Materiały źródłowe

• #1 Prevalence of anal fistulas: a systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9123633/

  Anal fistula refers to a clinical condition with local pain and inflammation associated with purulent discharge that affects the quality of life. […] The present systematic review and meta-analysis was performed according to MOOSE guidelines. […] All studies on the prevalence of anal fistula are related to Europe, and so far, no study has been conducted on other continents. […] The overall prevalence of anal fistula in European countries was 18.37 (95% CI: 18.20-18.55%) per 100,000 individuals, and the highest prevalence was reported for Italy (23.20 (95% CI: 22.82 to 23.59) per 100,000 people). […] Epidemiological data on the prevalence of anal fistula is essential for optimal policy-making to achieve the most effective scientific methods for controlling and treating this problem.

• #2

  https://www.journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/view/2365

  Anal fistula refers to a clinical condition with local pain and inflammation associated with purulent discharge that affects the quality of life. […] The overall prevalence of anal fistula in European countries was 18.37 (95% CI: 18.20-18.55%) per 100,000 individuals and the highest prevalence reported for Italy [ 23.20 (95% CI: 22.82 to 23.59) per 100,000 people]. […] Because all the studies included in this study are only related to Europe, the need to study in this field is strongly felt in other countries.

• #3 Epidemiology of Anal Fistula and Abscess | SpringerLink

  https://link.springer.com/10.1007/978-3-030-30902-2_1-1

  Perianal abscess and anal fistula are common anorectal benign diseases, known since ancient Egypt. […] Very recent studies have better defined their epidemiology with a mean prevalence of 823 per 100,000 people. […] Data confirm that 90% are cryptogenetic but IBD-associated lesions should always be considered because a mean prevalence of 4 per 100,000 people was recently calculated. […] The mean age of first presentation is reported to be 40 years in both sexes but men are twice as likely as women to develop perianal abscess or anal fistula. […] Smoking is still an important host risk factor. […] Research is moving into the comprehension of the complex interaction of host, local pro-inflammatory signals, and infections but data about microbiological factors in term of occurrence or recurrence are controversial.

• #4 Fistula-in-Ano: Practice Essentials, Anatomy, Etiology

  https://emedicine.medscape.com/article/190234-overview

  The true prevalence of fistula-in-ano is unknown. The incidence of a fistula-in-ano developing from an anal abscess ranges from 26% to 38%. […] One study showed that the prevalence of fistula-in-ano is 8.6 cases per 100,000 population. In men, the prevalence is 12.3 cases per 100,000 population, and in women, it is 5.6 cases per 100,000 population. The male-to-female ratio is 1.8:1. The mean patient age is 38.3 years.

• #5 Epidemiology, Incidence and Prevalence of Fistula in Ano | Abdominal Key

  https://abdominalkey.com/epidemiology-incidence-and-prevalence-of-fistula-in-ano/

  Epidemiology, Incidence and Prevalence of Fistula in Ano […] Anorectal fistulas have been the subject of medical and lay literature for over 2,500 years. […] The true incidence of anal fistulas is unknown. […] Most publications on anal fistula reflect the authors experience, some quite large, from a single institution. […] Also it is difficult, if not impossible, to accurately assess the incidence of anorectal abscess because so many drain spontaneously or are incised and drained in a surgeons office, emergency department or surgicenter. […] Thus among the 1,000 patients presented to the Surgical Section of the Diagnostic Clinic at the University of Virginia, 150 had anorectal pathology, 4 (0.4 %) had an abscess and 8 (0.8 %) had fistula. […] This is quite comparable to 532 fistulas treated in a population of 77,372 patients admitted to Brooklyn Hospital between 1930 and 1939 for an incidence of 0.69 %. […] Using operating room data in Helsinki Finland (19691978), the incidence of fistulas was calculated to be 8.6 per 100,000 populations (males 12.3 %, females 5.6 %). […] Nelson in his meta-analysis equated this with 20,00025,000 fistulas treated annually in the US. […] Interestingly, the ambulatory case of the National Center for Health Statistics reported 24,000 patients with a primary diagnosis of fistula treated in US Hospitals in 1979. […] The incidence of anorectal fistula can be estimated from the number of anorectal abscesses. […] In a series reported by Ramanujam from a large inner city hospital, the incidence of fistula was 34 %. […] Calculating backward, this would translate to an estimated annual incidence of 68,00096,000 cases in the US.

