Background: Fistula in-ano is an abnormal chronic infected tunnel (tract) between the rectum or the anal canal and perianal skin usually, with granulation tissue which connecting a primary orifice (internal) to a secondary one (external). This morbid antity represents a dilemma for both, patients and surgeon-proctologists because of postoperative issues occurrence such as fecal incontinence. The surgical management of this infectious condition has emerged nowadays, by emphasing new surgical techniques that preserve anal sphincter's integrity and functional. Over the last decade, numerous techniques sparing anal sphinters have gained popularity such as endoscopic approach (VAAFT), Laser, fibrin glue, transanal advancement flap repair [1,6]. In the same perspective,we are presenting in this paper, our preliminary outcomes of a combination of endoscopic approach (VAAFT) with Radifrequency Ablation of the fistula's tract that we nicknamed with the acronym of E-RaFisTura). Methods: We enrolled 10 males patients with anal fistula, age groupe 50-70 years, without any comorbidity in the term of diabetes mellitus, bowel inflammatory disease. Preoperatively each of them underwent a digital rectal examination, pelvic MRI, colonoscopy to rule out any concomitant abscess, Crohn's disease. Fleet enema, subcutaneus lower molecular weight heparin as well as intravenous broad spectrum antibiotic were administered an hour prior the surgical procedure. All patients were shifted to endoscopic surgical treatment of anal fistula (VAAFT) by using the fistuloscope of Piercarlo Meinero combined to the device of Fistura (Radiofrequency Ablation) with its probe 6-7 F (Figure 1 a,b,c). Then we visualized the fistula's tract and we seal it with radiofrequency thermocoagulation without damaging the anal sphincters by closing the internal opening with a suture node (Vicryl Rapid 3-0). Taxinomically, 2 patients had intersphincteric fistula, 3 transphincteric and the 5 others had submucosal anal fistula. Outcomes: We are inthe third month of follow up, none of the aboved mentioned patients has presented any postoperative issue excepting some local discomfort in immediate postoperative day, relieved with voltaren. Furthermore, the orificial wound healing is successful. Conclusion: Focused on our preliminary results, despite the small volume of patients, this combination of endoscopic and radiofrequency ablation can be regarded with optimism in selected patients. We will perform a powerful prospective study with a huge sample to have more accurate opinion. Bioethics Considerations: All enrolled patients had given their written consent prior. Furthermore,this surgical trial was approved by the Ethical commitee of Our Clinic.
to explore the biliary tree and to decrease jaundice preoperatively. Numerous randomized controlled trials have addressed the issue of preoperative biliary drainage and its impact on perioperative and postoperative results [3,4]. However, reports on outcomes of pancreatoduodenectomy following PBD have been conflicting. Some studies have underlined increased pre-operative, intra-operative and postoperative complications related to PBD such as bleeding, pancreatitis, duodenal perforation, cholangitis, cholecystitis, cardiopulmonary events and miscellaneous [5][6][7][8][9][10][11][12]. In contrast, others have noted no adverse effect on perioperative and postoperative outcomes and on the other hand, some authors have even noticed amelioration of postoperative outcomes with this strategy's application [3].Based on these considerations, the role of preoperative biliary drainage remains a matter of controversies. To assess its effects on postoperative outcomes, we performed this retrospective study. Material and MethodsThis is a retrospective study, comparing preoperative biliary drainage with surgery alone in 200 jaundiced patients with pancreatic Keywords: Obstructive jaundice; Pancreatic head cancer; Preoperative biliary drainage; Post-operative outcomes IntrodutionPancreatic cancer is an aggressive neoplastic disease, with overall 5-years survival rate from all stages of less than 5%, making it, the 4th cause of cancer related death in the United States of America. Despite the innovation of diagnostic and therapeutic modalities during the year 2013 it was estimated that approximately [45] 2200 people were diagnosed with pancreatic adenocarcinoma and 38,460 died from it. With the majority of patients presenting with unrespectable tumor, locally advanced or metastatic disease and around 80% of patients are jaundiced [1]. For those with respectable tumor without evidence of metastasis, pancreaticoduodenectomy is the only option for cure, whereas radiation therapy, chemotherapy, and other newer experimental therapeutic modalities such as anti-hormonal therapy or systemic use of anti-pancreatic cancer cell monoclonal antibodies have not led to substantial prognostic improvements.Obstructive jaundice is thought to increase the risk of perioperative and postoperative complications [2]. Experimental studies performed on mice assigned to biliary ligation to induce obstructive jaundice showed significant complications in these animals such as coagulopathy, Cholangitis, hepatic dysfunction, intestinal barrier derangement, immunity dysfunction, wound healing retardation, renal dysfunction, cardio-pulmonary insufficiencies as well as endotoxemia. Understanding well the pathophysiology of obstructive jaundice related complications in 1935 Sir A.O. Whipple first introduced the concept of preoperative biliary drainage in jaundiced patients with pancreatic head cancer in order to improve postoperative outcomes. Subsequently, Carter contributed with a percutaneous trans hepatic-cholangiography (PTC). In the late 1960s, McCune propo...
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