Primary Sphincteroplasty Comparing Two Different Stitches in Anal Fistula Treatment: Experimental Study in Rats

Abstract

Background: Anal fistula is by definition the communication between the rectum or anal canal with the perineal region, which may be epithelialized and has cryptoglandular origin in 90% of cases. There are a large number of techniques for successfully treating trans-sphincteric fistulas of 20-50%, including primary sphincteroplasty, but it is not clear whether the material used would influence the outcome. Aim: To analyze the efficacy of polydioxanone and polypropylene wire in primary post-fistulotomy sphincteroplasty in the treatment of trans-sphincteric fistulas in rats. Methods:Thirty Wistar rats had transfixation of the anal sphincter with steel wire, which remained for 30 days for the development of the anal fistula. After this period, it was removed and four groups were formed: A (control) without treatment; B (fistulotomy) submitted to such procedure and curettage only; C (polidioxanone) in which sphincteroplasty was performed after fistulotomy with polydioxanone wire; D (polypropylene) submitted to the same treatment as group C, but with polypropylene wire. After 30 days, euthanasia and removal of the specimens were performed for qualitative histopathological analysis, measurement of the area between the muscular cables edges and evaluation of the degree of local fibrosis. Results: There was persistence of the anal fistula in all animals of group A. There were no significant differences between groups B, C and D regarding the distance of the muscular cables (p=0.078) and the degree of fibrosis caused by the different treatments (p=0.373). Conclusions:There was no difference between polydioxanone and polypropylene wires in post-fistulotomy primary sphincteroplasty, and this technique was not superior to simple fistulotomy in relation to the distance of the muscular cables nor did it present differences in relation to the degree of local fibrosis.

A New Approach for Hemorrhoid Disease: Selective Dearterialization and Mucopexy Without Doppler Guidance

“…H emorrhoidal disease is highly prevalent and several treatment options are currently available. Pile excision has generally been regarded as the gold standard treatment but is associated with intense postoperative pain 10 . Minimally invasive techniques have thus gained wide acceptance among colorectal surgeons and their patients due to the lower morbidity.…”

CAN Stryphnodendron adstringens EXTRACT IMPROVE THE RESULTS OF FISTULOTOMY FOLLOWED BY PRIMARY SPHINCTEROPLASTY IN THE TREATMENT OF TRANSSPHINCTERIC FISTULAE?

“…The anal fistula is the second most common anorectal disorder, behind hemorrhoidal disease 6 , 25 , with intersphincteric type being the most common; however, transsphincteric fistulae are more challenging in terms of therapeutic approach, as they are associated with a greater number of patients who develop fecal incontinence after surgical treatment 16 , 19 .…”