520:
into the fistula to locate the internal opening in the anus and to identify any secondary tracts or abscess cavities. The anal canal is held open using a speculum and irrigation solution is used to give a clear view of the fistula tract. Light from the fistuloscope can be seen from inside the anal canal at the location of the internal opening of the fistula, which helps to locate the internal opening. In the operative phase of the procedure, the fistula tract is cleaned and the internal opening of the fistula is sealed. To do this, the surgeon uses the unipolar electrode, under video guidance, to cauterise material in the fistula tract. Necrotic material is removed at the same time using the fistula brush and forceps, as well as by continuous irrigation. The surgeon then closes the internal opening from inside the anal canal using stitches and staples.
491:
intersphincteric approach. Essential steps of the procedure include, incision at the intersphincteric groove, identification of the intersphincteric tract, ligation of intersphincteric tract close to the internal opening and removal of intersphincteric tract, scraping out all granulation tissue in the rest of the fistulous tract, and suturing of the defect at the external sphincter muscle. The procedure was developed by Thai colorectal surgeon, Arun
Rojanasakul, The first reports of preliminary healing result from the procedure were 94% in 2007. Additional ligation of the intersphincteric fistula tract did not improve the outcome after endorectal advancement flap.
40:
498:
surgical principle of this technique relies on the dynamic compression and permanent closure of the internal fistula opening by the superelastic clip. Consequently, the fistula tract dries out and heals instead of being kept open by continuous feeding with stool and fecal organisms. This minimally-invasive sphincter-preserving technique has been developed and clinically implemented by the German surgeon
Ruediger Prosst. First clinical data of the clip closure technique demonstrate a success rate of 90% for previously untreated fistulae and a success rate of 70% for recurrent fistulae.
477:
188:
261:
classification correlate quite well with the severity of the disease. Grade I & II are simpler fistulas and can be managed by
Fistulotomy whereas Grade III-V are complex fistulas in which fistulotomy should be not be done. They should be managed by Fistula experts. Unlike Park's and St James University Hospital Classification, this correlation is quite accurate with Garg's classification. Therefore this new classification is useful to both surgeons and radiologists.
1378:
465:
hospitalizations, the fistula plug procedure requires hospitalization for only about 24 hours. Currently, there are two different anal fistula plugs cleared by the FDA for treating ano-rectal fistulae in the United States. This treatment option does not carry any risk of bowel incontinence. In the systematic review published by Dr Pankaj Garg, the success rate of the fistula plug is 65–75%.
388: – this option involves an operation to cut the fistula open. Once the fistula has been laid open it will be packed on a daily basis for a short period of time to ensure that the wound heals from the inside out. This option leaves behind a scar, and depending on the position of the fistula in relation to the sphincter muscle, can cause problems with
519:
The VAAFT procedure is done in two phases, diagnostic and operative. Before the procedure, the patient is given a spinal or general anaesthetic and is placed in the lithotomy position (legs in stirrups with the perineum at the edge of the table). In the diagnostic phase, the fistuloscope is inserted
497:
is a recent surgical development, which involves the closure of the internal fistula opening with a superelastic clip made of nitinol (OTSC). During surgery, the fistula tract is debrided with a special fistula brush and the clip is transanally applied with the aid of a preloaded clip applicator. The
457:
is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the
118:
do not generally harm, but can be very painful, and can be irritating because of the drainage of pus (it is also possible for formed stools to be passed through the fistula). Additionally, recurrent abscesses may lead to significant short term morbidity from pain and, importantly, create a starting
471:
is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening
464:
involves plugging the fistula with a device made from small intestinal submucosa. The fistula plug is positioned from the inside of the anus with suture. According to some sources, the success rate with this method is as high as 80%. As opposed to the staged operations, which may require multiple
490:
is a novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano, known as LIFT (ligation of intersphincteric fistula tract) procedure. LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the
378:
it crosses. However, treatment is challenging as complete eradication of the anal sphincters may lead to continence impairment, but failure to excise the affected areas results in recurrence. Those already treated for recurring anal fistula are at higher risk to experience re-recurrence of the
437: – a length of suture material looped through the fistula which keeps it open and allows pus to drain out. In this situation, the seton is referred to as a draining seton. The stitch is placed close to the ano-rectal ring – which encourages healing and makes further surgery easy.
260:
Garg classification: This was done by Pankaj Garg in 2017. This classification is improvement over both Parks and St James
University Hospital Classification. This was based on MRI studies and operative findings in 440 patients. It classified the fistula in five grades. The grades of this
413:, "bristle") may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. This option minimizes scarring but can cause
335:
Transphincteric fistulae begin between the internal and external sphincter muscles or behind the anus, cross the external sphincter muscle and open an inch or more away from the anus. These may take a 'U' shape and form multiple external openings. This is sometimes termed a 'horseshoe
122:
Treatment, in the form of surgery, is considered essential to allow drainage and prevent infection. Repair of the fistula itself is considered an elective procedure which many patients opt for due to the discomfort and inconvenience associated with an actively draining fistula.
