Annals of Coloproctology

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Managing Deep Postanal Space Sepsis via an Intersphincteric Approach: Our Early Experience: Ker-Kan Tan, Dean C. Koh, Charles B. Tsang; Ann Coloproctol. 2013;29(2):55-59. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.55

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16 Citations

Purpose

Managing deep postanal (DPA) sepsis often involves multiple procedures over a long time. An intersphincteric approach allows adequate drainage to be performed while tackling the primary pathology at the same sitting. The aim of our study was to evaluate this novel technique in managing DPA sepsis.

Methods

A retrospective review of all patients who underwent this intersphincteric technique in managing DPA sepsis from February 2008 to October 2010 was performed. All surgeries were performed by the same surgeon.

Results

Seventeen patients with a median age of 43 years (range, 32 to 71 years) and comprised of 94.1% (n = 16) males formed the study group. In all patients, an internal opening in the posterior midline with a tract leading to the deep postanal space was identified. This intersphincteric approach operation was adopted as the primary procedure in 12 patients (70.6%) and was successful in 11 (91.7%). In the only failure, the sepsis recurred, and a successful advancement flap procedure was eventually performed. Five other patients (29.4%) underwent this same procedure as a secondary procedure after an initial drainage operation. Only one was successful. In the remaining four patients, one had a recurrent abscess that required drainage while the other three patients had a tract between the internal opening and the intersphincteric incision. They subsequently underwent a drainage procedure with seton insertion and advancement flap procedures.

Conclusion

Managing DPA space sepsis via an intersphincteric approach is successful in 70.6% of patients. This single-staged technique allows for effective drainage of the sepsis and removal of the primary pathology in the intersphincteric space.

Citations

Citations to this article as recorded by

Deep Postanal Abscess With Sacrococcygeal Osteomyelitis: A Case Report
Javid Ahmadov, Mustafa Anil Turhan, Ender Erguder, Sezai Leventoğlu, Bulent Mentes
Cureus.2025;[Epub] CrossRef
Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients
Pankaj Garg, Gabriele Naldini, Vincent De Parades, Petr Tsarkov, Vipul Yagnik, Kaushik Bhattacharya, Baljit Kaur, G Mahak
Clinical and Experimental Gastroenterology.2025; Volume 18: 121. CrossRef
Process to determine the level of the primary internal opening of anal fistula on magnetic resonance imaging
Pankaj Garg, Baljit Kaur, G. Mahak
Annals of Coloproctology.2025; 41(3): 253. CrossRef
Identifying landmark factors of anal fistulas through predictive modelling for adverse surgical outcomes: a retrospective cohort study
Guanlin Liu, Kaiqiang Xu, Qiang Meng, Jing Wang, Yunwei Li
BMC Surgery.2025;[Epub] CrossRef
Anorectal Abscess
Anna Kata, Jonathan S. Abelson
Clinics in Colon and Rectal Surgery.2024; 37(06): 368. CrossRef
Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
永罡秦
Advances in Clinical Medicine.2023; 13(01): 180. CrossRef
A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations
Christianna Oikonomou, Periklis Alepas, Stelios Gavriil, Dimitrios Kalliouris, Konstantinos Manesis, Petros Bouboulis, Dimitrios Filippou, Panagiotis Skandalakis
Annals of Coloproctology.2019; 35(4): 216. CrossRef
Klinische Anatomie der Anorektalregion in Bezug auf das Analfistelleiden
S. Stelzner, T. Wedel
coloproctology.2019; 41(6): 390. CrossRef
Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature
Pankaj Garg
Diseases of the Colon & Rectum.2018; 61(5): 612. CrossRef
The treatment of anal fistula: secondACPGBIPosition Statement – 2018
G. Williams, A. Williams, P. Tozer, R. Phillips, A. Ahmad, D. Jayne, C. Maxwell‐Armstrong
Colorectal Disease.2018; 20(S3): 5. CrossRef
Transanal opening of intersphincteric space (TROPIS) - A new procedure to treat high complex anal fistula
Pankaj Garg
International Journal of Surgery.2017; 40: 130. CrossRef
Clinical Significance of 2 Deep Posterior Perianal Spaces to Complex Cryptoglandular Fistulas
Heng Zhang, Zhi-yang Zhou, Bang Hu, De-chao Liu, Hui Peng, Shang-kui Xie, Dan Su, Dong-lin Ren
Diseases of the Colon & Rectum.2016; 59(8): 766. CrossRef
Complex Fistula-In-Ano
J. Graham Williams
Diseases of the Colon & Rectum.2016; 59(8): 707. CrossRef
S3-Leitlinie: Analabszess
A. Ommer, A. Herold, E. Berg, St. Farke, A. Fürst, F. Hetzer, A. Köhler, S. Post, R. Ruppert, M. Sailer, T. Schiedeck, O. Schwandner, B. Strittmatter, B. H. Lenhard, W. Bader, S. Krege, H. Krammer, E. Stange
coloproctology.2016; 38(6): 378. CrossRef
Behandlung kryptoglandulärer, supralevatorischer Abszesse im MRT-Zeitalter: eine Fallserie
A. Furtwängler
coloproctology.2015; 37(3): 214. CrossRef
Modern management of deep post-anal space abscess and horseshoe fistulas
Reuben D. Shin, Jason F. Hall
Seminars in Colon and Rectal Surgery.2014; 25(4): 210. CrossRef

