الناسور الشرجي المعقد عندما لا يحقق علاج الإنقاذ للحفاظ على العضلة العاصرة الالتئام

References

DOI: 10.1111/codi.1674

• 'Complex' anal fistulas are extrasphincteric, suprasphincteric or high transsphincteric fistulas involving greater than 30% of the external anal sphincter (EAS) and intersphincteric fistulas involving greater than 50% of the IAS.
• Rectovaginal fistula, anterior fistula in women, recurrent fistula and fistulas with horseshoe or multiple extensions are also classified as complex fistulas.
• Loose setons can be considered as a long-term solution in patients who have complex, recurrent fistulas and are at risk of worsening incontinence from further invasive treatment.
• Loose setons can be considered as a long-term solution in patients who do not want to have further surgery.
• A palliative seton can be considered for the management of recurrent perianal sepsis.
• Palliative seton can be offered to patients with an anal fistula who are keen to avoid further surgical intervention and a risk of injury to the sphincter mechanism.
• A defunctioning stoma can be considered in patients with severe and locally uncontrollable perianal sepsis with an anal fistula.