Anal Abscess and Fistula

Sneider, Erica B.; Maykel, Justin A.

doi:10.1016/j.gtc.2013.08.003

Cited by 44 publications

(30 citation statements)

References 36 publications

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“…In the present study, the male gender predominance (79%) and those with age ≤ 50 years (38%) came in concordance with those reported in studies of same interest [10,11] and other studies reported that perianal abscesses are seen two times more frequently in men than in women [2,4,12]. In agreement with our finding, it was stated that the peak incidence of perianal abscesses is in the third or fourth decade of life and it is two or three times more common in men than women with diabetes and increased BMI as the major traced risk factors for development of perianal abscesses [13,14 ].…”

Section: Discussionsupporting

confidence: 92%

“…Other studies of same interest reported that acute abscess recurrences occur in 10% and development of chronic fistula-in-ano occurs in up to 50% of patients [17] while another stated that 31% of patients developed fistula-in-ano following incision and drainage [18]. The decision of whether or not to perform a fistulotomy during the original incision and drainage of perianal abscess has been debated in the literature [2,19]. In a randomized clinical trial done by Oliver and colleagues compared simple drainage abscess drainage with and without fistula track treatment to evaluate the effectiveness and morbidity of both operations in the management of acute anal sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…They found that drainage of the abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteric, or low transsphincteric fistula with a minimal recurrence rate as 5% compared with 29% recurrence rate in patients treated with drainage alone [16]. Incontinence rates following fistulotomy depends on both the amount of muscle divided at the time of operation as well as any preexisting previous sphincter damage causing scarring of the anal canal [2,20,21]. Incontinence rates have been reported in previous reports to range from 18% to 52% [2,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Perianal abscesses arise from anal glands which have a predisposition to get obstructed and suppurated leading to abscess formation. Perianal abscesses and anal fistula are often found together [2]. While the initial treatment of perianal abscess is simple incision and drainage, other surgical procedures as fistulotomy may be required as a definitive measure for treating fistula because about 40% of patients present with a fistula after simple incision and drainage of their perianal abscesses [1,3].…”

Section: Introductionmentioning

confidence: 99%

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Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy

Saber¹

2016

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Introduction: Perianal abscess is one of the most common general surgical emergencies encountered in clinical practice and the initial treatment is simple incision and drainage, other surgical procedures as fistulotomy may be required as a definitive measure for treating fistula because about 40% of patients present with a fistula after simple incision and drainage of their perianal abscesses. The aim of this study was to detect the outcome of simple drainage versus drainage and fistulotomy for perianal abscess as regard to abscess recurrence, fistula formation and time off from work. Patients and Methods: A total number of 200 patients of both sexes; 100 for each group, their ages ranged between 21-65 years were enrolled to this parallel prospective randomized clinical trial where patients were divided randomly into two main groups; A and B. Group A patients [N =100] were subjected to simple incision & drainage and those of group B [N = 100] were subjected to drainage & fistulectomy for acute perianal abscess. End Points: The primary end points were abscess recurrence, fistula formation and incontinence. The secondary end points were time off from work, wound discharge, wound healing and patients' satisfaction. Results: Patient's satisfaction of the treatment maneuver in relation to abscess recurrence and fistula occurrence was 80 % and 95% of group A and B respectively. Conclusion: The present study showed that treatment of perianal abscess through the combined maneuver of incision-drainage with fistulotomy at the same time significantly reduced the likelihood of persistent abscess, recurrence and need for repeat surgery. Patient's satisfaction after treatment with this combined method showed a significant value than incision-drainage only as regard disease recurrence, time of wound discharge and the incidence of fistula formation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy

Saber¹

2016

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“…[78910] As defined, fistula is an unusual connection between two epithelial surfaces. FCD is difficult to treat and no clear assent is available for its best treatment.…”

Section: Introductionmentioning

confidence: 99%

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

et al. 2017

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Medical treatment for fistulizing Crohn's disease (FCD) is changing rapidly over the time by the introduction of novel therapeutic medicines, while no global consensus is available. This study aims to accomplish a systematic review and meta-analysis on the efficacy of tumor necrosis factor-alpha antibodies (anti-TNF-α antibodies) versus placebo in FCD. A systematic review of published literature was carried out till December 2016, and a meta-analysis of identified studies was done. Data have been explored from PubMed, Scopus, Cochrane Library Database, and Web of Science. Predefined exclusion criteria for included studies in meta-analysis are based on search methodology and are as follows: Randomized clinical trial about Crohn's disease (CD) patients without fistula, pediatrics CD, randomized clinical trials about pregnant women with FCD, nonhuman studies, randomized clinical trials with surgical therapies interventions, conference abstracts, case reports, and language other than English studies. All randomized placebo-controlled trials were included. To assess risk of bias, Jadad score was applied to evaluate trials' methodological quality. Relative risk (RR) and 95% confidence intervals were computed using Mantel-Haenszel and/or Rothman-Boice (for fixed effects) or Der Simonian-Laird (for random effects) techniques. Nine studies attained defined inclusion criteria. The meta-analysis results showed that anti-TNF-α antibodies are remarkably more effective in comparison to placebo for fistula closure maintenance (RR = 2.36; 95% confidence interval: 1.58–3.55; P < 0.0001) in patients with FCD, whereas anti-TNF-α antibodies were not superior to placebo neither in fistula improvement nor in fistula closure. We concluded that adalimumab and certolizumab pegol are both effective in fistula closure maintenance in adult patients with FCD.

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Dermatoses of Perineal and Perianal Skin

Mallon

2016

Rook's Textbook of Dermatology, Ninth Edition

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Dermatologists should be able to assess perineal and perianal skin competently and know when to involve other disciplines. The skin of the perineum includes perianal, groin and scrotum or vulval skin. Common dermatoses easily recognized elsewhere may have a different appearance in the perineum as clinical features can be altered by the microenvironment that exists in the flexures due to heat, moisture and friction. It is important to be familiar with the cutaneous manifestations of intestinal and sexually transmitted diseases. Cutaneous features of conditions such as Crohn disease or tuberculosis are relatively non‐specific and diagnosis of these diseases is reached by demonstration of their typical histology. This chapter concentrates on important entities relevant to perineal and perianal skin including pruritus ani, anal fistula, haemorrhoids, human papillomavirus infection, anal intraepithelial neoplasia and anal cancer.

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Anal Abscess and Fistula

Cited by 44 publications

References 36 publications

Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy

Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

Dermatoses of Perineal and Perianal Skin

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