472:
was, the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.
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A literature review published in 2018 showed an incidence as high as 21 people per 100,000. "Anal fistulas are 2–6 times more prevalent in males than females, with the condition occurring most frequently in patients in their 30s and 40s."
1108:
van
Onkelen, RS; Gosselink, MP; Schouten, WR (February 2012). "Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract?".
76:
and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of
421:. Once the fistula tract is in a low enough position it may be laid open to speed up the process, or the seton can remain in place until the fistula is completely cured. This was the traditional modality used by physicians in
256:
St James
University Hospital Classification: This was done by Morris et al. in the year 2000. This classification was improvement over Parks classification as it was based on MRI studies. It classified the fistula in five
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1406:
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or
Examination Under Anaesthesia). The fistula may be explored by using a fistula probe (a narrow instrument). In this way, it may be possible to find both openings. The examination can be an
1081:
Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K (March 2007). "Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract".
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can be used as with other infections, but the best way of healing infection is to prevent the buildup of pus in the fistula, which leads to abscess formation. This can be done with a
253:
was available. It classified the fistula in four grades: intersphincteric (grade I), transsphincteric (grade II), suprasphincteric (grade III) and extrasphincteric (grade IV).
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Intersphincteric fistulae begin between the internal and external sphincter muscles, pass through the internal sphincter muscle, and open very close to the anus.
1152:
Prosst RL, Herold A, Joos AK, Bussen D, Wehrmann M, Gottwald T, Schurr MO (September 2012). "The anal fistula claw: the OTSC clip for anal fistula closure".
1510:
2014:
1281:
Mennigen R, Laukötter M, Senninger N, Rijcken E (April 2015). "The OTSC(®) proctology clip system for the closure of refractory anal fistulas".
617:
406: – if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton (from the
1609:
778:
Morris J, Spencer JA, Ambrose NS (May 2000). "MR imaging classification of perianal fistulas and its implications for patient management".
1238:
Prosst RL, Ehni W, Joos AK (September 2013). "The OTSC Proctology clip system for anal fistula closure: first prospective clinical data".
995:
Garg P, Song J, Bhatia A, Kalia H, Menon GR (October 2010). "The efficacy of anal fistula plug in fistula-in-ano: a systematic review".
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1195:
Prosst RL, Ehni W (July 2012). "The OTSC Proctology clip system for anorectal fistula closure: the 'anal fistula claw': case report".
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Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the
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598:
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2089:
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815:"Comparing existing classifications of fistula-in-ano in 440 operated patients: Is it time for a new classification?"
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332:, proceed downward between the puborectalis and levator ani muscles, and open an inch or more away from the anus.
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Suprasphincteric fistulae begin between the internal and external sphincter muscles, extend above and cross the
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Intersphincteric fistula in the lower anal canal. Ultrasound image where the fistula is labeled with a letter F.
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are located). Causes of this type could be from a rectal, pelvic or supralevator origin, usually secondary to
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when they present with a fistula, and this requires clearing up before definitive treatment can be decided.
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1986:
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211:. Diagnosis may be aided by performing a fistulogram, proctoscopy and/or sigmoidoscopy. Possible findings:
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A unipolar electrode for diathermy of the internal tract. This is connected to a high frequency generator.
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can form which can eventually extend to the skin surface. The tract formed by this process is a fistula.
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1976:
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Parks, A. G.; Gordon, P. H.; Hardcastle, J. D. (1976-01-01). "A classification of fistula-in-ano".
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984:", translation by Francis Adams, Internet Classics Archive, Massachusetts Institute of Technology
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Rojanasakul A (September 2009). "LIFT procedure: a simplified technique for fistula-in-ano".
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A fistula brush and forceps for cleaning the tract and clearing any granulation tissue.
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1326:"PRACTICE GUIDELINES-Japanese Practice Guidelines for Anal Disorders II. Anal fistula"
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A video telescope (fistuloscope) to allow surgeons to see inside the fistula tract.
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2001:
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Parks AG, Gordon PH, Hardcastle JD (1976). "A classification of fistula-in-ano".
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2010:
2006:
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Japan: A man with an anal fistula. From the Yamai no Soshi, late 12th century.
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Other conditions in which infected perianal "holes" or openings may include
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Abscesses can recur if the fistula seals over, allowing the accumulation of
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pus, serous fluid and/or (rarely) feces discharge — can be bloody or
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1971:
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529:
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343:
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593:. Vol. 1 (26th ed.). Philadelphia: Elsevier. p. 935.
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is a surgical kit for treating anal fistulae. The system comprises:
2116:
2094:
1806:
208:
141:
111:. It can then extend to the surface again – repeating the process.
392:. This option is not suitable for fistulae that cross the entire
39:
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1934:
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risk of incontinence, and creates minimal stress for the patient.
