Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study

Brabender, D E; Moran, Katherine; Brady, Matthew T.; Carmichael, Joseph C.; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J.; Jafari, Mehraneh D.

doi:10.1007/s10151-020-02281-y

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…Случаев каловой инконтиненции зарегистрировано не было. Четыре пациента, чьи свищи были успешно закрыты, были осмотрены в стационарных условиях с полной ликвидацией всех клинических проявлений и отсутствием их морфологических признаков [20].…”

Section: результаты и обсуждениеunclassified

Rectal Fistulas: Current State of the Problem

Денисенко¹,

Гаин²,

Денисенко³

2022

Хирургия. Восточная Европа

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Введение. В структуре хирургических заболеваний свищи прямой кишки составляют 0,8–1,2%. По данных отечественных и зарубежных авторов, существует большое количество классификаций хронического парапроктита, однако не всегда в них отражается многообразие клинических форм и их осложнений. Свищи разделяют на интрасфинктерные, или подкожно-подслизистые, транссфинктерные и экстрасфинктерные. На сегодняшний день разработано большое количество методов хирургического лечения свищей прямой кишки. Все они не лишены недостатков, что приводит к постоянному поиску более современных и совершенных методов лечения. Цель. Провести анализ современных методов лечения свищей прямой кишки с оценкой их положительных сторон и недостатков. Материалы и методы. С использованием текстовой базы данных публикаций в сфере медицины и биологии PubMed (на основе раздела «биотехнология» Национальной медицинской библиотеки США) через доступ NCBI-Entrez проведен анализ более 350 источников специальной медицинской литературы по проблеме. Результаты. В сравнительном аспекте оценены современные методы лечения свищей прямой кишки: LIFT-технологии, видеоассоциированное лечение свищей прямой кишки (VAAFT), лечение свищей прямой кишки c помощью режущего сетона, лечение с использованием лазера, биорассасывающейся свищевой пробки Gore BioA Fistula Plug и коллагенового геля. Отмечено, что лазерные методы лечения свищей прямой кишки сопровождаются осложнениями в виде анальной инконтиненции, возникновением рецидива заболевания. Заключение. Проблема лечения свищей прямой кишки окончательно не решена. В настоящее время отсутствуют единые подходы к лечению данной патологии, не определено четких показаний для применения какого-либо конкретного метода хирургического лечения. Introduction. In the structure of surgical diseases, rectal fistulas account for 0.8–1.2%. According to the data of domestic and foreign authors, there are a large number of classifications of chronic paraproctitis, but they do not always reflect the diversity of clinical forms and their complications. Fistulas are divided into intra-sphincter or subcutaneous- submucosal, transsphincter and extrasphincter. To date, a large number of methods of surgical treatment of rectal fistulas have been developed. None of them are free from drawbacks, leading to a constant search for more modern and perfected methods of treatment. Purpose. To analyze modern methods of rectal fistulas treatment with evaluation of both their positive aspects and disadvantages. Materials and methods. Using the PubMed text database of medical and biological publications (based on the section "biotechnology" of the US National Library of Medicine), an analysis of more than 350 sources of special medical literature on the problem was carried out through NCBI-Entrez access. Results. In a comparative aspect, modern methods of rectal fistulas treatment such as LIFT technologies, video-associated treatment of rectal fistulas (VAAFT), treatment of rectal fistulas using a cutting seton, treatment using a laser, bio-absorbable fistula plug Gore BioA Fistula Plug and collagen gel were evaluated. It was noted that laser methods of rectal fistulas treatment were accompanied by complications in the form of anal incontinence and disease recurrence. Conclusion. The problem of rectal fistulas treatment has not been completely settled. Currently, there are no unified approaches to the treatment of this pathology, and no clear indications for the use any particular method of surgical treatment are defined.

