New Perspectives in the Treatment of Anal Fistulas

AbstractAnal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and sometimes controversial. Magnetic resonance imaging (MRI) is commonly performed in initial workup for AF. However, reports often lack key information for guiding treatment strategies. It has been shown that with structured radiology reports, there is less missing information. We present a structured MRI template report including 8 key descriptors of anal fistulas, whose effectiveness and acceptability are being assessed in a cross-sectional study (NCT04541238).

Download Full-text

Simple fistula-in-ano: is it all simple? A systematic review

Techniques in Coloproctology ◽

10.1007/s10151-020-02385-5 ◽

2021 ◽

Author(s):

F. Litta ◽

A. Parello ◽

L. Ferri ◽

N. O. Torrecilla ◽

A. A. Marra ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Fecal Incontinence ◽

Anal Fistula ◽

Randomized Clinical Trials ◽

Weighted Average ◽

Anal Fistulas ◽

Postoperative Continence ◽

Average Success Rate

Abstract Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

Download Full-text

Follow-up studies of sphincter-preserving operations for anal fistulas

Diseases of the Colon & Rectum ◽

10.1007/bf02062032 ◽

1997 ◽

Vol 40 (Sup 1) ◽

pp. S107-S111 ◽

Cited By ~ 3

Author(s):

Hisamitsu Hidaka ◽

Masazumi Kuroki ◽

Toshiaki Hirokuni ◽

Yuji Toyama ◽

Yasuhiko Nagata ◽

...

Keyword(s):

Anal Fistulas ◽

Follow Up Studies

Download Full-text

Anal Fistulas Due to Pseudomyxoma Anorectum

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2017.05.019 ◽

2017 ◽

Vol 354 (5) ◽

pp. e9 ◽

Cited By ~ 1

Author(s):

Shuai Wang ◽

Wan-Bin Yin ◽

Ling-Yu Kong

Keyword(s):

Anal Fistulas

Download Full-text

RNA Sequencing Reveals the Wound Repair Mechanism of Cuyuxunxi Prescription in Surgical Patients with Anal Fistulas

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207324666210520112816 ◽

2021 ◽

Vol 24 ◽

Author(s):

Yin Qu ◽

Zhijun Zhang ◽

Yafeng Lu ◽

De Zheng ◽

Wei Yang

Keyword(s):

Wound Healing ◽

Treatment Group ◽

Rna Sequencing ◽

Anal Fistula ◽

Wound Repair ◽

Inflammatory Responses ◽

Control Group ◽

Surgical Wound ◽

Anal Fistulas ◽

Skin Development

Background: Anal fistula is one of the most common colorectal and perirectal diseases in the world. Cuyuxunxi (CYXX) prescription is an efficient herbal fumigant used to promote the surgical wound healing of anal fistulas. Objective: This study aimed to explore the underlying molecular mechanism of CYXX prescription on surgical wound healing of anal fistulas. Methods: Ten patients with anal fistula were randomized into a control group or treatment group. The wound surface of patients in the control group was rinsed by normal saline, while that in the treatment group was rinsed by CYXX prescription. The wound tissues of patients with anal fistulas seven days after the surgery were collected for hematoxylin-eosin (HE) staining and RNA sequencing. The expressions of differentially expressed genes (DEGs) were validated by real-time quantitative PCR (RT-qPCR). Results: HE staining showed that CYXX treatment reduced the infiltration of inflammatory cells. A total of 472 DEGs, including 141 up-regulated genes and 331 down-regulated genes, were identified. These genes were significantly related to skin development, xenobiotic stimulus, and inflammation. In addition, the consistency rate of RT-qPCR and sequencing results was 83.33%, which showed a high relative reliability of the sequencing results. Conclusion: CYXX prescription could improve epidermis repair and reduce inflammatory responses.

Download Full-text

Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200004 ◽

2014 ◽

Vol 27 (2) ◽

pp. 101-103 ◽

Cited By ~ 8

Author(s):

Sergio Danilo Tanahara TOMIYOSHI ◽

Carlos Henrique Marques DOS SANTOS

Keyword(s):

Fecal Incontinence ◽

Anal Fistula ◽

Anorectal Manometry ◽

Fistulous Tract ◽

Complete Healing ◽

Fistula Tract ◽

Anal Fistulas ◽

Intersphincteric Fistula ◽

The Mean ◽

Initial Results

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.

Download Full-text

Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up

Surgical Innovation ◽

10.1177/1553350618808120 ◽

2018 ◽

Vol 26 (2) ◽

pp. 168-179 ◽

Cited By ~ 3

Author(s):

Michele Schiano di Visconte ◽

Andrea Braini ◽

Luana Moras ◽

Luigi Brusciano ◽

Ludovico Docimo ◽

...

Keyword(s):

Anal Fistulas ◽

Recurrent Fistula ◽

Pain Scores ◽

Significant Difference ◽

Paste Extrusion ◽

Observational Cohort ◽

Grading Scale

Background. Permacol paste injection is a novel treatment approach for complex cryptoglandular anal fistulas. This study was performed to evaluate the long-term clinical outcomes of treatment with Permacol paste for complex cryptoglandular fistulas. Methods. Patients with primary or recurrent complex cryptoglandular anal fistulas treated with Permacol paste from 2014 to 2016 were retrospectively analyzed. Results. A total of 46 patients (median age, 41.3 years; 21 female) underwent Permacol paste injection; 20 patients (43%) had previously undergone failed fistula surgery. The patients had experienced anal fistula-related symptoms for a median of 10 weeks (range, 3-50 weeks). All patients had a draining seton in situ for a median of 10 weeks (range, 4-46 weeks). The median follow-up time was 24 months (range, 1-25 months). At the 1-month follow-up, 2 patients had paste extrusion and 2 had anal abscesses. The mean preoperative Continence Grading Scale score was 1.10 ± 1.40, and that at 3 months postoperatively was 1.13 ± 1.39 ( P = .322). There was a significant difference in the preoperative and the 1- and 3-month postoperative pain scores ( P < .001). At the 24-month follow-up, the healing rate was 50% (n = 23). A total of 19 patients (41%) with a recurrent fistula after failed Permacol paste injection required additional operative procedures. The satisfaction rate at the 2-year follow-up was 65%. Conclusion. Permacol paste injection is minimally invasive and technically easy to perform. It can be considered as a viable and reasonable option for the treatment of complex cryptoglandular anal fistulas in patients with fecal continence disorders.

Download Full-text