Perianal Fistüllerde Cerrahi Tedavi Protokolleri ve Malignite Riski: Tek Merkezli Retrospektif Bir Çalışma

Yıl 2025, Cilt: 9 Sayı: 2, 187 - 192, 31.08.2025

Ufuk Tali , Hakan Balbaloglu

https://doi.org/10.29058/mjwbs.1616550

Öz

Amaç: Çalışmanın amacı, perianal fistül hastalığında farklı tedavi seçeneklerinin sonuçlarını tek bir büyük hasta kohortunda araştırmaktır.
Gereç ve Yöntemler: Çalışmaya 2020-2024 yılları arasında ameliyat edilen 176 ardışık hasta retrospektif olarak dahil edildi. Başvuru
semptomları (akıntı, şişlik vb.), perianal fistül tipleri (basit, intersfinkterik, ekstrasfinkterik vb.) ve cerrahi tedaviler (seton, fistülotomi, lazer
vb.) belirlendi
Bulgular: Çalışmamızda dört hastada malign patoloji sonucu saptandı. Bu hastaların ortak özelliği ileri yaşta olmaları ve kronik akıntı
şikayeti ile sağlık merkezlerine başvurmamış olmalarıydı.
Sonuç: Bu tür destekleyici görüntüleme ve tanısal işlemler, doğru tanı ve uygun tedavinin belirlenmesini kolaylaştırarak tedavi başarısını
artırabilir ve komplikasyon riskini azaltabilir.

Anahtar Kelimeler

Anal fistül , malignite , cerrahi

Surgical Treatment Protocols and Risk of Malignancy in Perianal Fistulas: A Single-Center Retrospective Study

Öz

Aim: The aim of the study was to investigate the outcomes of different treatment options for perianal fistula disease in a single large patient
cohort.
Material and Methods: The study retrospectively included 176 consecutive patients operated between 2020 and 2024. Symptoms at
presentation (discharge, swelling, etc.), perianal fistula types (simple, intersphincteric, extrasphincteric, etc.) and surgical treatments (seton,
fistulotomy, laser, etc.) were determined
Results: In our study, malignant pathology results were found in four patients. The common feature of these patients was their advanced
age and the fact that they had not applied to health centres with complaints of chronic discharge.
Conclusion: Such supportive imaging and diagnostic procedures may improve treatment success and reduce the risk of complications by
facilitating accurate diagnosis and determination of appropriate treatment

Anahtar Kelimeler

Anal fistula , malignancy , surgery

Kaynakça

• 1. Bartelsman JF. Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol. 2009;23(4):575-92. https://doi. org/10.1016/j.bpg.2009.04.010
• 2. Göksoy E (editor). General Surgery, Volume 2, Nobel Medical Publishing, Ankara; 2021;1138-39.
• 3. Geçim İ. Ethem, Demirkıran Arda, Principles of Surgery, Tarlan Ltd. Company. 2016;1229-30.
• 4. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011;24(1):14-21. https://doi. org/10.1055/s-0031-1272819
• 5. Öz DK, Zorlu SNY, Eskalen Z, Ateş FSÖ, Akyol C, Erden A, Geçim İE. Goodsall’s Rule Revisited: An MRI-Based Assessment of its Accuracy in Perianal Fistulas. Turk J Colorectal Dis. 2025;35(2):41-7. https://doi:10.4274/tjcd.galenos. 2025.2025-1-2.
• 6. Ong J, Jit-Fong L, Ming-Hian K, Boon-Swee O, Kok-Sun H, Eu KW. Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from a single institution. Tech Coloproctol. 2007;11:34–8. https://doi.org/10.1007/s10151-007- 0322-5
• 7. Leal RF, Ayrizono MLS, Coy CSR, Fagundes JJ, Góes JR. Mucinous adenocarcinoma derived from chronic perianal fistulas: report of a case and review of the literature. Tech Coloproctol. 2007;11:155–7. https://doi.org/10.1007/s10151-007-0348-8
• 8. Yamaguchi T, Kagawa R, Takahashi H, Takeda R, Sakata S, Nishizaki D. Diagnostic implications of MR imaging for mucinous adenocarcinoma arising from fistula in ano. Tech Coloproctol. 2009;13:251–3. https://doi.org/10.1007/s10151-009- 0509-z
• 9. Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas. BJS open. 2019;3(3);231–41. https://doi.org/10.1002/bjs5.50129
• 10. Enck P, Bielefeldt K, Rathmann W, Purrmann J, Tschöpe D, Erckenbrecht JF. Epidemiology of faecal incontinence in selected patient groups. Colorectal Dis. 1991;6:143–6. https://doi. org/10.1007/BF00341234
• 11. Theerapol A, So BY, Ngoi SS. Routine use of setons for the treatment of anal fistulae. Singapore Med J. 2002;43:305-307
• 12. Kronborg O. To lay open or excise a fistula-in-ano: a randomized trial. Br J Surg. 1985;72(12):970. doi: 10.1002/bjs.1800721211. PMID: 3910159. https://doi.org/10.1002/bjs.1800721211
• 13. Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, Washington KM, Carneiro F, Cree IA. WHO Classification of Tumours Editorial Board. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182-8. https://doi.org/10.1111/his.13975
• 14. Hama Y, Makita K, Yamana T, Dodanuki K. Mucinous adenocarcinoma arising from fistula in ano: MRI findings. AJR Am J Roentgenol. 2006;187(2):517-21. https://doi.org/10.2214/ AJR.05.0011
• 15. Rzepakowska A, Osuch-Wójcikiewicz E, Ochal-Choińska A, Bruzgielewicz A, Chęciński P, Nyckowska J, Szwedowicz P. Przetoki skórne jako powikłanie po laryngektomii całkowitej-- analiza materiału Kliniki Otolaryngologii WUM i przegląd piśmiennictwa [Pharyngocutaneous fistula as a complication after total laryngectomy--clinical study and literature review]. Otolaryngol Pol. 2011;65(5 Suppl):22-30. https://doi. org/10.1016/S0030-6657(11)70705-3
• 16. Osone K, Ogawa H, Katayama C, Shibasaki Y, Suga K, Komine C, Ozawa N, Okada T, Shiraishi T, Katoh R, Sakai M, Sano A, Yokobori T, Matsumura N, Sohda M, Shirabe K, Saeki H. Outcomes of surgical treatment in patients with anorectal fistula cancer. Surg Case Rep. 2021;7(1):32. https://doi.org/10.1186/ s40792-021-01118-6
• 17. Kodama M, Kobayashi D, Iihara K, Abe K, Sahara R, Sassa M, Yamana T, Furukawa S, Yao T, Uchida K, Tamura T, Negi M, Eishi Y. Adenocarcinoma within anorectal fistulae: different clinicopathological characteristics between Crohn’s disease-associated type and the usual type. Mod Pathol. 2019;32(2):314- 325 https://doi.org/10.1038/s41379-018-0105-8
• 18. Scharl M, Frei P, Frei SM, Biedermann L, Weber A, Rogler G. Epithelial-to-mesenchymal transition in a fistula-associated anal adenocarcinoma in a patient with long-standing Crohn’s disease. Eur J Gastroenterol Hepatol. 2014;26(1):114-8. https://doi.org/10.1097/MEG.0b013e32836371a2