The value of routine histopathological analysis in patients with fistula in-ano
Objective To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano. Method Histopathology reports of all the patients who underwent surgery for fistulae‐in‐ano over a period of 36 months were reviewed. Results Analysis included 84 patients of whi...
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| Published in | Colorectal disease Vol. 12; no. 2; pp. 94 - 96 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.02.2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1462-8910 1463-1318 1463-1318 |
| DOI | 10.1111/j.1463-1318.2008.01698.x |
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| Abstract | Objective To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano.
Method Histopathology reports of all the patients who underwent surgery for fistulae‐in‐ano over a period of 36 months were reviewed.
Results Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11–68). Forty‐one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn’s disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid‐fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn’s disease in one (1.2%) patient. All three patients had recurrent fistulae.
Conclusion As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in‐ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn’s disease. |
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| AbstractList | Objective
To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano.
Method
Histopathology reports of all the patients who underwent surgery for fistulae‐in‐ano over a period of 36 months were reviewed.
Results
Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11–68). Forty‐one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn’s disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid‐fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn’s disease in one (1.2%) patient. All three patients had recurrent fistulae.
Conclusion
As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in‐ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn’s disease. To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano. Histopathology reports of all the patients who underwent surgery for fistulae-in-ano over a period of 36 months were reviewed. Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11-68). Forty-one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn's disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid-fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn's disease in one (1.2%) patient. All three patients had recurrent fistulae. As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in-ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn's disease. To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano.OBJECTIVETo determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano.Histopathology reports of all the patients who underwent surgery for fistulae-in-ano over a period of 36 months were reviewed.METHODHistopathology reports of all the patients who underwent surgery for fistulae-in-ano over a period of 36 months were reviewed.Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11-68). Forty-one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn's disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid-fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn's disease in one (1.2%) patient. All three patients had recurrent fistulae.RESULTSAnalysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11-68). Forty-one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn's disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid-fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn's disease in one (1.2%) patient. All three patients had recurrent fistulae.As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in-ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn's disease.CONCLUSIONAs the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in-ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn's disease. Objective To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano. Method Histopathology reports of all the patients who underwent surgery for fistulae‐in‐ano over a period of 36 months were reviewed. Results Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11–68). Forty‐one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn’s disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid‐fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn’s disease in one (1.2%) patient. All three patients had recurrent fistulae. Conclusion As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in‐ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn’s disease. |
| Author | Samarasekera, D. N. Wijekoon, N. S. |
