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[Complex anal fistulas (author's transl)].

J Arnous, J Denis

    La Nouvelle Presse Medicale
    |September 10, 1979
    PubMed
    Summary
    This summary is machine-generated.

    The term ano-rectal fistula is inaccurate; fistulas are either rectal or anal, with rectal fistulas posing higher risks of incontinence. Complex anal fistulas often result from iatrogenic causes or surgical errors.

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    Area of Science:

    • Colorectal Surgery
    • Proctology

    Context:

    • Perianal suppurations are common and complex surgical conditions.
    • Over 6,500 patient cases inform this study on fistula classification and management.
    • Current terminology may not adequately describe fistula complexity.

    Purpose:

    • To propose a revised classification of perianal fistulas based on their origin and complexity.
    • To differentiate between rectal and anal fistulas and their associated risks.
    • To guide therapeutic strategies for complex anal fistulas.

    Summary:

    • The study suggests abandoning the term 'ano-rectal fistula'.
    • Fistulas are categorized as rectal (secondary to rectocolonic infection or iatrogenic) or anal (originating from an anal crypt).
    • Rectal fistulas present significant risks of postoperative incontinence due to their involvement of the sphincteric apparatus.

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  • Complex anal fistulas, often iatrogenic or resulting from surgical misadventures, require careful, staged management.
  • Antibiotic overuse and technical surgical errors contribute to fistula complexity.

    • Impact:

    • This classification aims to improve diagnostic accuracy and treatment planning for perianal fistulas.
    • Understanding fistula origins and complexity can reduce surgical complications, particularly incontinence.
    • A staged therapeutic approach is recommended for complex cases, allowing for progressive simplification of fistula tracks.