Anal Fistula Surgery Research Articles

Application of Anal Manometry in the Planning for Anal Fistula Surgery

Anal fistula does not heal spontaneously without surgery, and anal function should be preserved after muscle dissection, which is a challenge even to the most experienced surgeon. In order to develop a planner for anal fistula surgery, anal manometry used in the measurement of pressures in the anal canal to investigate the anal function is reviewed. In this review paper, current techniques are described and compared with each other, and technical and clinical challenges are discussed. There are four types of catheters used to measure anal sphincter pressure: water-perfused, solid-state, air-coupled, and fiber optic catheter. Parameters acquired by anal manometry and their relationship with fecal incontinence after anal fistula surgery are discussed. Vectormanometry can provide the pressure profile along the anal canal in three dimensional space, pressure vectorgram, and cross-sectional radial asymmetry, which have more advantages than the conventional method. Understanding the technology and development of anal manometry is critical for the anal fistula surgical planning. A novel design is highly desired for 3D pressure profile measurement along the entire anal canal simultaneously without pulling the catheter.

Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis

BackgroundPostoperative urinary retention (POUR) is a common complication characterized by fullness of the bladder without the ability to urinate. Its etiology in proctology surgery is multifactorial. This study aimed to identify the risk factors for POUR after radical surgery for anal fistula.MethodsWe retrospectively reviewed the clinical records of 511 patients who underwent radical surgery for anal fistula at the China-Japan Friendship Hospital from August 2022 to December 2023. Risk factors for POUR were analyzed by means of binary logistic regression analyses.ResultsPOUR occurred in 57 patients (11.2%) within 48 h post-surgery, and males were predominantly affected (84.4%). Independent risk factors included a history of urological disease (OR = 6.048; p < 0.001), incisions at position 1 (OR = 2.228; p = 0.046), high anal fistula (OR = 4.768; p < 0.001), VAS score ≥ 7 (OR = 2.805; p = 0.010), and GAD-7 score ≥ 5 (OR = 2.405; P = 0.024).ConclusionPOUR is a significant complication post-radical surgery for anal fistula, particularly among patients with urological disease, high anal fistula, and incisions at position 1. Surgeons should pay more attention to surgical methods for high anal fistulas and fistulas in the anterior rectum, and monitor postoperative bladder volume in high-risk patients. Enhanced postoperative pain and anxiety management can reduce the incidence of POUR and prevent long-term bladder damage.

Study on the effect and mechanism of Yanghe decoction Huacai on tissue repair ofsyndrome after anal fistula surgery.

To observe the clinical efficacy and safety of Yanghe decoction Huacai for the repair of Yin syndrome wounds with slow-healing after anal fistula surgery. A total of 120 patients with slow-healing negative wounds with after low-grade anal fistula surgery who met the inclusion criteria were divided into a treatment group and a control group based on a random number table method, with 60 patients in the treatment group and 60 patients in the control group. The treatment group was given Yanghe decoction Huacai in combination with routine treatment; the control group was only given routine treatment, in which the wound surface was disinfected with iodine, and then covered with sterile gauze. The course of treatment in both groups was 10 d. After treatment, the wound secretion score, wound granulation tissue score, the expression levels of basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGF-β1), and epidermal growth factor (EGF) in the wound, wound healing time and clinical efficacy were compared. There was no significant difference in age or gender between the two groups (P > 0.05). On the 10th and 15th days after the surgery, the wound secretion scores were higher in the treatment group than in the control group (P < 0.01). Comparing the two groups at the 10th and 15th day after surgery, the granulation tissue growth scores in the treatment group were better than the in control group (P < 0.01). On the 10th and 15th day after operation, the expression levels of bFGF, TGF-β1 and EGF factors in the treatment group were stronger than those in the control group. The healing time of the wounds in the treatment group was significantly shorter than in the control group (P < 0.01). The clinical efficacy of the two groups after treatment was compared, and the overall efficacy of the treatment group was significantly higher than that of the control group (P < 0.01). Yanghe decoction Huacai have significant efficacy in the treatment of slow-healing wounds with Yin syndrome after anal fistula surgery. It improves wound secretions, promotes the growth of wound granulation tissue, and shortens wound healing time. Its mechanism of action may be related to the control of wound inflammation. It is related to increasing the expression of bFGF, TGF-β1 and EGF in wound tissue, and promoting wound angiogenesis and fibroblast proliferation.

