Surgical Treatment Of Anal Fistula Research Articles

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.

Surgical treatment of anal fistula

A fistula of the anus is a chronic inflammatory process in the pararectal cell, intersphincter space and anal crypt with the presence of a formed fistula passage, where the affected anal crypt is the internal opening of the fistula. The urgency of surgical treatment of rectal fistulas is due to unsatisfactory results because of frequent anal incontinence and relapses of the disease. In this regard, most authors emphasize that the treatment of anal fistulas, as before, remains an urgent problem of colorectal surgery, and the search for new methods is a priority task of colorectal surgery. Literature analysis performed using the Elsevier, PubMed, eLIBRARY.RU, CyberLeninka, Google Scholar databases showed that the currently used technologies and methods of surgical treatment of anal fistulas do not allow us to determine their “gold standard”. In this regard, further analysis of the effectiveness and safety of their use, an assessment of the complications of surgical intervention and the frequency of relapses of the disease is necessary.

Minimally invasive surgical technologies in the treatment of anal fistulas (literature review)

Modern methods for the surgical treatment of anal fistulas are minimally invasive and aimed at minimizing damage to the external anal sphincter, reducing the frequency of relapses in the postoperative period, and eliminating anal incontinence. One of the most promising surgical interventions at the moment are sphincter-saving techniques. In recent decades, numerous studies about the clinical effectiveness of surgical methods of anal fistula treatment have been made. Therefore, the purpose of this literature review is to analyze and evaluate the long-term results of minimally invasive methods of treating anal fistulas, in particular, laser thermal obliteration of fistulas.

Treatment of the fistula tract with laser ablation in high anal fistula

<b>Aim and introduction:</b> Considering the recurrence and fecal incontinence rates in high anal fistulas, surgical treatment of anal fistulas is a challenging process, although many treatments have been defined today. The aim of our study is to evaluate the long-term results of laser ablation of the fistula tract in high anal fistulas.<br /> <b>Material and methods: </b>The files of patients who underwent laser ablation of the fistula tract due to high anal fistula between June 2020 and January 2022 were evaluated retrospectively. Moreover, their postoperative complications, preoperative and postoperative Cleveland fecal incontinence scores (CCFFSI score), postoperative first day and first-week visual analog scale (VAS) scores, follow-up times, and recurrence rates were analyzed.<br /> <b>Results:</b> 26 patients were included in the study. The mean follow-up period was 39.88±14.34 weeks, and the postoperative first and 7th day VAS scores were 4.61±1.41 and 0.8±1.02, respectively. Preoperative and postoperative CCFI scores were calculated as 1.8±1.41, 1.65±1.32, respectively. Recurrence was observed in 7 patients postoperatively. Postoperative anal abscess developed in 1 patient.<br /> <b>Conclusion: </b>Although laser ablation of the fistula tract can be safely performed as a technique that does not affect incontinence, recurrence rates should also be considered. Furthermore, more extensive randomized prospective studies on this technique should be performed.<b> </b>

Endoscopic Radiofrequency Ablation of Fistula in Ano (E-RaFisTura) in the Era of Surgical Innovation. A Serial Prospective Evaluation of 10 Patients

