Risk Factors for the Development of Urethrocutaneous Fistula after Hypospadias Repair: A Retrospective Study

정재욱,최석환,김범수,정성광 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.10

Purpose: The purpose of this study was to investigate the risk factors for urethrocutaneous fistula development after hypospadias repair. Materials and Methods: Between January 1990 and May 2010, 348 patients underwent hypospadias repair. This study included 294 patients who were followed up for more than 6 months. Potential risk factors for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials and methods, methods and duration of catheterization, combined congenital urologic disorders, timing of presentation and repair of fistula, and location of fistula. Data were analyzed retrospectively. Binary logistic regression analysis was used for univariate and multivariate analysis. Results: Out of 294 patients, 63 patients (21.4%, 63/294) developed urethrocutaneous fistulas after hypospadias repair. In the univariate analysis, fistula formation was statistically related with type of hypospadias and type of hypospadias repair. In the multivariate analysis with stratification by hypospadias site, however, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p<0.001). Conclusions: Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal-type hypospadias). Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorders were not related to the development of urethrocutaneous fistulas. Purpose: The purpose of this study was to investigate the risk factors for urethrocutaneous fistula development after hypospadias repair. Materials and Methods: Between January 1990 and May 2010, 348 patients underwent hypospadias repair. This study included 294 patients who were followed up for more than 6 months. Potential risk factors for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials and methods, methods and duration of catheterization, combined congenital urologic disorders, timing of presentation and repair of fistula, and location of fistula. Data were analyzed retrospectively. Binary logistic regression analysis was used for univariate and multivariate analysis. Results: Out of 294 patients, 63 patients (21.4%, 63/294) developed urethrocutaneous fistulas after hypospadias repair. In the univariate analysis, fistula formation was statistically related with type of hypospadias and type of hypospadias repair. In the multivariate analysis with stratification by hypospadias site, however, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p<0.001). Conclusions: Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal-type hypospadias). Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorders were not related to the development of urethrocutaneous fistulas.

유두상 갑상선암 수술 후 발생한 유미루

박종대,홍석준 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: Most of postoperative chylous fistula in the neck occur after lateral neck lymph node dissection. However we experienced chylous fistulas in the central neck as well as lateral neck after surgery for papillary thyroid carcinoma. Herein we reviewed our experience of chylous fistula and tried to make guideline for the decision of optimal treatment in the early period of chylous fistula. Methods: We retrospectively reviewed our thyroidectomy cases for the papillary thyroid carcinoma with central neck node dissection (n: 1220) and left neck node dissection (n: 149) over a period of 6years. In 17 patients, a chylous fistula was occurred, 8 in the lateral neck, 9 in the central neck. The treatment method, daily output, and the hospital course of the chylous fistula were analysed. Results: The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.7% and 5.4% respectively. All 9 central neck fistulas were successfully treated with conservative treatment . 6 lateral neck fistulas were also treated successfully with conservative treatment including medium chain triglyceride treatment and compression dressing. In 2 lateral neck fistulas, operative management was required, one due to poor response to conservative management and metabolic derrangement, another one due to large amount of daily output in the early post operative days. The maximal daily output of conservative management group and operative management group were below 250 cc/day and over 1,800 cc/day respectively. Conclusion: The chylous fistula in the neck could be occurred not only after lateral neck dissection but also after central neck dissection, although the clinical course of central neck fistula was relatively benign. Most of chylous fistulas could be treated conservatively. However, in the early high output fistula (over 1,800 cc/day) cases, prompt operative management should be considered for the prevention of metabolic derrangement and shortening the hospital course. (Korean J Endocrine Surg 2002;2:109-115)

크론병 치루

임석원,이철호,이광렬,유정준,박세영,김현식,전정열,이종균 대한대장항문학회 1997 Annals of Coloproctolgy Vol.13 No.1

Long-term outcomes after anal fistula surgery: results from two university hospitals in Thailand

Weeraput Chadbunchachai,Varut Lohsiriwat,Krisada Paonariang 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.2

