Polypropylene suture as a seton in recurrent fistula-in-ano in lower socioeconomic class-a good option

Background: Recurrent anal fistulas after previous fistula surgery are a unique problem that typically necessitates more anal surgical experience to address the cause of recurrence. The present study was planned with the objective to determine the outcomes of the polypropylene suture as a seton placement for the treatment of recurrent anal fistula.Methods: Patients between the ages of 20-80 years with recurrent fistula-in-ano with single external opening and with history of previous surgery. Patients with preoperative incontinence, patients with difficult follow-up and who were not ready to participate in the study, patients with fistulas caused by inflammatory bowel disease, malignancy, tuberculosis, or trauma, patients with a horseshoe or multiple fistulas, patients with recurrent fistula-in-ano with multiple external opening, or recurrent fistula-in-ano with diseases like Crohn’s disease, tuberculosis, actinomycosis, malignancy, or high level fistula-in-ano without internal opening, and patients with synchronous anorectal problems such as haemorrhoids were excluded.Results: Post-operative pain was observed in all patients while discharge, bleeding and inflammation were observed in 27, 10 and 8 patients, respectively on day 0. Majority of post-operative symptoms were resolves in almost all patients except, pain and discharge were observed in 2 and 1 patients, respectively on day 7. At 6 months follow-up, incontinence of flatus was found out in 2 patients while no patient had incontinence of faeces.Conclusions: Polypropylene suture as a seton in recurrent fistula-in-ano, in previously operated patient is safe and most acceptable treatment. Ksharsutra is not easily available but polypropylene suture is easily available.

Download Full-text

Clinical and diagnostic profile of patients with anal fistula: a cross sectional study from Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra

International Surgery Journal ◽

10.18203/2349-2902.isj20203073 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2494

Author(s):

Praffula V. Mahakalkar ◽

Ganesh Swami ◽

Halnikar Chandrashekhar S. ◽

Anant A. Takalkar

Keyword(s):

Anal Fistula ◽

Cross Sectional Study ◽

Internal Opening ◽

Age Group ◽

Cross Sectional ◽

Female Ratio ◽

Fistula In Ano ◽

Surgical Department ◽

Male Predominance ◽

External Opening

Background: Anal fistulas are one of the commonest causes for a persistent discharge seropurulent in nature that irritates the skin in the neighbourhood and leads to discomfort. Fistula-in-ano is seen quite frequently in perirectal perianal suppuration. The objective of this study to study the clinical profile and diagnosis of anal fistula at surgical OPD of VDGIMS.Methods: The present cross-sectional observational study was carried out in patients with fistula-in-ano admitted at surgical department of VDGIMS, Latur during the period of 2017-19 in 50 diagnosed patients. Data was analysed by using SPSS 24.0 version IBM USA.Results: Majority of the patients with anal fistula were from 41-50 years age group i.e. 15 (30%) and males were predominantly affected 40 (80%) compared to females i.e. 10 (20%). Male to female ratio was 4:1. Perianal discomfort was the commonest symptom in all patients i.e. 100%. It is followed by perianal discharge complained by 54% and perianal itching in 38% cases. The anterior position of external opening is found to be significant (p<0.05). Fistulogram showed external opening in all patients i.e. 50 cases whereas internal opening in 46 (92%) cases. Findings of MRI revealed that anal fistula was intra sphincteric in 28 cases i.e. 56%, extra sphincteric in 2 cases i.e. 4% and trans sphincteric in 20 cases i.e. 40%.Conclusions: Commonest age group affected in our study was 40-50 years with male predominance. Perianal discomfort and discharge were the commonest symptom. E. coli was the predominant organism isolated. Fistulogram and MRI is useful in detecting the aetiology of fistula in ano.

Download Full-text

AshwathaKsheer Sutra and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano): An Ayurvedic management protocol for treatment of fistula in ano

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4305 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 1357-1361

Author(s):

Monika Meshram ◽

Kiran Khandare

Keyword(s):

Internal Opening ◽

Anal Abscess ◽

Female Ratio ◽

Fistula In Ano ◽

Management Protocol ◽

Group A ◽

Group B ◽

Male To Female ◽

Single Blind

Fistula in ano is tract lined by granulation tissue having internal opening in anal canal and rectum and external opening in the perianal region. The incidence of a fistula-in-ano developing from an anal abscess ranges from 26-38%. The prevalence of non-specific anal fistula has been estimated to be 8.6 to 10/100,000 of the population per year, with a male to female ratio of 8:1.in contemporary sciences Bhagandara can be correlated with Fistula in Ano. To compare the efficacy of AshwathaKsheer Sutra and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano). The present study is designed as a Randomized single blind parallel in which 40 patients will be enrolled. Patients will be distributed in two group with 20 patients in each group. In group A AshwathaKsheerSutra and in group B UdumbarKsheerSutra will be changed after 7 days till the cure of fistula. Assessment of the patients will be done on day 1st, 8th, 15th, and 22nd after intervention, follow up will be taken on 29th day. Results will be drawn from the observations of objective parameters. Conclusion of the study will be drawn on the basis of statistical data calculated from the collected data.

Download Full-text

The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

10.21203/rs.3.rs-17069/v2 ◽

2020 ◽

Author(s):

Ruvindu H Waidyasekera ◽

Umesh Jayarajah ◽

Dharmabandhu Nandadeva Samarasekera

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Incidental Findings ◽

Flexible Sigmoidoscopy ◽

Internal Opening ◽

Fistula In Ano ◽

Recurrent Fistula ◽

Associated Symptoms

Abstract Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded. Results: The median age was 39(range:14-74) years and the majority were males(n=128,80.5%). Forty-nine patients(30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n=5, 3.1%) and polyps (n=7, 4.4%) were found. One patient(0.6%) had a healed anal fissure, 5 patients(3.1%) had inflamed mucosa and 2 patients(1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn’s disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn’s disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.

Download Full-text

Management of Complex Fistula in Ana with Fistulotomy and Stage Procedure

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i1.38952 ◽

2018 ◽

Vol 27 (1) ◽

pp. 83-87

Author(s):

MNH Masum ◽

A Yazdani ◽

M Masum ◽

MS Biswas ◽

MA Bhuiyan ◽

...

Keyword(s):

Anal Verge ◽

Advancement Flap ◽

Single Stage ◽

Fistula Tract ◽

Internal Opening ◽

Fistula In Ano ◽

Medical College ◽

Stool Incontinence ◽

Complex Fistula

Background: Complex fistula in ano is a troublesome disease and is difficult to treat. Complex fistula in ano occurs in various forms like multiple external and/or internal openings, internal opening above the dentate line, external opening far away from anal verge, anterior tract etc. They are almost invariably recurrent and frequently associated with other systemic diseases like tuberculosis, inflammatory bowel disease, malignancy etc.A complex fistula in ano has various modalities of treatments like application of setons, fistulotomy or fistulectomy, endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser and ligation of intersphincteric fistula tract (LIFT). Objective: The purpose of the study is to evaluate the outcome of complex fistula in ano by fistulotomy and staged procedure. Methods: The study was held in Dhaka medical college Hospital and various private hospitals located in Dhaka and Brahmonbaria within duration of 8 years (from January, 2011 to January, 2018). Among 256 patients (221 male, 35 female) with median age 48 years (30 to 72 years) with the diagnosis of complex fistula in ano, 135 underwent fistulotomy with application of Seton with stage procedure. 121 patients underwent single stage fistulotomy. 158 patients had history of previous operations. After stage procedure, regular follow up was done every week until wound healing occurred. Result: Among 256 patients 121 patients (47%) underwent single stage, 133 (52%) patients underwent two stage and 2 patients underwent three stage procedure during the trial period. Majority of the patients had minor incontinence; that is flatus and/or loose stool incontinence. But they only persisted for an average of 10 to 16 days and subsided spontaneously. None of the patient had any major (solid stool) incontinence. 4 patients (2%) had recurrence of fistula on an average of 3-6 months after complete healing. Recurrence occurred in the form of abscess, automatically burst internally, recurrent fistula.2 patients developed bleeding after single stage procedure and was managed by cauterization. Conclusion: With adequate postoperative care and regular follow up, application of Seton with ‘staged procedure’ in cases of complex fistula in ano is very effective and has very minimal complications. Chance of major incontinence and recurrence is also less. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 83-87

Download Full-text

A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

10.21203/rs.3.rs-43719/v1 ◽

2020 ◽

Author(s):

Hassan Al-Turaihi ◽

Blears Elizabeth ◽

Sugumar Kavin ◽

Deshmukh Maya ◽

Deshmukh Ganesh

Keyword(s):

Fecal Incontinence ◽

Advancement Flap ◽

Absorbable Suture ◽

Internal Opening ◽

Anal Fistulas ◽

Fistula In Ano ◽

Endorectal Advancement Flap ◽

Flap Failure ◽

Complex Fistula

Abstract Background Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods A retrospective review of patients with complex fistula-in-ano who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using Chi-squared test and student’s t-test or Mann-Whitney U test with statistical significance at alpha <0.05. Results With a median follow-up of 6.6 months (range: 1.6-84.5 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 3% (3/99) experienced postoperative fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of flap failure.Conclusion EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (3%) and a valid treatment option for complex fistula-in-ano.

Download Full-text

Stem Cell Therapy: A Compassionate Use Program in Perianal Fistula

Stem Cells International ◽

10.1155/2019/6132340 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

M. D. Herreros ◽

D. Garcia-Olmo ◽

H. Guadalajara ◽

T. Georgiev-Hristov ◽

L. Brandariz ◽

...

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Partial Response ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Perianal Fistula ◽

Internal Opening ◽

Compassionate Use ◽

Fistula In Ano

Aim. To report our experience in a compassionate use program for complex perianal fistula. Methods. Under controlled circumstances and approved by European and Spanish laws, a compassionate use program allows the use of stem cell therapy for patients with nonhealing diseases, mostly complex fistula-in-ano, who do not meet criteria to be included in a clinical trial. Candidates had previously undergone multiple surgical interventions that had failed. The intervention consisted of surgery (with closure of the internal opening or a surgical flap performance), followed by stem cell injection. Three types of cells were used for implant: stromal vascular fraction, autologous expanded adipose-derived, or allogenic adipose-derived stem cells. Healing was evaluated at 6th month follow-up. Outcome was classified as partial response or healing. Relapse was evaluated 1 year later. Maximum follow-up period was 48 months. Results. 45 patients (24 male) were included; the mean age was 45 years, which ranged from 24 to 69 years. Since some of them received repeated doses, 52 cases were considered (42 fistula-in-ano, 7 rectovaginal fistulas, 1 urethrorectal fistula, 1 sacral fistula, and 1 hidradenitis suppurativa). Regarding fistula-in-ano, there were 18 Crohn’s-associated and 24 cryptoglandular. 49 cases (94.2%) showed partial response starting 6.5 weeks of follow-up. 24 cases (46.2%) healed in a mean time of 5.5 months. A year later, all patients cured remained healed. No adverse effects related to stem cell therapy were reported. Conclusion. Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases.

Download Full-text

The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

10.21203/rs.3.rs-17069/v1 ◽

2020 ◽

Author(s):

Ruvindu H Waidyasekera ◽

Umesh Jayarajah ◽

Dharmabandhu Nandadeva Samarasekera

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Incidental Findings ◽

Flexible Sigmoidoscopy ◽

Internal Opening ◽

Fistula In Ano ◽

Recurrent Fistula ◽

Associated Symptoms

Download Full-text

Prevalence of fistula-in-ano in patients attending tertiary care institute of Gujarat: a cross-sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20192972 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2449

Author(s):

Akhilesh G. Sukhlecha

Keyword(s):

Tertiary Care ◽

Cross Sectional Study ◽

Medical Institute ◽

Cross Sectional ◽

Fistula In Ano ◽

External Opening ◽

Care Institute ◽

Envelope Method

Background: Present research was done to study the evidence, etiology signs, symptoms, pathogenesis and management and follow up of the patient for a period of 6 months after surgery.Methods: This was a clinical study of fistula in ano done at medical institute for the period of 1 year. 50 cases, clinically diagnosed, fistula in ano were selected randomly utilizing the closed envelope method and studied. Clinical examination including per rectal and proctoscopic was done in required patients. Patients were treated with fistulectomy or fistulotomy for fistulae. Patients were followed up for a period of 3 months to 1 year.Results: In this present series, 44% of patients were in the age group of 31-40 years. 70% of patients were, discharging wound was the presenting the complaint. 20% of patients with pain and swelling around the anal region. In the study of 50 cases were randomly selected patients of fistula in ano, 84% of them had only one external opening, while 10% had 2 external opening and another 6% had more than 2 openings, hence fistula in ano with a single external opening is commonest in occurrence.Conclusions: On the basis of observations, we can conclude that early diagnosis and appropriate management is the key to success. It not only reduces the complications but also improve the quality of life among these patients.