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101:
69:
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1377:
418:
283:
2084:
1814:
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81:. They can form when anal abscesses do not heal properly.
246:
108:
215:
The opening of the fistula onto the skin may be observed
131:
Anal fistulae can present with the following symptoms:
1151:
367:
There are several stages to treating an anal fistula:
860:
734:
585:
Madoff, Robert D.; Melton-Meax, Genevieve B. (2020).
1388:
777:
587:"136. Diseases of the rectum and anus: anal fistula"
100:. If the outlet of these glands becomes blocked, an
994:
342:Submucosal fistulae pass superficially beneath the
278:muscles, fistulae are classified into five types:
584:
2790:
921:Shawki, Sherief; Wexner, Steven D (2011-07-28).
228:may be felt; thickening due to chronic infection
152:depending on presence and severity of infection:
683:
1237:
684:Mappes, H. J.; Farthmann, E. H. (2001-01-01).
589:. In Goldman, Lee; Schafer, Andrew I. (eds.).
298:. Note that this type does not arise from the
1504:
1037:
1610:Esophagogastric junction outflow obstruction
920:
1649:Esophageal intramural pseudodiverticulosis
1511:
1497:
1194:
578:
195:Diagnosis is by examination, either in an
38:
1349:
956:
938:
830:
350:
346:and do not cross either sphincter muscle.
270:Depending on their relationship with the
178:Thick discharge, which keeps the area wet
475:
241:Park's classification: This was done by
186:
294:and open into the skin surrounding the
282:Extrasphincteric fistulae begin at the
2791:
1323:
495:Fistula clip closure (OTSC Proctology)
417:in a small number of cases, mainly of
218:The area may be painful on examination
2633:
1877:Small intestinal bacterial overgrowth
1492:
916:
914:
912:
910:
908:
792:10.1148/radiographics.20.3.g00mc15623
126:
856:
854:
852:
850:
812:
730:
728:
703:
701:
699:
697:
679:
677:
652:
650:
648:
646:
644:
642:
612:
610:
658:"Colorectal Surgery – Anal Fistula"
245:et al. from the UK in 1976, before
13:
1240:Minim Invasive Ther Allied Technol
1197:Minim Invasive Ther Allied Technol
905:
290:and proceed downward, through the
14:
2825:
2762:Spontaneous bacterial peritonitis
2609:Exocrine pancreatic insufficiency
1370:
927:World Journal of Gastroenterology
847:
725:
694:
674:
639:
607:
235:
84:Anal fistulae originate from the
2507:Secondary sclerosing cholangitis
1376:
1324:Yamana, Tetsuo (July 25, 2018).
1166:10.1111/j.1463-1318.2011.02902.x
1111:Diseases of the Colon and Rectum
1009:10.1111/j.1463-1318.2009.01933.x
618:"Anorectal sinuses and fistulae"
528:Some people will have an active
88:, which are located between the
1748:Gastric antral vascular ectasia
1743:Portal hypertensive gastropathy
1620:Gastroesophageal reflux disease
1317:
1274:
1231:
1188:
1145:
1101:
1074:
1031:
988:
973:
545:
429:, who used horsehair and linen.
47:Different types of anal fistula
2502:Primary sclerosing cholangitis
2352:Hepatic veno-occlusive disease
2174:Solitary rectal ulcer syndrome
863:The British Journal of Surgery
806:
771:
119:point for systemic infection.
1:
2559:Sphincter of Oddi dysfunction
713:Merck Manual Consumer Version
571:
33:Anal fistulae, fistula-in-ano
2468:Postcholecystectomy syndrome
1987:Intestinal pseudoobstruction
1595:Esophageal motility disorder
1252:10.3109/13645706.2013.826675
1209:10.3109/13645706.2012.692690
1123:10.1097/DCR.0b013e31823c0f74
523:
362:
182:
7:
923:"Idiopathic fistula-in-ano"
662:colorectal.surgery.ucsf.edu
554:
469:Endorectal advancement flap
443: – till anorectal ring
10:
2830:
2453:Gallstone / Cholelithiasis
1977:Functional colonic disease
1773:Zollinger–Ellison syndrome
832:10.1016/j.ijsu.2017.04.019
386:Lay-open of fistula-in-ano
2747:
2626:
2567:
2481:
2438:
2284:
2275:
2228:
2182:
2137:
2023:
1910:
1800:
1787:
1662:
1654:Acute esophageal necrosis
1536:
1527:
1451:
1392:
1295:10.1007/s10151-015-1284-7
1052:10.1007/s10151-009-0522-2
425:and formally codified by
51:
46:
37:
29:
24:
1753:Gastric dumping syndrome
1628:Laryngopharyngeal reflux
1615:Diffuse esophageal spasm
940:10.3748/wjg.v17.i28.3277
813:Garg P (13 April 2017).
