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coloproctology
Erschienen in: coloproctology 5/2011

01.10.2011 | Leitlinien

S3-Leitlinie: Kryptoglanduläre Analfisteln

AWMF-Registriernummer: 088/003

Erschienen in: coloproctology | Ausgabe 5/2011

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Zusammenfassung

Hintergrund

Kryptoglanduläre Analfisteln sind mit 2 auf 10.000 Einwohner/Jahr eine häufige Erkrankung mit einem Häufigkeitsgipfel bei jungen männlichen Erwachsenen. Die fehlerhafte Behandlung kann zu einer Beeinträchtigung der Lebensqualität, insbesondere durch Beeinträchtigung der Stuhlkontinenz führen.

Methode

Es wurde eine systematische Literaturrecherche durchgeführt.

Ergebnis

Relevante randomisierte Studien sind selten, so dass der Evidenzlevel insgesamt niedrig ist. Die Klassifikation der Analfisteln orientiert sich nach der Beziehung des Fistelgangs zum Schließmuskel. Für die Operationsindikation sind Anamnese und klinische Untersuchung ausreichend. Zusätzlich sollte intraoperativ eine Sondierung und/oder Anfärbung des Fistelgangs erfolgen. Endosonographie und Magnetresonanztomographie (MRT) sind in ihrer Aussage gleichwertig und können bei komplexen Fisteln als ergänzende Untersuchungen eingesetzt werden.
Als Therapie der Analfistel stehen folgende operative Verfahren zur Verfügung: Fistelspaltung, Fadendrainage, plastische Rekonstruktion mit Sphinkternaht sowie Okklusion mit Biomaterialien. Eine Spaltung sollte nur bei oberflächlichen Fisteln erfolgen. Die Gefahr der postoperativen Kontinenzstörung steigt mit der Menge des durchtrennten Sphinkteranteils. Bei allen hohen Analfisteln soll ein Schließmuskel schonendes Verfahren zur Anwendung kommen. Die Ergebnisse der verschiedenen Techniken zur plastischen Rekonstruktion in Bezug auf Heilungs- und Inkontinenzraten sind weitgehend identisch. Für die Okklusion mit Biomaterialien ist insgesamt eine geringere Heilungsrate zu konstatieren.

Schlussfolgerung

In dieser S3-Leitlinie werden erstmals im deutschen Raum evidenzbasierte Richtlinien für die Diagnostik und Therapie der kryptoglandulären Analfisteln zusammengestellt.
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Metadaten
Titel
S3-Leitlinie: Kryptoglanduläre Analfisteln
AWMF-Registriernummer: 088/003
Publikationsdatum
01.10.2011
Erschienen in
coloproctology / Ausgabe 5/2011
Print ISSN: 0174-2442
Elektronische ISSN: 1615-6730
DOI
https://doi.org/10.1007/s00053-011-0210-3

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