Perirectal fistula - diagnostic and therapeutic problems

Abstract

Problems of diagnosing and treating perirectal fistula are presented on the basis of literature and the author’s own experience. The etiopathology of perirectal fistulas as well as their various classifications are discussed according to the course of the fistula’s canal and the location of external and internal opening in relation to anatomic parts of the rectal sphincter systems. Diagnostic procedure, including history taking and physical examination, is presented as well as the possibility of imaging examinations. The usability of the last-mentioned in diagnostics preceding an operation is compared. Attention is drawn in particular to the significance of the operation alone in determining the course of the canal and the location of the fistula’s internal opening. Various operating techniques are presented as well as the dependence between the fistula’s type and the method of surgical intervention. Emphasis is laid on the great importance of the operator’s technical skills and his experience, which determine the efficiency of treatment.