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| References | Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectat/vaginal fistulas. Dis Colon Rectum 1996; 39: 10-14. McAnally AK, Dockerty MB. Carcinoma developing in chronic draining cutaeous sinuses and fistulas. Surg Gynecol Obstet 1949; 88: 87-96. Perrin WS. President's address: some landmarks in the history of rectal surgery. Proc R Soc Med 1932; 25: 338-46. O'Donohoe MK, Watdron RP, O'Malley E. Miliary tuberculosis presenting as an acute perianal abscess: report of a case. Dis Colon Rectum 1987; 30: 697-8. Lockhart-Mummery HE. Symposium. Crohn's disease: anal lesions. Dis Colon Rectum. 1975; 18: 200-2. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 1984; 73: 219-24. Sood A, Midha V. Epidemiology of inflammatory bowel disease in Asia. Indian. J Gastroenterol 2007; 26: 285-9. Wenner WJ Jr, Gutenberg M, Crombleholme T, Flickinger C, Bartlett SP. The pathological evaluation of the paediatric inguinal hernia sac. J Paediatr Surg 1998; 33: 717-8. Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens. BMC Surg 2007; 10: 7. Garcfa-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 1996; 39: 723-9. Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine surgical pathology in general surgery. Br J Surg 2006; 93: 362-8. Alvarez JL, Gutidrrez VM, Del Riego R et al. Aportaci6n de tres nuevos casos. Rev Esp Enferm Dig 1992; 81: 46-48. Schwartz DA, Loftus EV Jr, Tremaine WJ et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122: 875-80. Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula in ano. Br J Surg 1988; 75: 38-39. Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 1980; 21: 525-7. McCune WS, Thistlettwaiter JR. Fistula cancer. Ann Surg 1959; 149: 815-20. Gray BK, Lockhartmummery HE, Morson BC. Crohn's disease of the anal region. Gut 1965; 6: 515-24. Gaertner WB, Hagerman GF, Finne CO, Alavi K, Jessurun J, Rothenberger DA, Madoff RD. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. Dis Colon Rectum 2008; 51: 1061-7. Golub RW, Wise WE Jr, Kemer BA, Khanduju KS, Aguilar PS. Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-inano. J Gastrointest Surg 1997; 1: 487-91. Hamalainen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 1997; 40: 1443-7. 1984; 73 2006; 93 1992; 81 1997; 40 1996; 39 1949; 88 1987; 30 1965; 6 2002; 122 1980; 21 1975; 18 1932; 25 1997; 1 1988; 75 2007; 10 2008; 51 1959; 149 1998; 33 2007; 26 e_1_2_5_14_2 e_1_2_5_9_2 Jones AE (e_1_2_5_10_2) 2007; 10 Perrin WS (e_1_2_5_11_2) 1932; 25 e_1_2_5_16_2 e_1_2_5_8_2 e_1_2_5_15_2 e_1_2_5_7_2 e_1_2_5_5_2 e_1_2_5_12_2 e_1_2_5_20_2 e_1_2_5_4_2 e_1_2_5_21_2 e_1_2_5_3_2 Garcfa‐Aguilar J (e_1_2_5_6_2) 1996; 39 McAnally AK (e_1_2_5_19_2) 1949; 88 e_1_2_5_17_2 Sainio P (e_1_2_5_2_2) 1984; 73 Sood A (e_1_2_5_18_2) 2007; 26 Alvarez JL (e_1_2_5_13_2) 1992; 81 |
| References_xml | – reference: Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens. BMC Surg 2007; 10: 7. – reference: McCune WS, Thistlettwaiter JR. Fistula cancer. Ann Surg 1959; 149: 815-20. – reference: Gray BK, Lockhartmummery HE, Morson BC. Crohn's disease of the anal region. Gut 1965; 6: 515-24. – reference: Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 1984; 73: 219-24. – reference: Garcfa-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 1996; 39: 723-9. – reference: McAnally AK, Dockerty MB. Carcinoma developing in chronic draining cutaeous sinuses and fistulas. Surg Gynecol Obstet 1949; 88: 87-96. – reference: Lockhart-Mummery HE. Symposium. Crohn's disease: anal lesions. Dis Colon Rectum. 1975; 18: 200-2. – reference: Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula in ano. Br J Surg 1988; 75: 38-39. – reference: Sood A, Midha V. Epidemiology of inflammatory bowel disease in Asia. Indian. J Gastroenterol 2007; 26: 285-9. – reference: Alvarez JL, Gutidrrez VM, Del Riego R et al. Aportaci6n de tres nuevos casos. Rev Esp Enferm Dig 1992; 81: 46-48. – reference: O'Donohoe MK, Watdron RP, O'Malley E. Miliary tuberculosis presenting as an acute perianal abscess: report of a case. Dis Colon Rectum 1987; 30: 697-8. – reference: Hamalainen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 1997; 40: 1443-7. – reference: Golub RW, Wise WE Jr, Kemer BA, Khanduju KS, Aguilar PS. Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-inano. J Gastrointest Surg 1997; 1: 487-91. – reference: Wenner WJ Jr, Gutenberg M, Crombleholme T, Flickinger C, Bartlett SP. The pathological evaluation of the paediatric inguinal hernia sac. J Paediatr Surg 1998; 33: 717-8. – reference: Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectat/vaginal fistulas. Dis Colon Rectum 1996; 39: 10-14. – reference: Matthyssens LE, Ziol M, Barrat C, Champault GG. Routine surgical pathology in general surgery. Br J Surg 2006; 93: 362-8. – reference: Gaertner WB, Hagerman GF, Finne CO, Alavi K, Jessurun J, Rothenberger DA, Madoff RD. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. Dis Colon Rectum 2008; 51: 1061-7. – reference: Perrin WS. President's address: some landmarks in the history of rectal surgery. Proc R Soc Med 1932; 25: 338-46. – reference: Schwartz DA, Loftus EV Jr, Tremaine WJ et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122: 875-80. – reference: Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 1980; 21: 525-7. – volume: 51 start-page: 1061 year: 2008 end-page: 7 article-title: Fistula‐associated anal adenocarcinoma: good results with aggressive therapy publication-title: Dis Colon Rectum – volume: 93 start-page: 362 year: 2006 end-page: 8 article-title: Routine surgical pathology in general surgery publication-title: Br J Surg – volume: 122 start-page: 875 year: 2002 end-page: 80 article-title: The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota publication-title: Gastroenterology – volume: 26 start-page: 285 year: 2007 end-page: 9 article-title: Epidemiology of inflammatory bowel disease in Asia. Indian publication-title: J Gastroenterol – volume: 21 start-page: 525 year: 1980 end-page: 7 article-title: Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease publication-title: Gut – volume: 33 start-page: 717 year: 1998 end-page: 8 article-title: The pathological evaluation of the paediatric inguinal hernia sac publication-title: J Paediatr Surg – volume: 81 start-page: 46 year: 1992 end-page: 48 article-title: Aportaci6n de tres nuevos casos publication-title: Rev Esp Enferm Dig – volume: 73 start-page: 219 year: 1984 end-page: 24 article-title: Fistula‐in‐ano in a defined population. Incidence and epidemiological aspects publication-title: Ann Chir Gynaecol – volume: 1 start-page: 487 year: 1997 end-page: 91 article-title: Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula‐inano publication-title: J Gastrointest Surg – volume: 149 start-page: 815 year: 1959 end-page: 20 article-title: Fistula cancer publication-title: Ann Surg – volume: 18 start-page: 200 year: 1975 end-page: 2 article-title: Symposium. Crohn’s disease: anal lesions publication-title: Dis Colon Rectum – volume: 39 start-page: 10 year: 1996 end-page: 14 article-title: Long‐term analysis of the use of transanal rectal advancement flaps for complicated anorectat/vaginal fistulas publication-title: Dis Colon Rectum – volume: 30 start-page: 697 year: 1987 end-page: 8 article-title: Miliary tuberculosis presenting as an acute perianal abscess: report of a case publication-title: Dis Colon Rectum – volume: 10 start-page: 7 year: 2007 article-title: The value of routine histopathological examination of appendicectomy specimens publication-title: BMC Surg – volume: 25 start-page: 338 year: 1932 end-page: 46 article-title: President’s address: some landmarks in the history of rectal surgery publication-title: Proc R Soc Med – volume: 75 start-page: 38 year: 1988 end-page: 39 article-title: Tubercular fistula in ano publication-title: Br J Surg – volume: 88 start-page: 87 year: 1949 end-page: 96 article-title: Carcinoma developing in chronic draining cutaeous sinuses and fistulas publication-title: Surg Gynecol Obstet – volume: 40 start-page: 1443 year: 1997 end-page: 7 article-title: Cutting seton for anal fistulas: high risk of minor control defects publication-title: Dis Colon Rectum – volume: 6 start-page: 515 year: 1965 end-page: 24 article-title: Crohn’s disease of the anal region publication-title: Gut – volume: 39 start-page: 723 year: 1996 end-page: 9 article-title: Anal fistula surgery: factors associated with recurrence and incontinence publication-title: Dis Colon Rectum – ident: e_1_2_5_3_2 doi: 10.1007/BF02048261 – ident: e_1_2_5_14_2 doi: 10.1053/gast.2002.32362 – ident: e_1_2_5_21_2 doi: 10.1007/s10350-008-9294-4 – ident: e_1_2_5_9_2 doi: 10.1002/bjs.5268 – ident: e_1_2_5_7_2 doi: 10.1002/bjs.1800750114 – ident: e_1_2_5_20_2 doi: 10.1097/00000658-195906000-00004 – volume: 81 start-page: 46 year: 1992 ident: e_1_2_5_13_2 article-title: Aportaci6n de tres nuevos casos publication-title: Rev Esp Enferm Dig – ident: e_1_2_5_17_2 doi: 10.1007/BF02587272 – volume: 10 start-page: 7 year: 2007 ident: e_1_2_5_10_2 article-title: The value of routine histopathological examination of appendicectomy specimens publication-title: BMC Surg – volume: 26 start-page: 285 year: 2007 ident: e_1_2_5_18_2 article-title: Epidemiology of inflammatory bowel disease in Asia. Indian publication-title: J Gastroenterol – volume: 73 start-page: 219 year: 1984 ident: e_1_2_5_2_2 article-title: Fistula‐in‐ano in a defined population. Incidence and epidemiological aspects publication-title: Ann Chir Gynaecol – volume: 39 start-page: 723 year: 1996 ident: e_1_2_5_6_2 article-title: Anal fistula surgery: factors associated with recurrence and incontinence publication-title: Dis Colon Rectum doi: 10.1007/BF02054434 – ident: e_1_2_5_4_2 doi: 10.1016/S1091-255X(97)80138-2 – volume: 25 start-page: 338 year: 1932 ident: e_1_2_5_11_2 article-title: President’s address: some landmarks in the history of rectal surgery publication-title: Proc R Soc Med – ident: e_1_2_5_16_2 doi: 10.1136/gut.6.6.515 – ident: e_1_2_5_12_2 doi: 10.1007/BF02561691 – volume: 88 start-page: 87 year: 1949 ident: e_1_2_5_19_2 article-title: Carcinoma developing in chronic draining cutaeous sinuses and fistulas publication-title: Surg Gynecol Obstet – ident: e_1_2_5_5_2 doi: 10.1007/BF02070710 – ident: e_1_2_5_8_2 doi: 10.1016/S0022-3468(98)90195-6 – ident: e_1_2_5_15_2 doi: 10.1136/gut.21.6.525 |
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| Snippet | Objective To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano.
Method Histopathology reports of all... Objective To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in‐ano. Method Histopathology reports of all... To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano. Histopathology reports of all the patients who... To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano.OBJECTIVETo determine the positive yield of routine... |
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| SubjectTerms | Adolescent Adult Aged Biopsy Child Crohn Disease - complications Crohn's disease Female Fistula in-ano Histocytochemistry histopathology HIV Infections - complications Humans Male Middle Aged Rectal Fistula - etiology Rectal Fistula - pathology Rectal Fistula - surgery Recurrence Retrospective Studies tuberculosis Tuberculosis, Gastrointestinal - complications Young Adult |
| Title | The value of routine histopathological analysis in patients with fistula in-ano |
| URI | https://api.istex.fr/ark:/67375/WNG-D220QWWS-Z/fulltext.pdf https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fj.1463-1318.2008.01698.x https://www.ncbi.nlm.nih.gov/pubmed/19175634 https://www.proquest.com/docview/733945626 |
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