel.
引用
收藏
页码:274 / 277
页数:4
相关论文
共 11 条
[2]   ONE STAGE TREATMENT OF ANAL ABSCESSES AND FISTULAS [J].
FUCINI, C .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 1991, 6 (01) :12-16
[3]   Anal fistula surgery - Factors associated with recurrence and incontinence [J].
GarciaAguilar, J ;
Belmonte, C ;
Wong, WD ;
Goldberg, SM ;
Madoff, RD .
DISEASES OF THE COLON & RECTUM, 1996, 39 (07) :723-729
[4]   Incidence of fistulas after drainage of acute anorectal abscesses [J].
Hämäläinen, KPJ ;
Sainio, AP .
DISEASES OF THE COLON & RECTUM, 1998, 41 (11) :1357-1361
[5]   INCIDENCE OF FISTULA-IN-ANO COMPLICATING ANORECTAL SEPSIS - A PROSPECTIVE-STUDY [J].
HENRICHSEN, S ;
CHRISTIANSEN, J .
BRITISH JOURNAL OF SURGERY, 1986, 73 (05) :371-372
[6]   Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses [J].
Ho, YH ;
Tan, M ;
Chui, CH ;
Leong, A ;
Eu, KW ;
SeowChoen, F .
DISEASES OF THE COLON & RECTUM, 1997, 40 (12) :1435-1438
[7]   TREATMENT OF ANORECTAL ABSCESS WITH OR WITHOUT PRIMARY FISTULECTOMY - RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL [J].
SCHOUTEN, WR ;
VANVROONHOVEN, TJMV .
DISEASES OF THE COLON & RECTUM, 1991, 34 (01) :60-63
[8]  
Stelzner F., 1981, ANORECTALEN FISTELN
[9]   Prospective randomized trial of drainage alone vs drainage and fistulotomy for acute perianal abscesses with proven internal opening [J].
Tang, CL ;
Chew, SP ;
SeowChoen, F .
DISEASES OF THE COLON & RECTUM, 1996, 39 (12) :1415-1417
[10]   CONTINENCE DISORDERS AFTER ANAL FISTULOTOMY [J].
VANTETS, WF ;
KUIJPERS, HC .
DISEASES OF THE COLON & RECTUM, 1994, 37 (12) :1194-1197