• #6 Anal fistula epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Anal_fistula_epidemiology_and_demographics

  The prevalence of anal fistula is approximately 1-2 per 10,000 individuals worldwide. In England, the incidence of anal fistula is approximately 18.4 per 10,0000 per year. Anal fistula commonly affects individuals in the third, fourth, and fifth decades, with a peak around 40 years of age. Men are twice more commonly affected by anal fistula than women. […] In Spain, the prevalence of anal fistula is approximately 1.04 per 10,000 per year. […] In Italy, the prevalence of anal fistula is approximately 2.32 per 10,000 per year.

• #7 Anal fistula: everything you need to know | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/anal-fistula-everything-you-need-to-know

  It is estimated that 1-2 per 10,000 Europeans suffer from anal fistula. […] However, population-based studies on anal fistula epidemiology can be limited and outdated. […] These statistics may not be accurate and the prevalence of anal fistulas may be higher because many patients are treated with antibiotics in the community and some abscesses spontaneously regress or discharge.

• #8 Anorectal fistula: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/anorectal-fistula-clinical-manifestations-diagnosis-and-management-principles

  Anorectal fistulas are sometimes also referred to as „fistula-in-ano.” Anorectal fistulas related to Crohn disease require multidisciplinary management and are discussed elsewhere. […] The true prevalence of anal fistulas is unknown, as anorectal discomfort is often attributed to symptomatic hemorrhoids. The incidence of an anal fistula developing from an anal abscess ranges from 15 to 38 percent. The mean age for presentation of anal abscess and fistula disease is 40 years (range 20 to 60). Adult males are twice as likely to develop an abscess and/or fistula compared with women.

• #9 Prevalence of anal fistulas: a systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9123633/

  The current findings showed that among 224,097,362 people (the total number of people studied in the existing studies), there were 44,722 cases of anal fistula, and the total prevalence of anal fistula in European countries is 12.81 people per 100,000 people. […] The highest prevalence of anal fistula was found in Italy. […] The validity of the present results can be confirmed in part by the population-based nature of this study (224,097,362). […] The lack of similar data in other parts of the world indicates the urgent need for similar studies in other countries.

• #10 Fistula-in-Ano – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557517/

  Fistula-in-ano is one of the most common anorectal diseases. The prevalence is greater in men than women, with a rate of 12.3 cases per 100,000 and 5.6 cases per 100,000, respectively. The average age at diagnosis is 38 years, with most occurring between 20 to 40 years of age. Risk factors for fistula development include obesity, diabetes, smoking, hyperlipidemia, and a sedentary lifestyle. […] A diagnosis of fistula-in-ano should be considered for any patient with purulent or feculent anal drainage, especially with a history of an anorectal abscess, Crohns disease, or prior radiation. Diagnosis is often confirmed on physical exam, but more complex fistulas may require imaging for identification. Classification of the fistula is based on anatomy, which is best assessed during the exam. Due to high levels of pain with the exam, an exam under anesthesia may be necessary for an accurate diagnosis.

• #11 Perianal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perianal-fistula?lang=us

  Incidence is estimated at ~1:10,000, with a recognized male predilection of 2-4:1. […] It is unclear if ulcerative colitis is a risk factor for perianal disease. […] The majority of perianal fistulas related to Crohn disease will not heal spontaneously and require surgical management.

• #12 Perianal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perianal-fistula?embed_domain=hackmd.io%2525252F%25252540yIPUAFeCSL2JsU8smR5nJQ%2525252Fbnjhjgjghjghjghfavicon.icofavicon.ico&lang=us

  Incidence is estimated at ~1:10,000, with a recognized male predilection of 2-4:1. […] It is unclear if ulcerative colitis is a risk factor for perianal disease. […] The majority of perianal fistulas related to Crohn disease will not heal spontaneously and require surgical management. […] Malignancy arising from or associated with perianal fistula in Crohn disease is very rare (incidence 0.5%) with adenocarcinoma more common than squamous cell carcinoma.

