Advancement Flap and Ligation of Intersphincteric Fistula Tract
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Advancement Flap and Ligation of Intersphincteric Fistula Tract
Anorectal Disease- A 37-year-old healthy man with no history of fecal continence issues presents with a draining left anterior fistula-in-ano. The fistula goes directly from the intersphincteric groove to an anterior crypt at the dentate line. What is the most appropriate treatment?
- A 32-year-old woman with a history of Crohn’s disease presents with pain of 3 days’ duration and swelling in the perianal region. Computed tomography confirms an ischiorectal abscess with transsphincteric fistula. In addition to draining the abscess, what is the best next step in management?
- A 43-year-old woman underwent a ligation of intersphincteric fistula tract (LIFT) 7 weeks ago to close her posterior transsphincteric anal fistula. She has had persistent discharge from her intersphincteric wound. On clinical examination, she was found to have a persistent internal opening and the external opening has healed. What would be the most appropriate procedure to perform next to resolve her drainage?
- A 25-year-old smoker with a history of Crohn’s disease and morbid obesity underwent emergent abscess drainage and seton placement 6 months ago. The patient is being treated with biologics. On physical examination of the perianal area, a right posterolateral high transphincteric fistula is seen with a seton and normal anoscopy findings. Which of the following options would you recommend?
Anorectal Disease- A 43-year-old man presents with perianal fistula. Examination revealed an internal opening to be at the dentate line. Magnetic resonance imaging revealed a transsphincteric fistula encompassing half of the external sphincter with the mucosal opening at the right anterior location. No abscess or collections are present. What is the most appropriate surgical management for this patient?
- A 40-year-old woman, gravida 2, para 2 (both vaginal deliveries), initially presents with a transsphincteric anal fistula. She undergoes a ligation of intersphincteric fistula tract (LIFT) procedure. The patient now reports persistent seropurulent drainage from the surgical incision approximately 4 weeks postoperatively. Magnetic resonance imaging of the pelvis reveals an intersphincteric fistula but no associated abscess. Of the following options, which is the best next step in management of this patient’s fistula?
- A 53-year-old woman, gravida 3, para 3, with a BMI of 38 and diabetes, and who is an active smoker presents to your office with a draining seton placed for recurrent fistula in ano. Magnetic resonance imaging (MRI) shows a right anterolateral transsphincteric fistula with an anterior sphincter defect. Which factor places her at the highest risk for anal advancement flap failure?
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