Purpose: This study aimed to evaluate long-term outcomes after anal fistula surgery from university hospitals in Thailand. Methods: A prospectively collected database of patients with cryptoglandular anal fistula undergoing surgery from 2011 to 2017 in 2 university hospitals was reviewed. Outcomes were treatment failure (persistent or recurrent fistula), fecal continence status, and chronic postsurgical pain. Results: This study included 247 patients; 178 (72.1%) with new anal fistula and 69 (27.9%) with recurrent fistula. One hundred twenty-one patients (49.0%) had complex fistula; 53 semi-horseshoe (21.5%), 41 high transsphincteric (16.6%), 24 horseshoe (9.7%), and 3 suprasphincteric (1.2%). Ligation of intersphincteric fistula tract (LIFT) was the most common operation performed (n=88, 35.6%) followed by fistulotomy (n=79, 32.0%). With a median follow-up of 23 months (interquartile range, 12–45 months), there were 18 persistent fistulas (7.3%) and 33 recurrent fistulae (13.4%)—accounting for 20.6% overall failure. All recurrence occurred within 24 months postoperatively. Complex fistula was the only significant predictor for recurrent fistula with a hazard ratio of 4.81 (95% confidence interval, 1.82–12.71). There was no significant difference in healing rates of complex fistulas among seton staged fistulotomy (85.0%), endorectal advancement flap (72.7%), and LIFT (65.9%) (P=0.239). Four patients (1.6%) experienced chronic postsurgical pain. Seventeen patients (6.9%) reported worse fecal continence. Conclusion: Overall failure for anal fistula surgery was 20.6%. Complex fistula was the only predictor for recurrent fistula. At least 2-year period of follow-up is suggested for detecting recurrent diseases and assessing patient-reported outcomes such as chronic pain and continence status.

Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn’s Disease in Korea: Results from the CONNECT Study

( Jaeyoung Chun ),( Jong Pil Im ),( Ji Won Kim ),( Kook Lae Lee ),( Chang Hwan Choi ),( Hyunsoo Kim ),( Jae Hee Cheon ),( Byong Duk Ye ),( Young-ho Kim ),( You Sun Kim ),( Yoon Tae Jeen ),( Dong Soo H 대한간학회 2018 Gut and Liver Vol.12 No.5

Background/Aims: The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population. Methods: The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses. Results: The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses. Conclusions: Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses. (Gut Liver 2018;12:544-554)

인조혈관을 이용한 동정맥루의 조성위치와 개존율의 상관관계

송근영,장정환,김성환 대한혈관외과학회 2004 Vascular Specialist International Vol.20 No.1

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas

Garg Pankaj,Mongia Anvesha 대한대장항문학회 2024 Annals of Coloproctolgy Vol.40 No.1

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

한국인 크론병 환자에서 치루의 발생 빈도와 자연 경과

김자영 ( Ja Young Kim ),양석균 ( Suk Kyun Yang ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),최재원 ( Jae Won Choe ),조지윤 ( Ji Yun Jo ),양동훈 ( Dong Hoon Yang ),조윤경 ( Yun Kyung Cho ),김진호 ( Jin Ho Kim ) 대한장연구학회 2006 Intestinal Research Vol.4 No.1

