Intersphincteric Fistula Tract Research Articles

Subtotal fistulectomy and sliding anoderm flap: A new sphincter-sparing technique for anal fistula.

The underlying causes of failure or recurrence after ligation of the intersphincteric fistula tract are postulated to be refistulization, breakdown of the closure wound in the intersphincteric plane and faecal contents entering the internal opening, thereby causing recurrent infection. The aim of this study is to demonstrate the outcomes of subtotal fistulectomy with sliding anoderm flaps to prevent refistulization. This retrospective study used prospectively collected data. Patients with transsphincteric or intersphincteric fistulas were enrolled between August 2021 and July 2023. An anal manometric study was performed before and after surgery. Faecal incontinence was evaluated using the faecal incontinence severity index (FISI). Failure was defined as nonhealing of the surgical wound or fistula. Fifty-one patients who underwent subtotal fistulectomy with a sliding anoderm flap were included. After a median follow-up of 12 months (range 4-27 months), primary healing was achieved in 49 patients (96%). Two patients experienced treatment failure, while none developed postoperative recurrence. The median healing time was 10 weeks (range 6-24 weeks). The FISI scores did not change significantly after the surgery. The median resting pressure significantly reduced after surgery [125 cmH2O (range 59-204 cmH2O) vs. 99 cmH2O (range 36-176 cmH2O); p = 0.0001]. The median squeeze pressure significantly decreased after surgery [356 cmH2O (range 137-579 cmH2O) vs. 329 cmH2O (range 72-594 cmH2O; p = 0.005)]. Subtotal fistulectomy with a sliding anoderm flap showed excellent healing rates with no postoperative deterioration of anal function.

Traitement des fistules anales réfractaires à l’Infliximab au cours de la maladie de Crohn : Mise au point

Treatment of complex perianal fistulas in Crohn's disease remains a challenge especially after the failure of Infliximab. Update on the different therapeutic alternatives for anal fistula in Crohn's disease after failure of Infliximab. A research in the medical literature on PubMed and Google Scholar was carried out. We included cohort studies, reviews and randomized double-blinded therapeutic trials. Case reports and fundamental research studies have been excluded. Anti-TNF therapy, notably Infliximab remain the therapeutic option of choice. Since Infliximab efficacy has been estimated at 60%, with a significant loss-of response rate, new therapeutic strategies have been evaluated and may offer new opportunities for the management of anal fistulas: for example, Ustekinumab could be effective after failure of anti-TNF therapy, although further studies are required. Recent guidelines suggest that injection of mesenchymal stem cells is an effective and safe treatment for complex fistulas. Other surgical options have been proposed, such as endorectal advancement flap, fibrin glue injection, anal fistula plug and ligation of the intersphincteric fistula tract, but all with limited and debatable efficacy. Given the failure rate of all these options, new strategies are currently being evaluated. Anal fistulas in Crohn's disease are a real therapeutic challenge. New medical and surgical therapies are currently being evaluated, with promising results.

Predictors of recurrence and long-term patient reported outcomes following surgical repair of anal fistula, a retrospective analysis

PurposeSurgery for anal fistulas can result in devastating complications, including reoperations and fecal incontinence. There is limited contemporary evidence comparing outcomes since the adoption of the ligation of intersphincteric fistula tract procedure into mainstream practice. The purpose of this study is to compare recurrence rates and long-term outcomes of anal fistula following repair.MethodsData was collected from the electronic medical records or patient reported outcomes from patients aged 18 or older with a primary or recurrent cryptoglandular anal fistula. Primary outcome was recurrence defined as the identification of at least one fistula os or a high clinical suspicion of anal fistula. Secondary outcomes included fecal incontinence and postoperative quality of life.ResultsA total of 171 patients underwent definitive surgical repairs for their anal fistula. So 66.5% had a simple fistula, and 33.5% had a complex fistula. Of the 171 patients, 12.5% had a recurrence. The recurrence rates were 5.9% for simple fistula and 25.4% for complex fistula. Predictors of recurrence included diabetes mellitus, history of anorectal abscess, complex fistula, and sphincter sparing surgery. LIFT or plug/biologic procedures were both associated with a 50% or greater recurrence rate. No significant differences were found in fecal incontinence or associated quality of life between sphincter sparing or non-sphincter sparing surgical resections.ConclusionThe study provides insights into the long-term outcomes of surgical repair for anal fistula. We demonstrate that sphincter sparing operations are associated with increased recurrence, meanwhile, non-sphincter sparing surgeries did not increase the risk of fecal incontinence or worsen quality of life.

A commentary on "High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract technique".

A commentary on "High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract technique".

Ligation of the Intersphincteric Fistula Tract as an Emergency Treatment for Cryptoglandular Anal Fistula.

Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treating anal fistula of cryptoglandular origin. Our prospective study aimed to determine the postoperative outcomes of patients undergoing LIFT in emergency and elective settings. This was a single-centre prospective observational study of the LIFT procedure for the treatment of anal fistulas. The differences in the 6-month postoperative outcomes between the emergency and elective procedures were analysed, including the healing rate, healing time, recurrence rate, recurrence time, postoperative complications and length of hospital stay. Twenty-two patients were recruited for this study: 11 patients underwent LIFT as an emergency procedure (EM-LIFT), while the others underwent LIFT as an elective procedure (EL-LIFT). The healing rate for the EM-LIFT group was 90.9% (n = 10), with a median healing time of 2 months (range 0.5-4). For the EL-LIFT group, the healing rate was 100% (n = 11), with the same median healing time of 2 months (range 0.5-4). Two of the patients in the EM-LIFT group developed recurrence, with a median recurrence time of 5 months (range 4-6) and three developed recurrence in the EL-LIFT group, with the same median recurrence time of 5 months (range 4-6). There were minor postoperative complications of pain and subcutaneous infection, with no faecal incontinence. There was no statistically significant difference in postoperative outcomes between the groups. EM-LIFT is a feasible and safe primary procedure for active cryptoglandular-type anal fistulas.

Effectiveness of ligation of Inter Sphincteric Fistula Tract (LIFT) in the Management of Fistulas in ano in Maharashtra Population: Retrospective Study

Background: Anal fistula is one of the most common ano- rectal problems, resulting in very negative patientexperiences. The objectives of anal fistula treatments are to achieve healing with a low recurrence rate and preserveanal function.Method: 55 adult patients were confirmed to be competent for surgery. USG examination with 7 to 10 MHZtransducer passed into the anal canal, which is carried out with the patient in the left lateral position. Serial radialimages were taken to study the location and position of the fistula. The LIFT procedure was similar to Rojanaskulproposed method. The duration of surgery and healing time were also noted.Results: 48 (87.2%) were as per Parks classification, 5 (9.09%) intersphincteric, 2 (3.63%) suprasphincteric,Classification based on course of fistula – 20 (36.3%) anterior straight, 28 (50.9%) posterior straight, 5 (9.09%) curved,and 2 (3.63%) semi-horse shoe. Classification based on the tract – 50 (90.9%) single tracts, 5 (9.09%) multiple tracts.Conclusion: LIFT technique is simple and safe, with a high rate of healing and no risk of incontinence.

Observational Study of Effectiveness of Ligation of Intersphinsteric Fistula Tract (Lift) in Perianal Fistulas Operated at AIIMS Patna

Background: Perianal fistula or fistula-in-ano, is a chronic abnormal communication, usually lined by granulation tissue, which runs outwards from the anorectal lumen (the internalopening) to an external opening on the skin of the perineum and gluteal region. Perianal fistula develops as a result of anorectal sepsis. Ligation of intersphincteric fistula tract (LIFT) is a new sphincter saving method with good result in the management of fistula. The aim of study was to evaluate the effectiveness and functional outcomes of the LIFT patients operated at AIIMS Patna.

Compartive Study between Conventional Laying-Open Technique with Sphincter Repair and Ligation of Intersphincteric Fistula Tract (LIFT) in Treatment of High Trans-Sphincteric Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Objective To retrospectively evaluate the success rate, the recurrence and incontinence when using the Conventional laying-open and sphincter Repair technique in comparison to Ligation of Intersphincteric Fistula Tract (LIFT) for treating high trans-shpincteric perianal fistula. Patients and Methods This was a cohort retrospective, comparative study that was conducted on cases of fistula in the anus, who were subjected to surgery in Ain Shams University Hospitals and Ain shams specialized hospitals in the period from October 2021 to March 2022 (at least 30 cases) to evaluate the success rate, the recurrence rate, and incontinence rate when using the conventional laying open with sphincter repair technique compared to ligation of inter-sphincteric fistula tract (LIFT) For High trans-sphincteric perianal fistula. Results Regarding Relation of recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation and complications. that there was no statistically significant relation found recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation while there was statistically significant relation found with complications. Conclusion LIFT procedure is an effective and preferred sphincter-saving technique for fistula-inano with shorter healing time and lower incidence of postoperative anal incontinence, but have higher incidence of recurrence as compared to conventional layopen with sphincter repair which have a lower incidence of recurrence but have a relatively longer Healing time and higher incidence of postoperative anal incontinence. Both techniques are effective, have post operative good results and safe in treatment of high transsphincteric perianal fistula but Further research work is still warranted to confirm the long term outcome of these 2 techniques with a larger sample size and a longer follow up period. To know which technique is superior over the other.

Revolutionizing Fistula Treatment: A Case Series on the Application of Kshara Sutra Therapy

A chronic, abnormal contact between the epithelialized anal canal surface and the perianal skin is known as an anal fistula (fistula-in-ano), which can cause serious morbidity and lower quality of life. Traditional surgical procedures as well as more contemporary ones, like the application of fibrin glue, a plug, or closure of the intersphincteric fistula tract, are available as treatment options (LIFT). These conventional techniques, however, may have varying degrees of efficacy, and some may be connected to the risk of incontinence. The Kshara Sutra, an antiquated Ayurvedic parasurgical procedure, was used to treat a case series of 10 patients with a range of anal fistulas, ranging in complexity from simple to complex presentations. Patients in the cases range in age from 22 to 55, both male and female. Despite variations in their particular circumstances, all patients had completely healed fistulas following Kshara Sutra treatment. Additionally, this treatment showed promise in simplifying complicated fistulas. These results add to the expanding body of research that supports the use of Kshara Sutra therapy for the repair of anal fistulas, offering a promising, secure, and maybe more effective option than traditional surgical procedures.

Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis

IntroductionIdentifying the optimal treatment for anal fistula has been challenging. Since first reported in 2007, the ligation of the intersphincteric fistula tract (LIFT) procedure has reported healing rates between 40%...

Efficacy of Ligation of Inter-sphincteric Fistula Tract technique for fistula-in-ano: A prospective observational study

Background: Fistula-in-ano is one of the commonest diseases presented to the surgical outpatient department that affects the patient physically and psychologically. As the disease is known for recurrence, the ideal technique for fistula repair is still undetermined. Materials and Methods:We hereby report 85 patients diagnosed clinically and radiologically having fistula-inano who underwent the Ligation of Inter-sphincteric Fistula Tract (LIFT) procedure at a tertiary care center. Results: The median time for the LIFT procedure was 32.5 minutes (range 25-40 minutes), and the median time taken for healing of the wound was around eight weeks. The majority of patients (95.4%) had no recurrence, and only 4 (4.6%) had a recurrence on follow-up within one year. None of the patients presented with stool or flatus incontinence. Conclusion: The LIFT technique can be the preferred treatment option for fistula-in-ano that are having simple straight tract, single opening lying posteriorly, and having either trans-sphincteric or inter-sphincteric variety with lower complication rates and preserving continent anal sphincter allowing patients to return early to their routine activities normal daily activities

Management of Perianal Crohn's Disease - AJG.

Perianal Crohn's disease affects 25-35% of Crohn's disease patients and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health related quality of life scores typically related to pain and fecal incontinence. Additionally, perianal Crohn's patients have higher rates of hospitalizations, surgeries and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation as well as the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring and close follow-up. Surgical management is critical to drain abscesses prior to immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.

Autologous Fat Grafting: an Emerging Treatment Option for Complex Anal Fistulas

BackgroundAutologous fat grafting (AFG) has shown promise in the treatment of complex wounds, with trials reporting good healing rates and safety profile. We aim to investigate the role of AFG in managing complex anorectal fistulas. MethodsThis was a retrospective review of a prospectively maintained IRB-approved database. We examined the rates of symptom improvement, clinical closure of fistula tracts, recurrence, complications, and worsening fecal incontinence. Perianal disease activity index (PDAI) was obtained for patients undergoing combination of AFG and fistula plug treatment. ResultsIn total, 52 unique patients underwent 81 procedures, of which Crohn’s was present in 34 (65.4%) patients. The majority of patients previously underwent more common treatments such as endorectal advancement flap or ligation of intersphincteric fistula tract. Fat-harvesting sites and processing technique were selected by the plastic surgeons based on availability of trunk fat deposits. When analyzing patients by their last procedure, 41 (80.4%) experienced symptom improvement, and 29 (64.4%) experienced clinical closure of all fistula tracts. Recurrence rate was 40.4%, and complication rate was 15.4% (7 postoperative abscesses requiring I&D and 1 bleeding episode ligated at bedside). The abdomen was the most common site of lipoaspirate harvest at 63%, but extremities were occasionally used. There were no statistically significant differences in outcomes when comparing single graft treatment to multiple treatments, Crohn’s and non-Crohn’s, different methods of fat preparation, and diversion. ConclusionAFG is a versatile procedure that can be done in conjunction with other therapies and does not interfere with future treatments if recurrence occurs. It is a promising and affordable method to safely address complex fistulas.

EFFICACY OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) PROCEDURE IN MANAGEMENT OF FISTULA-IN-ANO – A PROSPECTIVE OBSERVATIONAL STUDY

An anal stula is a common benign anal condition and its surgical treatment runs the risk of anal incontinence and recurrence rates. However, the Ligation of the intersphincteric Fistula Tract (LIFT) devised in 2007 results in zero sphincter damage and shorter hospital stay compared to conventional stulotomy. The study aimed to nd the efcacy of the LIFT procedure in patients suffering from trans-sphincteric stula-in-ano in terms of wound infection, anal incontinence, and recurrence rate. A prospective, observational study was carried out among 40 patients of either sex diagnosed with anal stula in the Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar over a period of about 2 years. Statistical analysis was done by student t-test. The mean age group was 42.48 ± 10.33 years and 90% were male. Out of all the trans sphincteric stula-in-ano, 82.5% were posterior & 60.6% were posterior left side while the rest were anterior. The mean duration was 54.88 ± 10.17 mins. On average, hospital stay was 4.65 ± 1.37 days and the mean time to wound healing was 2.80 ± 1.02 weeks. Anal continence was 100% preserved in all patients. Only 3 (7.5%) patients had recurrence as observed at 6 months of follow-up. The LIFT procedure is an effective surgical procedure in terms of preventing wound infection and anal incontinence. The hospital stay was less, with early wound healing and a low pain score.

The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) procedure in management of Fistula in ano a prospective observational study

BackgroundFistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano.Material and methodsWe enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically.ResultsAt 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy.ConclusionLigation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant.

Comparison of the modified ligation of intersphincteric fistula tract (LIFT) with Incision thread drawing method on serum IgA and IL-10 levels in high simple anal fistula.

To compare the effect of different techniques on serum immunoglobulin A and interleukin-10 in patients with high simple anal fistula. .The cross-sectional study was conducted at Dongyang People's Hospital, Weishan, China, from January 2019 to April 2021, and comprised patients with high simple anal fistula who were randomly and equally divided into Group A getting treatment with modified ligation of intersphincteric fistula tract, and Group B getting treatment with incision-thread-drawing method. Serum immunoglobulin A and interleukin-10 as well as the Wexner score were compared between the groups. Data was analysed using SPSS 25. Of the 140 patients, there were 70(50%) in each of the two groups. There were 125(89.2%) male subjects overall. The mean age in Group A was 38.91±8.91 years, while in Group B it was 38.20±8.51. Mean hospital stay in Group A was shorter than that in Group B (p<0.001). Mean serum immunoglobulin A and interleukin-10 values were not significantly different at baseline, but on day 7 post-surgery, the difference was significant between the groups (p<0.05). Likewise, Wexner score was significantly different at 3 months post-surgery (p<0.05). There was no significant difference in the incidence of postoperative complications between the groups (p=0.730). The modified ligation of intersphincteric fistula tract method was found to be a better option in the management of patients with high simple anal fistula.

The risk factors for failure and recurrence of LIFT procedure for fistula in ano.

