Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula

Abstract Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

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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.

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LIGATION OF INTERSPHINCTERIC FISTULA TRACT AS AN ALTERNATIVE TREATMENT FOR PERIANAL FISTULA AT TERTIARY CARE HOSPITAL

LIAQUAT MEDICAL RESEARCH JOURNAL ◽

10.38106/lmrj.2021.3.3-02 ◽

2021 ◽

Vol 3 (3) ◽

pp. 53-58

Author(s):

Nawaz Ali Dal ◽

Ishrat Raheem Katyar ◽

Mohammad Qasim Mallah ◽

Ahsan Laghari ◽

Shiraz Shaikh ◽

...

Keyword(s):

Fistulous Tract ◽

Tertiary Care ◽

Perianal Fistula ◽

Perianal Abscess ◽

Sampling Technique ◽

Fistula Tract ◽

Care Hospital ◽

Therapeutic Success ◽

Preoperative Symptom ◽

Intersphincteric Fistula

This study was aimed to evaluate clinical outcome of patients with perianal fistula operated with the ligation of intersphincteric fistula tract (LIFT) technique. The study was conducted at Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro from July 2018 and August 2019. A total of 22 patients diagnosed with perianal fistula operated with the Ligation of Intersphincteric Fistula Tract (LIFT) technique were selected using non-probability consecutive sampling technique. Physical examination and magnetic resonance imaging (MRI) and/or endosonography (ES) were performed to make a confirmed diagnosis of fistula. They were classified according to Parks classification. All patients were subjected to intersphincteric fistulous tract ligation using the technique defined by Rojanasakul modified. There were 16 males and 6 females. Mean age was 42 years (range 23-68 years of age). Out of 22 patients, 17 patients had a history of perianal abscess drainage prior to surgery and an average preoperative symptom presentation was 2.2 years (range 0-10 years). Therapeutic success with first surgery was achieved in 77% and with a second surgery in 90%. None of this patients modified their preoperative Wexner. It was concluded that LIFT technique appears to be a convenient, reproducible, and effective surgical alternative. This provides an appropriate closing rate and without continence modification, Therefore indicated for complex cryptoglandular fistulas.

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The place of conventional anal fistula surgeries among modern surgical techniques included in the current anal fistula treatment algorithm

Nowa Medycyna ◽

10.5604/12335991.1232439 ◽

2016 ◽

Vol 23 (4) ◽

pp. 0-0

Author(s):

Małgorzata Kołodziejczak ◽

Przemysław Ciesielski

Keyword(s):

Anal Fistula ◽

Treatment Algorithm ◽

Surgical Techniques ◽

Fistula Tract ◽

Recurrence Rates ◽

Surgical Methods ◽

Preparatory Stage ◽

Anal Fistula Surgery ◽

Advancement Flaps ◽

Fistula Treatment

The high percentage of complications after anal fistula surgery have resulted inattempts to seek new surgical solutions, which involve both improving the existing conventional surgical methods, as well as the introduction of modern surgical techniques. Classical surgical methods, such as fistulotomy, fistulectomy and Hippocrates’ procedure (loose or cutting setons) still have their place in the modernfistula treatment algorithm, however, some of the indications have changed (e.g. Hippocrates’ technique) and even new indications have been introduced. The noveltiesare represented e.g. by the use of a loose seton as a preparatory stage in innovativesurgical techniques, such as laser obliteration, injecting stem cells into the fistula tractor ligation of intersphincteric fistula tract (LIFT). Advancement flaps were replacedby LIFT and laser techniques due to similar indications, higher efficacy and lowerinvasiveness of the latter ones. On the other hand, the LIFT procedure was replacedby laser obliteration in the treatment of non branching trans-sphincteric fistulasas a less invasive and equally effective method. Although techniques for closing thefistula tract with a plug or adhesives are still considered as minimally invasive, theyare unfortunately associated with high recurrence rates. Recently a new solutionhas appeared. It is known as BioLIFT and combines LIFT with the anal fistula plug.The estimated effectiveness of this procedure is 68.8%.

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Pre-Operative MRI in evaluation of Perianal fistulas

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i1.30934 ◽

2021 ◽

Vol 12 (1) ◽

pp. 55-60

Author(s):

Milind Sawant ◽

Giriraj Singh ◽

Harish S ◽

Kaushik Roy

Keyword(s):

Fistulous Tract ◽

Perianal Fistula ◽

Preoperative Assessment ◽

Common Type ◽

University Hospital ◽

Predictive Values ◽

Perianal Fistulas ◽

Anal Opening ◽

Associated Conditions

Background: Perianal fistula is a common and often an extremely distressing disorder. MRI is a preferred modality for the preoperative assessment of perianal fistulas. Aims and Objective: To evaluate the accuracy and predictive values of pre-operative MRI in diagnosing severity of perianal fistulas and the conditions associated with it like internal anal opening, secondary tract, abscess and supralevator extension. Materials and Methods: In this study, 44 patients with clinically suspected perianal fistulas underwent MRI for the evaluation of severity and presence of the associated conditions. St James’s University Hospital Classification was used to grade the perianal fistula. Pre-operative MRI grading was compared with the surgical findings in the 26 operated patients. Results: Out of 44 clinically suspected perianal fistulas, 41 (93%) were diagnosed as perianal fistulas by MRI. The most common type was grade 1 seen in 12(27.3%) patients followed by grade 4 fistula seen in 10(22.7%) patients. All 26 patients evaluated by surgical findings for severity of perianal fistulas were found to be graded in identical grades by pre-operative MRI. MRI was 100% sensitive in picking up all five grades. Conclusion: MRI helps in the accurate delineation of fistulous tract, identification of secondary tract and abscess.