Clinical Experience of Chang'an Niushi Anorectal Academic School in Treating Wound Healing after Anal Fistula Surgery

Clinical Experience of Chang'an Niushi Anorectal Academic School in Treating Wound Healing after Anal Fistula Surgery

Tongyangxiao Lotion promotes postoperative wound healing in a rat model of anal fistula by downregulating inflammatory factors and suppressing inflammation

To explore the mechanism of Tongyangxiao Lotion (TYX) for promoting wound healing following surgery for anal fistula. The active ingredients and drug targets of TYX were explored using TCMSP and BATMAN databases, and the targets associated with wound healing were screened using GeneCards and OMIM databases; the intersecting drug and wound-related targets were analyzed with protein-protein interaction (PPI) analysis and GO and KEGG enrichment analyses. In 25 SD rat models with simulated anal fistula surgery, the effect of wound dressing with TYX at low, medium and high doses (once daily for 14 days) on wound healing were assessed in comparison with potassium permanganate (PP) solution. The granulation tissues collected from the wounds were examined for pathological changes with HE staining and for TNF-α expression using immunohistochemistry. The expressions of 1β, TNF-α, IL-6 mRNA and proteins in the granulation tissue were detected using RT-qPCR, Western blotting or ELISA. Network pharmacology analysis yielded 156 common targets between TYX and wound healing, and among them IL-1β, TNF- α, and IL-6 were identified as potential targets of TYX for promoting wound healing. Six core components of TYX were capable of binding to IL-1β, TNF-α, and IL-6 with binding energies all below -6.0 Kcal/mol. In the rat models, the wounds with TYX and PP solution dressing showed significantly reduced inflammatory cell infiltration and increased fibroblasts and collagen deposition. TYX at the 3 doses and PP solution all significantly reduced the expressions of IL-6, IL-1β, TNF-α mRNA and IL-6 protein in the granulation tissues, but TYX at the medium and high doses produced significantly stronger effects than PP solution for lowering TNF-α protein expression and mRNA expressions of TNF- α and IL-6. TYX accelerates wound healing by down-regulating the inflammatory factors and reducing inflammation in the wounds.

Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial.

Few studies report outcomes for enhanced recovery pathways in ambulatory anorectal surgery. We hypothesize that an ambulatory anorectal enhanced recovery pathway with multimodal analgesia can reduce postoperative opioid use. To compare postoperative opioid use in patients undergoing ambulatory anorectal surgery who receive multimodal analgesia vs. standard of care without multimodal analgesia. A prospective randomized trial of patients undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Urban teaching hospital. Adults aged 18 to 70 undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Multimodal enhanced recovery pathway including pre- and postoperative non-opioid analgesia with oral acetaminophen, gabapentin and ketolorac. Primary endpoint was oral opioid use during the first postoperative week. Secondary endpoints included maximum pain and nausea scores, adverse events and emergency room or hospital admissions during the first 30 days postoperatively. Of the 109 enrolled patients, 20 were lost to follow-up. The remaining 89 patients had a median age of 38 (range, 20-67) years and included 41 (46%) females. There were no significant differences between the enhanced recovery protocol (Arm E) and non-enhanced recovery protocol (Arm NE) groups in terms of preoperative and surgical characteristics. The study primary endpoint, oral MME use during the first week, was significantly higher among patients in the NE arm (79 mg; range, 0-600) than patients in the E arm (8 mg; range, 0-390) (p = 0.002). On subgroup analysis, both fistula and hemorrhoid surgery patients assigned to the NE arm took significantly higher oral MME in the first week than patients in the E arm. There was no significant difference in secondary endpoints. Patients and providers were not blinded. Our findings are limited to hemorrhoid and fistula surgery and may not be applicable to other anorectal procedures. Enhanced recovery protocols including multimodal analgesia should be used in elective anal fistula and hemorrhoid surgery to decrease postoperative opioid use. See Video Abstract . ClinicalTrials.gov ID NCT03738904.

