Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas  

作　　者：Pankaj Garg Vipul D Yagnik Sushil Dawka Baljit Kaur Geetha R Menon 

机构地区：[1]Department of Colorectal Surgery,Garg Fistula Research Institute,Panchkula 134113,Haryana,India [2]Department of Colorectal Surgery,Indus International Hospital,Mohali 140201,Punjab,India [3]Department of Surgical Gastroenterology,Nishtha Surgical Hospital and Research Center,Patan 384265,Gujarat,India [4]Department of Surgery,SSR Medical College,Belle Rive 744101,Mauritius [5]Department of Radiology,SSRD Magnetic Resonance Imaging Institute,Chandigarh 160011,India [6]Department of Statistics,Indian Council of Medical Research,New Delhi 110029,India

出　　处：《World Journal of Gastroenterology》2022年第16期1608-1624,共17页世界胃肠病学杂志（英文版）

摘　　要：Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

关 键 词：Anal fistula Supralevator Suprasphincteric Extrasphincteric Magnetic resonance imaging 

分 类 号：R657.16[医药卫生—外科学]