Evaluation and management of perianal abscess and anal fistula: SICCR position statement

Amato, Antonio; Bottini, C.; Nardi, Paola De; Giamundo, Paolo; Lauretta, A.; Luc, A. Realis; Piloni, V.

doi:10.1007/s10151-019-02144-1

Cited by 96 publications

(96 citation statements)

References 178 publications

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“…Moreover, it must be considered that the lack of an univocal definition of "simple" fistula can make it difficult to pool the results of the different studies available. However, the selection of studies in this review was performed considering the definition of "simple" fistula provided by the most important international guidelines [4][5][6]. Only a few of the studies analyzed reported the adoption of imaging techniques (magnetic resonance imaging or endoanal ultrasound) to define the diagnosis, although this probably reflects the infrequent use of these techniques in this kind of anal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Among the included studies, 28 were prospective studies [21-25, 29, 38-40, 42, 44, 48, 51, 53, 56, 58-62, 64, 65, 68, 70, 71, 74-76], 19 were retrospective series [2, 8, 13-15, 18, 26-28, 33, 43, 45, 57, 63, 66, 67, 69, 72, 73], and 19 were randomized clinical trials (RCT) [16, 17, 19, 20, 30-32, 34-37, 41, 46, 47, 49, 50, 52, 54, 55] (Tables 1-2). The quality of the studies was generally low with a consistent risk of bias; the median score of the Jadad Scale for RCT was 3 (1-5), and only 2 studies had the highest possible score [52,55]; the median MINORS score for non-comparative studies was 12 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), with only one study that could be regarded as excellent [44], while the median MINORS score for comparative studies was 17 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) (Tables 1, 2). Risk of bias of the selected studies could be attributed mainly to a retrospective design, difficulty or impossibility of patients' and operators' blinding, small sample size, short follow-up, heterogeneity of the analyzed variables, absence of uniform definition of the main outcomes (success rate, continence impairment).…”

Section: Study Selection and Risk Of Biasmentioning

confidence: 99%

“…However, the definition of low fistula has changed over time, with a trend towards lowering the percentage of the external anal sphincter (EAS) crossed by the fistula tract [3]. According to several guidelines [4][5][6], an AF is defined "simple" when the tract is intersphincteric, or low transsphincteric (crossing < 30% of the EAS). Instead, AFs are defined as complex in cases of--high transphincteric tract (crossing > 30% of the EAS); in patients considered at risk for postoperative fecal incontinence (anterior fistula in women, recurrent fistula, or pre-existent fecal incontinence) even though with low transphincteric tract; suprasphincteric or extrasphincteric tracts; and in AFs with multiple tracts in a horseshoe fashion or those associated with inflammatory bowel disease (IBD), radiation, malignancy, tuberculosis, or chronic diarrhea [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Simple fistula-in-ano: is it all simple? A systematic review

et al. 2021

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Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selection and Risk Of Biasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simple fistula-in-ano: is it all simple? A systematic review

et al. 2021

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“…ERAF is a classic sphincter-sparing operation for the treatment of complex CPAF, and its healing rate is 66–87% [ 3 ]. 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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“…Caution should be reserved to debilitated patients, for a possible local spread (Fournier's gangrene) with general sepsis [7]. If this conservative therapy is not successful, outpatient drainage with seton positioning [8], in local anaesthesia, can be performed as a definitive solution or as a "bridge step" for further radical surgery (MR or endoluminal ultrasound is currently denied). All patients should be instructed for the management of seton and for using smart follow-up.…”

Section: Management Of Proctological Patients In Covid-19 Timesmentioning

confidence: 99%

From high volume to “zero” proctology: Italian experience in the COVID era

Mascagni

Eberspacher

Mascagni

et al. 2020

Int J Colorectal Dis

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Purpose The coronavirus disease 2019 (COVID-19) pandemic hit Italy early and strongly, challenging the whole health care system. Proctological patients and surgeons are experiencing a previously unseen change in care with unknown repercussion. Here we discuss the proctological experience of 4 Italian hospitals during the COVID-19 pandemic. Methods Following remote brainstorming, the authors summarised their experience in managing proctological patients during the COVID-19 pandemics and put forward some practical observations to further investigate. Results The 4 hospitals shifted from a high-volume proctological activity to almost "zero" visits and surgery. Every patient accessing the hospital must respect a specific COVID-19 protocol. Proctological patients can be stratified based on presentation and management considerations into (1) neoplastic patients, the only allowed to be surgically treated, (2) the ones requiring urgent care, operated only in highly selected cases and (3) the stable, already known patients, managed remotely. Changes in the clinical management of the proctological disease are presented together with some considerations to be explored. Conclusions In the absence of scientific evidence, these practical considerations may be valuable to proctological surgeons starting to face the COVID-19 pandemics. Beside the more clinical considerations, this crisis produced unexpected consequences such as an improvement of the therapeutic alliance and a shift towards telemedicine that may be worth exploring also in the post-COVID-19 era.

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Evaluation and management of perianal abscess and anal fistula: SICCR position statement

Cited by 96 publications

References 178 publications

Simple fistula-in-ano: is it all simple? A systematic review

Simple fistula-in-ano: is it all simple? A systematic review

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

From high volume to “zero” proctology: Italian experience in the COVID era

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