Predictive Factors for Recurrence of Fistula-in-Ano After Surgery: A 10-year Experience in a Single Center Study

OBJECTIVE This study aimed to evaluate the recurrence rate of fistula- in-ano treatment and factors associated with recurrence. METHODS A retrospective cohort study was performed of cryptoglandular-cause fistula-in-ano patients who underwent surgery between January 2010 and June 2020. Cox’s regression analysis was used to identify predictive factors for recurrence FIA. RESULTS The study included 282 patients of whom 233 (82.6%) were male, 76 (27.0%) had previous anal fistula surgery, 77 (27.3%) had a complex type of fistula, 72 (25.5%) were high transphincteric, 3 (1.0%) were suprasphincteric, and 2 (0.7%) were extrasphincteric. Five types of operations were performed: 106 (37.6%) fistulotomies, 43 (15.2%) fistulectomies, five (1.8%) setons, six (2.1%) endorectal advancement flaps (ERAF), and 122 (43.3%) ligations of the intersphincteric fistula tract (LIFT). The recurrence rate was 20.1% (57 patients) among whom 54 (94.0%) were detected at follow- up within 12 months, 2 patients were detected in the second year, and 1 patient was detected in the third year. Four independent factors associated with the recurrence of FIA after surgery were identified: female gender (HR 2.67; 95% CI 1.34-5.34), BMI &gt;25 kg/m2 (HR 2.47; 95% CI 1.38-4.44), complex type of fistula (HR 2.02; 95% CI 1.02-3.97), and anterior opening (HR 2.14; 95% CI 1.12-4.10). Compared to the LIFT procedure, fistulotomy was the protective factor (HR 0.12; 95% CI 0.03-0.46) while ERAF had a higher rate of recurrence (HR 6.12; 95% CI 1.87-20.03). CONCLUSIONS Patients with high BMI and female patients should be advised of the higher chance of recurrence after anal fistula surgery. More complex fistula-in-ano and sphincter-preserving surgery was also associated with a higher recurrence rate. The complete healing of the surgery should be monitored for two years after surgery. KEYWORDS predictive factors, recurrence, fistula-in-ano, anal fistula

Methylene Blue as an Adjuvant Analgesic Postoperative Anal Fistula: A Randomized Clinical Trial

Introduction. Anal fistula is a pathological condition that connects the anorectal mucosa to the perianal skin, requiring various types of surgical procedures. However, surgery often causes postoperative pain. The use of methylene blue is being studied as a potential analgetic adjuvant in anal fistula surgery. Previous studies have shown that methylene blue can effectively reduce postoperative pain in various types of anorectal surgery. This study aims to determine methylene blue's clinical efficacy as an analgetic adjuvant. Methods. A double-blind, randomized controlled trial was conducted. Subjects consisting of subjects with simple anal fistula to undergo fistulectomy were randomly allocated into two groups. The first group received adjuvant analgesics in the form of methylene blue and NSAIDs, while the second group only received NSAIDs. Methylene blue 4 mL 1% was administered subcutaneously to the edge of the wound, sprayed on the surgery site, and intravenously administered ketorolac 3 x 30 mg. Randomization was done using the double-blind method. Pain levels were evaluated on the first, second, third, and seventh postoperative days using a visual analog scale (VAS). Results. Thirty-four subjects were enrolled (17 subjects in each group). Significant differences in pain levels (VAS values) were recorded between the group receiving the combination of methylene blue and NSAIDs compared to the group receiving only NSAIDs on days 1 to 3 after surgery (p &lt;0.05). This difference was no longer significant between the two groups on the seventh postoperative day (p &gt;0.05). Conclusion. The use of methylene blue in subjects undergoing anal fistula surgery as an adjuvant analgesic along with NSAIDs may reduce the intensity of pain better than NSAIDs alone.

Exploring the mechanism of Huanglian ointment in alleviating wound healing after anal fistula surgery through metabolomics and proteomics

Anal fistula is a common anal and intestinal disease. The wound of anal fistula surgery is open and polluting, which is the most difficult to heal among all surgical incisions. To investigate the mechanism of Huanglian ointment (HLO) on wound healing after anal fistula incision. The S. aureus infected wound in SD rats were used to imitate poor healing wound after anal fistula surgery. SD rats with wound sites (n = 24) were randomly divided into four groups (Control group, Model group, Potassium permanganate (PP) treatment group, and HLO treatment group). The wound healing rate was evaluated, HE staining was used to evaluate the pathological changes of each group, ELISA was used to detect the secretion of inflammatory factors in each group, and the mechanism was explored through metabolomics and proteomics in plasma rat. Compared to other groups, the rate of wound healing in the HLO group was higher on days 7 and 14. Histological analysis showed that collagen and fibroblast in HLO rats were significantly increased, inflammatory cells were reduced, and vascular endothelial permeability was increased. ELISA results showed that the secretion of inflammatory factors in HLO rats was significantly lower. Significant proteins and metabolites were identified in the wound tissues of the infected rats and HLO-treated rats, which were mainly attributed to Cdc42, Ctnnb1, Actr2, Actr3, Arpc1b, Itgam, Itgb2, Cttn, Linoleic acid metabolism, d-Glutamine and d-glutamate metabolism, Phenylalanine, tyrosine and tryptophan biosynthesis, Phenylalanine metabolism, alpha-Linolenic acid metabolism, and Ascorbate and aldarate metabolism. In conclusion, this study showed that HLO can promote S. aureus infected wound healing, and the data provide a theoretical basis for the treatment of wounds after anal fistula surgery with HLO.

DLPL Sphincter Saving Laser Surgery for Complex Anal Fistula - A Gold Standard Procedure. Study of 40 Cases

Introduction: Complex anal fistula (CAF) is a complex condition to treat because of the possibility of recurrence and impoverished continence. DLPL (Distal laser proximal ligation), is a novel approach to treating difficult anal fistula that involves suturing the proximal portion of the fistula tract close to the internal opening and using a diode laser to close the distal part of the fistula tract. This study aimed to evaluate the clinical efficacy and safety of DLPL Sphincter Saving Laser Surgery for Complex Anal Fistula. Aim of the study: The aim of this study was to evaluate the clinical efficacy and safety of DLPL Sphincter Saving Laser Surgery for Complex Anal Fistula - A Gold Standard Procedure in a study of 40 cases. Methods: This study was a prospective observational study that investigated the outcomes of DLPL (Distal Laser Proximal Ligation) for patients with complex anal fistula. The patients met clinical diagnosis of complex anal fistula according to the Parks classification, age of 10 years or more, and failure of previous conservative or surgical treatments. The patients were followed up at 3 and 6 months after the surgery, and assessed using fistulogram, endo anal ultrasound, MRI. Result: The study enrolled 40 patients (35 males and 5 females) with mean age being 31.25 years. 31 (77.50%) patients had non-specified histopathology. 2 (5.00%) patients had Chron’s disease, 2 (5.00%) patients had F.B Granuloma, and 5 (12.50%) patients had Tuberculosis. The patients were assessed using fistulogram, endo anal ultrasound, MRI. After 6 months, the patients were followed up and 38 (95.00%) patients had no recurrence, only 2 (5.00%) patients had recurrence. Conclusion: The results showed high success rate and low complication rate of DLPL for complex anal fistula. Therefore, this study concluded that DLPL is a safe and effective sphincter-saving technique for complex anal fistula, and that it may be considered as a gold standard procedure for this challenging c

National observational study about the surgical treatment of anal fistula: Does the kind of hospital modify the results?

