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Published byJamel Sturtevant
Modified over 2 years ago
Advancement flaps for fistula in ano SR Brown Sheffield teaching hospitals
Perfect operation Easy to perform No risk of incontinence Effective
History First proposed 1902 (Noble) for rectovaginal fistulae Anal fistulae 1912 (Elting)
Objectives Indications Types and Techniques Results
Indications High trans-sphincteric/supra-sphincteric fistulae Anterior fistulae in women Rectovaginal fistulae (Crohn’s)
Contraindications Acute presentation Large opening Rectal disease –Neoplasia –Crohn’s –Radiation
Types of advancement flap Endorectal –Full thickness –Partial thickness –mucosal Anocutaneous –V-Y,Y-V –Rhomboid, House
Method Bowel preparation Antibiotics Position
Essential steps Excision of internal opening Excision primary tract Formation flap Attention to external component
Excision fistula tract Sharp dissection core out/curettage Excise secondary tracts Continue to internal sphincter/complete tract
Mobilisation rectal flap Adrenaline (1:300,000) Partial/full thickness internal sphincter flap (based proximally) Divergent lateral incisions Meticulous haemostasis Excise internal opening +/- closure internal tract
Suturing flap Suture with absorbable Vicryl 2/0 Tension free Leave external opening to drain/Malecot catheter/glue No indication for bowel confinement/stoma
Principles for success Stagger the mucosal and muscular suture line Width of base of flap > twice the apex No sepsis
Results Difficulties Due to –Population Inflammatory/Non inflammatory High/low fistulae Recurrent –Surgeon –Follow up –Thoroughness of reporting
Results Endorectal Technique StudyYearNo. pts.Recurrence (%) Incontinence (%) Oh19831513- Aguilar1985151210 Athanasiadas19941692021 Schouten1999442535 Ortiz20009178 Mizrahi200266339 Sonoda20025525- Dixon20042917-
Reasons for Incontinence Direct damage to sphincter Stretching Scarring Decreased sensation
The anocutaneous flap
Results Anocutaneous technique StudyYearNo PatientsRecurrence (%) Incontinence (%) Del Pino19961127- Nelson2000732316 Zimmerman2001265430 Amin20031817- Sungertekin20046590
Factors that influence healing Redo procedures Crohn’s Rectovaginal fistulas Smoking
Summary Advancement flaps useful part of armamentarium for fistulas Techniques equally effective Consent for recurrences/incontinence particularly certain groups
Rectovaginal fistulae causes Inflammatory –Crohn’s –Neoplastic –Post-radiotherapy Non inflammatory –obstetric
Rectovaginal fistulae types
Types of repair Transanal advancement flap Lay open and primary repair (perineoproctotomy) Transperineal repair (+/- transposition) Transvaginal repair
Fistula-in-ano: a probing of the treatment options
SURGERY FOR ANAL FISSURES UNIVERSITY OF HULL ACADEMIC SURGICAL UNIT CASTLE HILL HOSPITAL.
ANORECTAL FISTULA Treatment Dr. Ayed Haddad Consultant Colorectal & General Surgeon.
The Best Surgical Treatment for Fistula-in-ano
Recent Advances in Surgical Management of Complex Cryptoglandular Anal Fistula YK Fong, Queen Mary Hospital.
Division of General Surgery, St Paul's Hospital Z. Rahimi M. Hoorzad American journal of surgery, May 2010.
Urethral Reconstruction Jerry G. Blaivas, MD Clinical Professor of Urology New York Hospital Cornell Medical Center Adjunct Professor of Urology SUNY-Downstate.
Date of download: 6/9/2016 From: Diagnosis and Treatment of Perianal Fistulas in Crohn Disease Ann Intern Med. 2001;135(10): doi: /
THE MANAGEMENT OF OBSTETRIC ANAL SPHINCTER INJURY (EVIDENCE BASED)
General Principles of Medical and Surgical Management of Inflammatory Bowel Disease Jeraldine S. Orlina Colorectal Conference December 22, 2005.