• #13 MRI for assessment of anal fistula | springermedizin.de

  https://www.springermedizin.de/mri-for-assessment-of-anal-fistula/9251282

  Magnetic resonance imaging (MRI) is the best imaging modality for preoperative assessment of patients with anal fistula. MRI helps to accurately demonstrate disease extension and predict prognosis. This in turn helps make therapy decisions and monitor therapy. […] Anal fistula is a somewhat uncommon condition. It affects approximately ten individuals in 100,000. It usually affects men, in their fourth decade. Men are affected two- to four-times more commonly; the reason is thought to be partially due to the higher abundance of anal glands. […] The role of imaging is, therefore, to outline all hidden tracts and define the relationship of the fistula to the anal sphincter. […] MRI performed adequately should be regarded as the gold standard for preoperative assessment, replacing surgical examination under anesthetic (EUA) in this regard.

• #14 MRI for assessment of anal fistula | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-010-0022-y

  Magnetic resonance imaging (MRI) is the best imaging modality for preoperative assessment of patients with anal fistula. MRI helps to accurately demonstrate disease extension and predict prognosis. This in turn helps make therapy decisions and monitor therapy. Anal fistula is a somewhat uncommon condition. It affects approximately ten individuals in 100,000. It usually affects men, in their fourth decade. Men are affected two- to four-times more commonly; the reason is thought to be partially due to the higher abundance of anal glands. The disease usually begins as an abscess and in chronic stages develops into a fistula in 60% of cases. The role of imaging is, therefore, to outline all hidden tracts and define the relationship of the fistula to the anal sphincter. MRI performed adequately should be regarded as the gold standard for preoperative assessment, replacing surgical examination under anesthetic (EUA) in this regard. MRI helps not only to accurately demonstrate disease extension but also to predict prognosis, make therapy decisions, and monitor therapy. MRI has been shown to reduce recurrent disease and, therefore, reoperation. MRI can be used for monitoring therapy and predicting prognosis even in patients with Crohns disease. MRI has in several studies been shown to be highly predictive of patient outcome.

• #15 Anal Fistula | Concise Medical Knowledge

  https://www.lecturio.com/concepts/anal-fistula/

  Anal fistulas are abnormal communications between the anorectal lumen and another body structure, often to the skin. […] Incidence: 9 per 100,000 adults per year. […] More common between the 3rd and 5th decades of life. […] 50% of patients with anorectal abscess will eventually develop a fistula.

• #16 SciELO Brasil – Epidemiological profile of patients with fistula in ano Epidemiological profile of patients with fistula in ano

  https://www.scielo.br/j/jcol/a/sjhMns8Fj4SRDpMGhZQkYzc/?lang=en

  There is a lack of consistent national data on the evaluation of the epidemiological profile of patients with anal fistula. […] To evaluate the epidemiological profile of patients with anal fistula at a center specialized in coloproctology. […] 93.2% of the patients were less than 60 years old, 66.7% were male, 88.9% had the disease less than one year, the most frequent procedures were fistulotomy (55.6%) and fistulectomy (36.8%), with a greater percentage of patients having undergone only one procedure (74.4%), 8.5% had Crohns disease, 7.7% systemic hypertension and 3.4% had diabetes mellitus. […] In the studied group, there was a predominance of anal fistulae in men under 60 years old and without comorbidities, diagnosed for up to one year, most of them submitted to fistulotomy or fistulectomy at one time. Patients operated after one year of illness and also those with Crohns disease were submitted mainly to curettage + seton and multiple procedures.

