CAN Stryphnodendron adstringens EXTRACT IMPROVE THE RESULTS OF FISTULOTOMY FOLLOWED BY PRIMARY SPHINCTEROPLASTY IN THE TREATMENT OF TRANSSPHINCTERIC FISTULAE?

Adriana de Souza RÓS,Moisés Soares da SILVA-NETO,Isabela CALDEIRA,Doroty Mesquita DOURADO,Leandro de Oliveira FURTADO,Carlos Henrique Marques dos SANTOS

doi:10.1590/0102-672020200003e1540

Abstract

ABSTRACT Background: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. Aim: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. Methods: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with “U” stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. Results: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). Conclusions: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.

Highlights

The anal fistula is the second most common anorectal disorder, behind hemorrhoidal disease[6,25], with intersphincteric type being the most common; transsphincteric fistulae are more challenging in terms of therapeutic approach, as they are associated with a greater number of patients who develop fecal incontinence after surgical treatment[16,19]
CAN Stryphnodendron adstringens extract improve the results of fistulotomy followed by primary sphincteroplasty in the treatment of transsphincteric fistulae? ABCD Arq Bras Cir Dig. 2020;33(3):e1540
Among the various techniques used in the treatment of transsphincteric fistula, the advancement of the mucosal flap and the fistulotomy followed by primary sphincteroplasty stand out

Summary

Introduction

The anal fistula is the second most common anorectal disorder, behind hemorrhoidal disease[6,25], with intersphincteric type being the most common; transsphincteric fistulae are more challenging in terms of therapeutic approach, as they are associated with a greater number of patients who develop fecal incontinence after surgical treatment[16,19]. The Kshara Sutra is an alternative outpatient treatment method with the use of drugs in order to cure the anal fistula, providing preserved anal continence and a 3.33% disease recurrence rate, with even less pain, fewer complications and low cost[4,21]. This therapy is rarely used in the West. The purpouse of this research was to evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistula in rats

Objectives

Methods

Results

Conclusion