Complex anal fistula remains a challenge for colorectal surgeon

Cadeddu, Federica; Salis, Franco; Lisi, Giorgio; Ciangola, I; Milito, G

doi:10.1007/s00384-014-2104-7

Cited by 49 publications

(29 citation statements)

References 63 publications

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“…The goals of surgical treatment for patients with anal fistula are to eradicate fistula track, to drain associated sepsis, to prevent recurrence and to preserve anal sphincter integrity. This implies the preservation of sphincter function [1,2,5,6,[20][21][22][23][24][25][26][27]. For the sake of rationality and care practice, classification can be limited to high fistulas (complex fistulas) and low fistulas (simple fistulas) [20].…”

Section: Discussionmentioning

confidence: 99%

“…For the sake of rationality and care practice, classification can be limited to high fistulas (complex fistulas) and low fistulas (simple fistulas) [20]. Thus the surgical technique will depend on low or high fistula (significantly affecting the sphincters: trans-sphincteric superior or supra-sphincteric) [1,2,5,11,12,26]. The recognition of the orifices (external and internal, of the main fistulous tract which are essential elements for its management [1-5, 20, 27].…”

Section: Discussionmentioning

confidence: 99%

“…Fistulotomy remains the standard surgical treatment for low anal fistulas, but presents a risk of sequential continence disorders for high fistula [20,24,27]. Indeed, the success rate of this procedure ranging from 84 to 95% [18,[24][25][26][27]. On the other hand, the option of fistulectomy treatment with the placement of elastic seton (progressive elastic traction) should be considered in patients with complex fistula with significant sphincter involvement [1,2].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger

Sani¹,

Adamou²,

James³

et al. 2018

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Bakground: Anal and perianal sepsis is common anorectal disorders found in surgical practice. This study aims to report epidemiological aspects and outcomes of management of anal and perianal suppuration. Methods: This was a retrospective study from January 2011 to June 2016 at Niamey National Hospital. Patients operated on for anal and perianal suppuration of non-specific anorectal origin were included. Results: During the study period, we collected 141 cases of anal and perianal suppurations. The average age of our patients was 42±8.8 years. The sex ratio was 3.27 in favor of men. The origin of the patients was urban in 73.8% of the cases. The history of diabetes mellitus was found in 14.2% (n=20). Anal fistulas and anal abscesses (n=115) were simple in 46% (n=53) and complex in 54% (n=62). A fistulectomy with the placement of an elastic seton was performed for 41.13% of cases (n=58) and fistulotomy in 29.78%. The evolution of 6 months was marked by a recurrence in 10.63% (n = 15), the anal incontinence of gas at 9.21% (n=13). Deaths (n=4) were recorded in patients with Fournier's gangrene. Uncomplicated therapeutic success was 80.13% (n=113). Conclusion: The surgical treatment of anal fistula (the main cause of anal and perianal suppuration) aims to eradicate the suppuration and to preserve the anal continence. The fistulotomy done in the context of the management of a simple fistula gives a better outcome. Incontinence-related complications and relapses must impose thoroughness and patience in the surgical treatment of complex fistulas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger

Sani¹,

Adamou²,

James³

et al. 2018

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“…The main clinical manifestations of the disease are mucopurulent discharge in this area, pain syndrome, discomfort, which significantly reduces the patient's quality of life [1]. According to foreign literature, the prevalence of rectal fistula in European countries is 10.4-3.2 persons per 100,000 population [2]; this disease is more common among men than in women with a ratio of 1.8: 1 [3]. Reticular fistulas are diagnosed in patients of different ages, but most often they occur in the age group of 30-50 years [4], that is, in the most able-bodied and socially active part of the population.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Modified Method of Ligation of Intersphincteric Fistula Tract (Lift) and Standard Operations in Patients With Transsphincteric Rectal Fistulas

Кryvoruchko¹,

Firsyk²,

Bozhko³

2019

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Background. The search for and development of new minimally invasive methods for the surgical treatment of anal fistulas is a relevant area of surgery. Such methods combine less traumatization and preservation of the sphincter's complex. Employment of such methods for surgical treatment of anal fistulas reduced the time of stay of patients in the hospital and improved their quality of life. Subjects and methods. A retro-and prospective study involved 58 patients with uncomplicated transsphincteric anal fistulas. All patients were treated in the hospital from January 2014 to April 2019. The patients were divided into two groups: the first group included 32 patients who were operated on according to the standard procedure using fistulotomy and Seton procedure; the second group consisted of 26 patients who were operated on using the modified LIFT method. Results. Most of these patients (72.4%) were men at the age of 42.53 6.79. The median of BMI was 25.7 kg/m2. There wasn't mortality after operations. The median follow-up was 21 (6-48) weeks. In the first group there were 3 cases (9.3%) of anal sphincter insufficiency and 7 cases of recurrent fistulas (21.9%) at different times after surgery. In the second group there were no anal sphincter failure following administration of the modified method LIFT, but there were 15.4% of recurrent anal fistulas. Conclusion. The proposed modified method of ligation of intersphincteric fistula tract is an effective method for the treatment of anal fistulas. The results obtained suggest that the developed method can be used to treat other types of anal fistulas.

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“…Anal Fistula Plugs (AFPs), derived from porcine small intestinal submucosa, is an absorbable biomaterial, which could provide a scaffold for host fibroblasts to promote tissue ISSN 0970-938X www.biomedres.info healing and repair damaged tissue [7,8]. AFP was first described in 2006 by Johnson et al to treat anal fistula in the attempt to achieve closure.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of anal fistula plug treatment regimens in anal fistula patients

Fang¹,

Miao²,

Hu³

et al. 2018

biomedicalresearch

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Aim: Anal Fistula Plug (AFP) is considered as a new promising technique in treating anal fistula patients, mainly due to it could maintain the integrity of patients' integrity and decrease patients' discomfort with a simple operation. It also is beneficial to the following surgical options if needed. However, the underlying clinical efficacy is still unknown. Herein, we aimed to investigate the clinical efficacy of AFP in anal fistula patients by a retrospective analysis. Methods: We collected 52 anal fistula patients from the 2 nd affiliated hospital of Wenzhou Medical University and the hospital of traditional Chinese and Western medicine in Wenzhou between August 2012 and July 2016. Among them, 25 patients were treated with AFP, while 27 patients were treated with incision-thread-drawing. After treatments, all patients were evaluated by analyzing the differences on postoperative pain, cure rates, healing time, scar area and anal sphincter function at the subsequent follow-up. Results: The results showed that there were significant differences on postoperative pain between the two groups (P<0.001). Further, the healing time in patients with AFP treatment was remarkably lower than those with incision-thread-drawing treatment (P<0.05), whereas the anal scar area and the functional score of anal sphincterin patients with AFP treatment was markedly higher than those with incision-thread-drawing treatment (P<0.001). Nevertheless, the cure rates were not obviously different between the two groups. Conclusions: Taken together, these data suggested that AFP procedure could notably alleviate postoperative pain, shorten healing time, and retain anal sphincter function as compared to incisionthread-drawing procedure.

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Complex anal fistula remains a challenge for colorectal surgeon

Cited by 49 publications

References 63 publications

Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger

Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger

Comparison of Modified Method of Ligation of Intersphincteric Fistula Tract (Lift) and Standard Operations in Patients With Transsphincteric Rectal Fistulas

Clinical efficacy of anal fistula plug treatment regimens in anal fistula patients

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