Low Anal Fistula Research Articles

Clinical Study on the Treatment of Low Anal Fistula in Infants and Young Children by Anal Gland Excision and Virtual Hanging Procedure

Objective: To compare the efficacy of anal adenectomy with virtual hanging wire and anal fistulotomy in the treatment of low anal fistula in infants and children. Methods: 60 children with low anal fistula who were admitted to our hospital from October 2021 to March 2022 and met the inclusion criteria were randomly divided into two groups of 30 cases each; the treatment group was treated with anal adenectomy and virtual hanging wire surgery, and the control group was treated with anal fistula resection. The clinical efficacy after treatment was compared. Results: The total effective rate of both groups was 96.67% and the difference between the two groups was not statistically significant (P > 0.05). The postoperative pain score of the treatment group was lower than that of the control group (P < 0.05). The length of hospitalization and healing time of the treatment group was lower than that of the control group (P < 0.05). The anal function of the patients in both groups was normal, and there was no adverse reaction. Conclusion: Anal gland excision and virtual hanging surgery for the treatment of low anal fistula in infants and children have the advantages of mild pain, reduced length of hospitalization, short healing time, and better patient experience as compared to anal fistula excision.

A Comparative Study between Fistulectomy and Fistulotomy with Marsupialization in Management of Simple low Anal Fistula

A Comparative Study between Fistulectomy and Fistulotomy with Marsupialization in Management of Simple low Anal Fistula

A Comparison of Management of Low Anal Fistula by Fistulotomy and Fistulectomy

A Comparison of Management of Low Anal Fistula by Fistulotomy and Fistulectomy

A clinical study of laser fistulectomy for high and low anal fistula in ANO

A clinical study of laser fistulectomy for high and low anal fistula in ANO

Effect of Agnikarma in Perianal Subcutaneous Fistula- A Case Report

Fistula-in-ano is a debilitating disease affecting anorectal region. It is an abnormal tract lined with fibrous tissue and unhealthy granulation tissue. It usually begins from a perianal abscess caused by cryptoglandular infection. The abscess burst spontaneously and forms fistula-in-ano. It may also seen in association with other diseases like Crohn’s disease, lymphogranuloma venereum, actinomycosis, malignancy and TB. It is distressing to the patient and the surgeon due to its recurrent nature and the complications like postoperative incontinence. The disease can be classified as low anal and high anal fistulae on the basis of its internal opening. Perianal subcutaneous fistula is included under low anal fistula. Generally, the modern treatment measures for fistula-in-ano include fistulectomy, fistulotomy, advancement flaps, fistula clip closure, LIFT technique, VAAFT procedure, anal fistula plug repair, fibrin glue and seton technique. The prime aim of the treatment is to eradicate the tract and drain the site of infection while preserving anal continence. In Ayurveda, Fistula-in-ano can be correlated with Bhagandara on the basis of signs and symptoms. Since it is difficult to treat, Acharya Susruta considered it as one among Ashtamahagada. He described the treatment as Shastra Karma, Kshara Karma, Agni Karma. In the present case study, a 35-year old male patient visited the OPD with perianal subcutaneous fistula was selected for Agnikarma after fistulotomy to reduce the treatment period and to improve the quality of living. Daily dressing was done with Jathyadi ghrta and the patient was cured within 21 days of intervention. The follow up was done for next 3 months and no complications were noted.

Comparison between Fistulotomy vs Fistulotomy with Marsupialization in Simple Low Anal Fistulae: A Randomized Control Trial