• #17 SciELO Brasil – Epidemiological profile of patients with fistula in ano Epidemiological profile of patients with fistula in ano

  https://www.scielo.br/j/jcol/a/sjhMns8Fj4SRDpMGhZQkYzc/?lang=en

  Anal abscesses and fistulas represent about 70% of perianal diseases, which require surgical treatment and occur in 1:10,000 inhabitants per year. […] There are few recent national and even international data on the epidemiology, classification, and treatment of anal fistulas, so there is a need for research seeking to show the current status of this condition. […] In the present study, it was observed that 8.5% of the sample had CD, which is also in agreement with literature data. […] In the sample studied there was a predominance of anal fistulas in men under 60 years of age and without comorbidities, diagnosed up to one year, most undergoing fistulotomy or fistulectomy at a single time.

• #18 Anal Fistula Market Size, Share, Trends and Forecast 2024-2034

  https://www.imarcgroup.com/anal-fistula-market

  The 7 major anal fistula markets are expected to exhibit a CAGR of 3.4% during 2024-2034. […] The anal fistula market has been comprehensively analyzed in IMARC’s new report titled „Anal Fistula Market: Epidemiology, Industry Trends, Share, Size, Growth, Opportunity, and Forecast 2024-2034”. […] Anal fistulas account for over 70% of perianal illnesses that require surgical treatment and occur in 1:10,000 people each year. […] The incidence of an anal fistula emerging from an anal abscess is between 15 and 38%. […] The average age for the manifestation of anal fistula is 40 years (range 20-60). […] Adult males are twice as probable to develop an anal fistula as women. […] The overall prevalence of anal fistula in European countries was 18.37 per 100,000 people. […] IMARC Group’s new report provides an exhaustive analysis of the anal fistula market in the United States, EU4 (Germany, Spain, Italy, and France), United Kingdom, and Japan.

• #19 Anal Fistulas and Fissures: Background, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/776150-overview

  Anal fissures affect males and females equally; however, an anterior fissure is more likely to develop in women (25%) than in men (8%). […] Although anal fissures are the most common cause of rectal bleeding in infants, they are primarily seen in young adults. Eighty-seven percent of people with a chronic anal fissure are between the ages of 20 and 60 years. Anal fissures in children may indicate sexual abuse. […] Anal fistulas are a complication of anorectal abscesses, which are more common in women than in men. For reasons of intrinsic anatomy, rectovaginal fistulas are found only in women. Approximately 30-50% of patients with an anorectal abscess form an anal fistula, and approximately 80% of anal fistulas arise from anorectal infection.

• #20 Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer

  https://www.wjgnet.com/1007-9327/full/v30/i28/3373.htm

  The perianal disease affects up to one-third of individuals with Crohn’s disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). […] In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. […] The patient prognosis is generally poor due to a late diagnosis, and the lack of specificity of symptoms may explain why cancer diagnosis is often delayed. For this reason, surveillance programmes aimed at early detection of neoplastic lesions are urgent. […] To prevent adverse outcomes, an algorithm for anal cancer screening in IBD is proposed. The optimal management of PFCD should include not only the best medical and surgical therapies but also preventive measures to avoid negative outcomes.

• #21 European Crohn´s and Colitis Organisation – ECCO – P801 Treatment patterns of complex perianal fistula in Crohn’s disease in five European countries: the PREFACE study, a retrospective chart review

  https://ecco-ibd.eu/publications/congress-abstracts/item/p801-treatment-patterns-of-complex-perianal-fistula-in-crohn-8217-s-disease-in-five-european-countries-the-preface-study-a-retrospective-chart-review.html

  Presence of fistulas in Crohns disease (CD) is an indicator of poor prognosis; 22.1% of CD patients suffer from fistulising disease with high variability in complex perianal fistula (CPF) prevalence. […] There is limited information available about the management of CPF in a real-world setting. […] Almost one fourth of the patients with CPF already had anal or perianal fistulas at CD diagnosis. […] Based on ECCO guidelines it was expected that almost all CPFs in CD patients should be treated with anti-TNF with or without surgical intervention. […] However, the use of anti-TNF during CPF episodes was lower than expected. […] Almost two third of CPFs were trans-sphincteric and if inadequately treated, sphincter function may be compromised.

