Fistulectomy with Primary Sphincter Reconstruction

Herold, Alexander

doi:10.1007/978-1-4614-9014-2_10

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Fistulectomy is a valid alternative but, even if it’s more radical compared to traditional fistulotomy, is less used because of some disadvantages: longer operating time, wider surgical wound, prolonged time of healing and more than tripled incidence of incontinence to flatus (Wexner et al 1996 ). Many present findings demonstrated fistulotomy resulted in lesser pain, bleeding, shorter wound healing time and shorter duration of postoperative wound discharge in comparison to a fistulectomy, but the current studies were mostly small samples and non-RCT researches (Parkash et al 1985 ; Herold 2014 ; van der Hagen et al 2006 ). Therefore, we designed this meta-analysis, and the purpose is to compare the advantages and disadvantages of two kinds of surgical procedures.…”

Section: Introductionmentioning

confidence: 63%

Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula

Liang

Tang

2016

SpringerPlus

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ObjectiveWe evaluated the efficacy of fistulectomy compared to fistulotomy, and which procedure was the best procedure for patients with low anal fistula.MethodsThe literature search included PubMed, EMBASE, Cochrane library, Google original studies and a manual search of reference on the topic of fistulectomy compared to fistulotomy for anal fistula that had a deadline for publication by June 2016. Randomized controlled trials studies were included in the review. The outcome variables were analyzed which including operative time, healing time, postoperative complications, recurrence and incontinence.ResultsSix randomized controlled trials (fistulectomy = 280, fistulotomy = 285) were considered suitable for the meta-analysis, with a total of 565 patients. The result of meta-analysis indicated no statistically significant difference in operative time [OR 4.74, 95 % CI −2.74, 12.23, p = 0.21] and healing time [OR −3.32, 95 % CI −19.86, 13.23, p = 0.69] between the fistulectomy and fistulotomy procedures. Three main postoperative complications were included, and the combined result indicated no statistically significant difference in overall complications [OR 1.39, 95 % CI 0.51, 3.78, p = 0.52] and subgroup complication. At the end of follow up, two kinds of surgical methods have the same low recurrence rate and faecal incontinence. The result revealed that there was no significant difference in rate of fistula recurrence between the fistulectomy and the fistulotomy [OR 1.39, 95 % CI 0.70, 2.73, p = 0.34].ConclusionThe meta-analysis indicates that there is no conclusive evidence if fistulectomy or fistulotomy procedure is better in the treatment of low anal fistula.

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Section: Introductionmentioning

confidence: 63%

Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula

Liang

Tang

2016

SpringerPlus

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“…15 Recurrence and incontinence have been a common phenomenon associated specially with complex fistulas since the cure and the continence come at the cost of each other, similar to what happens with fistulotomy; although the recurrence rate has been reported as being low (4 to 7%) in some studies, high rates of postoperative incontinence (27 to 82%) suggest its limitation in complex cases. [16][17][18] Outcomes of fistulectomy and even of cutting seton have also not been satisfactory in terms of incontinence rates, reaching upt o 25% for the former 19 and 67% for the latter. 20 Therefore, the sphincter-sparing techniques emerged but had one or more significant limitations.…”

Section: Discussionmentioning

confidence: 99%

Management of Complex Fistula-in-ano by Interception of Fistula Track with Application of Ksharasutra (IFTAK): A Novel Technique

Sahu

Sharma

2022

Journal of Coloproctology

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Objective Despite all the technological advances, successful management of complex fistula-in-ano is still a challenge due to recurrence and incontinence. The present study evaluates the outcomes of a novel technique, Interception of Fistula Track with Application of Ksharasutra (IFTAK) in terms of success rate and degree of incontinence. Methods In the present prospective study, 300 patients with complex fistula-in-ano were treated by the IFTAK technique, whose surgical steps include: incision at the anterior or posterior midline perianal area, identification and interception of the fistulous track at the level of the external sphincter, rerouting the track (and extensions) at the site of interception, and application of a ksharasutra (medicated seton) in the proximal track (from the site of interception to the internal opening) that is laid open gradually, with the resulting wound healing with minimum scarring. The distal track is allowed to heal spontaneously. Results There were 227 trans-sphincteric and 73 intersphincteric varieties of fistula with supralevator extension in 23 cases, of which 130 were recurrent fistulas, 29 had horseshoe track, while 25 had blind fistula with no cutaneous opening. The mean duration of the ksharasutra application was 8.11 ± 3.86 weeks with an overall success rate of 93.33% at the 1-year follow-up. A total of 3.67% of the cases reported with a mild impairment of continence on the Wexner incontinence scoring system. Pre- and postoperative anal manometry evaluation showed minimal reduction in median basal and squeeze pressures. Conclusion The IFTAK technique is a minimally invasive, daycare surgical procedure for the management of complex fistula-in-ano with low recurrence and minimal sphincter damage.

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Utility of Adding Sphincter Reconstruction to Fistulotomy/Fistulectomy

Herold¹

2021

Anal Fistula and Abscess

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Fistulectomy with Primary Sphincter Reconstruction

Cited by 6 publications

References 7 publications

Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula

Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula

Management of Complex Fistula-in-ano by Interception of Fistula Track with Application of Ksharasutra (IFTAK): A Novel Technique

Utility of Adding Sphincter Reconstruction to Fistulotomy/Fistulectomy

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