Anal fistula

Seow‐Choen, Francis; Nicholls, R. J.

doi:10.1002/bjs.1800790304

Cited by 138 publications

(65 citation statements)

References 147 publications

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“…Perianal fistulae occur in approximately 10 out of 10,000 persons [1]. It usually occurs in adult men with maximum incidence between third and fifth decades [2]. Perianal fistulae are not only painful and irritating but can also be a nidus for systemic spread of infection.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Singh¹,

Singh

Thukral³

et al. 2014

JCDR

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Aims:The purpose of the study was to evaluate the role of Magnetic Resonance Imaging in detection and characterization of perianal fistulae and correlating it with surgical findings.Methods: Fifty consecutive patients with suspected perianal fistulae having one or more external openings were prospectively selected for MRI evaluation. Previously operated or patients with recurrent perianal disease were excluded from the study. MRI findings were recorded according to "St. James's University Hospital MR Imaging Classification of Perianal Fistulae" and correlated with surgical observations. Finally, comparison between T2-weighted fat saturated and postcontrast T1-weighted fat saturated sequences was done.Results: Amongst the total of 50 patients, per-operative findings confirmed perianal fistulae in 45 patients. The sensitivity and specificity of MRI in correctly detecting and grading the primary tract was found to be 95.56% and 80% respectively; for abscess, it was 87.50% and 95.24% respectively. High sensitivity was also discerned in identification of secondary tract (93.75%), correct localization of internal opening (95.83%) and for correctly detecting the horse-shoeing (87.50%). Our assumption of null hypothesis was accepted on comparing results of T2-weighted fat saturated sequences and postcontrast T1-weighted fat saturated sequences. Conclusion:Magnetic Resonance Imaging (MRI) was highly accurate in assessment of surgically important parameters (primary tract and its grading, internal opening, secondary tract, abscess, horseshoeing) of perianal fistulae. Comparison of results of imaging findings on T2-weighted and postcontrast T1-weighted fat saturated sequences were statistically similar, so contrast study can be omitted, particularly while evaluating primary / previously unoperated perianal fistulae.

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Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Singh¹,

Singh

Thukral³

et al. 2014

JCDR

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“…As a matter of fact, no single technique is appropriate for the treatment of all fistulas, and the surgeon's experience and judgement should guide treatment decision. Low fistulas, where the tract is submucosal, intersphincteric or located in the lower third of the external anal sphincter, are usually treated by fistulotomy with low recurrence rates and relatively little impact on incontinence [3][4][5]. On the other hand, surgical treatments for high and complex fistulas may result in variable degree of anal sphincter impairment.…”

Section: Introductionmentioning

confidence: 99%

Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study

et al. 2011

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Background Ligation of the intersphincteric tract (LIFT), a novel sphincter-saving technique, has been recently described with promising results. Literature data are still scant. In this prospective observational study, we present our experience with this technique. Methods Between October 2010 and April 2011, 18 patients with 'complex' fistulas underwent LIFT. All patients were enrolled in the study after a physical examination including digital examination and proctoscopy. For the purpose of this pilot study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula or pre-existing incontinence. Endpoints were healing time, presence of recurrence, faecal incontinence and surgical complications. Results Ten patients were men and 8 were women; mean age was 39 years; minimum follow-up was 4 months. Three patients required drainage seton insertion and delayed LIFT. After LIFT, 1 patient experienced haemorrhoidal thrombosis. At the end of the follow-up, 15 patients (83%) healed with no recurrence. Three patients had persistent symptoms and required further surgical treatment. We did not observe postoperative worsening of continence. Conclusions Results from our pilot study indicate that this novel sphincter-saving approach is effective and safe for treating complex anal fistula.

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“…Different seton material has been used with the various rates of recurrence and incontinence, but this depends on expertise and judgement of the complexity of fistula by the surgeon [7].…”

Section: Discussionmentioning

confidence: 99%

“…A simple fistula is treated by fistulotomy (opening the fistulous tract) or fistulectomy curettage or cautery of the tract, and healing by secondary infection [7]. While most of the fistulas start as a simple single primary tract, recurrent infection eventually causes the formation of extensions (secondary tracts).…”

Section: Introductionmentioning

confidence: 99%

Tightening of seton using Roeder's knot in Complex Fistula - in - ano : with knot pusher (specially designed)

Kumar¹,

Hastir²

2017

Int J Surg Med

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Objective: There are two main complications after surgery of complex fistula-in-ano: faecal incontinence and recurrence. Summary Background Data: To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roeder's knot with specially designed Rajneesh's seton knot pusher. Method: The study includes 40 patients who had undergone treatment of complex and high fistula-in-ano at Civil Hospital, Jalandhar from January 2010 to September 2012 and from September 2012 to January 2017 at Punjab Institute of Medical Sciences (PIMS). Results: Forty patients of complex fistula-in-ano were taken up for study with the age (mean ± standard deviation) of 35 ± 10.6 years. The Roeder's knot was tightened with a median of 5 times (3-10 times) as OPD procedure. All the patients were on follow-up for a minimum period of 6 months, and none of the patients had any incontinence. Recurrence occurred in one case. There was breakage of thread at knot site with knot pusher in two cases. Conclusion: Tightening of seton using Roeder's knot with Rajneesh's knot pusher is safe, cost effective treatment for complex fistula-in-ano and follow-up is easy. Tightening of fistula is an outdoor procedure rather than replacing the loose seton. Patients were on the monitoring every week, and seton with Roeder's knot tightened in O.P.D after application of 2% Xylocaine jelly. Incontinence was assessed according to Wexner's score. KEYWORDS:Seton, Roeder's knot, Knot Pusher, Fistula-in-ano, Tightening HOW TO CITE THIS ARTICLEKumar R, Hastir A. Tightening of seton using Roeder's knot in Complex Fistula -in -ano : with knot pusher (specially designed).Int J Surg Med.

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Anal fistula

Cited by 138 publications

References 147 publications

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study

Tightening of seton using Roeder's knot in Complex Fistula - in - ano : with knot pusher (specially designed)

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