• #22 European Crohn´s and Colitis Organisation – ECCO – P801 Treatment patterns of complex perianal fistula in Crohn’s disease in five European countries: the PREFACE study, a retrospective chart review

  https://www.ecco-ibd.eu/publications/congress-abstracts/item/p801-treatment-patterns-of-complex-perianal-fistula-in-crohn-8217-s-disease-in-five-european-countries-the-preface-study-a-retrospective-chart-review.html

  Presence of fistulas in Crohns disease (CD) is an indicator of poor prognosis; 22.1% of CD patients suffer from fistulising disease with high variability in complex perianal fistula (CPF) prevalence. […] This study describes the treatment patterns of patients with CPF in CD in Europe. […] Almost one fourth of the patients with CPF already had anal or perianal fistulas at CD diagnosis. […] Based on ECCO guidelines it was expected that almost all CPFs in CD patients should be treated with anti-TNF with or without surgical intervention. […] However, the use of anti-TNF during CPF episodes was lower than expected. […] Almost two third of CPFs were trans-sphincteric and if inadequately treated, sphincter function may be compromised.

• #23 Anorectal Fistula | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688756/all/Anorectal_Fistula?q=Abscess+Anorectal

  True prevalence unknown […] Mean age of presentation for anal abscess and fistula is ~40 years. […] Males are twice as likely to develop an abscess and/or fistula. […] Lifetime risk of developing anorectal fistulas is 2030% in Crohn disease patients.

• #24 What You Need to Know About Complex Perianal Fistula

  https://ghlf.org/inflammatory-bowel-disease/complex-perianal-fistula-if-you-have-crohns-disease/

  About one in every four people with Crohns disease will have a fistula in their lifetime. […] Fistulas are a common complication of Crohns disease that are best treated with a combination of medication and surgery by a multidisciplinary team. […] Tsai L, et al. Epidemiology and Natural History of Perianal Crohns Disease: A Systematic Review and Meta-Analysis of Population-Based Cohorts. Inflammatory Bowel Disease. 2022. doi: https://doi.org/10.1093/ibd/izab287.

• #25 The Epidemiology and Classification of Anal Fistula

  https://www.jstage.jst.go.jp/article/jcoloproctology/66/10/66_991/_article/-char/en

  No prospective cohort study has been carried out to clarify the etiology of anal fistula, although retrospective studies have demonstrated an association between anal fistula and diarrhea, especially in males. […] The crypt-glandular infection theory is generally accepted by many anatomists and surgeons as the etiology of anal fistula in adults, which postulates that bacterial invasion from the anal crypt into the anal gland, followed by the formation of infectious focus, predisposes the patient to anal fistula. […] The incremental trend of anal fistula among the obese population is thought to be due to the fact that in non-obese adipose tissue, M2 macrophages suppress inflammatory change, whereas in obese adipose tissue, activated M1 macrophages secrete inflammatory cytokines and promote inflammatory reaction. […] The correct diagnosis and rigorous radical operation of anal fistula require a standard classification in order to accurately grasp the position of the whole pathomorphism.

• #26 Anal Fistula – Market Insight, Epidemiology, and Market Forecast – 2034

  https://www.giiresearch.com/report/del1506436-anal-fistula-market-insight-epidemiology-market.html

  The Anal Fistula epidemiology division provide insights about historical and current Anal Fistula patient pool and forecasted trend for every seven major countries. It helps to recognize the causes of current and forecasted trends by exploring numerous studies and views of key opinion leaders. This part of the DelveInsight report also provides the diagnosed patient pool and their trends along with assumptions undertaken. […] The disease epidemiology covered in the report provides historical as well as forecasted Anal Fistula epidemiology scenario in the 7MM covering the United States, EU5 countries (Germany, Spain, Italy, France, and the United Kingdom), and Japan from 2020 to 2034. […] The epidemiology segment also provides the Anal Fistula epidemiology data and findings across the United States, EU5 (Germany, France, Italy, Spain, and the United Kingdom), and Japan.