IntroductionPerforming the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an anal fistula (AF). Material and methodsA retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and fecal incontinence (FI). Results1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p = 0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p = 0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. ConclusionCure and FI in patients who underwent AF surgery were independent from hospital volume.

Research progress on the application of Chinese herbal medicine in anal fistula surgery.

Anal fistula is a rapidly developing anorectal disease that can lead to anal dysfunction if left untreated. Minimally invasive surgery is an important treatment option for anal fistula, as it can reduce the risk of anal sphincter injury and protect anal function. However, postoperative complications such as infection, pain, bleeding, edema, and fat liquefaction can occur, resulting in slow wound healing thus negatively impacting the patient's quality of life. Recent studies have shown that Chinese herbal therapy has distinct pharmacological effects and is more effective in treating postoperative complications in anal fistula patients compared to conventional drug therapy. It not only promotes wound healing but also reduces the occurrence of complications. Chinese herbs can also modulate relevant signaling pathways such as PI3K/Akt, HIF-1, and TGF-β/Smad to enhance the wound healing process. Various methods of Chinese herbal medicine (CHM) have been used to treat post-anal fistula operation wounds, including traditional Chinese medicine (TCM) sitz baths, external application of TCM, internal administration of TCM, anal absorption, and acupuncture, all of which have shown promising therapeutic effects in clinical practice. This article aims to review the theory and clinical application of CHM in anal fistula surgery in recent years and provide valuable references for its treatment.

Estudio observacional nacional sobre tratamiento quirúrgico de fístula anal: ¿tiene impacto en los resultados el tipo de hospital?

IntroductionPerforming the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an Anal Fistula (AF). Material and methodsA retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and Fecal Incontinence (FI). Results1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p=0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p=0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. ConclusionCure and FI in patients who underwent AF surgery were independent from hospital volume.

A magnetic resonance imaging-based decision-making tool for predicting complex anal fistulas healing in the early postoperative period

BackgroundMagnetic resonance imaging (MRI) has excellent accuracy in diagnosing preoperative lesions before anal fistula surgery. However, MRI is not good in identifying early recurrent lesions and effective methods for quantitative assessment of fistula healing are still warranted. This retrospective study aimed to develop and validate a specific MRI-based nomogram model to predict fistula healing during the early postoperative period.MethodsPatients with complex cryptoglandular anal fistulas who underwent surgery between January 2017 and October 2020 were included in this study. MRI features and clinical parameters were analyzed using univariate and multivariate logistic regression analysis. A nomogram for predicting fistula healing was constructed and validated.ResultsIn total, 200 patients were included, of whom 186 (93%) were male, with a median age of 36 (18–65) years. Of the fistulas, 58.5% were classified as transsphincteric and 19.5% as suprasphincteric. The data were randomly divided into the training cohort and testing cohort at a ratio of 7:3. Logistic analysis revealed that CNR, ADC, alcohol intake history, and suprasphincteric fistula were significantly correlated with fistula healing. These four predictors were used to construct a predictive nomogram model in the training cohort. AUC was 0.880 and 0.847 for the training and testing cohorts, respectively. Moreover, the decision and calibration curves showed high coherence between the predicted and actual probabilities of fistula healing.ConclusionsWe developed a predictive model and constructed a nomogram to predict fistula healing during the early postoperative period. This model showed good performance and may be clinically utilized for the management of anal fistulas.

Role of Microbiome in the Outcomes Following Surgical Repair of Perianal Fistula: Prospective Cohort Study Design and Preliminary Results.

