The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study

Abramowitz, Laurent; Soudan, D.; Souffran, Marc-Henry; Bouchard, D.; Castinel, A.; Suduca, J.-M.; Staumont, G.; Devulder, Franck; Pigot, F.; Ganansia, Roland; Varastet, Marina

doi:10.1111/codi.13121

Cited by 57 publications

(30 citation statements)

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“…If one could identify the factor(s) that make one fistula persist despite all the sphincter‐saving treatments flung at it, while the other heals with minimal intervention, one may be able to truly conquer this disease. Until then, we may have to embrace this complex disease with simplicity, as patients may suffer more from the complications of an unsuccessful novel surgery than the minor incontinence imposed by a simple fistulotomy in selected cases …”

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confidence: 99%

Management of anal fistula in Australia and New Zealand: a survey of colorectal surgeons

Aksakal

Keck

Mirbagheri

2020

ANZ Journal of Surgery

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confidence: 99%

Management of anal fistula in Australia and New Zealand: a survey of colorectal surgeons

Aksakal

Keck

Mirbagheri

2020

ANZ Journal of Surgery

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“…8,356–376 Overall, 102,460 patients were enrolled in non-IBD studies (66.7% women) and 8289 in IBD studies (63.9% women), with the number of patients per study ranging from six to 47,714. Among non-IBD trials there were 137 prospective cohort studies, 48,50–53,58,59,61,62,64,68–72, 74–76,79–81,93,103,104,107,110–113,119,120,124–126,128,131,135,137, 142–145,149,151,153,…”

Section: Resultsmentioning

confidence: 99%

“…After careful evaluation of full‐text papers 27 studies were excluded: 15 studies 23–37 did not evaluate FI assessment, six manuscripts 38–43 were just protocols, five were paediatric studies, 44–48 and one trial 49 had an inappropriate study design. Finally, 328 studies were included in our review: 306 studies…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 102,460 patients were enrolled in non‐IBD studies (66.7% women) and 8289 in IBD studies (63.9% women), with the number of patients per study ranging from six to 47,714. Among non‐IBD trials there were 137 prospective cohort studies, 48 , 50–53 , 58 , 59 , 61 , 62 , 64 , 68–72 , 74–76 , 79–81 , 93 , 103 , 104 , 107 , 110–113 , 119 , 120 , 124–126 , 128 , 131 , 135 , 137 , 142–145 , 149 , 151 , 153 , 157–163 , 166 , 168 , 169 , 171–174 , 176–182 , 187 , 190 , 192 , 197 , 198 , 202 , 204 , 207 , 211–214 , 216 , 218 , 219 , 221 , 222 , 224 , 225 , 231 , 234 , 235 ,…”

Section: Resultsmentioning

confidence: 99%

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Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

et al. 2020

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Background Fecal incontinence is a disabling condition affecting up to 20% of women. Objective We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials. Methods We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019. Results In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies. Conclusion Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.

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“…From ancient times up to a few decades ago, treatment had remained unchanged, taking the form of a fistulotomy (“lay-open”) with knife or cautery, or the use of a seton. Despite the high healing rates [6, 7], impaired continence may result from fistulotomy, particularly in patients with high transsphincteric AF [8–10].…”

Section: Introductionmentioning

confidence: 99%

Contemporary surgical practice in the management of anal fistula: results from an international survey

et al. 2019

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BackgroundManagement of anal fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons.MethodsAn online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques.ResultsIn March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons’ experience. Only 1–4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn’s disease.ConclusionsProfound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.Electronic supplementary materialThe online version of this article (10.1007/s10151-019-02051-5) contains supplementary material, which is available to authorized users.

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The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study

Abstract: Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.

Cited by 57 publications

References 31 publications

Management of anal fistula in Australia and New Zealand: a survey of colorectal surgeons

Management of anal fistula in Australia and New Zealand: a survey of colorectal surgeons

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

Contemporary surgical practice in the management of anal fistula: results from an international survey

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