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Interventional treatment of Anal Fistula: A Retrospective Analysis

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2021.10.2.0171 ◽

2021 ◽

Vol 10 (2) ◽

pp. 225-228

Author(s):

Duran Y ◽

Polat IF ◽

Gokce H ◽

Gokce FS ◽

Bali I ◽

...

Keyword(s):

Retrospective Analysis ◽

Anal Fistula ◽

Perianal Fistula ◽

Day Surgery ◽

Fistula Tract ◽

Interventional Treatment ◽

Female Ratio ◽

Surgical Methods ◽

Quality Of Life Index ◽

Fistula Treatment

Introduction: Anal fistula is a benign anorectal disease. Infection of Hermann and Desfosses anal glands is responsible for the formation of abscesses and/or fistulas. The main treatment is surgery but recurrence and sometimes incontinence are frequently observed. So to choose surgical methods of anal fistula treatment is very important. Aim: The aim of this retrospective study was to evaluate the reliability and feasibility of Video-assisted anal fistula treatment (VAAFT) at the anal fistula surgery. Materials and Methods: A retrospective analysis was performed on data collected during a 11-year period (2008-2019) from 52 patients who underwent fistulotomy with loose seton technique. The male to female ratio was 3:1 and the mean patient age was 48.34 years. Results: Mortality, recurrence, complications rate were 0%. Though the patients were scheduled as day-surgery cases, the average duration of hospital stay was 1.18 days. Quality of life index (QOLI) for these patients were often be improved by treating their fistula. Conclusion: The appropriate treatment for anal fistula is dependent upon the anatomy and the location of the fistula tract. Detection of the inner mouth is the touchstone in the treatment of anal fistula. It could be determined location of inner mouth of the anal fistula easily with transparent anoscope guideline. VAAFT seems to be a safe and effective technique for treating perianal fistula without recurrence and anal incontinence.

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Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2019-0020 ◽

2019 ◽

Vol 12 (2) ◽

pp. 139-146

Author(s):

Mladen E. Ovcharov ◽

Iliya V. Valkov ◽

Milan N. Mladenovski ◽

Nikolay V. Vasilev

Keyword(s):

Recurrence Rate ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Surgical Techniques ◽

Reoperation Rate ◽

University Hospital ◽

Recurrence Rates ◽

Chi Square ◽

Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

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Gas-filled urachal abscess with a pinging sound in a heifer calf

Veterinární Medicína ◽

10.17221/61/2019-vetmed ◽

2019 ◽

Vol 64 (No. 8) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

R Sato ◽

K Yamada ◽

Y Shinozuka ◽

H Ochiai ◽

K Onda

Keyword(s):

Fistulous Tract ◽

Failure To Thrive ◽

Abdominal Distension ◽

Intravenous Urography ◽

University Hospital ◽

Growth Depression ◽

Poor Growth ◽

History Of ◽

Heifer Calf ◽

Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

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Electrocardiographic markers of atrial cardiomyopathy predict ineffective cardioversion: a FinCV2 cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0408 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Relander ◽

T Hellman ◽

T Vasankari ◽

I Nuotio ◽

K.E.J Airaksinen ◽

...

Keyword(s):

Sinus Rhythm ◽

Independent Predictor ◽

P Wave ◽

University Hospital ◽

Funding Source ◽

Recurrence Rates ◽

Cardiovascular Research ◽

Wave Duration ◽

P Wave Duration ◽

Af Recurrence

Abstract Background Rhythm control using electrical cardioversion (CV) is a common treatment strategy for patients with symptomatic atrial fibrillation (AF). However, little is known about electrocardiographic (ECG) markers predicting CV failure and AF recurrence. Methods This study included 726 patients who underwent a CV for AF lasting >48h in a referral hospital. We analysed markers of atrial cardiomyopathy in post-CV sinus rhythm ECGs and compared them with CV failure and AF recurrence rates within 30 days after CV as well as their combination (ineffective CV). Of those with failed CV the most recent sinus rhythm ECG was used. Results CV was unsuccessful in 66 out of 726 patients (9.09%). Advanced interatrial block (IAB) defined as P-wave duration ≥120ms and biphasic morphology in inferior (II, III and aVF) leads (OR 3.96, 95%-CI 2.09–7.52, p<0.001) was an independent predictor for CV failure. Within 30 days after CV, AF recurred in 214 (32.4%) patients. Advanced IAB (OR 2.10, 95%-CI 1.19–3.72, p=0.011) was an independent predictor for AF recurrence. In total CV was ineffective (CV failure or AF recurrence) 280 of 726 times (38.6%). Advanced IAB (OR 2.72, 95%-CI 1.64–4.51, p<0.001) was an independent predictor for ineffective CV. Partial IAB categorized as P-wave duration ≥120ms with no biphasic morphology did not predict any end points. Conclusions Advanced IAB predicts CV inefficacy. This study identified ECG markers of atrial cardiomyopathy for clinical use in CV patient selection. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study research was funded by grants from the Finnish Medical Foundation, the Finnish Foundation for Cardiovascular Research, State Clinical Research Fund of Turku University Hospital, Turku, Finland, Finnish Cardiac Society, the Emil Aaltonen Foundation, and the Maud Kuistila Foundation.