687:Anal abscess and fistula
451: – to allow healing
376:external anal sphincters
265:
2369:Alcoholic liver disease
1902:Bile acid malabsorption
1846:Peptic (duodenal) ulcer
398:external anal sphincter
231:A discharge may be seen
94:external anal sphincter
2804:Diseases of intestines
2379:Hepatic encephalopathy
1763:Buried bumper syndrome
1694:Peptic (gastric) ulcer
1578:Mallory–Weiss syndrome
1521:human digestive system
1342:10.23922/jarc.2018-009
875:10.1002/bjs.1800630102
749:10.1002/bjs.1800630102
591:Goldman-Cecil Medicine
481:
351:Differential diagnosis
192:
70:abnormal communication
2604:Pancreatic pseudocyst
2473:Porcelain gallbladder
1585:Zenker's diverticulum
479:
455:Fibrin glue injection
190:
2408:Hepatorenal syndrome
2347:Budd–Chiari syndrome
2304:Autoimmune hepatitis
2129:Intestinal adhesions
1887:Short bowel syndrome
1716:Functional dyspepsia
1634:Esophageal stricture
1600:Nutcracker esophagus
1385:at Wikimedia Commons
312:inflammatory process
221:There may be redness
2547:Choledocholithiasis
2418:Metabolic disorders
2384:Acute liver failure
2357:Portal hypertension
2309:Alcoholic hepatitis
2152:Radiation proctitis
2071:Mesenteric ischemia
2043:Gastroenterocolitis
1872:Blind loop syndrome
1682:Ménétrier's disease
1590:Barrett's esophagus
1330:J Anus Rectum Colon
709:"Anorectal Fistula"
622:www.meb.uni-bonn.de
330:puborectalis muscle
251:endoanal ultrasound
96:and drain into the
16:Disease of the anus
2799:Colorectal surgery
2722:Undefined location
2713:Grynfeltt–Lesshaft
2614:Pancreatic fistula
2597:Pancreatic abscess
2552:Biliary dyskinesia
2523:Mirizzi's syndrome
2024:Large and/or small
1704:Dieulafoy's lesion
1573:Boerhaave syndrome
1452:External resources
1154:Colorectal Disease
997:Colorectal Disease
482:
292:levator ani muscle
276:external sphincter
193:
127:Signs and symptoms
2786:
2785:
2782:
2781:
2622:
2621:
2224:
2223:
2081:Bowel obstruction
1783:
1782:
1486:
1485:
1381:Media related to
933:(28): 3277–3285.
600:978-0-323-55087-1
243:Alan Guyatt Parks
199:setting or under
63:
62:
19:Medical condition
2821:
2774:Pneumoperitoneum
2631:
2630:
2541:Common bile duct
2423:Wilson's disease
2413:Peliosis hepatis
2282:
2281:
2159:Proctalgia fugax
2066:Abdominal angina
1991:Ogilvie syndrome
1940:Pseudomembranous
1798:
1797:
1758:Gastric volvulus
1723:Pyloric stenosis
1534:
1533:
1519:Diseases of the
1513:
1506:
1499:
1490:
1489:
1390:
1389:
1380:
1364:
1363:
1353:
1321:
1315:
1314:
1283:Tech Coloproctol
1278:
1272:
1271:
1235:
1229:
1228:
1192:
1186:
1185:
1149:
1143:
1142:
1105:
1099:
1098:
1083:J Med Assoc Thai
1078:
1072:
1071:
1040:Tech Coloproctol
1035:
1029:
1028:
992:
986:
977:
971:
970:
960:
942:
918:
903:
902:
858:
845:
844:
834:
810:
804:
803:
775:
769:
768:
732:
723:
722:
720:
719:
705:
692:
691:
681:
672:
671:
669:
668:
654:
637:
636:
634:
633:
624:. Archived from
614:
605:
604:
582:
203:(referred to as
42:
22:
21:
2829:
2828:
2824:
2823:
2822:
2820:
2819:
2818:
2789:
2788:
2787:
2778:
2743:
2732:Internal hernia
2618:
2563:
2528:Biliary fistula
2486:
2477:
2463:Adenomyomatosis
2458:Cholesterolosis
2434:
2428:Hemochromatosis
2299:Viral hepatitis
2271:
2220:
2178:
2164:Rectal prolapse
2133:
2100:Fecal impaction
2090:Intussusception
2053:Crohn's disease
2019:
2002:Toxic megacolon
1914:
1912:Large intestine
1906:
1851:Curling's ulcer
1804:
1802:Small intestine
1791:
1779:
1687:Gastroenteritis
1658:
1523:
1517:
1487:
1482:
1481:
1447:
1446:
1401:
1373:
1368:
1367:
1322:
1318:
1279:
1275:
1236:
1232:
1193:
1189:
1150:
1146:
1106:
1102:
1079:
1075:
1036:
1032:
993:
989:
978:
974:
919:
906:
859:
848:
811:
807:
776:
772:
733:
726:
717:
715:
707:
706:
695:
690:. Zuckschwerdt.
