Fistulotomy and Sphincter Reconstruction in the Treatment of Complex Fistula-in-Ano

Arroyo, Antonio; Pérez-Legaz, Juan; Moya, Pedro; Armañanzas, Laura; Lacueva, Javier; Pérez-Vicente, Francisco; Candela, Fernando; Calpena, Rafael

doi:10.1097/sla.0b013e31824e9112

Cited by 70 publications

(49 citation statements)

References 15 publications

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“…The weighted average rate of sphincter dehiscence (which is regarded as the most feared postoperative complication related to FIPS) was 2.2 %, and it ranged from 0 to 8.3 % (Table 3). Other minor reported postoperative complications were: proctalgia or defecation disorders, urinary retention, fecal impaction, anal abscess [38], deformity [34] and wound complications [36]. The skin wound was sutured in seven studies [19,29,31,32,34,37,38] with a weighted average healing rate without dehiscence of 68.9 % (range 28.6-100 %) ( Table 3).…”

Section: Clinical Results: Success and Morbiditymentioning

confidence: 99%

“…The use of complete bowel preparation was described in seven series [19,29,33,34,36,38,39], while Ratto et al [20] preferred enemas. Ten studies reported pre-and/or postoperative administration of antibiotics [19,29,30,[32][33][34][36][37][38][39], and one study reported no use of antibiotics [20] ( Table 2).…”

Section: Perioperative Detailsmentioning

confidence: 98%

“…1). Among the included studies, eight were retrospective series [19, 30-33, 36, 37, 39], five were prospective studies [20,28,29,35,38], and one was a randomized clinical trial [34]. The quality of the studies, assessed according to the NOS and the Jadad Scale, is reported in Table 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…One hundred and seven records were excluded for various reasons; therefore, 17 full-text articles were assessed for eligibility. Fourteen reports satisfied the inclusion criteria [19,20,[28][29][30][31][32][33][34][35][36][37][38][39], while three studies were excluded because their results were updated in a more recent article [40][41][42] (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…Fistulectomy was performed in ten studies [19, 28-33, 35, 36, 39] and fistulotomy in four studies [20,34,37,38]. The reconstructive phase included end-to-end sphincteroplasty in 12 studies [19,20,28,[30][31][32][33][35][36][37][38][39] and overlapping sphincteroplasty in only two studies [29,34]. When reported, the weighted average duration of the surgical procedure was 26.5 min (range 20.9-35.0 min), and the weighted average duration of postoperative stay was 4.5 days (range 1.3-7.3 days) ( Table 2).…”

Section: Perioperative Detailsmentioning

confidence: 99%

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Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

et al. 2015

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There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex anal fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex anal fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex anal fistulas.

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Section: Clinical Results: Success and Morbiditymentioning

confidence: 99%

Section: Perioperative Detailsmentioning

confidence: 98%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Perioperative Detailsmentioning

confidence: 99%

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Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

et al. 2015

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Photodynamic Therapy for the Treatment of Complex Anal Fistula

et al. 2019

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Background and ObjectivesTo validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula.Study Design/Materials and MethodsThis prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i‐PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow‐up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5‐aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J).ResultsIn total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3–5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure‐related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow‐up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively.Conclusioni‐PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Fistulectomy with Primary Sphincter Reconstruction

Herold¹

2013

Anal Fistula

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Fistulotomy and Sphincter Reconstruction in the Treatment of Complex Fistula-in-Ano

Cited by 70 publications

References 15 publications

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

Photodynamic Therapy for the Treatment of Complex Anal Fistula

Fistulectomy with Primary Sphincter Reconstruction

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