Michele Schiano di Visconte1, Gianluca Piccoli2, Luigi Brusciano3, Ludovico Docimo3, Marta Veronese2. 1. Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy. mschianodivisconte@gmail.com. 2. Department of Radiology, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy. 3. Division of General, Mininvasive and Obesity Surgery, University of Study of Campania "Vanvitelli", Naples, Italy.
Abstract
AIM: The aim of this retrospective study is to evaluate the preliminary results of a mini-invasive procedure for the treatment of supralevator abscesses (SLA) of cryptoglandular origin by extrasphincteric extension. METHOD: In this clinical study, an innovative two-stage procedure was tested for the surgical treatment of SLA. As first step and as a preparation for surgery, the interventional radiologist positioned a CT-guided percutaneous perianal guidewire inside the abscess cavity under local anesthesia. As second step, the surgeon performed an abscess incision and drainage around the guidewire, with a complete debridement of all the necrotic tissue. If a complex anal fistula was identified, a loose seton was placed in situ. RESULTS: Nine patients, comprising 5 men (55%) and 4 women (45%), underwent the above-mentioned two-stage procedure to treat SLA of cryptoglandular origin. Median age was 32 years (range, 25-42 years). A silicone draining seton was placed during the surgical procedure in 5 patients (55%), since a coexisting fistula was also revealed by surgery. A repeat surgery, along with a new drainage procedure, was required in one patient out of nine (11.1%) for a complete wound healing. The complete wound healing was achieved after a median of 30 days (range, 26-38). At the 1-year follow-up, the healing rate was 89%. CONCLUSIONS: The treatment of SLA of cryptoglandular origin by using this innovative two-stage procedure may be a safe and convenient surgical option to effectively decrease the risk of recurrence and anal sphincteric injuries.
AIM: The aim of this retrospective study is to evaluate the preliminary results of a mini-invasive procedure for the treatment of supralevator abscesses (SLA) of cryptoglandular origin by extrasphincteric extension. METHOD: In this clinical study, an innovative two-stage procedure was tested for the surgical treatment of SLA. As first step and as a preparation for surgery, the interventional radiologist positioned a CT-guided percutaneous perianal guidewire inside the abscess cavity under local anesthesia. As second step, the surgeon performed an abscess incision and drainage around the guidewire, with a complete debridement of all the necrotic tissue. If a complex anal fistula was identified, a loose seton was placed in situ. RESULTS: Nine patients, comprising 5 men (55%) and 4 women (45%), underwent the above-mentioned two-stage procedure to treat SLA of cryptoglandular origin. Median age was 32 years (range, 25-42 years). A silicone draining seton was placed during the surgical procedure in 5 patients (55%), since a coexisting fistula was also revealed by surgery. A repeat surgery, along with a new drainage procedure, was required in one patient out of nine (11.1%) for a complete wound healing. The complete wound healing was achieved after a median of 30 days (range, 26-38). At the 1-year follow-up, the healing rate was 89%. CONCLUSIONS: The treatment of SLA of cryptoglandular origin by using this innovative two-stage procedure may be a safe and convenient surgical option to effectively decrease the risk of recurrence and anal sphincteric injuries.
Authors: Andreas Ommer; Alexander Herold; Eugen Berg; Alois Fürst; Marco Sailer; Thomas Schiedeck Journal: Int J Colorectal Dis Date: 2012-02-24 Impact factor: 2.571
Authors: Jon D Vogel; Eric K Johnson; Arden M Morris; Ian M Paquette; Theodore J Saclarides; Daniel L Feingold; Scott R Steele Journal: Dis Colon Rectum Date: 2016-12 Impact factor: 4.585