Fistula in ano (FIA) is a common anorectal problem. There are several techniques that have been used for treatment; however, all of them carry risks of recurrence and incontinence. Ligation intersphincteric fistula tract (LIFT) is a type of treatment with a promising result of preserving the anal sphincter function. This study aimed to evaluate the outcome and risk factor of LIFT failure and to demonstrate the pattern of recurrence. The research funding was supported by Rajavithi Hospital. From January 2015 to January 2020, there were 250 cases of fistula in ano operations. A total of 148 patients underwent LIFT operation. The patients' average age was 39.72 ± 10.55 years and the average follow-up period was 111.86 ± 79.73 days. The average time to diagnose the recurrence was 99.12 ± 30.08 days. In addition, average time to perform a surgery after the diganosis was 64.67 ± 25.76 days. The study's analyses used data on age, sex, type of fistula, operative intervention, healing time, reinterventions, and recurrence. There were 22.97% of recurrence among 148 LIFT patients. Half of the patients who underwent the operation had a preoperative imaging study with MRI or endoanal ultrasonography in the first time due to the complexity of the disease. Factors associated with operation failure were collection, fistula tract size more than 5 millimeters, and the failure of ligating the tract in one attempt. LIFT procedure is one of the several sphincter saving procedures to treat FIA. Recurrence is related with the complexity of the disease. Most of the recurrence is diseases that are easier to treat, such as performing a re-operation or fistulotomy.

Ligation of the Intersphincteric Fistula Tract (LIFT) as a first approach in the surgical treatment of transsphincetric anal fistula is associated with modest initial success rates

PurposeDescribe our institutional experience with ligation of the intersphincteric fistula tract (LIFT) operation as the first procedure in the treatment of transsphincteric anal fistula and try to identify predictors of success. MethodsThis is a retrospective multi-institutional series based on two tertiary academic Hospitals in the USA. Consecutive adult patients presenting with cryptoglandular transsphincteric anal fistula that underwent a LIFT operation were included. ResultsThe study included 77 patients, of which 68% were male and 32.5% obese. Fifteen patients presented with a recurrent fistula, and preoperative seton was placed in over 80% of the cases. No intra or postoperative complications were recorded. With a median follow-up of 37 months, the success rate was 51%; LIFT failure occurred more often in younger patients. Other patient characteristics, seton placement, fistula characteristics, patient positioning, and suture used for tract ligation were not associated with treatment outcome. None of the patients referred fecal incontinence. Seventy-four percent of patients with treatment failure underwent further surgical treatment; the success rate of the second operation was 71%. ConclusionsLIFT as the first operation was associated with a modest success rate with no intra or postoperative complications. Seton placement, patient characteristics, and operative variables were not associated with failure. Most failures could be treated surgically with acceptable success rates.

Thirteen-year audit of the management of anorectal fistulae in a tertiary colorectal unit

Persistent anorectal fistulae are referred for assessment in the Durban Metropolitan area to the colorectal unit at the tertiary hospital. This audit aimed to report the assessment and management of these fistulae to benchmark the outcomes from these approaches at a South African tertiary colorectal unit. Retrospective analysis of prospectively collected data of patients with anorectal fistulae over a 13-year period at a tertiary referral centre. Data analysed included demographics, clinical presentation, comorbidity, management and outcome. Study outcomes measures were healing time and secondary outcome measures were complications of surgery. One hundred and thirty-three patients (median age 44 and M:F ratio 2.8:1) with 206 fistulae were accrued. The initial assessment and diagnostic procedures included insertion of seton (126), fistulectomy (14), and fistulotomy (65). Definitive procedures included two-stage seton fistulotomy (43), ligation of the inter-sphincteric fistula tract (LIFT) procedure (39), modified Hanley procedure (17), and mucosal advancement flap (5). One patient had no surgery and nine did not undergo a definitive procedure. Additional procedures included anal sphincter reconstruction (2) and repair of rectovaginal fistula (2). Residual anal incontinence occurred in 13.5%. The failure rate was 6% and healing occurred in 94%. The median healing time was 8 months after the initial surgery and 4 months following the definitive procedure. The fistula healing rate overall was 94% and was associated with an incontinence rate of 13.5%.

Invited Commentary: Management of Anal Fistula with Ligation of Intersphincteric Fistula Tract vs Endorectal Advancement Flap.

Los Angeles, CA Disclosure Information: Nothing to disclose. Disclosures outside the scope of this work: Dr Fleshner is a paid consultant to Takeda Pharmaceuticals.