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

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. 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. 2. Göksoy E (editor). General Surgery, Volume 2, Nobel Medical Publishing, Ankara; 2021;1138-39.
3. 3. Geçim İ. Ethem, Demirkıran Arda, Principles of Surgery, Tarlan Ltd. Company. 2016;1229-30.
4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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