“Core out” or “curettage” in rectal advancement flap for cryptoglandular anal fistula

Uribe, Natalia; Balciscueta, Zutoia; Mínguez, Miguel; Martín, M. Carmen; López, Manuel; Mora, Francisco; Vicent, Primo

doi:10.1007/s00384-015-2133-x

Cited by 26 publications

(17 citation statements)

References 25 publications

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“…Study and patient characteristics are shown in Table S1 (supporting information) , . Five studies were RCTs, six were prospective cohort studies and 19 were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

et al. 2019

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Background High perianal fistulas require sphincter‐preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas. Methods A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta‐analysis was performed using a random‐effects model. Results Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent). Conclusion Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.

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“…Study and patient characteristics are shown in Table S1 (supporting information) , . Five studies were RCTs, six were prospective cohort studies and 19 were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

et al. 2019

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“…And mild to moderate incontinence occurred in 35% of the patients after operation. Anorectal pressure measurements showed that resting pressure and systolic pressure decreased [21]. In a retrospective analysis, Data are mean (SD) or number (%).…”

Section: Discussionmentioning

confidence: 99%

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Zhou

Zhang

et al. 2020

Stem Cell Res Ther

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Background: Crohn's fistula-in-ano is a refractory disease in colorectal and anal surgery. Although autologous adiposederived stem cell (ADSC) has been used in the treatment of Crohn's fistula-in-ano because of its convenience, nonincision of normal tissue, good tolerance, repeatability, quick recovery, less pain, less damage to anal function, and high quality of life during the perioperative period, there are no reports of its use in China. This is the first clinical trial in China on the treatment of Crohn's fistula-in-ano with ADSC to evaluate its efficacy and safety. Methods: A total of 22 patients with Crohn's fistula-in-ano were enrolled in this study from January 2018 to October 2018 in the

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“…So it is recommended for the treatment of fistula-in-ano by American Society of Colon and Rectal Surgeons (ASCRS) and Italian Society of Colorectal Surgery (Società Italiana di Chirurgia Colo-Rettale, SICCR) (Strong recommendation based on moderate-quality evidence, 1B) [ 3 , 23 ]. Although the sphincter is not been incised, it is still reported that 13.2% of patients with CPAF suffer from mild to moderate incontinence in a systematic review, and anorectal manometry found that the anal canal resting pressure and anal canal squeeze pressures are decreased postoperatively [ 3 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study

Zhang

Zhou

et al. 2020

Stem Cell Res Ther

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Background Complex cryptoglandular perianal fistula (CPAF) is a kind of anal fistula that may cause anal incontinence after surgery. Minimally invasive surgery of anal fistula is constantly emerging. Over the past 20 years, there are several sphincter-sparing surgeries, one of which is autologous adipose-derived stem cell (ADSC) transplantation. However, to date, there is no study regarding the treatment of complex CPAF with ADSC in China. This is the first study in China on the treatment of complex CPAF with ADSC to evaluate its safety and efficacy. Methods Totally, 24 patients with complex CPAF were enrolled in this prospective case-control study from January 2018 to December 2019 in the National Colorectal Disease Center of Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine. Patients were divided into ADSC group and endorectal advancement flap (ERAF) group according to their desire. The healing of fistulas (healing of all treated fistulas at baseline, confirmed by doctor’s clinical assessment and magnetic resonance imaging or transrectal ultrasonography) was evaluated at week 12 after treatment. In addition to their safety evaluation based on adverse events monitored at each follow-up, the patients were also asked to complete some scoring scales at each follow-up including pain score with visual analog score (VAS) and anal incontinence score with Wexner score. Results The closure rates within ADSC group and ERAF group at week 12 were 54.55% (6/11) and 53.85% (7/13), respectively, without significant difference between them. VAS score in ADSC group was significantly lower than that in ERAF group at the 5th day postoperatively [1(0,2) VS 2(2,4), p = 0.011], but no differences were observed at the other time. Wexner score of all patients was not increased with no significant differences between the two groups. Adverse events were observed fewer in ADSC group (27.27%) than that in ERAF group (53.85%), but there was no significant difference between them. Conclusion This study indicated safety and efficiency of ADSC for the treatment of complex CPAF in the short term, which is not inferior to that of ERAF. ADSC may provide a promised and potential treatment for complex CPAF conforming to the future of the treatment, which is reconstruction and regeneration. Trail registration ChiCTR, ChiCTR1800014599. Registered 23 January 2018—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=24548

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“Core out” or “curettage” in rectal advancement flap for cryptoglandular anal fistula

Cited by 26 publications

References 25 publications

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study

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