Crohn’s Colitis SR Brown Colorectal Surgeon Sheffield Teaching Hospitals.
Haemorrhoidectomy Mr Graham Williams Consultant Surgeon Royal Wolverhampton Hospitals.
R2 정상완. Introduction Perianal fistulas : ¼ of Crohn’s disease (CD) physical and psychologic morbidity with a long-term risk of proctectomy metronidazole,
Tips and Tricks of Avoiding and Management of Anastomotic Complications Feza H. Remzi, MD, FACS,FASCRS., FTSS (Hon)Chairman Department of Colorectal Surgery.
Perianal suppuration- Abscess & Fistula
Fistulotomy and Setons Mr Graham Williams Consultant Colorectal Surgeon Royal Wolverhampton Hospitals NHS Trust.
Dr alibakhshi general&cancer surgeon. HEMATOMA AND SEROMA Treatment — Small hematomas and seromas can be managed expectantly, while large collections.
Updates on the Treatment of Hemorrhoidal Disease
ANORECTAL ABSCESSES AND FISTULA-IN-ANO
Gynaecological Fistulas Max Brinsmead MB BS PhD May 2015.
Wound Management Year 4 Aim of Talk
Anal Fistula What are the causes of fistula and what is Eisenhammer's theory? What is Park's classification of anal fistula? What are the options for managing.
Journal Club Case Presentation
ANAL PAIN JAMES FRANCOMBE CONSULTANT COLORECTAL SURGEON WARWICK HOSPITAL.
Dr. Saadallah M. Al – Zacko MD, FRCS Dr. Tawfeeq Waleed MD.
Anal Fissure and Fistula
Nursing Care & Interventions for Clients with Inflammatory Intestinal Disorders Keith Rischer RN, MA, CEN.
Urethrovaginal Fistula & Urethral Reconstruction
Anal Disease/Neoplasms 5 October Which of the following is not true about a rectovaginal fistula A.Can result from obstetric or operative injury.
1 Wounds, ulcers, fistulae & cysts. wounds 2 3 Mechanism of injury Traumatic wounds Sharp, penetrating Sharp, penetrating Blunt Blunt Bullet Bullet.
Specialists Without Borders
Lee L Swanstrom MD, FACS Division of GI and Minimally Invasive Surgery Legacy Health System Portland, OR The Future of Foregut Surgery: NOTES and Esophageal.
Am J Gastroenterol 2012; 107:1213– June 2012 R3. 김동희 /prof. 이창균.
IN THE NAME OF GOD. INTRODUCTION Management of injuries to the nail bed is based on the integrity of the nail plate and nail margin.
Questions: Component Separation
Treatment for Anal fistula
Advanced Proctology Course for Physicians Available January 1 , 2007 Order Online at.
Slawomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA.
Robotic-Assisted Surgery in Urogynecology: Passing Fad or Here to Stay Marie Fidela R. Paraiso, M.D. Professor of Surgery Head, Division of Urogynecology.
Anal Fissure: the Facts (Are there any?) Tamzin Cuming Colorectal Consultant Homerton University Hospital.
Repair of obstetric anal sphincter tears Journal Club 18 th February 2011 By Dr. Ian Haines GP-ST1 & Nevine te West.
Open Approaches for Rectal Prolapse John Hartley Academic Surgical Unit University of Hull.
UOG Journal Club: April 2016 Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: randomized controlled trial G.
HERNIA. DEFINITION HERNIA TYPES Primary Incisional.
Rectal Examination. Rectal Examination Anatomy I The rectum is the curved lower, terminal segment of large bowel. It is about 12 cms long and runs.
Pelvic Floor Dysfunction
Role of surgery in treatment of fecal incontinence disorders Rasoul Azizi M.D Colo-Rectal Surgeon Associate Professor of surgery School of Medical Sciences,
Diseases of Rectum and Anal Canal
Palatal fistula Dr. Hayder H. Hindawi Plastic & reconstructive surgeon
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