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2016 ; 29
(2
): 92-100
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Management of Complex Perineal Fistula Disease
#MMPMID27247533
Akiba RT
; Rodrigues FG
; da Silva G
Clin Colon Rectal Surg
2016[Jun]; 29
(2
): 92-100
PMID27247533
show ga
Management of complex perineal fistulas such as high perianal, rectovaginal,
pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic
approach. The first step is to control any sepsis with drainage of abscess and/or
seton placement. Patients with large, recurrent, irradiated fistulas benefit from
stoma diversion. In patients with Crohn's disease, it is essential to induce
remission prior to any repair. There are different approaches to repair complex
fistulas, from local repairs to transperineal and transabdominal approaches.
Simpler fistulas are amenable to local repair. More complex fistulas, such as
those secondary to irradiation, require interposition of healthy,
well-vascularized tissue. The most common flap used for this treatment is the
gracilis muscle with good outcomes reported. Once healing is confirmed by imaging
and endoscopy, the stoma is reversed.