Anal fistulae are common, predominantly cryptoglandular, and almost invariably require surgical treatment. Recurrences are common for procedures other than fistulotomy regardless of technique and adequacy of repair. Growing evidence supports the pivotal role of specific intestinal bacteria in anastomotic failures after bowel resection. Anal crypts harbor colonic microbiota suggesting that similar mechanisms to anastomotic healing might prevail after anal fistula repair and hence influence healing. This study aims at assessing the potential role of the intestinal microbiome in the clinical outcomes after surgical repair of cryptoglandular anal fistula. This is a pilot prospective cohort study enrolling patients with anal fistula undergoing endoanal advancement flap. For microbiome analysis, stool samples are taken via rectal swab before the procedure; additionally, a portion of the fistula is collected intraoperatively after fistulectomy. Samples from groups with treatment failure are compared to samples from patients who healed after surgical repair. Alpha and beta diversities and differential abundance of microbial taxa are determined and compared between groups with DADA2 analytical pipeline. Five patients have been enrolled to date (one female, four male). At median follow-up of 6months (2-11), one patient experienced disease recurrence at 3months. DNA from the 5 rectal swab and tissue samples was extracted, showing increased relative abundance of Enterococcus faecalis in samples from the patient who developed a recurrent fistula but not in those without recurrence. These very preliminary data suggest that intestinal microbiome may represent a crucial determinant of the surgical outcomes after anal fistula surgery.

Clinical research progress in Traditional Chinese Medicine in treating wound healing after anal fistula surgery.

In the study of the mechanism of wound healing after anal fistula surgery, how to scientifically and efficiently promote wound healing is of great significance. At present, modern medical treatment of wounds after anal fistula surgery mostly focuses on physical therapy intervention, new wound dressing and packing, and external application of growth factors. However, these therapies have many problems, and there is still no consensus on their clinical use. Traditional Chinese Medicine (TCM) has several methods to promote wound healing, such as oral administration, rubbing, and fumigation, which have a long history and obvious efficacy, but research in this area is relatively scattered and lacks classification and summarizing. Therefore, this paper analyzes and summarizes the existing research on TCM for promotion of wound healing after anal fistula surgery, carries out targeted analyses according to different clinical syndromes and treatment methods, and analyzes the defects in current research and anticipates future research trends in order to provide theoretical support for the advantages of TCM in promoting wound healing after anal fistula surgery.

Simplified dressing change after surgery for high anal fistula: A prospective, single centre randomized controlled study on loose combined cutting seton (LCCS) technique.

Dressing change is the most important part of postoperative wound care. The aim of this study was to evaluate whether a more effective, simple and less painful method of dressing change for anal fistulas could be found without the need for debridement and packing. Data related to postoperative recovery were recorded at postoperative days 3, 7, 14, 21 and 180. In this experiment, 76 subjects diagnosed with high anal fistula were randomly divided into a simplified dressing change (SDC) group and a traditional debridement dressing change(TDDC) group according to a ratio of 1:1. The SDC group had significantly fewer pain scores, bleeding rates, dressing change times, inpatient days and lower average inpatient costs than the TDDC group. There were no significant differences in wound healing time, area and depth and Wexner score between the two groups. Studies have shown that the use of simplified dressing changes does not affect cure or recurrence rates, but significantly reduces dressing change times and pain during changes, reducing patient inpatient length of stay and costs.

Efficacy and feasibility of stromal vascular fraction containing adipose derived stem cells obtained from freshly prepared lipoaspirate for treatment of complex anorectal fistulas- A novel approach

