Anal fistulas

152 Pages·2017·0.78 MB·English

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Anal fistulas New perspectives on treatment and pathogenesis Robbert van Onkelen

Anal fistulas: New perspectives on treatment and pathogenesis
Robbert Sebastiaan van Onkelen
Anal fistulas: New perspectives on treatment and pathogenesis
The work presented in this thesis was conducted at the Department of Immunol-
ogy, and the Department of Surgery of the Erasmus Medical Center, Rotterdam, the
Netherlands.
Printing of this thesis was financially supported by Erasmus University Rotterdam.
ISBN: 978-94-6169-782-0
Cover design: R.S. van Onkelen
Printing and lay-out: Optima Grafische Communicatie, Rotterdam, the Netherlands
© 2015 Robbert Sebastiaan van Onkelen. All rights reserved. None of the contents
may be reproduced, stored, or transmitted in any form or by any means without prior
written permission of the author, or when appropriate, the publisher of the published
articles.
Anal fistulas:
New perspectives on treatment and pathogenesis
Anale fistels:
Nieuwe inzichten in behandeling en pathogenese
Proefschrift
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam,
op gezag van de
rector magnificus
prof.dr. H.A.P. Pols
en volgens besluit van het College voor Promoties.
De openbare verdediging zal plaatsvinden op
dinsdag 24 november 2015 om 11.30 uur
door
Robbert Sebastiaan van Onkelen
geboren te Alkmaar
PromotiECommiSSiE
Promotor prof.dr. J.D. Laman
Overige leden prof.dr. C.G.M.I. Baeten
prof.dr. E.P. Prens
prof.dr. C.J. van der Woude
Copromotor dr. W.R. Schouten
CoNtENtS
Chapter 1 Introduction and outline of thesis 7
treatment
Chapter 2 Different characteristics of high and low 21
transsphincteric fistulas
Chapter 3 Predictors of outcome after transanal advancement 31
flap repair for high transsphincteric fistulas
Chapter 4 Is it possible to improve the outcome of transanal 45
advancement flap repair for high transsphincteric
fistulas by additional ligation of the intersphincteric
fistula tract?
Chapter 5 Ligation of the intersphincteric fistula tract in low 55
transsphincteric fistulas: A new technique to avoid
fistulotomy
Chapter 6 Treatment of anal fistulas with high intersphincteric 67
extension
Pathogenesis
Chapter 7 Identification of epithelialization in high 79
transsphincteric fistulas
Chapter 8 Assessment of microbiota and peptidoglycan in 89
perianal fistulas
Chapter 9 Pro-inflammatory cytokines in anal fistulas 103
Appendices
Chapter 10 Summary and general discussion 115
Chapter 11 Summary in Dutch (Nederlandse samenvatting) 127
Chapter 12 Acknowledgments (Dankwoord) 137
About the author 143
List of publications 145
PhD portfolio 147

Chapter 1
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Introduction and outline of
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thesis
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