S3-Leitlinie: Kryptoglanduläre Analfisteln

• DOI: 10.1007/s00053-016-0110-7
• Publication Date: 2016-12-05T12:12:38Z
• Authors: A. Ommer; A. Herold; E. Berg; S. Farke; A. Fürst; F. Hetzer; A. Köhler; S. Post; R. Ruppert; M. Sailer; T. Schiedeck; O. Schwandner; B. Strittmatter; B. H. Lenhard; W. Bader; S. Krege; H. Krammer; E. Stange
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Medizin; 3. Good health

Background: Fistula-in-ano of cryptoglandular origin is a common disease with an incidence of 2 per 10,000 inhabitants per year and the peak incidence is in young male adults. Inadequate treatment can have adverse effects on the quality of life and in particular lead to a reduction of fecal continence. Methods: A new systematic review of the literature was performed based on the S3 guidelines published in 2011 in order to develop updated guidelines for anal fistulas. Results: Relevant randomized studies are rare and the level of evidence is generally low. The classification and diagnostics of anal fistulas are still based on the unchanged recommendations from the previous publication. The therapy of anal fistulas can be performed by one of the following operative procedures: fistulotomy or lay-open technique, drainage seton, plastic surgery reconstruction techniques including suturing of the sphincter or occlusion with biomaterials. The new ligation of the intersphincteric fistula tract (LIFT) technique was presented in several studies. The results with respect to healing rates and continence disorders largely correspond to those of plastic reconstruction techniques. The assessment of other new techniques, such as laser, video-assisted anal fistula treatment (VAAFT) and over the scope (OTS) clips, is currently not possible due to a lack of representative literature. The lay-open technique should only be performed in cases of superficial fistulas. The risk of postoperative incontinence increases with the amount of sphincter muscle incised. In cases of high anal fistulas a sphincter preserving procedure should be preferred. The results of the various reconstruction techniques are relatively similar. Using biomaterials for occlusion the healing rate is much lower than originally reported. An assessment of the importance of new materials, such as plugs, collagen and autologous stem cells, is also not possible due to a lack of evidence. Conclusion: These revised S3 guidelines provide evidence-based protocols and recommendations for the diagnostics and treatment options of cryptoglandular fistula-in-ano based on the currently available literature.