목적: 치루는 크론병의 흔한 합병증으로서 서양의 연구에서는 발생빈도가 13-38%로 보고되었다. 본 연구는 한국인 크론병 환자에서 치루의 발생빈도와 자연경과를 밝히기 위해 시행되었다. 대상 및 방법: 1989년 6월부터 2005년 2월 사이에 서울아산병원 염증성 장질환 클리닉에서 진료받은 613명의 환자들 중 2개월 미만의 추적관찰을 한 경우를 제외한 총 546명을 대상으로 치루에 대한 자료를 수집하였다. 결과: 전체 546명의 환자(남자 355명, 여자 191명) 중 265명(48.5%)에서 355회의 치루가 발생하였다. 크론병의 다른 증상 없이 첫 증상으로 치루가 나타난 환자는 82명(15.0%)이었고, 치루가 발생한 265명 중 205명(77.4%)은 크론병 진단 이전 또는 진단 당시 치루가 있었다. 치루의 누적 발생률은 1년에 40.7%, 5년에 48.2%, 10년에 55.3%, 20년에 62.1%였다. 치루의 치료에 있어서 내과적 치료는 첫 번째 발생한 치루의 경우는 22.6%에서, 재발한 치루도 포함하여 계산할 경우는 30.7%에서 행해졌다. 또한 첫 번째 발생한 치루에 대한 수술률은 87.5%였으며, 재발한 치루도 포함하여 계산할 경우 수술률은 80.8%였다. 치료 성공률은 내과적 치료의 경우 첫 번째 발생한 치루의 경우는 21.7%, 재발한 치루까지 포함한 경우는 23.9%였고, 외과적 치료의 경우는 각각 84.5%, 83.6%였다. 265명의 치루 환자 중 77명(29.1%)에서 2회 이상 치루가 발생하였으며, 치루의 누적 재발률은 1년에 10.1%, 5년에 26.9%, 10년에 42.4%, 20년에 68.8%였다. 결론: 한국인 크론병 환자에서 치루의 발생률은 서양의 보고에 비해 높은 것으로 보인다. 특히 크론병의 진단에 앞서 치루가 나타나는 빈도가 매우 높으므로 치루 환자에서 크론병의 가능성을 염두에 둔다면 크론병 진단까지의 기간을 줄일 수 있겠고, 적절한 치료를 통해 항문협착과 같은 심각한 합병증의 발생도 낮출 수 있을 것으로 생각한다. Background/Aims: We performed this study to investigate the incidence and natural history of perianal fistulas in Korean patients with Crohn`s disease (CD). Methods: A total of 546 patients diagnosed with CD at Asan Medical Center were included. Results: Perianal fistulas occurred in 265 patients (48.5%), with 355 episodes. Eighty-two patients (15.0%) initially presented with perianal fistulas in the absence of other symptoms suggestive of CD. Out of 265 patients who developed perianal fistulas, 205 (77.4%) presented with perianal fistulas before, or at the time of, the diagnosis of CD. The cumulative incidence of perianal fistulas at 1, 5, 10, 20 years was 40.7%, 48.2%, 55.3% and 62.1%, respectively. Medical treatment was done in 30.7%, and surgery in 80.8% of perianal fistulas. The remission rate was 23.9% with medical treatment, and 83.6% with surgery. At least 1 recurrent fistula occurred in 77 patients (29.1%). The cumulative recurrence rate of perianal fistulas at 1, 5, 10, 20 years was 10.1%, 26.9%, 42.4% and 68.8%, respectively. Conclusions: The incidence of perianal fistulas in Korean patients with CD appears to be higher than that of Western patients. Also, the proportion of patients who develop perianal fistulas before the diagnosis of CD is very high. Therefore, we should consider the possibility of CD in patients with perianal fistulas to manage them properly, and thereby to reduce there complications. (Intestinal Research 2006;4:22-31)

방광질루 치료에 있어 술식에 따른 임상적 고찰

주명수,김태효,정상욱,정한,김홍식,김건석,김청수 大韓泌尿器科學會 2000 Korean Journal of Urology Vol.41 No.2

뇌경막 동정맥루를 동반한 장기간 지속된 외상성 경동맥-해면정맥동루 - 증례보고 -

박경범,박인성,김준수,김기정,황수현,김은상,정진명,한종우,김재형,Park, Kyung Bum,Park, In Sung,Kim, Joon Soo,Kim, Ki Jeong,Hwang, Soo Hyun,Kim, Eun-Sang,Jung, Jin-Myung,Han, Jong Woo,Kim, Jae Hyung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Traumatic carotid-cavernous fistula is a rare complication of moderate to severe head injury. For the treatment of carotid-cavernous fistula, detachable balloon occlusion is the best method of choice. A 26 year old male patient was hurt with a left periorbital penetrating injury 20 years ago, and then left side exophthalmos, bruit and right hemiparesis developed 10 years later. We experienced the very rare case of direct carotidcavernous fistula with cavernous dural arteriovenous fistula. Brain MRIs and cerebral angiograms revealed that direct carotid-cavernous fistula was accompanied by cavernous dural arteriovenous fistula due to longstanding venous hypertension and development of collateral circulation. Detachable balloon occlusion and surgical internal carotid artery ligation were not enough to occlude fistular flow, so cavernous dural arteriovenous fistula embolization was necessary. The authors present a case of long-standing traumatic carotid-cavernous fistula with cavernous dural arteriovenous fistula, with review of the literature.