{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:32:08Z","timestamp":1762432328837},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Kryptoglandul\u00e4re Analfisteln stellen eines der h\u00e4ufigsten kolorektalen Krankheitsbilder dar und treten mit einer Inzidenz von etwa 20\/100000 Personen auf. Analfisteln sind definiert als\n            eine entz\u00fcndliche Verbindung zwischen dem Analkanal und der perianalen Haut und k\u00f6nnen sich aus einem Abszess oder einem chronischen Infekt des Anorektums entwickeln. Die chirurgische\n            Behandlung der Erkrankung stellt das Mittel der Wahl dar. Bereits bei der Behandlung eines akuten Abszesses sollte gleichzeitig nach dessen Ursache gesucht werden. Findet sich eine\n            Verbindung zum Analkanal, ohne dass relevante Anteile der Sphinktermuskulatur betroffen sind, so sollte eine prim\u00e4re Fistelspaltung durchgef\u00fchrt werden. Werden gr\u00f6\u00dfere Anteile des\n            Schlie\u00dfmuskels umfasst, so ist meist die Einlage einer Fadendrainage sinnvoll. Zur elektiven Behandlung von krytoglandul\u00e4ren Analfisteln gelten grunds\u00e4tzlich zwei Empfehlungen. Distal\n            gelegene Fisteln sollten offengelegt werden unter der Ma\u00dfgabe, m\u00f6glichst wenig Sphinktermuskulatur zu opfern. Bei hoch proximalen und komplexen Fisteln sollten dagegen sphinkterschonende\n            Operationstechniken zum Einsatz kommen. Als Mittel der Wahl gilt hier der Mukosa- oder Advancement-Flap. Alternativ werden in der Literatur u.\u00a0a. Clips, Fibrininjektionen, Fistel-Plugs,\n            Fistelligaturen oder auch laserbasierte Verfahren beschrieben. Bei intermedi\u00e4ren Fisteln kann eine Fistulektomie mit prim\u00e4rer Sphinkterrekonstruktion sinnvoll sein. Jede Operation erfolgt\n            im Spannungsfeld zwischen definitiver Fistelheilung und potenzieller Gef\u00e4hrdung der Kontinenz des Patienten. Es ist h\u00e4ufig schwierig, eine verl\u00e4ssliche Prognose \u00fcber die postoperativ zu\n            erwartende Kontinenzfunktion abzugeben. Neben der Fistelmorphologie ist insbesondere zu beachten, ob bereits proktologische Voroperationen vorliegen, welches Geschlecht der Patient hat und\n            ob Schlie\u00dfmuskelfunktionsst\u00f6rungen vorbestehen. Da f\u00fcr den Erfolg der Behandlung auch die Expertise des Operateurs eine entscheidende Rolle spielt, sollte der Eingriff, insbesondere bei\n            komplexen Fisteln oder bei Z.\u00a0n. Voroperationen, in einem proktologischen Schwerpunktzentrum durchgef\u00fchrt werden. Die nachfolgende Arbeit beleuchtet neben den klassischen Verfahren wie der\n            Fistulektomie oder dem plastischen Fistelverschluss alternative Methoden und deren Einsatzbereiche.<\/jats:p>","DOI":"10.1055\/a-2049-9722","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T22:40:17Z","timestamp":1685745617000},"page":"209-219","source":"Crossref","is-referenced-by-count":4,"title":["Therapie der kryptograndul\u00e4ren Analfisteln: aktuelle Goldstandards und Alternativen"],"prefix":"10.1055","volume":"148","author":[{"given":"Stefan","family":"Fritz","sequence":"additional","affiliation":[{"name":"Deutsches End- und Dickdarmzentrum Mannheim, Mannheim, Deutschland"},{"name":"Chirurgische Klinik, Universit\u00e4tsmedizin Mannheim, Medizinische Fakult\u00e4t Mannheim, Universit\u00e4t Heidelberg, Mannheim, Mannheim, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Reissfelder","sequence":"additional","affiliation":[{"name":"Chirurgische Klinik, Universit\u00e4tsmedizin Mannheim, Medizinische Fakult\u00e4t Mannheim, Universit\u00e4t Heidelberg, Mannheim, Mannheim, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieter","family":"Bussen","sequence":"additional","affiliation":[{"name":"Deutsches End- und Dickdarmzentrum Mannheim, Mannheim, Deutschland"},{"name":"Chirurgische Klinik, Universit\u00e4tsmedizin Mannheim, Medizinische Fakult\u00e4t Mannheim, Universit\u00e4t Heidelberg, Mannheim, Mannheim, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s00053-016-0110-7","article-title":"S3-Leitlinie: Kryptoglandul\u00e4re Analfisteln","volume":"39","author":"A Ommer","year":"2017","journal-title":"Coloproctology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"707","DOI":"10.3238\/arztebl.2011.0707","article-title":"Cryptoglandular anal fistulas","volume":"108","author":"A Ommer","year":"2011","journal-title":"Dtsch Arztebl Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"103","DOI":"10.23922\/jarc.2018-009","article-title":"Japanese Practice Guidelines for Anal Disorders II. 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