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coloproctology
Erschienen in: coloproctology 1/2017

05.12.2016 | Leitlinien

S3-Leitlinie: Kryptoglanduläre Analfisteln

2. revidierte Fassung, AWMF‑Registriernummer: 088/003

verfasst von: Dr. A. Ommer, Prof. Dr. A. Herold, Dr. E. Berg, Prof. Dr. S. Farke, Prof. Dr. A. Fürst, Prof. Dr. F. Hetzer, Dr. A. Köhler, Prof. Dr. S. Post, Dr. R. Ruppert, Prof. Dr. M. Sailer, Prof. Dr. T. Schiedeck, Prof. Dr. O. Schwandner, Dr. B. Strittmatter, Dr. B. H. Lenhard, Prof. Dr. W. Bader, Prof. Dr. S. Krege, Prof. Dr. H. Krammer, Prof. Dr. E. Stange

Erschienen in: coloproctology | Ausgabe 1/2017

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Zusammenfassung

Hintergrund

Kryptoglanduläre Analfisteln sind mit 2 pro 10.000 Einwohner/Jahr eine häufige Erkrankung mit einem Häufigkeitsgipfel bei jungen männlichen Erwachsenen. Eine nicht adäquate Behandlung kann zu einer Beeinträchtigung der Lebensqualität und insbesondere zur Reduktion der Kontinenzleistung führen.

Methode

Aufbauend auf der S3-Leitlinie aus dem Jahr 2011 wurde eine erneute systematische Literaturrecherche durchgeführt, und die Leitlinien wurden aktualisiert.

Ergebnis

Relevante randomisierte Studien sind weiterhin selten, so dass das Evidenzniveau weitgehend unverändert niedrig bleibt. Bezüglich Klassifikation und Diagnostik gelten die Empfehlungen der vorausgehenden Leitlinie unverändert. Zur Therapie der Analfistel stehen folgende operative Verfahren zur Verfügung: Fistelspaltung, Fadendrainage, plastische Rekonstruktion mit Sphinkternaht sowie Okklusion mit Biomaterialien. Als neue Technik wurde in mehreren Studien das LIFT-Verfahren vorgestellt. Die Ergebnisse bezüglich Heilungsraten und Kontinenzstörungen entsprechen weitgehend denen der plastischen Rekonstruktionstechniken. Die Bewertung weiterer neuer Verfahren (Laser, VAAFT, OTS-Clip) ist mangels repräsentativer Literatur derzeit nicht abschließend möglich. Eine Fistelspaltung sollte nur bei oberflächlichen Fisteln erfolgen. Die Gefahr der postoperativen Kontinenzstörung steigt mit der Menge des durchtrennten Sphinkteranteils. Bei allen hohen Analfisteln soll ein sphinkterschonendes Verfahren zur Anwendung kommen. Die Ergebnisse der verschiedenen Techniken zur plastischen Rekonstruktion sind weitgehend identisch. Für die Okklusion durch Biomaterialien ist insgesamt eine deutlich geringere Heilungsrate zu konstatieren als primär berichtet. Auch hier ist der Stellenwert neuerer Materialien (neue Plugs, Kollagen, autologe Stammzellen) mangels Evidenz nicht abschließend möglich.

Schlussfolgerung

In dieser S3-Leitlinie werden auf dem Boden der aktuellen Literatur evidenzbasierte Richtlinien und Empfehlungen für die Diagnostik und Therapie kryptoglandulärer Analfisteln zusammengestellt.
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Metadaten
Titel
S3-Leitlinie: Kryptoglanduläre Analfisteln
2. revidierte Fassung, AWMF‑Registriernummer: 088/003
verfasst von
Dr. A. Ommer
Prof. Dr. A. Herold
Dr. E. Berg
Prof. Dr. S. Farke
Prof. Dr. A. Fürst
Prof. Dr. F. Hetzer
Dr. A. Köhler
Prof. Dr. S. Post
Dr. R. Ruppert
Prof. Dr. M. Sailer
Prof. Dr. T. Schiedeck
Prof. Dr. O. Schwandner
Dr. B. Strittmatter
Dr. B. H. Lenhard
Prof. Dr. W. Bader
Prof. Dr. S. Krege
Prof. Dr. H. Krammer
Prof. Dr. E. Stange
Publikationsdatum
05.12.2016
Verlag
Springer Medizin
Erschienen in
coloproctology / Ausgabe 1/2017
Print ISSN: 0174-2442
Elektronische ISSN: 1615-6730
DOI
https://doi.org/10.1007/s00053-016-0110-7

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