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Modified Lift Versus Cutting Seton for Transphincteric Fistula -Experience at Tertiary Care Hospital

10.53350/pjmhs2115123257 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3257-3260

Author(s):

Muhammad Najam Iqbal ◽

Ashfaq Nasir

Keyword(s):

Comparative Study ◽

Anal Incontinence ◽

Complete Healing ◽

Fistula Tract ◽

Fistula Closure ◽

Fistula In Ano ◽

Group A ◽

Prospective Comparative Study ◽

Cutting Seton ◽

Group B

Background: Fistula in ano is a common disease which has high recurrence rate and high fecal incontinence rate after surgery. We compared modified LIFT (Ligation of the intersphincteric fistula tract (LIFT) through lateral approach ) with cutting seton for transphincteric fistula. Aim: This study is aimed at which procedure is better with respect to postoperative complications Study design: It was a prospective comparative study. Methods: This was a prospective comparative study from 01-01-2019 to 30-06-2021 which was conducted on 50 patients who presented with transsphincteric fistula in ano (FIA) in surgical ward of Bahawal Victoria Hospital Bahawalpur. Patients were divided into two groups .Patients of Group A underwent modified lift procedure and patients of group B underwent cutting seton procedure. Data was collected on a proforma which included patients’ name ,age ,sex, age group, comorbid disease like diabetes mellitus ,chronic liver disease, cardiovascular disease and chronic renal failure, fistula tract involving less than 50% or more than 50% external sphincter ,procedure done, healing time of wound, complications like recurrence and incontinence. Patients were followed for 6 months for healing rate ,recurrence and incontinence. Data was analysed on spss 22 version Results: In Group A, complete healing (fistula closure without recurrence) was achieved in 20 patients (80%) out of 25. There was no case of anal incontinence after the procedure. 5 (20%) patients experienced recurrence in 6 months . In Group B, complete healing (fistula closure without recurrence) was achieved in 21 patients (84%), in 6 months follow up . 4(16%) patients were diagnosed as a case of anal incontinence. There were 4 (16%) patients with recurrence. Conclusion: Modified LIFT is better in terms of incontinence where as cutting seton is better in terms of recurrence.it is suggested that for high lying fistula modified LIFT is better procedure and for low lying fistula involving less than 50% sphincter cutting seton is better procedure.. Keywords: Modified LIFT (ligation of ineter sphincteric fistula tract) ,Cutting seton , transphincteric fistula.

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A comparative study in the management of fistula in ANO using various modalities

International Surgery Journal ◽

10.18203/2349-2902.isj20182226 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2223 ◽

Cited By ~ 2

Author(s):

Ramachandra M. L. ◽

Mayank Garg

Keyword(s):

Fistulous Tract ◽

Selection Method ◽

Fistula Tract ◽

Internal Opening ◽

Necrotic Tissue ◽

Fistula In Ano ◽

Sphincter Function ◽

Medical College ◽

Operative Complications ◽

Comparative Prospective Study

Background: Fistula in ano is a track that connects deeply the anal canal or rectum to the skin around the anus. Fistula in ano most commonly follows an anorectal sepsis1. The main principles of management of anal fistula are closure of internal opening of fistula tract, drainage of infection or necrotic tissue, and eradication of fistulous tract with preservation of sphincter function. The objectives were to compare the various aspects like per operative complications, post-operative complications, mean hospital stay in the treatment of fistula in ano using various modalities like fistulotomy, fistulectomy, setons and lift procedure.Methods: This is a randomised, comparative, prospective study of 80 cases of fistula in ano, presenting at surgical opd of K.R. Hospital, Mysore attached to Mysore Medical College and research Institute. Out of which, 20 cases are treated by fistulectomy, 20 by seton, 20 by fistulotomy and the rest 20 cases by LIFT procedure by random selection method, during period of NOVEMBER 1, 2016 to 31st October 2017.Results: Most common age of presentation is 31-40 years and more common in males then females (M:F= 2.3:1 ). Per operative complications include bleeding seen more in patients undergoing fistulectomy. Per operative course of LIFT procedure patients was complication free. Postoperative pain seen more in patients undergoing setons procedure.Conclusions: we conclude that LIFT procedure and Fistulotomy were acceptable procedures for simple, uncomplicated low lying and high lying fistula.

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