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Section: результаты и обсуждениеunclassified

Rectal Fistulas: Current State of the Problem

Денисенко¹,

Гаин²,

Денисенко³

2022

Хирургия. Восточная Европа

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“…This procedure can be used in conjunction with fistulotomy and debridement of the tract to reduce possible damage to the sphincter mechanism. [56][57][58] In the LIFT method, the fistula tract is found within the intersphincteric space, and it is ligated plus cut in that plane. 59,60 Video-assisted fistula treatment (VAFT) is a novel method that introduces narrow cameras into the fistula tract and performs treatment strategies including drainage, curettage, and injection.…”

Section: Treatment Options For Perianal Fistulamentioning

confidence: 99%

Advanced Regenerative Medicine Strategies for Treatment of Perianal Fistula in Crohn’s Disease

Nazari

Naei

Heirani‐Tabasi

et al. 2021

Inflammatory Bowel Diseases

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Regenerative medicine is an emerging therapeutic method that aims to reconstruct tissues and organs. This advanced therapeutic approach has demonstrated great potential in addressing the limitations of medical and surgical procedures for treating perineal fistula in patients with Crohn’s disease. Recent developments in stem cell technology have led to a massive good manufacturing practices (GMPs) production of various stem cells, including mesenchymal and embryonic cells, along with induction of pluripotent stem cells to repair damaged tissues in the fistula. The recent advances in separation and purification of exosomes, as biologic nanovesicles carrying anti-inflammatory and regenerative agents, have made them powerful tools to treat this inflammatory disease. Further, tremendous advances in nanotechnology, biomaterials, and scaffold fabrication methods enable tissue engineering methods to synthesize tissue-like structures to assist surgical techniques. This review focuses on advanced regenerative-based methods including stem cell therapy, exosome therapy, and tissue engineering used in the treatment of perianal fistula. Relevant in vitro and in vivo studies and the latest innovations in implementation of regenerative medicine for this disease are also separately reviewed. Additionally, current challenges regarding implementation of g stem cells, exosomes, and tissue engineering methods for bridging the gaps between laboratory findings and clinic application will be discussed.

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“…Numerous studies, as well as a few quantitative or qualitative analyses have reported on the clinical efficacy and postoperative outcomes of various types of laser treatment for anal fistula [19][20][21][22]. However, because these studies differed in terms of study design, sample size, Parks' Classification for anal fistula patients, laser treatment patterns, and reported outcomes, the evidence for the true clinical effectiveness of laser treatment for anal fistula requires further critical appraisal.…”

Section: Introductionmentioning

confidence: 99%

Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis

et al. 2023

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Introduction Anal fistula is the natural evolution of perianal abscess and one of the most common perianal diseases for adults. For complex fistula, it is still very challenging for anorectal surgeons to manage. With the introduction of laser technique in surgery, it is becoming more and more widely used for the treatment of cryptoglandular anal fistula. During the past decade, numerous studies have reported the clinical effectiveness and postoperative outcomes of different forms of laser treatment for anal fistula. However, as these studies were varied in terms of baseline characteristics, the evidence for the true clinical effectiveness of laser treatment for anal fistula need further critical appraisal. Therefore, the purpose of this study is to evaluate the outcomes of surgical laser therapy for cryptoglandular anal fistula stratified by laser type and Parks’ classification through a synthesis of quantitative and qualitative evidence. Methods and analysis This study will be carried out with adherence to the Cochrane Handbook. We will search PubMed, Cochrane Library, and Embase until June, 2022 to identify all relevant interventional and observational studies examining the effects of laser therapy on the clinical outcomes for cryptoglandular anal fistula. Data extraction from eligible studies will be performed independently by two unblinded authors using standardized extraction forms. Risk of bias assessment for each study will be conducted using Cochrane tool for randomized controlled trials (RCTs) and the Newcastle–Ottawa scale (NOS) tool for observational studies. The DerSimonian-Laird random-effects model will be used to calculate the pooled estimates. Heterogeneity will be examined by subgroup analysis stratified by laser type and Parks’ classification and other study characteristics. Potential publication bias will be assessed by funnel plot symmetrical and Egger’s regression tests. Conclusions The synthesis of quantitative and qualitative evidence of this systemic review will yield updated and comprehensive evidence of laser treatment on specific outcomes, which can provide anorectal surgeons with high level evidence-based recommendations to improve patient care and clinical outcomes. OSF registration number: DOI 10.17605/OSF.IO/36ADW.

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Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study

Cited by 14 publications

References 14 publications

Rectal Fistulas: Current State of the Problem

Rectal Fistulas: Current State of the Problem

Advanced Regenerative Medicine Strategies for Treatment of Perianal Fistula in Crohn’s Disease

Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis

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