Background: Fistula in-ano is an abnormal chronic infected tunnel (tract) between the rectum or the anal canal and perianal skin usually, with granulation tissue which connecting a primary orifice (internal) to a secondary one (external). This morbid antity represents a dilemma for both, patients and surgeon-proctologists because of postoperative issues occurrence such as fecal incontinence. The surgical management of this infectious condition has emerged nowadays, by emphasing new surgical techniques that preserve anal sphincter's integrity and functional. Over the last decade, numerous techniques sparing anal sphinters have gained popularity such as endoscopic approach (VAAFT), Laser, fibrin glue, transanal advancement flap repair [1,6]. In the same perspective,we are presenting in this paper, our preliminary outcomes of a combination of endoscopic approach (VAAFT) with Radifrequency Ablation of the fistula's tract that we nicknamed with the acronym of E-RaFisTura). Methods: We enrolled 10 males patients with anal fistula, age groupe 50-70 years, without any comorbidity in the term of diabetes mellitus, bowel inflammatory disease. Preoperatively each of them underwent a digital rectal examination, pelvic MRI, colonoscopy to rule out any concomitant abscess, Crohn's disease. Fleet enema, subcutaneus lower molecular weight heparin as well as intravenous broad spectrum antibiotic were administered an hour prior the surgical procedure. All patients were shifted to endoscopic surgical treatment of anal fistula (VAAFT) by using the fistuloscope of Piercarlo Meinero combined to the device of Fistura (Radiofrequency Ablation) with its probe 6-7 F (Figure 1 a,b,c). Then we visualized the fistula's tract and we seal it with radiofrequency thermocoagulation without damaging the anal sphincters by closing the internal opening with a suture node (Vicryl Rapid 3-0). Taxinomically, 2 patients had intersphincteric fistula, 3 transphincteric and the 5 others had submucosal anal fistula. Outcomes: We are inthe third month of follow up, none of the aboved mentioned patients has presented any postoperative issue excepting some local discomfort in immediate postoperative day, relieved with voltaren. Furthermore, the orificial wound healing is successful. Conclusion: Focused on our preliminary results, despite the small volume of patients, this combination of endoscopic and radiofrequency ablation can be regarded with optimism in selected patients. We will perform a powerful prospective study with a huge sample to have more accurate opinion. Bioethics Considerations: All enrolled patients had given their written consent prior. Furthermore,this surgical trial was approved by the Ethical commitee of Our Clinic.

Long term results of surgical treatment of anal fistula in a case series of 483 patients

BackgroundAnal fistula is a common condition with a wide variety of clinical presentations, which make evaluation and treatment challenging and patient outcomes uncertain. This study describes lessons learned in the surgical treatment of 483 patients over a 20-period that led to a logical, pragmatic, effective approach to treating this condition. Materials and methodsThis is a retrospective, observational study of consecutive patients managed by a single surgeon at a tertiary medical center from 1996 through 2018. Age and gender, comorbidities, location of internal and external openings, sphincter length, initial and subsequent surgical treatments, number of operations performed, and final outcomes were recorded. Patients with inflammatory bowel disease and obstetrical injury were analyzed separately. ResultsData for analysis were available on 483 patients; 44 had inflammatory bowel disease; 22 had prior obstetrical injury. Among the 419 patients with neither IBD nor birth injury, men predominated (66% vs 34%); 80% had prior abscesses. A variety of surgical procedures were done, tailored to the specific characteristics of the patient. Digital measurement of sphincter length was the most important element of pre-operative evaluation to determine whether a simple fistulotomy, a sphincter saving procedure, or a series of staged procedures was needed. 97% of patients with non-complex fistulas healed after relatively simple procedures. The 18% with complex fistulas and those with recurrent fistulas needed up to 4 operations before healing was achieved. Fistulas healed in about half the patients with IBD and in 80% or women with prior obstetrical injury. ConclusionMeasurement of sphincter length along with careful evaluation of anatomy and etiology enable a tailored, successful approach to treatment of anal fistula. Surgeons should be familiar with a variety of surgical approaches so that treatment can be designed based on the specific anatomic and physiologic characteristics of individual patients.