BackgroundAnal fistulas are relatively common. Despite diverse treatment modalities and tremendous advance and optimization of surgical approaches, considerable recurrence and high failure rates are not uncommon especially after surgery for complex anal fistulas. Therefore, autologous adipose-derived stem cell therapy for the treatment of complex perianal fistula can be an innovative and promising option with potential high cure rate and long-term healing. AimTo assess the efficacy and feasibility intralesional administration of stromal vascular fraction containing autologous, adipose-derived stem cells prepared from fresh lipoaspirate for management of complex and recurrent anal fistula. MethodsTotally, 28 patients with complex perianal fistulas were enrolled in this prospective case-series study from March 2018 and August 2022. They were 22 male and 6 females patient) with 38.8 years average ages (ranges from 26 to 54 years). All patients were assigned to receive intralesional injection with autologous freshly prepared adipose-derived stem cells from lipoaspirate suction in a concentration of 1 × 107 cell/ml. The healing of fistulas, confirmed by clinical assessment and magnetic resonance imaging was evaluated at week 6 weeks, 12 weeks and 6 months after treatment. If no evidence of healing was not seen at 6 weeks, a second dose of same concentration was administered. In addition to fistula healing, adverse effect (functional outcomes), complications and procedure safety were also evaluated. ResultsThe overall healing rate of fistulas treated by injection of ADSCs was 60.7% (17/28), while healing rate after first injection was 50% (14/28) and after second injection was 30% (3/10).Three patients were lost after first injection. During the follow up period of 6 months none of the patients who showed complete healing, recorded relapse of their fistulas (recurrence 0%). Further, none of the patients recorded complications or adverse reactions related to stem cell therapy during the study and none of them had worsening fecal incontinence during follow-up period. Postoperative pain assessed by.VAS score was significantly low (>3). Fecal continence assessed by Wexner score of all patients was not changed or affected. ConclusionsInjection of complex perianal fistulas by freshly prepared autologous ADSCs could be a valid and effective treatment modality. It is safe, feasible and minimally invasive procedure that lacks the risk of injury to anal sphincter complex, unlike other surgical procedures that endanger the anal continence.Further, second dose of ADSCs injection could improve the rate of healing, without adding adverse effects.

The Efficacy of Sophora Flavescens Fumigation in Improving Anal Health After Anal Fistula Surgery

We are in the process of recovering patients undergoing treatments with Sophora flavescens (experimental) or potassium permanganate (control) fumigation following anal fistula surgery. The experimental group had a shorter wound healing time and lower pain measurement on the Visual Analogue Scale on postoperative days 7 and 14 than the control group (P &lt; 0.05). Although no inter-group notable difference was identified in clinical efficacy (P &gt; 0.05), the anal function of the experimental group was improved, and the levels of pro-inflammatory cytokines were lower after treatment (P &lt; 0.05). Assessment of the nutritional status after surgery, key to postoperative recovery, showed that the weight and upper arm circumference decreased in both groups after treatment, but the experimental group was higher than the control group (P &lt; 0.05), and prealbumin, albumin, and transferrin were also higher in the experimental group than in the control group after treatment (P &lt; 0.05). Finally, the two groups did not differ significantly in adverse reactions and relapse (P &gt; 0.05). SF facilitates wound healing after anal fistula surgery, mitigates patient pain, and improves anal health.

Analysis of Ambulatory Proctologic Surgery for Simple Anal Fistulas in Terms of Recovery, Complications, Recurrence, and Cost.

Background Ambulatory anorectal surgeries have increased in the last few years. This clinical study aimed to compare general operating room conditions with outpatient procedures for simple anal fistulas in terms of healing success, recurrence, cost, complications, and sustainability. Methodology Only primary fistulotomy and seton application for simple anal fistulas were retrospectively analyzed. Results Two-hundred fifty patients (73.7%) were male, and 89 (26.3%) were female. Sixty patients (17.7%) were treated in the operating room, and 279 (82.3%) were treated in the outpatient clinic conditions. Of the ambulatory surgeries, 160 patients underwent fistulotomy and 119 patients loose seton. On the other hand, 34 patients underwent fistulotomy and 26 patients loose seton in operating room conditions. No significant difference was found between the groups according to the distribution of age, gender, complications, and recurrence (P> 0.05). Cost-effectiveness assessment according to the place (ambulatory/operating room) and type of operation (fistulotomy/loose seton) reveals that ambulatory surgery provides significantly more savings (P< 0.001). Conclusions For simple anal fistulas, ambulatory anorectal surgery is a safe approach that can be performed at a lower cost than operating room conditions.