Anal Fistulas In Patients Research Articles

Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study.

The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. We prospectively studied the first patients receiving MSC injections at our center and undergoing 12months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.

Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn\u2019s disease: a retrospective cohort analysis

BackgroundSurgical closure of anal fistulas with rectal advancement flaps is an established standard method, but it has a high degree of healing failure in some cases. The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap placement between patients with cryptoglandular fistulas and patients with Crohn’s disease (CD).MethodsFrom January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database, and healing rates were retrospectively analysed.ResultsThe median follow-up period was 189 days (95% CI: 109–269). The overall complication rate was 5.8%. The total healing rate for all rectal advancement flaps was 56%. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76% vs. 30%, p < 0.001), were administered more immunosuppressant medication (65% vs. 5%, p < 0.001), and had more rectovaginal fistulas (29% vs. 8%, p = 0.001) and more protective stomas (49% vs. 2%, p < 0.001) than patients without CD. However, no difference in healing rate was noted between patients with or without CD (47% vs. 60%, p = 0.088).ConclusionsPatients with anal fistulas with and without Crohn’s disease exhibit the same healing rate. Although patients with CD display different patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined.Trial registration Not applicable due to the retrospective study design.

Effectiveness of Biological Agents in the Treatment of Pediatric Patients with Crohn’s Disease and Anal Fistulae

Introduction: Anal fistulae have a significant impact on the quality of life of patients with Crohn’s disease (CD). In this cross-sectional study, we aimed to determine whether biological agents were effective in treating anal fistulae in patients with CD. Methods: Fifty-three patients diagnosed with CD were retrospectively enrolled. Their data regarding symptoms, treatments, and disease progression from January 2007 to December 2016 were reviewed from the medical records. Fifteen (28%) patients with CD were complicated by anal fistulae. Results: The male-to-female ratio was 13:2, and the mean age at onset was 11 years and 6 months. Among the 15 patients, 14 (93%) had anal fistulae as an initial symptom. Almost all patients were treated by providing elemental diet, 5-aminosalicylic acid, and steroids as induction therapy. Biological agents were used in 8 patients (53.3%), and fistula closure was confirmed in all of them. Among the 7 patients not treated with biological agents, 1 (14.3%) had a recurrent anal fistula, while another had incomplete fistula closure. Regarding surgical management, 2 patients were treated using the seton method, and no patients required a colostomy. Conclusion: Treatment with biological agents is highly effective concerning the closure of anal fistulae in patients with CD, and reducing pain may improve their quality of life.

Anal abscess microbiology as an anal fistula predictor

In order to determine the microbiology of anal abscess as a predictor of anal fistulas in patients who attended the external consultation of the Coloproctology unit of the Dr. Antonio María Pineda University Central Hospital, a prospective, descriptive, longitudinal study was conducted from September 2018 to July 2019. In this study, the population consisted of patients with a diagnosis of anal abscess, without associated comorbidities or contraindications for surgery, who agreed to be included in the study. A non-probabilistic, intentional sample consisting of 42 patients was determined. An appointment-based study protocol was applied by outpatient for patients who met the inclusion criteria applied, to perform due medical history through anamnesis, physical examination and culture taking of suppuration from the anal abscess to subsequently establish medical and surgical behavior thereof. The results were expressed in absolute numbers and percentages, a prevalence of ischiorectal abscesses was observed, followed by deep post-anal space abscesses. Anaerobic bacteria were isolated in 100% of the sample. In all fistulized patients, E. Coli was isolated as a predominant germ.

Magnetic resonance imaging monitoring of post-treatment changes to Crohn’s disease–related anal fistula in patients prescribed infliximab

Magnetic resonance imaging monitoring of post-treatment changes to Crohn’s disease–related anal fistula in patients prescribed infliximab

Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up.

