Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula

Buchanan, G. N.; Owen, H A; Torkington, Jared; Lunniss, Peter J.; Nicholls, R. J.; Cohen, C. Richard G.

doi:10.1002/bjs.4466

Cited by 142 publications

(94 citation statements)

References 20 publications

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“…This endpoint was achieved in 72 per cent of patients. Long‐term recurrence was reported in 43 per cent18 and 83 per cent13 of patients. Further drainage of abscess was required in 42·8 per cent19, and in one study21 two patients developed a cancer related to the fistula.…”

Section: Resultsmentioning

confidence: 96%

“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Use of a seton alone, with removal at various time points, was reported in six retrospective fistula cohort studies13 14, 18 19, 21 22, and included a total of 329 Crohn's fistulas. In the four studies14 18, 19 22 assessing short‐term healing, success rates ranged from 14 to 81 per cent.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

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Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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“…by pain or secretion. In this case, it is suggested to perform a seton placement or a fistulotomy [9]. Nevertheless the operative therapy is limited in complex fistulas.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of a Complex System of Fistulas in Crohns Disease

Gloor¹

2016

J Hepatol Gastroint Dis

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Fistulas in Crohn's disease are a common problem in treatment of the disease. Especially perianal fistulas may cause a loss in patient's quality of life. They are coincident with an unfavourable development of Crohn's disease. Because of the frequent young patient's age, they come along with a long life of suffering and high cost for treatment. Therefore a good clinical diagnostic and a balance between drug therapy and surgery is needed. In this report, we present the case of a 28-year old male patient with a complex system of fistula in Crohn's disease. Based on clinical and radiological findings we performed operative treatment in combination to immunosuppressive therapy as an interdisciplinary collaboration.

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“…4 About 50% of the patients who undergo surgery develop surgical recurrence within 10 years after the initial surgery. 5 To allow a redo surgery, the trauma of the operative access should be as small as possible to prevent the development of dense intraabdominal adhesions. 6 Because of the smaller trauma and better cosmetic results, 6 the laparoscopic access has been implemented into the surgical therapy for Crohn's disease during the last decades.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease

Hoffmann¹,

Siebrasse²,

Schlöricke³

et al. 2017

OAS

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Aim:To investigate, via data analysis, the long-term outcome of patients who underwent either laparoscopic or open surgery for Crohn's disease. Methods: A total of 113 patients who had undergone first abdominal surgery due to Crohn's disease between January 2000 and December 2010 in a maximum care provider facility, were included in the statistical analysis. All patients provided their informed consent prior to inclusion. Data were collected from a database. Follow-up data included data from central mortality registries, general practitioners and a specialized clinic. Statistical analysis of the general patient data and the different operations and approaches were performed with the use of chi-square test, Fisher's exact test, and the Mann-Whitney U test. Results: The median follow-up period in case of open and laparoscopic surgery was found to be 9 and 6 years, respectively. Statistically significant differences were observed for the following parameters in case of open and laparoscopic surgery, respectively: age (median=44 vs. 36 years, range=15-76 vs. 15-72 years; p=0.007), urgency of operation (23 out of 34 planned vs. 6 out of 70 planned; p<0.001), year of resection (median=2003 vs. 2006, range=2000-2010 vs. 2000-2010; p=0.001). The length of stay in hospital was significantly shorter in the laparoscopic group than that of open surgery group (8 vs. 11 days, respectively; p<0.0001). We did not control for factors such as age and comorbidities in our statistical analysis. We also did not find any differences with regard to perioperative and 90-day mortality, surgical complications, length of specimen, stoma, surgical recurrence rate (10% in both groups) and number of re-admissions. Moreover, we did not find differences between patients with early operation after first symptoms and patients with long course of disease. A statistically significant difference was found for long-term mortality that was higher in the open surgery group than that of laparoscopic group (p=0.005) (the median for open surgery group was significantly higher than that of laparoscopic group). Conclusion: The outcome of laparoscopic and open surgery is at least comparable. Shorter length of hospital stay and comparable surgical recurrence rates are advantages of laparoscopy.

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Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula

Abstract: The success rate of the LST for complex fistula in ano falls over time. Counselling before seton removal should emphasize that, although most patients do not require sphincter division and some are cured by this technique, many patients develop further sepsis that usually requires surgery.

Cited by 142 publications

References 20 publications

Systematic review of surgical interventions for Crohn's anal fistula

Systematic review of surgical interventions for Crohn's anal fistula

A Rare Case of a Complex System of Fistulas in Crohns Disease

Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease

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Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula

Cited by 142 publications

References 20 publications

Systematic review of surgical interventions for Crohn's anal fistula

Systematic review of surgical interventions for Crohn's anal fistula

A Rare Case of a Complex System of Fistulas in Crohns Disease

Long-term outcome of laparoscopic and open surgery in patients with Crohn&rsquo;s disease

Contact Info

Product

Resources

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Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease