MULTISTAGE MINIMALLY INVASIVE TREATMENT FOR PERIANAL ABSCESS

AIM: to improve the results of treatment for perianal abscess using ultrasound navigation, seton drainage of the internal fistula and subsequent minimally invasive treatment of fistula.
PATIENTS AND METHODS: seventy-two patients with perianal abscess were included in cohort retrospective study. At the first stage the abscess opening and seton under ultrasound navigation with contrast was performed. On the second stage the FiLaC procedure was performed.
RESULTS: follow-up was 8-14 weeks, 29 (53.7%) patients had subcutaneous or submucosal seton displacement, while 8 (11.1%) produced complete healing. Twenty-one (29.2%) patients required fistulectomy. In 25 (46.3%) patients, intra- and transsphincteric fistulas were detected in 18 (33.3%) and 7 (12.9%) cases, respectively. All these patients underwent laser coagulation of the fistula. After a single laser coagulation, fistula healing within 4 weeks was found in 19 (76.0%) patients. Six (24.0%) patients underwent second laser coagulation of the fistula, while healing was observed in 2 (8.0%) patients. Four (16.0%) patients after second coagulation produced recurrence and have underwent surgery (LIFT procedure or advancement flap).
CONCLUSION: perianal abscess opening with seton provides recovery in 14.8% and produces «ideal» fistula for laser ablation in 46.2% within 10-14 weeks after. Multistage minimally multistage approach provides healing and not affects anal continence in 84.0%.

1. Shelygin Yu.A. Chronic paraproctitis (fistula of the anus, fistula of the rectum). In Clinical recommendations. Koloproctologia. By ed. Shelygin Yu.A. М.: GEOTAR-Мedia , 2015;.рр. 82-107. (in Russ.).

2. Ilkanich A.Ja., Darvin V.V., Slepyh N.V., Barbashinov N.A. et al. Video assisted anal fistula treatment: feasibility and results. Koloproktologia. 2014;no. 2(48), pp. 20-22. (in Russ.).

3. Giamundo P, Esercizio L, Geraci M, Tibaldi L et al. (2015) Fistulatract Laser Closure (FiLaC): long-term results and new operative strategies. Tech. Coloproctol. 19:449-453.

4. Musin A.I., Kostarev I.V. Management of anal abscess. Annaly Khirurgii. 2017; v. 22, no. 2, pp. 81-87. (in Russ.).

5. Titov A.Yu., Kostarev I.V., Fomenko O.Yu. et al. VAAFT: preliminary results of treatment of complex anal fistulas with different methods of closure of internal fistula opening. Koloproctologia. 2015; no. 3(53), pp. 73-79. (in Russ.).

6. Khitar’jan A.G., Kovalev S.A., Kislov V.A., Romodan N.A. et al. Treatment of complicated form rectal fistulas with the modified filactechnology. Tavricheskij mediko-biologicheskij vestnik, Simferopol’. 2016; v. 19, no. 4, pp. 95-105. (in Russ.).

7. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009; 11(6):564-571.

8. Ommer A, Herold A, Berg E, Fürst A, et al. German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg. 2017 Mar;402(2):191-201. doi: 10.1007/s00423-017-1563-z. Epub 2017 Mar 1.

9. Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term followup from a single institution. Tech Coloproctol. 2017 Apr;21(4):269-276.

10. Stazi A, Izzo P, D’Angelo F, Radicchi M, et al. Video-assisted anal fistula treatment in the management of complex anal fistula: a single-center experience. Minerva Chir. 2018 Apr;73(2):142-150.

11. Zanotti C, Martinez-Puente C, Pascual I, Pascual M. et al. (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Color Dis. 2007;22:1459-1462.

12. Zhukov B.N., Isaev V.R., Chernov A.A. Osnovy koloproktologii dlya vracha obshchej praktiki: monografiya. Samara, RF: Ofort; 2009. (in Russ.).