Combination of simple advancement flap and fistulectomy to treat complex anal fistula as a complication of hemorrhoidectomy: Case report

Abstract Background The use of adipose-derived mesenchymal stem cells showed great regenerative properties. They were used in several surgical fields such as plastic, orthopaedic and colorectal surgery with good results. It was recently published their efficacy to treat Crohn-related anal fistula but they were obtained through a laboratory process with significant costs. The aim of the study is to evaluate the effect of the micro-fragmented autologous adipose tissue injection associated with the advancement flap for the treatment of Crohn-related complex perianal fistula in one surgical step. Methods From January 2017 to February 2018 all the patients that fulfil the following criteria were enrolled in the study. Inclusion criteria were Crohn-related complex anal fistula confirmed by pelvic magnetic resonance or 3D-360° transanal ultrasound, fistula drained with a seton from 4 to 6w, first sphincter-saving procedure. The harvested fat from the abdominal wall was processed using the Lipogems® kit (Figure 1). The internal opening was closed through 2/0 PDS stiches with mucosal flap above it. The final product was then injected around the internal opening and fistula tract previously debrided (Figure 2 and 3). Outcomes were determined at 1-3-6-12 months follow-up assessing success rate, defined as clinical remission without any discharge. Results Ten patients underwent the procedure in the time interval between two biologic drug administration (6 infliximab –4 adalimumab). The homogenous follow-up was 12 months with an overall healing rate of 60%. No perioperative or postoperative complications were recorded. Conclusion Micro-fragmented autologous adipose tissue injection showed promising results to promote Crohn-related complex anal fistula healing. These good results are probably related to the reduction of inflammation and the activation of a reparative mechanisms.

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Seton in Treating ComplexAnorectal Fistula-Our Experience

Journal of Surgical Sciences ◽

10.3329/jss.v17i1.43698 ◽

2019 ◽

Vol 17 (1) ◽

pp. 14-17

Author(s):

Md Shahadot Hossain Sheikh ◽

Md Ibrahim Siddique ◽

Mohammed Tanvir Jalal ◽

Md Saifull Islam ◽

KM Saiful Islam ◽

...

Keyword(s):

Anal Fistula ◽

Fistulous Tract ◽

External Sphincter ◽

Advancement Flap ◽

Treatment Modalities ◽

Anorectal Fistula ◽

Complex Anal Fistula ◽

Acceptable Method ◽

Faecal Continence

Background : Complex anorectal fistula may be endowed by the level at which the primary tract crosses the sphincters, the presence of secondary extensions or the difficulties faced in the treatment. Existing different treatment modalities like local advancement flap, LIFT procedure, fistulotomy and use of seton. Surgeons are afraid of incontinence in treating complex anorectal fistula. The aim of treatment of anal fistula is to cure the disease avoiding faecal incontinence. Among different procedures, Seton, a thread of foreign material, passed through the fistulous track and encircling sphincter mass thereby severing the muscle gradually without allowing it to spring apart and replacing the cut by the line of fibrosis thus avoiding incontinence, is an acceptable method practiced world wide. The purpose of the study is to evaluate and share our experience with others about the result of using seton in the treatment of complex anal fistula in our setting. Method: Between January 2003 and December 2008, I have taken the 1st 100 patients underwent surgery for complex anal fistula in Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medial University, Dhaka. It involved initial identification and partial laying open of the fistulous tract. A tight seton is placed around the external sphincter and is not removed until the internal orifice has migrated towards the perianal skin. Results: Out of 100 patients with mean age 43 years (range 19-65 years) 6 female and rest male underwent the procedure of seton. The median follow-up was 28.6 (24-36) months. The mean time of wound healing was 9.5 weeks (range 6-15). Recurrence occurred in two patient (2%). Continence disorders of flatus and loose stool were noted in 14 patients (14%). The duration with the seton in place was 56 days (range 20-190). Conclusion: The technique shows excellent results in the treatment of complex anal fistulous with preservation of faecal continence. Journal of Surgical Sciences (2013) Vol. 17 (1) : 14-17

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Long‐term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence?

Colorectal Disease ◽

10.1111/codi.15251 ◽

2020 ◽

Vol 22 (11) ◽

pp. 1649-1657

Author(s):

N. Uribe ◽

Z. Balciscueta ◽

B. Cuneo ◽

M.C. Martín ◽

J. Tabet ◽

...

Keyword(s):

Clinical Outcomes ◽

Anal Fistula ◽

Advancement Flap ◽

Fistula Repair ◽

Complex Anal Fistula ◽

Predictors Of Recurrence ◽

Transanal Advancement Flap

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Advancement Flap for the Treatment of a Complex Anal Fistula

Annals of Coloproctology ◽

10.3393/ac.2014.30.4.161 ◽

2014 ◽

Vol 30 (4) ◽

pp. 161

Author(s):

Do Sun Kim

Keyword(s):

Anal Fistula ◽

Advancement Flap ◽

Complex Anal Fistula

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Correction to: Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure

International Journal of Colorectal Disease ◽

10.1007/s00384-018-3217-1 ◽

2018 ◽

Vol 34 (3) ◽

pp. 559-559

Author(s):

Michele Podetta ◽

Cosimo Riccardo Scarpa ◽

Guillaume Zufferey ◽

Karel Skala ◽

Frederic Ris ◽

...

Keyword(s):

Anal Fistula ◽

Advancement Flap ◽

Complex Anal Fistula

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A Case Report of Hide-Line-Suture-Prosthesis Repair for Anal Fistula

Proceedings of Anticancer Research ◽

10.26689/par.v5i6.2786 ◽

2021 ◽

Vol 5 (6) ◽

pp. 27-29

Author(s):

Liwen Wang ◽

Yihing Li ◽

Zhenzhen Xue ◽

Qikai Liu

Keyword(s):

Case Report ◽

Anal Fistula ◽

Rectovaginal Fistula ◽

Early Years ◽

Diagnosis And Treatment ◽

Curative Effect ◽

Treatment Experience ◽

Complex Anal Fistula ◽

Low Complex

Hide-line-suture-prosthesis repair was introduced by Yibing Li from Shenzhen TCM Anorectal Hospital. In his early years, it was used in rectovaginal fistula, in which it achieved good curative effect. As the pathology of rectovaginal fistula and anal fistula is similar, Yibing Li innovated and applied it to anal fistula cases. This is a case report of a patient with low complex anal fistula who was treated in Shenzhen TCM Anorectal Hospital after two surgeries. The purpose of this report is to share the diagnosis and treatment experience in this case, so as to provide reference for clinicians.

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