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Transsphincteric Fistula-in-Ano with External Opening 3 cm from Anal Verge
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Trans-sphincteric fistulas may have an additional high inter-sphincteric extension going up to the anorectal ring or into the supralevator space (Figure 23.7). Access to this space may be difficult if one were to use a conservative sphincter-saving procedure. If a fistulotomy or fistulectomy is done then one can easily visualize this extension, which can either be excised by an inter-sphincteric dissection or curetted thoroughly.
Fissure-in-Ano and Fistula-in-Ano
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Clarence E. Clark, Jacquelyn Seymour Turner
Fistulectomy is mainly a historical procedure that was used for fistulae that involved a significant amount of anal sphincter muscle such as transsphincteric and suprasphincteric fistulae. However, fistulectomy was noted to cause fecal incontinence and thus has been replaced by endorectal advancement flap (ERAF). ERAF involves the mobilization of the mucosa, submucosa, and musculomucosa of the rectum for advancement over the internal opening where the flap is secured. It has a reported overall success rate of 63.6%, with a 77.1% success rate in patients with cryptoglandular disease (Sonoda et al., 2002). While fistulotomy remains the gold standard of treating fistula-in-ano, many techniques such as ERAF are evolving to improve surgical outcomes for this disease.
Colorectal Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Surgical options➢ Fistulotomy done if the fistula lies entirely below the puborectalis, with laying open the fistulous tract. The wound then heals gradually by secondary intention.➢ Fistulectomy excision of the fistula tract is another option for low anorectal fistula.➢ Seton insertion either loose, tight or chemical. Draining setons are used as cutting setons are too painful. Setons are used for high anorectal fistula. The theory is to achieve a staged fistulotomy by placing a seton suture that is sporadically tightened so as to gently cut through the tract and muscle while allowing healing and fibrosis to develop between divided muscles, thus preserving sphincteric function and faecal continence.➢ Advancement flap.➢ Plugs and glues.
The prediction of surgical intervention in patients with tubo-ovarian abscess
Published in Journal of Obstetrics and Gynaecology, 2022
Jong Ha Hwang, Bo Wook Kim, Soo Rim Kim, Jang Heub Kim
In the 32 patients comprising the surgical intervention group, laparoscopy and laparotomy were performed in 17 (53.1%) and 14 (43.8%) patients, respectively. One patient was treated with abscess drainage via culdotomy and pigtail insertion, 15 patients underwent unilateral salpingectomy or unilateral salpingo-oophorectomy, and 12 patients underwent bilateral salpingectomy or bilateral salpingo-oophorectomy. Four cases of total hysterectomy in addition to adnexal surgery were identified. Four patients underwent appendectomy because the TOA spread to the periappendiceal area. One patient underwent low anterior resection because the TOA resulted from colon cancer with perforation. Fistulectomy was performed in one patient with a fistula between the TOA and abdominal skin. Two patients were diagnosed with actinomycosis.
Crohn’s disease exclusion diet in children with Crohn’s disease: a case series
Published in Current Medical Research and Opinion, 2021
Luca Scarallo, Elena Banci, Valentina Pierattini, Paolo Lionetti
An 8-year-old boy was referred to our outpatient clinic from another referral center in Italy, following a diagnosis of ileocolic CD complicated by perianal involvement (Paris Classification: L3, B1, G1, P)16. An anti-TNF alpha treatment with adalimumab was promptly initiated, along with PEN (Modulen IBD). Despite interrupting PEN after only few weeks due to scarce tolerance, the patient showed a marked improvement of both abdominal and perianal disease symptoms and normalization of laboratory parameters. Twelve months later, a recrudescence of complex perianal disease was observed; pelvic magnetic resonance imaging (MRI) showed 2 trans-sphinteric fistulae tracts. Therefore, fistulectomy with seton placement was performed. Post-operative course was regular and seton was removed 6 months after surgery with complete healing of the tract. Despite complete resolution of perianal inflammation, the patient experienced luminal disease relapse symptoms re-occurrence and iron-refractory anemia. Ileo-colonoscopy revealed aphthous ulcers involving the terminal ileum, whereas capsule endoscopy showed also jejunal involvement. Despite the intensification of adalimumab regimen, laboratory tests showed persistently elevated inflammatory markers (CRP 11.2 mg/dL, ESR 86 mm/h) and fecal calprotectin (686 mg/kg). Moreover, MRE revealed multiple enhancement with only moderate thickening in the terminal ileum (transmural thickening: 8 mm).
Acquired lacrimal fistula: classification and management
Published in Orbit, 2022
Nandini Bothra, Monalisa Pattnaik, Mohammad Javed Ali
The present study concludes that most acquired lacrimal fistulae heal themselves once the associated NLDO is taken care of. It appears logical that early lacrimal drainage surgery may prevent development of the lacrimal fistula, but would need a further study to ascertain it. The cases that need surgical fistulectomy are usually the chronic ones with large, deep and sunken fistula with a cutaneous lining.