Transanal Opening of Intersphincteric Space for Fistula-in-Ano

2021 ◽  
pp. 000313482198904
Author(s):  
Yu-bo Li ◽  
Ju-hua Chen ◽  
Meng-di Wang ◽  
Jun Fu ◽  
Bing-chuan Zhou ◽  
...  
Keyword(s):  
Fistula Tract ◽  
Resonance Imaging ◽  
Clinical Database ◽  
Fistula In Ano ◽  
Fistula Surgery ◽  
P 16 ◽  
Preoperative Magnetic Resonance ◽  
Intersphincteric Fistula

Background The role of the intersphincteric space in the pathogenesis of fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric rectal abscesses have been surgically managed by laying open and draining the intersphincteric space as well as by the modified ligation of intersphincteric fistula tract (LIFT) procedure. In 2017, the transanal opening of intersphincteric space (TROPIS) technique was reported for the treatment of high, complex anal fistulae. Aim We aim to investigate the advantages of performing the TROPIS procedure in patients with fistula-in-ano. Methods This was a prospective cohort study investigating the outcomes in patients who had undergone a procedure using the TROPIS technique for the treatment of fistula-in-ano. Preoperative magnetic resonance imaging scans and electronic colonoscopies were performed on all patients. A clinical database evaluating the following variables was constructed: age, gender, body mass index (BMI), previous fistula surgery, type of fistula, postoperative complications, duration of follow-up, success rate, and incontinence scores pre- and postoperatively. Results The TROPIS procedure was performed on 41 patients with fistula-in-ano with a follow-up time of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 females, mean age 38.6±13.2 years, and mean BMI 23.5±3.9 kg·m−2. All patients (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% (6) of patients, and the healing of high fistula was 86.5% (32). Of those patients who had not healed completely, 2 were found to have contracted iatrogenic infections due to foreign residues and underwent surgery with the passing of a loose seton. The additional 4 patients who had not healed underwent a fistulotomy and healed completely thereafter. There were no significant changes in incontinence scores. The incontinence scores were .15 ± .36 preoperatively and .22 ± .47 3 months postoperatively (t = −1.438, P = .16). Conclusions The TROPIS technique is a novel sphincter-preserving procedure, which can be effectively used in treating fistula-in-ano.

scholarly journals LONG-TERM OUTCOMES OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT FOR COMPLEX FISTULA-IN-ANO: MODIFIED OPERATIVE PROCEDURE EXPERIENCE

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Ke WEN ◽  
Yun-Fei GU ◽  
Xue-Liang SUN ◽  
Xiao-Peng WANG ◽  
Shuai YAN ◽  
...  
Keyword(s):  
Success Rate ◽  
Operative Procedure ◽  
Cleveland Clinic ◽  
Fistula Tract ◽  
Long Term Outcomes ◽  
Fistula In Ano ◽  
Complex Fistula ◽  
Intersphincteric Fistula

ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.

scholarly journals A novel template for anorectal fistula reporting in anal endosonography and MRI – a practical concept

2019 ◽  
Vol 21 (4) ◽  
pp. 483
Author(s):  
Iwona Sudoł-Szopińska ◽  
Małgorzata Kołodziejczak ◽  
Giulio Santoro Aniello
Keyword(s):  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Fistula Tract ◽  
Anal Endosonography ◽  
Anorectal Fistula ◽  
Resonance Imaging ◽  
Anal Sphincters ◽  
Fistula Surgery ◽  
Magnetic Resonance Imaging Mri

Anorectal fistula surgery is associated with risks of recurrence and/or faecal incontinence due to anal sphincter injuries. In order to minimise these complications, preoperative evaluation of the anatomy of the fistula tract and morphology of the anal sphincters is mandatory. Anal endosonography (AES) and Magnetic Resonance Imaging (MRI), due to high resolution of images and ability to identify a number of fistula elements which are important for surgeons in treatment planning, are the methods of choice in the diagnosis of anorectal fistulas.In this paper, a new template for endosonographic and MRI report, systematically describing all anorectal fistula’s characteristics, is presented. This template provides practical information for the surgeon, useful in preoperative assessment and postoperative follow-up.

scholarly journals The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Carlos Placer-Galán ◽  
Jose Mª Enriquez-Navascués ◽  
Tania Pastor-Bonel ◽  
Ignacio Aguirre-Allende ◽  
Yolanda Saralegui-Ansorena
Keyword(s):  
Systematic Review ◽  
Anal Fistula ◽  
Meta Analysis ◽  
Fistula Tract ◽  
Cochrane Library ◽  
Fistula In Ano ◽  
Intersphincteric Fistula ◽  
The Impact ◽  
Seton Placement ◽  
Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) for Fistula-in-Ano

2013 ◽  
Vol 56 (3) ◽  
pp. 343-347 ◽  
Author(s):  
Wendy Y. Liu ◽  
Armen Aboulian ◽  
Amy H. Kaji ◽  
Ravin R. Kumar
Keyword(s):  
Long Term Results ◽  
Fistula Tract ◽  
Fistula In Ano ◽  
Intersphincteric Fistula

Adjunctive role of preoperative liver magnetic resonance imaging added to computed tomography among resected pancreatic cancer patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 207-207
Author(s):  
Hyoung Woo Kim ◽  
Jin-Hyeok Hwang ◽  
Jong-chan Lee ◽  
Kyu-hyun Paik ◽  
Jingu Kang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Hepatic Metastases ◽  
Resonance Imaging ◽  
Liver Mri ◽  
Hepatic Recurrence ◽  
Liver Magnetic Resonance Imaging ◽  
Hepatic Lesions

207 Background: Multi-detector computed tomography using pancreatic protocol (pCT) has been a preferred diagnostic imaging modality before resection of the pancreatic ductal adenocarcinoma (PDAC), because an adjunctive role of liver magnetic resonance imaging (MRI) is still unclear. The current study evaluated whether liver MRI added to pCT can help to select proper surgical candidates, and reduce the risk of early recurrence, eventually result in longer survival in resected PDAC patients. Methods: Among 197 PDAC patients who underwent curative-intended surgery, 167 patients who achieved complete resection with no grossly visible tumor were enrolled retrospectively. All patients had no metastatic lesions on pCT and/or MRI, preoperatively. Among them, 102 patients underwent pCT alone (CT group), and 65 patients liver MRI as well as pCT (MRI group). Results: By adding the liver MRI, hepatic metastases were newly discovered in 3 of 58 patients (5.2%) with no hepatic lesions on pCT and in 17 of 53 patients (32.1%) with indeterminate hepatic lesions on pCT. Among 167 patients who achieved R0/R1 resection, the median overall and disease-free survival were 20.1 vs 29.3 months and 8.5 vs 10.0 months in the CT and the MRI group, respectively (p = 0.011 and = 0.012), during median follow-up of 16.4 months. 80 (78.4%) patients in the CT group and 39 (60.0%) in the MRI group experienced recurrence during follow-up. Cumulative initial hepatic recurrence rate was higher in the CT group than in the MRI group (43.7% vs 18.5% at 1yr and 57.4% vs 26.9% at 2yr, p < 0.001), although the other sites recurrence did not differ in both groups. Conclusions: Liver MRI added to pCT has an incremental value in detecting PDAC hepatic metastases. Furthermore, because PDAC patients who underwent resection after liver MRI as well as pCT expect lower rate of hepatic recurrence and better survival than pCT alone, therefore, liver MRI added to pCT is needed to patients who planned curative resection of PDAC.

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