• #27 Crohn’s disease-related anal fistula cancer diagnosed by examination under anesthesia: a case report | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-023-01722-8

  As the number of patients with inflammatory bowel disease (IBD) increases, the incidence of IBD-related colorectal cancer (CRC) is also on the rise. […] Japanese patients with CD are reported to have a higher frequency of anorectal cancer than the Western population; however, methods for early diagnosis have not yet been established because of perianal pain during the examination. […] We report a case of CD-related anal fistula cancer that was detected early by surveillance examination under anesthesia (EUA). […] EUA is effective for the early detection and treatment of CD-related CRC and may contribute to an improved prognosis. […] In a long-term CD patient with anorectal lesions, we performed an EUA to diagnose the coexistence of anal fistula cancer at an early stage, and surgical resection was achieved.

• #28 Crohn’s disease-related anal fistula cancer diagnosed by examination under anesthesia: a case report | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-023-01722-8

  CD-related colorectal cancer in Japan is characterized by (a) cancer onset at a young age (around 50 years old), (b) a long disease duration of more than 10 years, (c) invasive types (types 3, 4, or 5), (d) a tendency for poorly differentiated types (mucous carcinoma, poorly differentiated carcinoma), and (e) a predilection for the anorectal area. […] Based on these characteristics, it has been proposed that patients with the disease for at least 10 years undergo surveillance examinations every 12-24 months. […] EUA is expected to be useful for the early detection and curative treatment of difficult-to-diagnose CD-related anorectal cancers.

• #29 Anal Fistula – Risk Factors – Clinical Features – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/anal-fistula/

  The majority are associated with anorectal abscess formation, with one third of patients with an anorectal abscess having an associated perianal fistula at the time of presentation. […] Outside of the emergency setting (i.e. anorectal abscess), the majority of fistula are investigated initially with MRI imaging, used to visualise the anatomy of the tract. Any surgical intervention can then be planned based on this. […] MRI pelvis scan is the mainstay of initial investigation.

• #30 Magnetic resonance imaging monitoring of post-treatment changes to Crohn’s disease–related anal fistula in patients prescribed infliximab | HKMJ

  https://www.hkmj.org/abstracts/v24n6/634.htm

  The incidence of inflammatory bowel disease, particularly Crohns disease, is rising in Hong Kong. The age-adjusted incidence of Crohns disease increased from 0.01 per 100 000 population in 1985 to 1.46 per 100 000 population in 2014. Crohns disease is a multisystem disorder with specific radiological features such as transmural inflammation, fistulation, and skip lesions. Perianal fistulas often complicate Crohns disease, affecting up to 36% of patients. […] Current evidence shows encouraging results for closure of perianal fistulas. According to a local consensus statement, biologics are advocated in patients with active fistulising Crohns disease, particularly those with complex perianal fistulising disease. […] Crohns diseaserelated anal fistulae are frequently encountered in radiologic practice due to their complexity and propensity for incomplete treatment response and relapse. Magnetic resonance imaging is a well-established diagnostic tool for anal fistula. Its inherent high spatial and contrast resolution allows precise anatomical delineation.

• #31 Magnetic resonance imaging monitoring of post-treatment changes to Crohn’s disease–related anal fistula in patients prescribed infliximab | HKMJ

  https://www.hkmj.org/abstracts/v24n6/634.htm

  Magnetic resonance imaging plays a critical role in helping determine the appropriate treatment that should be individualised according to the type of perianal fistula and the degree of involvement of surrounding pelvic structures. […] Magnetic resonance imaging also plays an important role in evaluation of the response to medical therapy. This pictorial review demonstrates the ability of MRI to monitor the response to therapy of anal fistula in Crohns disease patients receiving infliximab.

