Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy.
Department of Radiology, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy.
Int J Colorectal Dis. 2019 Apr;34(4):763-767. doi: 10.1007/s00384-019-03243-z. Epub 2019 Jan 15.
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.
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.
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%.
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.
本回顾性研究旨在评估经括约肌外间隙微创治疗肛隐窝源性高位肛旁脓肿（SLA）的初步结果。
在这项临床研究中，我们创新性地采用两阶段手术方法治疗 SLA。首先，在局麻下，介入放射科医生将 CT 引导下经皮经肛旁导丝置于脓肿腔内。第二步，外科医生围绕导丝进行脓肿切开引流，彻底清除所有坏死组织。如果发现复杂的肛瘘，则在原位放置松质缝线。
9 例（男 5 例，女 4 例）接受上述两阶段手术治疗肛隐窝源性高位 SLA。中位年龄为 32 岁（范围 25-42 岁）。5 例（55%）患者在手术过程中放置了硅胶引流缝线，因为手术还发现存在并存的瘘管。9 例中有 1 例（11.1%）需要再次手术和新的引流程序，以完全愈合伤口。中位愈合时间为 30 天（范围 26-38 天）。在 1 年随访时，愈合率为 89%。
采用这种创新性两阶段手术方法治疗肛隐窝源性高位 SLA 可能是一种安全有效的手术选择，可以有效降低复发和肛门括约肌损伤的风险。