Laparoscopic Versus an Open Colectomy in an Emergency Setting: A Case-Controlled Study: Frederick H. Koh, Ker-Kan Tan, Charles B. Tsang, Dean C. Koh; Ann Coloproctol. 2013;29(1):12-16. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.12

7,452 View
55 Download
22 Citations

Abstract PDF

Purpose

Laparoscopy continues to be increasingly adopted for elective colorectal resections. However, its role in an emergency setting remains controversial. The aim of this study was to compare the outcomes between laparoscopic and open colectomies performed for emergency colorectal conditions.

Methods

A retrospective review of all patients who underwent emergency laparoscopic colectomies for various surgical conditions was performed. These patients were matched for age, gender, surgical diagnosis and type of surgery with patients who underwent emergency open colectomies.

Results

Twenty-three emergency laparoscopic colectomies were performed from April 2006 to October 2011 for patients with lower gastrointestinal tract bleeding (6), colonic obstruction (4) and colonic perforation (13). The hand-assisted laparoscopic technique was utilized in 15 cases (65.2%). There were 4 (17.4%) conversions to the open technique. The operative time was longer in the laparoscopic group (175 minutes vs. 145 minutes, P = 0.04), and the duration of hospitalization was shorter in the laparoscopic group (6 days vs. 7 days, P = 0.15). The overall postoperative morbidity rates were similar between the two groups (P = 0.93), with only 3 patients in each group requiring postoperative surgical intensive-care-unit stays or reoperations. There were no mortalities. The cost analysis did not demonstrate any significant differences in the procedural (P = 0.57) and the nonprocedural costs (P = 0.48) between the two groups.

Conclusion

Emergency laparoscopic colectomy in a carefully-selected patient group is safe. Although the operative times were longer, the postoperative outcomes were comparable to those of the open technique. The laparoscopic group did not incur a higher cost.

