title: Horseshoe tract of anal fistula: bad luck or an avoidable extension? Lessons from 82 cases.
abstract: OBJECTIVE
  The aim of this study was to analyse the characteristics of horseshoe tract formation in anal fistula.
  
  
  METHODS
  We retrospectively analysed the data from all consecutive patients who underwent surgery for an anal fistula from November 2004 to March 2011. A horseshoe tract was defined as a circumferential extension connecting both sides of the anorectum.
  
  
  RESULTS
  During the period of analysis, 1876 patients were operated on for a fistula. Of these, 82 (4.4%) had a horseshoe extension. The majority (72%) were male and the median age was 46 (17-84) years. The primary tract was high transsphincteric in 90% of cases and the primary opening was posterior in 65% of cases. The location of the horseshoe extension was posterior in 66% of cases with spread in the deep perianal space in 62%. In all, 71% were cryptoglandular and 24% were seen in Crohn's disease (20). Of the 62 non-Crohn's patients previous treatment was common and included surgery (42), antibiotics alone (41) and non-steroidal anti-inflammatory drugs (21).
  
  
  CONCLUSIONS
  Horseshoe extension in anal fistula is uncommon. With Crohn's disease excepted, the majority had had previous treatment.
authors.affiliation: Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris, France. proctologie@hopital-dcss.org
authors.forename: V
authors.initials: V
authors.lastname: de Parades
authors.forename: N
authors.initials: N
authors.lastname: Fathallah
authors.forename: P
authors.initials: P
authors.lastname: Blanchard
authors.forename: J-D
authors.initials: JD
authors.lastname: Zeitoun
authors.forename: B
authors.initials: B
authors.lastname: Bennadji
authors.forename: P
authors.initials: P
authors.lastname: Atienza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal