One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion

Farag, Ahmed; Elbarmelgi, Mohamed Yehia; Mostafa, M. F.; Mashhour, Abdrabou N.

doi:10.1016/j.asjsur.2018.12.005

Cited by 40 publications

(34 citation statements)

References 10 publications

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“…Postoperative impaired continence after fistulotomy for low and mid FIA (lower 2/3 of external anal sphincter) is reported in up to 22% of patients [36]. The existing literature suggests there is a positive effect on postoperative continence after fistulotomy and fistulectomy with primary sphincter repair [37][38][39][40]. Direct sphincter repair was performed by 3-5% of the respondents in our study.…”

Section: Discussionmentioning

confidence: 67%

Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands

et al. 2021

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Background Management of cryptoglandular fistula-in-ano (FIA) can be challenging. Despite Dutch and international guidelines determining optimal therapy is still quite difficult. The aim of this study was to report current practices in the management of cryptoglandular FIA among gastrointestinal surgeons in the Netherlands. Methods Dutch surgeons and residents who are treating FIA regularly were sent a survey invitation by email. The survey was available online from September 19 to December 1 2019. The questionnaire consisted of 28 questions concerning diagnostic and surgical techniques in the treatment of intersphincteric and transsphincteric FIA. Results In total, 147 (43%) surgeons responded and completed the survey. Magnetic resonance imaging was the preferred diagnostic imaging modality (97%) followed by the endo-anal ultrasound (12%). In case of a high FIA, 86% used a non-cutting seton. Most respondents removed a seton between 6 weeks and 3 months (n = 84, 58%). Fistulotomy was the procedure of preference in low transsphincteric (86%) and low intersphincteric FIA (92%). Mucosal advancement flap (MAF) and ligation of intersphincteric fistula tract (LIFT), with 78% and 46%, respectively, were the procedures that were applied most often in high transsphincteric FIA. In high intersphincteric FIA 67% performed a MAF and 33% a fistulotomy. Thirty-three percent of all respondents stated that they habitually closed the internal fistula opening, half of them used a Z-plasty. For debridement of the fistula tract the preferred method was curettage (78%). Conclusions Dutch gastrointestinal surgeons use various techniques in the management of FIA. Novel promising techniques should be investigated adequately in sufficient large trials to increase consensus. A core outcome measurement and a prospective international database would help in comparing results. Until then, treatment should be adjusted to the individual patient, governed by fistula characteristics and patient choice.

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Section: Discussionmentioning

confidence: 67%

Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands

et al. 2021

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“…This is the great dilemma of the coloproctologist, offering a technique that achieves a high cure rate but also observing the degree of complications, with incontinence being one of the most feared. Undoubtedly, the results of fistulotomy followed by primary sphincteroplasty are consistent in terms of the chance of cure, low risk of recurrence, reduced cost, technical ease for specialists and with the great advantage of solving the problem with a single procedure in most cases, allowing thus an earlier return to the usual activities for these patients 5,7,15 .…”

Section: Discussionmentioning

confidence: 86%

CAN Stryphnodendron adstringens EXTRACT IMPROVE THE RESULTS OF FISTULOTOMY FOLLOWED BY PRIMARY SPHINCTEROPLASTY IN THE TREATMENT OF TRANSSPHINCTERIC FISTULAE?

Rós

Santos

Dourado

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. Aim: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. Methods: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with “U” stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. Results: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). Conclusions: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.

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“…In den letzten 1,5 Jahren wurden größere retrospektive Fallserien mit hunderten Patienten durchgeführt und die Operationstechnik als sicheres chirurgisches Verfahren mit hoher primärer Heilungsrate und niedrigem Rezidiv-oder Inkontinenzrisiko beschrieben [3,11]…”

Section: Welche Patienten Profitieren Von Dieser Technik?unclassified

Fistelchirurgie und primäre Sphinkterrekonstruktion

Kronberger

2019

coloproctology

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Zusammenfassung Die operative Therapie transsphinktärer Fisteln zeichnet sich durch eine variantenreiche Methodik aus. Die zumeist durchgeführten Techniken sind wohl die Fistulektomie mit Lappenplastik, die Fistulotomie mit oder ohne Sphinkterrepair und die (modifizierte) LIFT-Technik (Ligatur des intersphinktären Fisteltrakts). Ungeklärt aber ist die genaue Definition der Indikation einer Technik zu allen definierten Fisteltypen, was zum Teil dem Studiendesign anzuschulden ist und zu einer Variabilität der Auswertungen führt. Im vorliegenden Beitrag wird der Frage nach bisher vorhandenen Erfahrungen und Studien zur operativen Technik mit primärem Sphinkterrepair bei bestimmten Fisteltypen nachgegangen. In den letzten Jahrzehnten sind randomisierte Studien zu hoch- und suprasphinktären sowie zu rezidivierenden Fisteln mit guten Heilungs- und postoperativen Inkontinenzraten zur Technik der Fistulotomie mit Exzision des Fistelgewebes und primärem Sphinkterrepair erschienen. Die Technik wird in großen retrospektiven Studien jedoch bei allen transsphinktären Fisteln als erfolgreiche Therapieoption mit guter Kontinenzerhaltung beschrieben.

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One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion

Cited by 40 publications

References 10 publications

Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands

Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands

CAN Stryphnodendron adstringens EXTRACT IMPROVE THE RESULTS OF FISTULOTOMY FOLLOWED BY PRIMARY SPHINCTEROPLASTY IN THE TREATMENT OF TRANSSPHINCTERIC FISTULAE?

Fistelchirurgie und primäre Sphinkterrekonstruktion

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