682:
675:
666:
664:
656:
655:
640:
631:
629:
616:
615:
608:
601:
583:
579:
574:
557:
548:
526:
365:
353:
308:Crohn's disease
268:
238:
185:
171:unpleasant odor
149: — itching
136:skin maceration
129:
58:General surgery
20:
17:
12:
11:
5:
2827:
2817:
2816:
2811:
2806:
2801:
2784:
2783:
2780:
2779:
2777:
2776:
2771:
2769:Hemoperitoneum
2766:
2765:
2764:
2753:
2751:
2745:
2744:
2742:
2741:
2740:
2739:
2734:
2729:
2718:
2717:
2716:
2715:
2710:
2697:
2696:
2691:
2686:
2681:
2676:
2675:
2674:
2669:
2658:
2657:
2652:
2651:
2650:
2639:
2637:
2628:
2624:
2623:
2620:
2619:
2617:
2616:
2611:
2606:
2601:
2600:
2599:
2594:
2589:
2584:
2573:
2571:
2565:
2564:
2562:
2561:
2556:
2555:
2554:
2549:
2536:
2535:
2530:
2525:
2516:
2515:
2514:
2509:
2504:
2493:
2491:
2479:
2478:
2476:
2475:
2470:
2465:
2460:
2455:
2450:
2444:
2442:
2436:
2435:
2433:
2432:
2431:
2430:
2425:
2415:
2410:
2405:
2404:
2403:
2398:
2388:
2387:
2386:
2381:
2371:
2366:
2365:
2364:
2359:
2354:
2349:
2337:
2336:
2335:
2325:
2324:
2323:
2313:
2312:
2311:
2306:
2301:
2290:
2288:
2279:
2273:
2272:
2270:
2269:
2268:
2267:
2257:
2256:
2255:
2250:
2240:
2238:Blood in stool
2234:
2232:
2226:
2225:
2222:
2221:
2219:
2218:
2213:
2211:Anal dysplasia
2208:
2203:
2198:
2188:
2186:
2180:
2179:
2177:
2176:
2171:
2166:
2161:
2156:
2155:
2154:
2143:
2141:
2135:
2134:
2132:
2131:
2126:
2125:
2124:
2114:
2113:
2112:
2102:
2097:
2092:
2087:
2078:
2076:Angiodysplasia
2073:
2068:
2057:
2056:
2055:
2045:
2040:
2039:
2038:
2027:
2025:
2021:
2020:
2018:
2017:
2011:Diverticulosis
2007:Diverticulitis
2004:
1995:
1994:
1993:
1984:
1974:
1969:
1968:
1967:
1962:
1957:
1952:
1947:
1942:
1932:
1926:
1924:
1908:
1907:
1905:
1904:
1899:
1897:Milroy disease
1894:
1889:
1884:
1879:
1874:
1869:
1867:Tropical sprue
1864:
1855:
1854:
1853:
1843:
1842:
1841:
1836:
1831:
1820:
1818:
1795:
1789:Lower GI tract
1785:
1784:
1781:
1780:
1778:
1777:
1776:
1775:
1765:
1760:
1755:
1750:
1745:
1740:
1735:
1730:
1725:
1720:
1719:
1718:
1708:
1707:
1706:
1701:
1691:
1690:
1689:
1684:
1679:
1668:
1666:
1660:
1659:
1657:
1656:
1651:
1646:
1641:
1636:
1631:
1625:
1624:
1623:
1617:
1612:
1607:
1602:
1592:
1587:
1582:
1581:
1580:
1575:
1565:
1564:
1563:
1558:
1553:
1542:
1540:
1531:
1529:Upper GI tract
1525:
1524:
1516:
1515:
1508:
1501:
1493:
1484:
1483:
1480:
1479:
1468:
1456:
1455:
1453:
1449:
1448:
1445:
1444:
1433:
1418:
1402:
1397:
1396:
1394:
1393:Classification
1387:
1386:
1372:
1371:External links
1369:
1366:
1365:
1336:(3): 103–109.
1316:
1273:
1230:
1187:
1144:
1100:
1073:
1030:
1003:(10): 965–70.
987:
980:Hippocrates, "
972:
904:
846:
805:
770:
724:
693:
673:
638:
606:
599:
576:
575:
573:
570:
569:
568:
563:
556:
553:
547:
544:
525:
522:
517:
516:
515:
514:
511:
508:
499:
492:
487:LIFT Technique
474:
473:
466:
459:
452:
444:
438:
430:
401:
364:
361:
357:pilonidal cyst
352:
349:
348:
347:
340:
337:
333:
326:
267:
264:
263:
262:
258:
254:
237:
236:Classification
234:
233:
232:
229:
222:
219:
216:
184:
181:
180:
179:
175:
174:
173:
172:
169:
166:
163:
160:
154:
153:
150:
144:
138:
128:
125:
114:Anal fistulae
79:anal abscesses
61:
60:
55:
49:
48:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2826:
2815:
2814:Anal diseases
2812:
2810:
2807:
2805:
2802:
2800:
2797:
2796:
2794:
2775:
2772:
2770:
2767:
2763:
2760:
2759:
2758:
2755:
2754:
2752:
2750:
2746:
2738:
2735:
2733:
2730:
2728:
2725:
2724:
2723:
2720:
2719:
2714:
2711:
2709:
2706:
2705:
2704:
2703:
2699:
2698:
2695:
2692:
2690:
2687:
2685:
2682:
2680:
2677:
2673:
2670:
2668:
2665:
2664:
2663:
2660:
2659:
2656:
2653:
2649:
2646:
2645:
2644:
2643:Diaphragmatic
2641:
2640:
2638:
2636:
2632:
2629:
2625:
2615:
2612:
2610:
2607:
2605:
2602:
2598:
2595:
2593:
2590:
2588:
2585:
2583:
2580:
2579:
2578:
2575:
2574:
2572:
2570:
2566:
2560:
2557:
2553:
2550:
2548:
2545:
2544:
2543:
2542:
2538:
2537:
2534:
2531:
2529:
2526:
2524:
2520:
2517:
2513:
2510:
2508:
2505:
2503:
2500:
2499:
2498:
2495:
2494:
2492:
2490:
2484:
2480:
2474:
2471:
2469:
2466:
2464:
2461:
2459:
2456:
2454:
2451:
2449:
2448:Cholecystitis
2446:
2445:
2443:
2441:
2437:
2429:
2426:
2424:
2421:
2420:
2419:
2416:
2414:
2411:
2409:
2406:
2402:
2399:
2397:
2394:
2393:
2392:
2391:Liver abscess
2389:
2385:
2382:
2380:
2377:
2376:
2375:
2374:Liver failure
2372:
2370:
2367:
2363:
2360:
2358:
2355:
2353:
2350:
2348:
2345:
2344:
2343:
2342:
2338:
2334:
2331:
2330:
2329:
2326:
2322:
2319:
2318:
2317:
2314:
2310:
2307:
2305:
2302:
2300:
2297:
2296:
2295:
2292:
2291:
2289:
2287:
2283:
2280:
2278:
2274:
2266:
2263:
2262:
2261:
2258:
2254:
2251:
2249:
2246:
2245:
2244:
2241:
2239:
2236:
2235:
2233:
2231:
2227:
2217:
2214:
2212:
2209:
2207:
2204:
2202:
2199:
2197:
2193:
2190:
2189:
2187:
2185:
2181:
2175:
2172:
2170:
2167:
2165:
2162:
2160:
2157:
2153:
2150:
2149:
2148:
2145:
2144:
2142:
2140:
2136:
2130:
2127:
2123:
2120:
2119:
2118:
2115:
2111:
2108:
2107:
2106:
2103:
2101:
2098:
2096:
2093:
2091:
2088:
2086:
2082:
2079:
2077:
2074:
2072:
2069:
2067:
2063:
2062:
2058:
2054:
2051:
2050:
2049:
2046:
2044:
2041:
2037:
2034:
2033:
2032:
2031:Enterocolitis
2029:
2028:
2026:
2022:
2016:
2012:
2008:
2005:
2003:
1999:
1996:
1992:
1988:
1985:
1983:
1980:
1979:
1978:
1975:
1973:
1970:
1966:
1963:
1961:
1958:
1956:
1953:
1951:
1948:
1946:
1943:
1941:
1938:
1937:
1936:
1933:
1931:
1928:
1927:
1925:
1922:
1918:
1913:
1909:
1903:
1900:
1898:
1895:
1893:
1890:
1888:
1885:
1883:
1880:
1878:
1875:
1873:
1870:
1868:
1865:
1863:
1859:
1858:Malabsorption
1856:
1852:
1849:
1848:
1847:
1844:
1840:
1837:
1835:
1832:
1830:
1827:
1826:
1825:
1822:
1821:
1819:
1816:
1812:
1808:
1803:
1799:
1796:
1794:
1790:
1786:
1774:
1771:
1770:
1769:
1766:
1764:
1761:
1759:
1756:
1754:
1751:
1749:
1746:
1744:
1741:
1739:
1736:
1734:
1733:Gastroparesis
1731:
1729:
1726:
1724:
1721:
1717:
1714:
1713:
1712:
1709:
1705:
1702:
1700:
1699:Cushing ulcer
1697:
1696:
1695:
1692:
1688:
1685:
1683:
1680:
1678:
1675:
1674:
1673:
1670:
1669:
1667:
1665:
1661:
1655:
1652:
1650:
1647:
1645:
1644:Megaesophagus
1642:
1640:
1637:
1635:
1632:
1629:
1626:
1621:
1618:
1616:
1613:
1611:
1608:
1606:
1603:
1601:
1598:
1597:
1596:
1593:
1591:
1588:
1586:
1583:
1579:
1576:
1574:
1571:
1570:
1569:
1566:
1562:
1559:
1557:
1554:
1552:
1549:
1548:
1547:
1544:
1543:
1541:
1539:
1535:
1532:
1530:
1526:
1522:
1514:
1509:
1507:
1502:
1500:
1495:
1494:
1491:
1478:
1474:
1473:
1469:
1467:
1463:
1462:
1458:
1457:
1454:
1450:
1443:
1439:
1438:
1434:
1432:
1428:
1427:
1423:
1419:
1417:
1413:
1412:
1408:
1404:
1403:
1400:
1395:
1391:
1384:
1379:
1375:
1374:
1361:
1357:
1352:
1347:
1343:
1339:
1335:
1331:
1327:
1320:
1312:
1308:
1304:
1300:
1296:
1292:
1288:
1284:
1277:
1269:
1265:
1261:
1257:
1253:
1249:
1245:
1241:
1234:
1226:
1222:
1218:
1214:
1210:
1206:
1203:(4): 307–12.