Permacol paste injection is a novel treatment approach for complex cryptoglandular anal fistulas. This study was performed to evaluate the long-term clinical outcomes of treatment with Permacol paste for complex cryptoglandular fistulas. Patients with primary or recurrent complex cryptoglandular anal fistulas treated with Permacol paste from 2014 to 2016 were retrospectively analyzed. A total of 46 patients (median age, 41.3 years; 21 female) underwent Permacol paste injection; 20 patients (43%) had previously undergone failed fistula surgery. The patients had experienced anal fistula-related symptoms for a median of 10 weeks (range, 3-50 weeks). All patients had a draining seton in situ for a median of 10 weeks (range, 4-46 weeks). The median follow-up time was 24 months (range, 1-25 months). At the 1-month follow-up, 2 patients had paste extrusion and 2 had anal abscesses. The mean preoperative Continence Grading Scale score was 1.10 ± 1.40, and that at 3 months postoperatively was 1.13 ± 1.39 ( P = .322). There was a significant difference in the preoperative and the 1- and 3-month postoperative pain scores ( P < .001). At the 24-month follow-up, the healing rate was 50% (n = 23). A total of 19 patients (41%) with a recurrent fistula after failed Permacol paste injection required additional operative procedures. The satisfaction rate at the 2-year follow-up was 65%. Permacol paste injection is minimally invasive and technically easy to perform. It can be considered as a viable and reasonable option for the treatment of complex cryptoglandular anal fistulas in patients with fecal continence disorders.

Metabolic syndrome in patients with anal fistulae

Aim of work: to study the incidence of components of metabolic syndrome in patients with anal fistulae, to analyze combinations of different components of metabolic syndrome and types of pararectal fistulae.&#x0D; Materials and Methods. A clinical examination of 508 patients (85.2% – men; 21.5% at the age of 20-39 years, 43.9% – 40-59 years, 34.6% – ≥60 years) with anal fistulae (of them 48.0% were transsphincteric and 29.3% – extrasphincteric fistulae) who underwent treatment in the department of coloproctology of municipal clinical hospital №5 of Dushanbe in the period from 2010 to 2015, was conducted with the aim of identification of components of metabolic syndrome.&#x0D; Results. In 282 patients (55.5% of the total number of patients with anal fistulae, 90.8% of them being men) components of metabolic syndrome were identified: obesity – in 229 patients (45.1% of the total patients with anal fistulae), arterial hypertension – in 115 patients (22,6%), type 2 diabetes mellitus – in 58 patients (11.4%), IHD – in 8 patients (1.6%). In the presence of components of metabolic syndrome the recurrent forms of fistulae were recorded in 16.3% of cases (in the absence – in 12.8% of cases), and complicated forms – extrasphincteric (29.3%) predominated over intrasphincteric forms (22.7%); in control group the proportion of the mentioned forms was 24.8% and 29.2%, respectively. Transsphincteric forms were most common in both groups (48.0% and 46.0%).&#x0D; Conclusions. Components of metabolic syndrome in different combinations were identified in more than half (55.5%) the patients with anal fistulae (obesity – 45.1%, arterial hypertension – 22.6%, 2 type diabetes mellitus – 11.4%, IHD – 1.6%). A tendency was recorded to a more common recurrence of anal fistulae and to a more complicated forms of anal fistulae in patients with components of metabolic syndrome.

Metabolic syndrome in patients with anal fistulae

Aim of work: to study the incidence of components of metabolic syndrome in patients with anal fistulae, to analyze combinations of different components of metabolic syndrome and types of pararectal fistulae.&#x0D; Materials and Methods. A clinical examination of 508 patients (85.2% – men; 21.5% at the age of 20-39 years, 43.9% – 40-59 years, 34.6% – ≥60 years) with anal fistulae (of them 48.0% were transsphincteric and 29.3% – extrasphincteric fistulae) who underwent treatment in the department of coloproctology of municipal clinical hospital №5 of Dushanbe in the period from 2010 to 2015, was conducted with the aim of identification of components of metabolic syndrome.&#x0D; Results. In 282 patients (55.5% of the total number of patients with anal fistulae, 90.8% of them being men) components of metabolic syndrome were identified: obesity – in 229 patients (45.1% of the total patients with anal fistulae), arterial hypertension – in 115 patients (22,6%), type 2 diabetes mellitus – in 58 patients (11.4%), IHD – in 8 patients (1.6%). In the presence of components of metabolic syndrome the recurrent forms of fistulae were recorded in 16.3% of cases (in the absence – in 12.8% of cases), and complicated forms – extrasphincteric (29.3%) predominated over intrasphincteric forms (22.7%); in control group the proportion of the mentioned forms was 24.8% and 29.2%, respectively. Transsphincteric forms were most common in both groups (48.0% and 46.0%).&#x0D; Conclusions. Components of metabolic syndrome in different combinations were identified in more than half (55.5%) the patients with anal fistulae (obesity – 45.1%, arterial hypertension – 22.6%, 2 type diabetes mellitus – 11.4%, IHD – 1.6%). A tendency was recorded to a more common recurrence of anal fistulae and to a more complicated forms of anal fistulae in patients with components of metabolic syndrome.