Objective: To compare the efficacy of fistulotomy with marsupialization vs fistulotomy alone in the treatment of simple low lying anal fistula in terms of wound healing and postoperative pain. Study Design: Randomized control trial Place and Duration: Department of General Surgery, JPMC Karachi, duration of Study was 6 months from 23rd Aug 2020 to 23rd Feb 2021. Methodology: Sixty patients of either gender having ages 25-60 years presented with low anal fistula were included in this study. Detailed demographics were recorded after taking informed written consent from all the patients. Patients were divided in to two groups. Fistulotomy was performed on 30 patients in group A and fistulotomy with marsupialization was performed on 30 patients in group B. Patients were asked to choose envelop labelled treatment A and treatment B for the randomization. All patients were followed up on 24 hours after surgery and on weekly interval up to 4 weeks to determine the outcomes in terms of wound healing and pain score. Data was analyzed by SPSS 23.0. Results: In group A mean age of patients was 43.633+8.568 years while in group B mean age was 41.800+9.813 years. The mean Pain score after 24 hours in group A was 6.100+0.922 while in group B it was 5.033+0.718 with overall mean Pain score after 24 hours of 5.566+0.980. The mean Pain score after 5th day in group A was 4.266+0.639 while in group B it was 2.833+0.698 with overall mean Pain score after 5th day of 3.550+0.981. In Group A efficacy was achieved in 4 patients (6.7%) while in Group B efficacy was achieved in 14 (23.3%) patients. Conclusion: Marsupialization of the wound after fistulotomy for low anal fistula results in faster wound healing and less mean post operative pain as compare to fistulotomy alone. Keywords: Low Anal Fistula, Marsupialization, Fistulotomy, Pain, Wound Healing

Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?

AimFistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods Patients operated by fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/day for one year postoperatively. Incontinence (solid, liquid, gas and urge) was evaluated objectively (Vaizeys scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group] and at 6-months follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results101 MRI-documented low anal-fistula patients were included. There were 79 males (mean age 39.412.9 years) and median follow-up was 12 months (6-18months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores-0.130.63) preoperatively and occurred in 20/99 (mean incontinence scores-1.032.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially improved in other 10 (mean incontinence scores-0.311.09). Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p=0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p=0.07, not significant).ConclusionsFistulotomy, even in low fistulas, can lead to significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

Effects of auricular acupoint acupuncture therapy on postoperative pain in patients undergoing surgery for low anal fistula

Effects of auricular acupoint acupuncture therapy on postoperative pain in patients undergoing surgery for low anal fistula

A comparative study of wound opening versus primary closure after fistulectomy in the lower anal fistula

Objectives. The aim of the study is to investigate the outcome of primary wound closure versus non-wound closure after fistulectomy in terms of postoperative pain and wound healing time. Materials and Methods. A prospective comparative randomized study was performed on patients admitted to the General Surgery Department of our Institute (Dec.1, 2019-Nov.31, 2021), with a diagnosis of low anal fistula and undergoing fistulectomy. 54 patients were included in the study and were assigned alternately and equally in group A (fistulectomy with laying open of wound) and group B (fistulectomy with primary closure), with 27 patients in each group. On day 1 postoperatively, the pain score was assessed by analog visual scale. Patients were followed for 6 weeks, and healing was assessed by visual examination of epithelialization at each follow-up visit. Results. In our study, the average healing time in group A was 20.77 days and in group B 14.07 days (the average healing time in group B is significantly longer than in group A, with P value of <0.00001). In our study, the average pain score among the participants in group A is 4, and among the participants in group B it is 2,148, with the value P <0.00001, which is statistically significant. Conclusion. Primary closure fistulectomy is a better method for treating low anal fistula due to the fact that it causes less pain, accelerated healing compared to wound opening fistulectomy. However, further studies are needed to compare other methods of treating low anal fistula.

Perioperative management of a rare case of severe polycythemia vera with gout coming for an emergency minor surgery – A concern for the anesthesiologists

Polycythaemia Vera is a chronic myeloproliferative neoplasm with an unknown etiology and is a rare occurrence. The erythrocytosis and thrombocytosis along with the hypercoagulable state as a direct result of surgery predispose these patients to thrombosis and hence haemorrhage. Here, we report the anaesthetic issues concerning an elderly male patient presenting with complaints of difficulty in passing stools, fever, and cough with mucoid sputum and diagnosed to be having low anal fistula and perianal abscess with presence of haemorrhoids along with polycythaemia and gout, who was not on any treatment, and posted for an emergency perianal abscess drainage and fistulectomy. With a hematocrit of 63.3% and normal arterial oxygen saturation, the anesthetic management included a thorough preoperative evaluation of associated comorbidities, proper positioning, conducting regional anesthesia meticulously and prevention of acute thrombotic or hemorrhagic episodes. The uneventful perioperative period resulted in the smooth recovery of the patient.