• #32 MRI for assessment of anal fistula | springermedizin.de

  https://www.springermedizin.de/mri-for-assessment-of-anal-fistula/9251282

  MRI helps not only to accurately demonstrate disease extension but also to predict prognosis, make therapy decisions, and monitor therapy. […] MRI has been shown to reduce recurrent disease and, therefore, reoperation. […] MRI has in several studies been shown to be highly predictive of patient outcome. […] This MR grading has been shown to correlate with outcome: grades 1 and 2 are associated with favorable outcome (i.e., no recurrences and therefore no need for reoperations), while grades 3-5 are associated with less favorable outcome (leading to recurrences needing reoperations). […] MRI has become the dominant method for the evaluation of fistulas and conveying information to clinicians, especially surgeons.

• #33 Mucinous adenocarcinoma arising from chronic perianal fistula—a multidisciplinary approach – Díaz-Vico – Journal of Gastrointestinal Oncology

  https://jgo.amegroups.org/article/view/27102/20958

  Mucinous adenocarcinoma (MA) is a rare entity. Indeed, the pathogenesis of fistula-associated perianal MA is still controversial. […] The relation between both entities was first described by Rosser et al. in 1934, who reported seven cases of fistula that had undergone malignant transformation. The pathogenesis of this malignancy is still controversial. MA has an indolent growth and, although metastases to inguinal lymph nodes may be present in advanced cases, distant metastases are uncommon. However, these locally aggressive neoplasms entail a high probability of local recurrence. […] There is no uniform consensus until date regarding diagnosis and/or therapeutic strategies due to the lack of randomized prospective trials embracing this rare malignancy. […] Due to the lack of available data and definitive therapeutic guidelines, the aim of this study is to present our experience based on the outcomes after combining preoperative concurrent chemoradiotherapy, ischioanal APR and eventual adjuvant chemotherapy, and discuss the clinical features with respect to safety and efficacy of the multimodality therapy.

• #34 Mucinous adenocarcinoma arising from chronic perianal fistula—a multidisciplinary approach – Díaz-Vico – Journal of Gastrointestinal Oncology

  https://jgo.amegroups.org/article/view/27102/html

  Mucinous adenocarcinoma (MA) is a rare entity. Indeed, the pathogenesis of fistula-associated perianal MA is still controversial. Due to the lack of informed evidence regarding this malignancy, no guidelines have been established concerning diagnostic and treatment strategies. […] The relation between both entities was first described by Rosser et al. in 1934, who reported seven cases of fistula that had undergone malignant transformation. The pathogenesis of this malignancy is still controversial. MA has an indolent growth and, although metastases to inguinal lymph nodes may be present in advanced cases, distant metastases are uncommon. However, these locally aggressive neoplasms entail a high probability of local recurrence. The subtle symptoms that resemble a fistula-associated perianal MA to an inflammatory benign pathology make an early diagnosis difficult.

• #35 Mucinous adenocarcinoma arising from chronic perianal fistula—a multidisciplinary approach – Díaz-Vico – Journal of Gastrointestinal Oncology

  https://jgo.amegroups.org/article/view/27102/html

  There is no uniform consensus until date regarding diagnosis and/or therapeutic strategies due to the lack of randomized prospective trials embracing this rare malignancy. […] Due to the lack of available data and definitive therapeutic guidelines, the aim of this study is to present our experience based on the outcomes after combining preoperative concurrent chemoradiotherapy, ischioanal APR and eventual adjuvant chemotherapy, and discuss the clinical features with respect to safety and efficacy of the multimodality therapy. […] Mucinous adenocarcinoma arising from chronic perianal fistula is an uncommon neoplasm with indolent growth and locoregional aggressiveness. As these tumors have a high risk of local recurrence, an aggressive and multimodal approach should be carried out to reduce positive surgical margin rates and increase R0 resection rates.

• #36

  https://journals.lww.com/dcrjournal/abstract/1966/09050/cancer_in_anal_fistulas__report_of_two_cases.9.aspx

  We have presented two examples of difficulties encountered in making a diagnosis, and have shown how improper medical or surgical therapy may hinder correct treatment of cancer. […] Over a period of 13 years, two patients have been treated for neoplastic anal fistula. The lesson to be learned is that an early diagnosis is seldom reached and consequently correct treatment is delayed. […] It is emphasized that cancer should be suspected whenever a chronic fistula is surrounded by a large area of swelling and tenderness and drains blood and mucus. […] Biopsy is the most effective means of discovering a malignant complication, but the tissue to be examined must be removed from the deep tissues involved and not from the margins of external fistulous tracts. […] In addition to the reports listed in the bibliography, 131 similar reports have been found.

