Use of the OVESCO OTSC® Proctology Clip for closure of fistula-in-ano at Wits Donald Gordon Medical Centre - a single centre experience

Grossberg, S J; Harran, N; Bebington, Brendan; Lutrin, D

doi:10.17159/2078-5151/2020/v58n2a3131

Cited by 6 publications

(11 citation statements)

References 18 publications

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“…The healing rates of transsphincteric, suprasphincteric, extrasphincteric, and rectovaginal fistulas were 61%, 74%, 100%, and 20%, respectively [50]. However, other results were more disappointing, with a 47% overall success rate, 66.7% for simple, and 38.5% for complex [51].…”

Section: Anal Fistulamentioning

confidence: 99%

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Hwang

2022

J Anus Rectum Colon

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Recent trends in benign anal disease treatment are minimizing surgery to preserve normal anorectal anatomical unit and its functions. However, some surgeons still prefer and are confident with the use of conventional solid surgical methods. In this report, we will investigate the recent trends in the treatment for hemorrhoids, fistula, and anal fissure. The practice guidelines of advanced countries, including UK, Italy, France, USA, Japan, and ESCP, are referred to in this review. Opinions suggested in international meetings were also added. In the management of hemorrhoids, surgical treatments and office procedures were recommended according to a patient's status and preference. For the management of complex anal fistula, novel sphincter-preserving surgical techniques are more widely accepted than a sphincter-dividing procedure of immediate repair following fistulectomy. The treatment of anal fissures is well covered in the guidelines of the ASCRS.

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Section: Anal Fistulamentioning

confidence: 99%

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Hwang

2022

J Anus Rectum Colon

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“…There are only three studies in which outcomes after treatment with OTSC are reported exclusively for cryptoglandular anal fistula [123,126,130]. The rate of fistula healing ranged from 47% to 90% and included patients with various levels of fistula complexity.…”

Section: Effects On Fistula Healing Recurrence and Incontinence Follo...mentioning

confidence: 99%

European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula

Reza,

Gottgens,

Kleijnen

et al. 2023

Colorectal Disease

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AimThe primary aim of the European Society of Coloproctology (ESCP) Guideline Development Group (GDG) was to produce high‐quality, evidence‐based guidelines for the management of cryptoglandular anal fistula with input from a multidisciplinary group and using transparent, reproducible methodology.MethodsPreviously published methodology in guideline development by the ESCP has been replicated in this project. The guideline development process followed the requirements of the AGREE‐S tool kit. Six phases can be identified in the methodology. Phase one sets the scope of the guideline, which addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care. The target population for this guideline are healthcare practitioners in secondary care and patients interested in understanding the clinical evidence available for various surgical interventions for anal fistula. Phase two involved formulation of the GDG. The GDG consisted of 21 coloproctologists, three research fellows, a radiologist and a methodologist. Stakeholders were chosen for their clinical and academic involvement in the management of anal fistula as well as being representative of the geographical variation among the ESCP membership. Five patients were recruited from patient groups to review the draft guideline. These patients attended two virtual meetings to discuss the evidence and suggest amendments. In phase three, patient/population, intervention, comparison and outcomes questions were formulated by the GDG. The GDG ratified 250 questions and chose 45 for inclusion in the guideline. In phase four, critical and important outcomes were confirmed for inclusion. Important outcomes were pain and wound healing. Critical outcomes were fistula healing, fistula recurrence and incontinence. These outcomes formed part of the inclusion criteria for the literature search. In phase five, a literature search was performed of MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews by eight teams of the GDG. Data were extracted and submitted for review by the GDG in a draft guideline. The most recent systematic reviews were prioritized for inclusion. Studies published since the most recent systematic review were included in our analysis by conducting a new meta‐analysis using Review manager. In phase six, recommendations were formulated, using grading of recommendations, assessment, development, and evaluations, in three virtual meetings of the GDG.ResultsIn seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations.ConclusionThis is an up‐to‐date international guideline on the management of cryptoglandular anal fistula using methodology prescribed by the AGREE enterprise.

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“…As discussed earlier, due to complete involvement of EAS, the most commonly performed procedure, fistulotomy, is contraindicated in these fistulas[ 25 ] unless it is coupled with primary sphincter repair. The newer sphincter-sparing procedures, like video-assisted anal fistula treatment[ 24 ], fistula laser closure[ 24 ], over-the scope clip (OTSC)[ 37 - 39 ], anal fistula plug (AFP)[ 40 ], stem cells[ 28 ] etc, have dismal success rates in complex fistulas. In fact, there are hardly any studies that have analyzed the success rates of these newer procedures in high-5 fistulas.…”

Section: Management Guidelinesmentioning

confidence: 99%

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

Garg¹,

Yagnik²,

Dawka³

et al. 2022

WJG

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Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

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Use of the OVESCO OTSC® Proctology Clip for closure of fistula-in-ano at Wits Donald Gordon Medical Centre - a single centre experience

Cited by 6 publications

References 18 publications

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

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