Histoacryle Injection VS. Silver Nitrate Injection in Treatment of Low Non Branching Anal Fistula

Histoacryle Injection VS. Silver Nitrate Injection in Treatment of Low Non Branching Anal Fistula

Clinical Efficacy and Safety of Simultaneous Surgical Treatment of Mixed Hemorrhoids with Low Anal Fistula

Clinical Efficacy and Safety of Simultaneous Surgical Treatment of Mixed Hemorrhoids with Low Anal Fistula

ROLE OF ASPHOTA (HEMIDESMUS INDICUS R.BR.) KSHARASUTRA IN THE MANAGEMENT OF LOW-ANAL FISTULA

In this modern era, due to a sedentary lifestyle and improper dietary habit digestive disorder shows greater inci- dence. Among them, fistula-in-ano is troubleshooting one, which is a communicating tract between two epithelial surfaces lined by granulation tissues. Due to the higher recurrence rate and postoperative complication fistula-in- ano is a headache in the present era. In Ayurvedic classics, Ksharasutra prayoga is mentioned for the treatment of Nadi Vrana, which can be adopted in the management of anal fistula. The objective of the present study was to be evaluated the efficacy of Asphota Kshara sutra in the management of low anal fistula. The clinical trial was con- ducted in OPD and IPD of Shalyatantra department at Pankajakasthuri Ayurveda Medical College. The intervention was ligation of the fistulous tract with Asphota Ksharasutra. 25 subjects were selected satisfying inclusion and exclusion criteria. The clinical assessment was done before treatment, after treatment and follow up on the 30th day after cutting through of the tract. The assessment was done based on parameters prepared for anal fistula by Paul O Madson and Peter. Pain, burning sensation, inflammation, itching, discharge and unit cutting time was statistically analysed in different periods. Outcome variables were analysed statistically by using the Friedman test and Wilcox- son signed-rank rest, and a conclusion was drawn. Pain, burning sensation, inflammation, discharge, itching was effectively managed using Asphota Ksharasutra. The unit cutting time of Aspota ksharasutra was found to be more than standard Ksharasutra. The result showed that Aspota Ksharasutra is effective in the management of low anal fistula. Keywords: Fistula-in-ano; Asphota ksharasutra.

Is Fistulotomy with Marsipulization more Effective than Fistulectomy alone for Low Fistula in Ano?

Abstract Background Fistula in ano is a very common perianal condition seen in outpatient departments. Fistulotomy and fistulectomy are two conventional options of surgery. The present study is designed to observe wound healing time and mean postoperative pain score in the comparison of outcome of the fistulectomy to fistulotomy with marsupialization. Methods This prospective randomized trial was conducted in the surgical department of the Civil Hospital Karachi for a period of 12 months, in which 60 patients with low anal fistula were divided into 2 groups. Thirty patients in group A were treated with fistulectomy, and 30 in group B were treated with fistulotomy with marsupialization. The postoperative pain severity was assessed after 24 hrs through a visual analogue scale and on weekly and fortnightly follow-ups for 6 weeks. Wound healing was assessed by clinical examination on weekly and fortnightly follow-ups for 6 weeks to estimate the mean healing time. Results The mean pain score was significantly lower in group B in comparison to group A (3.6 ± 1.99 versus 2.40 ± 1.52; p = 0.01). The mean wound healing time was shorter in group B in comparison to group A (4.23 ± 0.77 versus 5.80 ± 0.41 weeks; p = 0.0005). Conclusion Fistulotomy with marsupialization is a simple, easy, and more effective method than fistulectomy for the treatment of simple perianal fistula.

Effect of peer support nursing on improvement of caregiver preparedness for care of low anal fistula in infants

Effect of peer support nursing on improvement of caregiver preparedness for care of low anal fistula in infants

Effect of peer support nursing on improvement of caregiver preparedness for care of low anal fistula in infants

Effect of peer support nursing on improvement of caregiver preparedness for care of low anal fistula in infants

Research on high anal fistula: a bibliometric analysis.