Download Full-text

Fistula in ano: open method compared to lift method ligation of intersphincteric fistula track

International Surgery Journal ◽

10.18203/2349-2902.isj20174892 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3714

Author(s):

Vigna Sai Potula

Keyword(s):

Internal Opening ◽

Female Ratio ◽

Fistula In Ano ◽

Open Method ◽

Intersphincteric Fistula ◽

Fistula Track ◽

High Level ◽

A Prospective Study ◽

Surgery Department ◽

Male To Female

Background: To compare fistula in ano open method with lift method ligation of intersphincteric fistula track.Methods: This is a prospective study which consisted of 70 patients suffering from fistula-in-ano who were admitted to surgery department. All patients above 18 years of age, cases of transsphincteric low anal fistula, maturation of tract were included in the study.Results: In this study, 60 patients were included totally, of which, 10 patients were excluded as 5 patients had tuberculosis, 2 had Crohn’s disease and 3 were excluded as they lost follow up. Hence, 50 patients were included in the study. 40 were males and 10 were females with a male to female ratio of 4:1 in this study. The average age of fistula in ano was 45.34±10.39 years. The incidence of fistula in ano was maximum in the age group of 46-55 years. The minimum incidence was in the age < 30 years. The most common primary fistula is intersphincteric track (46%), followed by transsphincteric track (42%). The most common type of fistula in ano patients was discharge from the tract which was in all patients, in others, perianal pain and bleeding was observed. Fistula in ano can be divided into low and high level of fistula. High level of fistula-in-ano was found in 64 % of patients and low level of fistula-in-ano was found in 36% of patients. Recurrence was seen in 6 patients with high suprasphincteric track who were ligated below the internal opening and 10 patients had a recurrence with transsphincteric track of which 6 were obese which made identifying the fistula track difficult.Conclusions: The LIFT procedure is advantageous as no chance of incontinence prevails as the infective focus is removed without dividing any part of sphincter complex, other advantages are that it is easy to learn, perform, safe, high healing rate, low morbidity and easily treat fistula in ano at primary health care level.

Download Full-text

A CASE REPORT ON GUGGULU BASED KSHARSUTRA ALONG WITH SAPTAVINSHATI GUGGULU IN TREATMENT OF BHAGANDARA (FISTULA-IN-ANO)

AYUSHDHARA ◽

10.47070/ayushdhara.v7i3.568 ◽

2020 ◽

pp. 2711-2714

Author(s):

Suman Yadav ◽

Ashutosh Kumar Yadav ◽

Anand puri

Keyword(s):

Case Report ◽

Fibrous Tissue ◽

Modern Science ◽

Point Of View ◽

Internal Opening ◽

Perianal Region ◽

Fistula In Ano ◽

History Of ◽

Anorectal Region

Bhagandara is one of the commonest diseases which occur in anorectal region. Acharya Sushruta had described this disease in Ashtamahagada that means disease difficult to cure. It starts as deep rooted Pidika around the Guda within two Angula or finger circumference and form into a track with an external opening in the skin of perianal region and an internal opening in the mucosa of anal canal or rectum lined by unhealthy granulation tissue and fibrous tissue which in modern science can be correlated to Fistula-in-ano. As the recurrence rate of fistula in ano is high after modern treatment. To overcome these difficulties, the concept of Ksharsutra mentioned in the classics is very beneficial from the treatment point of view. So, the Guggulu (Commiphora mukul) based Ksharsutra therapy along with oral Ayurvedic formulations is taken to prove its efficacy in treating Bhagandara. Here a case report of a 32 year old, male patient having history of Bhagandara (Fistula-in-ano) since last 2 years is discussed. He had complaints of left gluteal swelling, pain, pus discharge from perianal region and itching around anal region. For which he took allopathic treatment and got no relief, finally patient came to our hospital for better Ayurvedic management. He was treated with Guggulu based Ksharsutra therapy along with oral medication of Saptavinshati Gugglu vati 500 mg with water twice daily. Lastly, he got treated in 60 days and follow up of the patient was maintained up to 6 months where no complication was reported. It was proved that Ksharsutra application in combination with oral Ayurvedic medication worked effectively. This case report will help and enlighten the budding young scholars working in this area.

Download Full-text