Citations

Citations to this article as recorded by

Validity of laparoscopic surgery for lower gastrointestinal perforations
Kensuke Kudou, Ryoko Aoyama, Kento Ishihara, Tomohide Kawashita, Shuhei Kajiwara, Takashi Motomura, Takafumi Yukaya, Tomonori Nakanoko, Yosuke Kuroda, Masahiro Okamoto, Tadashi Koga, Yo‐Ichi Yamashita, Eiji Oki, Tomoharu Yoshizumi
Asian Journal of Endoscopic Surgery.2024;[Epub] CrossRef
Iatrogenic ureteral injury during laparoscopic versus open colectomy
Ayman M. Abdulmohaymen
Al-Azhar Assiut Medical Journal.2024; 22(1): 7. CrossRef
Comparison of Laparoscopic and Open Emergency Surgery for Colorectal Perforation: A Retrospective Study
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Journal of Laparoendoscopic & Advanced Surgical Techniques.2023; 33(5): 464. CrossRef
Short-term outcomes of laparoscopic approach to colonic obstruction for colon cancer
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Surgical Endoscopy.2021; 35(6): 2986. CrossRef
Effects of laparoscopic vs open abdominal surgery on costs and hospital readmission rate and its effect modification by surgeons’ case volume
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Surgical Endoscopy.2020; 34(10): 1. CrossRef
Minimally invasive interventions in emergency large bowel surgery
B.M. Niyozbekov, T.Z. Rzaev, Z.B. Khalilov, M.A. Chinikov
Khirurgiya. Zhurnal im. N.I. Pirogova.2020; (6): 109. CrossRef
Procedural and post-operative complications associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection
Yong Sheng Li, Fan Chun Meng, Jun Kai Lin
Medicine.2020; 99(40): e22431. CrossRef
Did we prioritize quality improvement in general surgery: Time for a focus on outcomes and enhanced recovery care plans?
Byron D. Hughes, Eric Sieloff, Hemalkumar B. Mehta, Anthony J. Senagore
The American Journal of Surgery.2019; 217(3): 534. CrossRef
Enhanced recovery after surgery for emergency colorectal surgery: Are there any differences between intra-abdominal infection and other indications?
V. Lohsiriwat
Journal of Visceral Surgery.2019; 156(6): 489. CrossRef
Réhabilitation améliorée dans les urgences chirurgicales colorectales : quelles différences entre les péritonites et les autres indications ?
V. Lohsiriwat
Journal de Chirurgie Viscérale.2019; 156(6): 523. CrossRef
Role of Emergency Laparoscopic Colectomy for Colorectal Cancer
Abigail E. Vallance, Deborah S. Keller, James Hill, Michael Braun, Angela Kuryba, Jan van der Meulen, Kate Walker, Manish Chand
Annals of Surgery.2019; 270(1): 172. CrossRef
Emergent Laparoscopic Colectomy Is an Effective Alternative to Open Resection for Benign and Malignant Diseases: a Meta-Analysis
Sun-Bing Xu, Zhong Jia, Yi-Ping Zhu, Ren-chao Zhang, Ping Wang
Indian Journal of Surgery.2017; 79(2): 116. CrossRef
Colectomie par laparoscopie ou par laparotomie pour tumeur colique droite en occlusion : revue systématique de la littérature et méta-analyse
R. Cirocchi, F.C. Campanile, S. Di Saverio, G. Popivanov, L. Carlini, D. Pironi, R. Tabola, N. Vettoretto
Journal de Chirurgie Viscérale.2017; 154(6): 399. CrossRef
Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis
R. Cirocchi, F. Cesare Campanile, S. Di Saverio, G. Popivanov, L. Carlini, D. Pironi, R. Tabola, N. Vettoretto
Journal of Visceral Surgery.2017; 154(6): 387. CrossRef
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Rosa M Jimenez Rodriguez, Juan José Segura-Sampedro, Mercedes Flores-Cortés, Francisco López-Bernal, Cristobalina Martín, Verónica Pino Diaz, Felipe Pareja Ciuro, Javier Padillo Ruiz
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Caecal pneumatosis is not an absolute contraindication for endoluminal stenting in patients with acute malignant large bowel obstruction
James Ngu, Bettina Lieske, Kok Hong Dedrick Chan, Tian Zhi Lim, Wai‐Kit Cheong, Ker‐Kan Tan
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Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy
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World Journal of Emergency Surgery.2014;[Epub] CrossRef
Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status
Ajay Gupta, Khalid Habib, Athur Harikrishnan, Niraj Khetan
Indian Journal of Surgery.2014; 76(6): 436. CrossRef
Sham Feeding? Same Feeding?
Hungdai Kim
Annals of Coloproctology.2013; 29(6): 224. CrossRef

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