1202:
1198:
1191:
1183:
1179:
1175:
1171:
1167:
1163:
1160:(9): 1112–7.
1159:
1155:
1148:
1140:
1136:
1132:
1128:
1124:
1120:
1116:
1112:
1104:
1096:
1092:
1088:
1084:
1077:
1069:
1065:
1061:
1057:
1053:
1049:
1046:(3): 237–40.
1045:
1041:
1034:
1026:
1022:
1018:
1014:
1010:
1006:
1002:
998:
991:
985:
983:
976:
968:
964:
959:
954:
950:
946:
941:
936:
932:
928:
924:
917:
915:
913:
911:
909:
900:
896:
892:
888:
884:
880:
876:
872:
868:
864:
857:
855:
853:
851:
842:
838:
833:
828:
824:
820:
816:
809:
801:
797:
793:
789:
786:(3): 623–35.
785:
781:
780:Radiographics
774:
766:
762:
758:
754:
750:
746:
742:
738:
731:
729:
714:
710:
704:
702:
700:
698:
689:
688:
680:
678:
663:
659:
653:
651:
649:
647:
645:
643:
628:on 2018-06-05
627:
623:
619:
613:
611:
602:
596:
592:
588:
581:
577:
567:
564:
562:
559:
558:
552:
543:
541:
537:
533:
531:
521:
512:
509:
506:
505:
503:
500:
496:
493:
489:
488:
484:
483:
478:
470:
467:
463:
460:
456:
453:
450:
449:
445:
442:
439:
436:
435:
431:
428:
424:
423:Ancient Egypt
420:
416:
412:
409:
405:
404:Cutting seton
402:
399:
395:
391:
387:
384:
383:
382:
381:
377:
373:
368:
360:
358:
345:
341:
338:
334:
331:
327:
324:
321:
317:
313:
309:
305:
301:
297:
293:
289:
288:sigmoid colon
285:
281:
280:
279:
277:
273:
259:
255:
252:
248:
244:
240:
239:
230:
227:
223:
220:
217:
214:
213:
212:
210:
206:
202:
198:
189:
177:
176:
170:
167:
164:
161:
158:
157:
156:
155:
151:
148:
145:
143:
139:
137:
134:
133:
132:
124:
120:
117:
112:
110:
105:
103:
99:
95:
91:
87:
82:
80:
75:
71:
68:is a chronic
67:
59:
56:
54:
50:
45:
41:
36:
32:
28:
23:
2721:
2700:
2577:Pancreatitis
2539:
2489:biliary tree
2362:Nutmeg liver
2339:
2265:Hematochezia
2216:Pruritus ani
2201:Anal abscess
2196:Anal fistula
2195:
2192:Anal fissure
2105:Constipation
2059:
1930:Appendicitis
1738:Gastroptosis
1728:Achlorhydria
1567:
1556:Eosinophilic
1477:Anal fistula
1470:
1459:
1435:
1420:
1405:
1383:Anal fistula
1333:
1329:
1319:
1289:(4): 241–6.
1286:
1282:
1276:
1246:(5): 255–9.
1243:
1239:
1233:
1200:
1196:
1190:
1157:
1153:
1147:
1117:(2): 163–6.
1114:
1110:
1103:
1089:(3): 581–6.
1086:
1082:
1076:
1043:
1039:
1033:
1000:
996:
990:
981:
975:
930:
926:
866:
862:
822:
818:
808:
783:
779:
773:
740:
736:
716:. Retrieved
712:
686:
665:. Retrieved
661:
630:. Retrieved
626:the original
621:
590:
580:
561:Anal fissure
549:
546:Epidemiology
534:
527:
518:
501:
494:
485:
468:
462:Fistula plug
461:
454:
446:
434:Seton stitch
432:
415:incontinence
410:
403:
390:incontinence
385:
369:
366:
354:
320:diverticular
300:dentate line
269:
194:
147:pruritus ani
130:
121:
115:
113:
106:
83:
72:between the
66:Anal fistula
65:
64:
25:Anal fistula
2757:Peritonitis
2519:Cholestasis
2497:Cholangitis
2440:Gallbladder
2328:Fatty liver
2248:Hematemesis
2230:GI bleeding
2036:Necrotizing
1965:Lymphocytic
1960:Collagenous
1955:Microscopic
1892:Steatorrhea
1793:Enteropathy
1639:Inlet patch
1561:Herpetiform
1546:Esophagitis
982:On Fistulae
869:(1): 1–12.
