Pilonidalsinus und Analfistel

Abstract

Proctologic fistulas are divided into pilonidal sinuses affecting the anal cleft and fistula in ano as tracts between the anus and perianal skin. An uncomplicated finding of a pilonidal sinus is treated by minimally invasive excision of the fistula tract using local anesthesia and acute abscesses must be drained prior to excision. Conservative approaches as well as radical excision are no longer recommended. In complicated situations a wide excision with plastic closure by a Limberg flap is the treatment of choice. Fistula in ano must be differentiated into subcutaneous and deep intersphincteral fistulas with no involvement of the anal sphincter and high intersphincteral transphincteral, suprasphincteral and extrasphincteral fistulas. Fistulas in the first group are candidates for fistulotomy with a low risk of incontinence and a high healing rate but the latter group has an increased risk of incontinence and fistula recurrence. Fistulas can be closed by an anal fistula plug without risk of incontinence but with a high risk of recurrence. In the case of recurrence a fistulectomy with closure of the internal opening and an anorectal advancement flap is performed.