Advancement Flap Technique for Anal Fistula in Patients With Crohn's Disease: A Systematic Review of the Literature

IntroductionTreatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. MethodsA systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. ResultsFrom 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low-level evidence. Results in a series with follow-up from 8.4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. ConclusionThe review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.

Resultados del tratamiento quirúrgico de la fístula anal en pacientes con enfermedad de Crohn mediante técnica de colgajo de avance endorrectal: revisión sistemática de la literatura

IntroductionTreatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex. MethodsA systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included. ResultsFrom 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low- level evidence. Results in a series with follow-up from 8,4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results. ConclusionThe review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.

PTU-209 Intra-operative swab cultures do not predict the development of anal fistula in patients undergoing emergency incision and drainage of perianal abscess: Abstract PTU-209 Table 1

Introduction Routine swab cultures at the time of perianal abscess drainage remains common practice in modern day emergency colorectal surgery. We aimed to analyse the effectiveness of culture swabs to predict short term and long term outcomes of perianal abscess drainage. Method 350 consecutive patients from January 2008 to December 2010 undergoing incision and drainage (I&D) of perianal abscesses with packing of wound in community were analysed for readmission, follow up outpatient visit, repeat procedure for ongoing symptoms and presence of anal fistula at follow up examination under anaesthesia (EUA). Patients with inflammatory bowel disease and known anal fistula disease were excluded. Inter-group comparative analyses were made for patients with and without intra-operative culture swabs and for the microbial growth. Results Overall fistula formation rate after I and D was 12% at 36 month follow up. No statistical significant differences were found between the different groups for rate of readmission, presence of fistula and number of outpatient consultations (P > 0.05). There was no significant difference in fistula rates for patients with positive microbial growth and negative microbial growth (10% vs. 8%, p = 0.12). No significant variation was observed for different types of organisms and rate of fistula formation. (See Table 1). Conclusion Routine swab cultures do not influence short and long term outcome associated with I&D of perianal abscess. Disclosure of interest None Declared.

2102315 Surgical and Endoanal Sonographic Assessment of Complex Anal Fistula in Patients Suspected of Having Secondary Tract

2102315 Surgical and Endoanal Sonographic Assessment of Complex Anal Fistula in Patients Suspected of Having Secondary Tract

A Prospective Evaluation of the Ligation of the Intersphincteric Tract Procedure for Complex Anal Fistula in Patients With Crohn's Disease

To evaluate 2- and 12-month outcomes after ligation of the intersphincteric fistula tract (LIFT) in Crohn's disease (CD). Surgical approaches to perianal fistulas in CD are frequently ineffective and hampered by concerns over adequate wound healing and sphincter injury. The efficacy of LIFT in CD patients is unknown. Consecutive cases of CD patients with transsphincteric fistulas were prospectively analyzed. Fistula healing and 2 validated quality-of-life indices were assessed. Fifteen CD patients (9 women; mean age = 34.8 years) were identified. Location of the fistula was lateral (n = 10; 67%) or midline (n = 5; 33%). LIFT site healing was seen in 9 patients (60%) at 2-month follow-up. No patient developed fecal incontinence. LIFT site healing was seen in 8 of the 12 patients (67%) with complete 12-month follow-up. Significant factors for long-term LIFT site healing were lateral versus midline location (P = 0.02) and longer mean fistula length (P = 0.02). Patients who had successful operations significantly improved both their mean Wexner Perianal Crohn's Disease Activity Index and McMaster Perianal Crohn's Disease Activity Index quality-of-life scores at 2-month follow-up (14.0-3.8, P = 0.001, and 10.4-1.8, P = 0.0001, respectively). CD-associated anal fistulas may be treated with LIFT. This surgical procedure is a safe, outpatient procedure that minimizes both perianal wound creation and sphincter injury.

Endoanal ultrasonography may distinguish Crohn’s anal fistulae from cryptoglandular fistulae in patients with Crohn’s disease: a cross-sectional study

The aim of the study was a cross-sectional investigation into the types of anal fistulae in patients with Crohn's disease using 3-dimensional endoanal ultrasonography. The study population consisted of 45 patients with established Crohn's disease referred in a 2-year period for treatment of anal fistula. The fistulae were classified according to the presence of three criteria: 1. bifurcation or secondary extension; 2. cross-sectional width ≥ 3 mm; and 3. content of hyperechoic secretions. The fistulae of 24 patients (53%) satisfied two or three criteria and were classified as true Crohn's fistulae, while the fistulae of 21 patients satisfied one or none of the criteria and were the cryptoglandular type. The fistulae in the two or three criteria group had been in existence for 8.4 years on average and those in the cryptoglandular group for 4.5 years on average (P = 0.283). The corresponding numbers of previous operations for fistula were 5.7 (range 0-32) and 1.5 (range 0-6), respectively (P = 0.0211). The presence of colitis or proctitis was similar across the groups, but the perianal Crohn's disease activity index was higher with a Crohn's type of fistula (P = 0.0097). Also, a larger proportion had been treated with anti-TNF-monoclonal antibody (0.0169). Endoanal ultrasonography was capable of discerning two subgroups of fistula in Crohn's patients. These groups were clinically different indicating that the prospect of surgical cure is also different.

Outcomes of anal fistula surgery in patients with inflammatory bowel disease

Background Anal fistulas in patients with Crohn's disease are especially difficult to manage because of nonhealing and incontinence. We reviewed our outcomes for the newer sphincter-preserving techniques of anal fistula plug and fibrin glue compared with standard treatments of advancement flap closure and seton drain insertion. Methods This was a retrospective study of patients with inflammatory bowel disease treated for high transsphincteric anal fistulas. The primary outcome was healing and continence at 12 weeks postoperatively. Results Between 1997 and 2009, 51 patients with anal fistulas and inflammatory bowel disease were identified in the St Paul's Hospital Anal Fistula Database. Postoperative healing rates at 12 weeks for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 75%, 0%, 20%, and 28%, respectively. Continence scores were not altered by these procedures. Conclusions Closure of the primary fistula opening in patients with inflammatory bowel disease using a biologic anal fistula plug had improved healing compared with fibrin glue, seton drain, and flap advancement. Given its low morbidity and relative simplicity, the anal fistula plug should be considered for treating high transsphincteric anal fistulas in patients with inflammatory bowel disease.

Persistent orocutaneous and anal fistulae induced by nicorandil: a case report

IntroductionAlthough nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals.Case presentationA 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy.ConclusionManagement of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.