743:(1): 1–12.
536:Antibiotics
441:Fistulotomy
427:Hippocrates
316:appendiceal
304:anal glands
302:(where the
224:An area of
201:anaesthesia
86:anal glands
30:Other names
2793:Categories
2749:Peritoneal
2727:Incisional
2648:Congenital
2592:Hereditary
2569:Pancreatic
2533:Haemobilia
2206:Hemorrhoid
2184:Anal canal
2122:Infectious
2110:Functional
1945:Ulcerative
1829:Duodenitis
1768:Gastrinoma
1472:Patient UK
819:Int J Surg
718:2016-06-27
667:2016-07-03
632:2016-07-03
572:References
566:Hemorrhoid
226:induration
197:outpatient
165:tenderness
98:anal canal
74:anal canal
2737:Richter's
2694:Spigelian
2689:Obturator
2679:Umbilical
2512:Ascending
2483:Bile duct
2316:Cirrhosis
2294:Hepatitis
2277:Accessory
2147:Proctitis
1998:Megacolon
1972:Dysentery
1882:Whipple's
1834:Jejunitis
1824:Enteritis
1711:Dyspepsia
1672:Gastritis
1605:Achalasia
1538:Esophagus
1461:eMedicine
949:1007-9327
899:204100917
883:0007-1323
825:: 34–40.
765:204100917
737:Br J Surg
530:infection
524:Infection
448:Colostomy
379:disease.
363:Treatment
344:submucosa
336:fistula.'
323:abscesses
183:Diagnosis
53:Specialty
2809:Fistulas
2667:Indirect
2662:Inguinal
2396:Pyogenic
2341:Vascular
2117:Diarrhea
2095:Volvulus
2061:Vascular
2000: /
1989: /
1950:Ischemic
1917:Appendix
1807:Duodenum
1677:Atrophic
1551:Candidal
1466:med/2710
1360:31559351
1311:23284320
1303:25715788
1268:25219225
1260:23971828
1225:23099041
1217:22657572
1174:22122680
1139:25873518
1131:22228159
1095:17427539
1068:11643866
1060:19636496
1025:30693484
1017:19438881
967:21876614
841:28414118
800:10835116
555:See also
394:internal
372:internal
314:such as
272:internal
209:anoscopy
162:swelling
142:purulent
90:internal
2708:Petit's
2684:Femoral
2587:Chronic
2401:Amoebic
2169:Anismus
1935:Colitis
1862:Coeliac
1839:Ileitis
1811:Jejunum
1664:Stomach
1568:Rupture
1442:D012003
1351:6752149
1182:2605631
958:3160530
891:1267867
757:1267867
257:grades.
102:abscess
2702:Lumbar
2672:Direct
2655:Hiatus
2635:Hernia
2487:Other
2253:Melena
2139:Rectum
1622:(GERD)
1358:
1348:
1309:
1301:
1266:
1258:
1223:
1215:
1180:
1172:
1137:
1129:
1093:
1066:
1058:
1023:
1015:
965:
955:
947:
897:
889:
881:
839:
798:
763:
755:
597:
419:flatus
310:or an
284:rectum
116:per se
2627:Other
2582:Acute
2333:MASLD
2286:Liver
2260:Lower
2243:Upper
2085:Ileus
1921:Colon
1815:Ileum
1630:(LPR)
1431:565.1
1416:K60.3
1307:S2CID
1264:S2CID
1221:S2CID
1178:S2CID
1135:S2CID
1064:S2CID
1021:S2CID
895:S2CID
761:S2CID
540:seton
502:VAAFT
408:Latin
266:Types
168:fever
2015:SCAD
1437:MeSH
1426:9-CM
1356:PMID
1299:PMID
1256:PMID
1213:PMID
1170:PMID
1127:PMID
1091:PMID
1056:PMID
1013:PMID
963:PMID
945:ISSN
887:PMID
879:ISSN
837:PMID
796:PMID
753:PMID
595:ISBN
411:seta
396:and
374:and
296:anus
274:and
159:pain
92:and
2321:PBC
2048:IBD
1982:IBS
1422:ICD
1407:ICD
1346:PMC
1338:doi
1291:doi
1248:doi
1205:doi
1162:doi
1119:doi
1048:doi
1005:doi
953:PMC
935:doi
871:doi
827:doi
788:doi
745:doi
318:or
286:or
249:or
247:MRI
205:EUA
109:pus
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