• #37 Anal Fistula Market Size, Share, Trends and Forecast 2024-2034

  https://www.imarcgroup.com/anal-fistula-market

  According to the report, the United States has the largest patient pool for anal fistula and also represents the largest market for its treatment. […] What is the number of prevalent cases (2018-2034) of anal fistula across the seven major markets? […] What is the size of the anal fistula patient pool (2018-2023) across the seven major markets? […] What would be the forecasted patient pool (2024-2034) across the seven major markets? […] What are the key factors driving the epidemiological trend of anal fistula? […] What will be the growth rate of patients across the seven major markets?

• #38 Early Signs of Anal Cancer: 6 early signs of anal cancer often mistaken for less serious conditions, as experts warn of surging cases | Times Now

  https://www.timesnownews.com/health/6-early-signs-of-anal-cancer-often-mistaken-for-less-serious-conditions-as-experts-warn-of-surging-cases-article-151565184

  Cases of anal cancer have been rising significantly across the world, with doctors being able to identify who is at the most risk. According to experts, anal cancer – which develops in the tissues of the anus or the lining of the anal canal has increased by 2.9 per cent for women and 1.6 per cent for men. […] According to the latest study, researchers analysed data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from 2017 to 2021 and found that if the growing trend continues, the incidence of anal cancer in women over age 65 would double in less than two decades. […] Doctors say anal cancer can be completely treated if detected early. […] Anal fistula is an abnormal opening that goes from your anus to the skin around your anus.

• #39 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. […] In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade. […] The broad field of anal fistulas has seen noteworthy updates and advancements over the past decade, which are detailed in this article. […] In a large study involving 419 patients with anal fistula, RIFIL fistulas were identified in 10% of cases. Complex fistulas were significantly more common in RIFIL than non-RIFIL fistulas (85.7% vs. 38.5%, P0.00001), and the rate of surgical failure was also significantly higher in the RIFIL group (30.6%) compared to the non-RIFIL group (7.2%, P=0.0001). Consequently, accurate diagnosis and proper management of RIFIL fistulas are crucial to prevent recurrence.

• #40 Our Super Specialty: Complex Anal Fistula | Columbia Surgery

  https://columbiasurgery.org/global-colorectal-center/our-super-specialty-complex-anal-fistula

  Anorectal fistulas are a common and vexing problem that can significantly affect quality of life. […] Anyone is at risk of developing the condition, however, they may be associated with other conditions like Crohns disease, where fistulas might be more complex, recurrent and particularly difficult to manage. […] Different procedures can be used, however success rates are variable regardless of the type of procedure, surgeon performing the operation, the center where it is done, or any specific disease process the patient might have. […] A recent study that reviewed Dr Churchs specific results for the management of anal fistulas revealed a success rate of healing of 98% in patients without Crohns disease and 87% in those with Crohns disease. […] Patients with Crohns disease often develop disease near the anus that includes fistulas.

• #41 Our Super Specialty: Complex Anal Fistula | Columbia Surgery

  https://columbiasurgery.org/global-colorectal-center/our-super-specialty-complex-anal-fistula

  Other fistulas occur in the setting of Crohns disease in the tissues around the anus. These patients need biologic therapy to control the Crohns disease before surgery to repair the fistula. […] Our teams expertise in interventional endoscopic techniques for inflammatory bowel disease, structural problems related to the colon and rectum, and correction of surgical complications lends itself to extending these techniques for the management of simple and complex fistulas related to the gastrointestinal tract.

• #42 Top Published Expert Doctors for Rectal Fistula

  https://findexpertmd.com/d/Rectal_Fistula

  631 top medical experts on Rectal Fistula across 40 countries and 23 U.S. states, including 524 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials: at least 129 including 3 Active, 58 Completed, 22 Recruiting.

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