Cryptoglandular anal fistula

Abstract

Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.

Management of Complex Perineal Fistula Disease

“…26,27 Adding bioabsorbable mesh interposition was successful in 93.5% 28 and insertion of a fistula plug was successful in 95%. 29 The LIFT has the advantages of minimal impairment of continence (6%) 7 and potential to convert a high fistula to an intersphincteric one even in the case of failure. 23,25,28 Rectal Advancement Flap Rectal advancement flap (RAF) is one of the most commonly used techniques for CPF in patients with a normal or minimally diseased rectum.…”

Unexpected complication after radical (inguinal) orchidectomy: trans-sphincteric anoscrotal fistula

“…Traditionally, low fistula-in-ano can be managed with fistulotomy as the rate of faecal incontinence is low in these cases. Alternative modalities such as cutting setons, fibrin glue, mucosal clips, advancement flaps and fistulectomy may carry a lower risk of affecting continence but with lower success 2 4–9…”

“…For these patients, options include mucosal advancement flaps, ligation of the internal fistula tract, anal fistula plugs and an increasing number of novel techniques 2 4 9 10…”

Chronic arthritis of the hip joint: an unusual complication of an inadequately treated fistula-in-ano

“…A fistula-in-ano is a chronic manifestation of an acute cryptoglandular infection progressing to abscess formation 2. When the abscess bursts or is drained, it forms an epithelialised tract extending from the abscess in the anal canal or the rectum to other epithelialised surface, usually the skin.…”