High anal fistula (HAF) treatment is more complicated than low anal fistula treatment. Improper treatment can easily affect anal function. The main treatment of HAF is surgery; however, external medicine and systemic medicine may also be used as adjuvant treatments. This study used bibliometric methods to analyze the relevant literature and provide a rough outline of the current status of HAF research. A subject word-search strategy was used to retrieve HAF-related documents from the Science Citation Index Expanded (SCI-E) database. CiteSpace software was used to analyze the exported raw data files, and draw a visual map, and BUSRT was used to detect and analyze the usage of keywords. A total of 1,020 documents were retrieved using "high anal fistula" as the search term, and the number of documents generally shows an increasing trend over time. These papers were mainly published in developed countries, such as Europe and the United States (US). The US is the country that has carried out the most relevant cooperative research; however, there is a lack of cooperation among a large number of authors. The keyword analysis showed that the current research focus is the treatment of HAF, while research on the prevention of HAF is largely lacking. More international multi-center clinical research studies on HAF should be conducted, and research on HAF prevention should also be strengthened.

Treatment of Haemorrhoidal Disease by Laser Haemorrhoidoplasty at Dakar Preliminary Study of 21 Patients.

Background:Surgical treatment of haemorrhoidal disease by laser haemorrhoidoplasty is a minimally invasive procedure that facilitates the postoperative course. Due to less aggression on the anoderm and the anal canal mucosa, it causes less significant postoperative pain and low morbidity compared with conventional excision according to the Milligan–Morgan or Fergusson procedure. We report, through a preliminary study, our data on laser haemorrhoidoplasty and discuss the indications and results.Materials and Methods:This is a descriptive prospective study carried out on 21 patients operated on for haemorrhoidal disease by laser haemorrhoidoplasty with or without mucopexy.Results:The series was composed of 17 men and 4 women with a male/female ratio of 4.25:1. The average age was 39.6 years with a range of 27–62 years. The symptomatology was rectal bleeding in 16 cases (76%) and anal swelling in 18 cases (85.7%). These include grade 2 haemorrhoids in 2 cases (9.5%), grade 3 in 12 cases (57%), and grade 4 in 7 cases (33%). It was associated with an anal fissure in four cases (19%) and an anal fistula in three cases (14.2%). Mucopexy and laser coagulation were performed therapeutically in 13 cases (61.9%) and laser coagulation without mucopexy was performed in 8 cases (38%). The energy delivered was on average 1488 or 496 J per pile. It was associated with skin tag excision in 18 cases (85.7%), fissurectomy, sphincterotomy, anoplasty in 4 cases (19.2%), and fistulectomy for low anal fistula in 2 cases (9.5%). Piles retraction was judged sufficient in 17 patients (81%). The postoperative course was simple with no notable complaints in 16 patients (76%). Complications consisted of minimal bleeding in six cases (28%), significant bleeding in two cases with readmission, residual skin tag in six cases (28.5%), and subcutaneous fistula in two cases (9.5%). No recurrence of the symptoms of the haemorrhoidal disease was noted.Conclusion:Laser haemorrhoidoplasty is a minimally invasive alternative for the treatment of haemorrhoidal disease, especially for grade 2 and 3 haemorrhoids without major prolapse. Postoperative pain is minimal, and the risk of stenosis or incontinence is almost non-existent.

Local Perianal Anesthetic Infiltration Is Safe and Effective for Anorectal Surgery.

Background: General or regional anesthesia is predominantly used for anorectal surgery, however in the recent years more attention was drawn in the use of local anesthesia for anorectal surgery. In this study we present the technique and results of the use of local perianal anesthetic infiltration for minor anorectal operations.Methods: In this cohort study patients undergoing surgery for hemorrhoids, anal fissures and low anal fistulas were included. Posterior perineal block was induced with a mixture containing 0.125% bupivacaine and 0.5% lidocaine. All patients were followed up at 30 days either by a post-operative visit or a telephone call and all post-operative complications over the post-operative 30-day period were registered.Results: One thousand and twenty-six consecutive patients were included in our study. For all patients' intraoperative analgesia was achieved after performing perianal anesthetic infiltration and no additional support from the anesthesia team was necessary in any of case. Complications were observed in 14 (1.4%). Urinary retention occurred in 5 (0.5%) cases. Six cases of bleeding occurred after hemorrhoidectomy (0.6%) and 1 (0.1%) after lateral internal sphincterotomy. Perianal abscess developed for two patients (0.2%).Conclusions: Local anesthesia using posterior perineal block technique is safe and effective for intraoperative analgesia in anorectal surgery, saving a substantial operation cost by avoiding the involvement of an anesthesia team and resulting in minimal incidence of urinary retention and other complications.