Oral Spherical Adsorptive Carbon for the Treatment of Intractable Anal Fistulas in Crohn's Disease: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Anal fistulas are common in individuals with Crohn's disease (CD). We sought to evaluate the efficacy of oral spherical adsorptive carbon (AST-120) (Kremezin; Kureha Corporation, Tokyo, Japan) for the treatment of intractable anal fistulas in patients with CD. In this multicenter, randomized, double-blind, placebo-controlled trial, patients with CD and at least one active anal fistula under treatment were assigned to receive either AST-120 or placebo for 8 wk. Improvement was defined as a reduction of 50% or more from baseline in the number of draining fistulas observed at both 4 and 8 wk. Remission was defined by closure of all draining fistulas at both 4 and 8 wk. The Perianal Disease Activity Index (PDAI) and Crohn's Disease Activity Index (CDAI) were also assessed. In total, 62 patients were randomized, of whom 57 received AST-120 (N = 27) or placebo (N = 30). The improvement rate in the AST-120 group (37.0%) was significantly greater than that in the placebo group (10.0%) (P= 0.025). The corresponding remission rates were 29.6% and 6.7%, respectively (P= 0.035). PDAI significantly improved at both 4 and 8 wk with AST-120, compared to placebo (P= 0.004 and P= 0.005, respectively). CDAI was also significantly improved at both 4 and 8 wk in the AST-120 group, compared to the placebo group (P= 0.007 and P= 0.001, respectively). AST-120 treatment was well tolerated and no life-threatening adverse events were observed. AST-120 is useful for the control of intractable anal fistulas in CD patients.

Ｃｒｏｈｎ病に合併した難治性痔瘻に対するｓｅｔｏｎ法の長期成績

Ｃｒｏｈｎ病に合併した難治性痔瘻に対するｓｅｔｏｎ法の長期成績

Evaluation of the Use of BioGlue® in the Treatment of High Anal Fistulas: Preliminary Results of a Pilot Study

Treatment of anal fistulas by use of adhesives is an attractive method because of its simplicity and it can be performed on an ambulatory basis. Furthermore, if the treatment is unsuccessful, adhesive use does not subsequently prevent the surgeon from utilizing alternative surgical techniques and/or products. BioGlue Surgical Adhesive is a two-component surgical adhesive composed of bovine serum albumin and glutaraldehyde. We evaluated the usefulness of BioGlue for the treatment of high transsphincter anal fistulas. Patients diagnosed with high transsphincter anal fistulas of cryptoglandular origin, whether relapsed or not, were included in this study. A seton was placed before the injection of BioGlue into the fistula track of high transsphincter anal fistulas in patients with secondary tracts and/or purulent collections. Clinical charts, operative reports, and endoanal echography results obtained for each patient were reviewed. Fourteen patients (13 males; mean age, 39.9 (range, 24-66) years) with high transsphincter anal fistulas of cryptoglandular origin were recruited into the study. The average time of symptom evolution was 35.6 (range, 2-96) months. Ten of 14 cases were for relapsed fistulas. Six patients required the placement of a seton 37 (range, 32-42) days before the BioGlue injection. Patients were followed for a mean length of 13.92 (range, 3-21) months, and the fistula healed completely in only seven patients (50 percent). These preliminary results demonstrate that BioGlue may be useful for treating patients with high transsphincter anal fistulas. Further prospective long-term studies are needed.

Microbiological analysis and endoanal ultrasonography for diagnosis of anal fistula in acute anorectal sepsis

Treatment of anorectal sepsis requires prompt surgical drainage, but it is important to identify any associated anal fistula for preventing recurrence. We evaluated whether microbiological analysis and/or endoanal ultrasonography could be used to predict anal fistula in patients with acute anorectal sepsis. Five hundred fourteen consecutive patients with acute anorectal sepsis were studied. Clinical data, digital examination findings, endosonographic findings, and results of microbiological analysis were compared with definitive surgical findings of the presence or absence of anal fistula. Anorectal abscess with anal fistula was found in 418 patients, and anorectal abscess without anal fistula was found in 96 patients. Microbiological examination showed that Escherichia coli, Bacteroides, Bacillus, and Klebsiella species were significantly more prevalent in patients with fistula (P<0.01), and coagulase-negative Staphylococci and Peptostreptococcus species were significantly more prevalent in patients without fistula (P<0.01). Results of endoanal ultrasonography were concordant with the definitive surgical diagnosis in 421 (94%) of 448 patients studied. Acute anorectal sepsis due to colonization of "gut-derived" microorganisms rather than "skin-derived" organisms is more likely to be associated with anal fistula. When the microbiological analysis yields gut-derived bacteria, but no fistula has been found in the initial drainage operation, repeat examinations during a period of quiescence, including careful digital assessment and meticulous endosonography, are warranted to identify a potentially missed anal fistula.