Kosmetyczny aspekt operacji proktologicznych

Although it may seem that the aesthetic appearance of a wound after proctological surgery is of secondary importance relative to the cure of disease, it may affect proper healing, treatment efficacy and the maintenance of anal function. Cosmetic correction of the anal region primarily includes removal of marginal anodermal folds and correction of deformities after proctological surgeries. We present indications for the removal of hypertrophied anodermal folds, as well as situations when such surgery should be abandoned. The most common deformities after proctological surgeries include keyhole deformity, which forms after anal fissure surgery with posterior sphincterotomy and surgical treatment of anal fistula with Hippocrates’ drainage, as well as deformities due to abnormal wound healing. In addition to poor cosmetic result, deformities may lead to functional complications in the form of anal leakage, underwear staining and poor gas continence, which requires surgical correction. Another group includes patients with anal deformity due to scars after multiple proctological procedures, but with no functional defects. The management in these patients largely depends on their mental attitude to these defects and usually no surgical treatment is implemented. Good cosmetic result after proctological surgery often corresponds with good functional outcome and patient’s postoperative satisfaction.

Assessment of the rationale for the use of preventive antibiotic (clindamycin) therapy in patients operated on for anal fistula based on authors’ own experience

Introduction. Bacterial infection of the anal glands has been considered the main cause of anal fistulae for many years. Other most common causes include Crohn’s disease, ulcerative colitis, any type of immunosuppression (e.g. HIV infection, immunosuppressants), foreign bodies, and injuries. Studies assessing the type of bacterial pathogen involved in the formation of an anal fistula are sparse. Furthermore, it seems that although surgery remains the primary treatment of the disease, the importance of treating cryptic infection and the use of antibiotic therapy based on culture findings seems underestimated. Aim. The aim of this study was to assess the rationale for the use of preventive antibiotic therapy in patients after proctological surgeries. Material and methods. In the period from January 1 to December 31, 2019, 46 patients (40 men, 6 women) aged 28 to 71 years (mean age 49 years) were operated on at the Department of General Surgery of the County Hospital in Ostrów Mazowiecka for anal fistulae. All patients were operated on by the same surgeon experienced in proctological surgery. Bacterial cultures were collected intraoperatively and preventive antibiotic therapy in the form of IV clindamycin 2 × 600 mg was used in all patients. Results. A large number of Bacteroides spp. showed high resistance (88%) to clindamycin. Anaerobic bacteria showed 60% resistance to clindamycin. Conclusions. 1. Clindamycin should not be used in preventive antimicrobial treatment in patients undergoing surgical treatment for anal fistula in the Department of General Surgery of the County Hospital in Ostrów Mazowiecka. 2. The variable sensitivity of bacteria to antimicrobials should be considered and antibiotic prophylaxis should be changed depending on the resistance developed to the subsequent antibiotics used.

Analysis of the Factors Affecting Recurrence and Postoperative Incontinence after Surgical Treatment of Anal Fistula: A Retrospective Cohort Study

Analysis of the Factors Affecting Recurrence and Postoperative Incontinence after Surgical Treatment of Anal Fistula: A Retrospective Cohort Study

Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

An 8 Years experience in surgical treatment of anal fistula

Aim: To review our experience with patients who had been operated for perianal fistula based on cryptoglandular etiological basis and to reveal risk factors affecting postoperative results.Material and Methods: A total of 65 perianal fistula patients, who underwent surgical treatment, were screened for this retrospective study.Results: The mean age was 45.4 ± 10.6 years, with a predominance rate of male patients. The previous surgery rate for anal sepsis was 44.6%. The median (min-max) follow up time was 19 (15–103) weeks, and the duration of symptoms was 18 (6-250) weeks. The most common fistula type was intersphincteric (36.9%), and fistulotomy was the most preferred surgery (50.8%). New postoperative incontinence was found in 6 (8.2%) of patients, 5 (83.3%) of them had gas incontinence. The healing rate in the follow-up period was unsatisfactory for 12 (18.5%) patients. The significant risk factors for failure were BMI≥30 kg/m2 (p0.001), complex fistula with multiple fistula tracts (p=0.001), duration of symptoms ≥12wk (p=0.012), a history of previous surgery for anal sepsis (p=0.001), the presence of baseline incontinence (p=0.003), procedures except for fistulotomy (p=0.009).Conclusion: The risk factors most associated with failure were obesity (BMI≥30 kg/m2) and multiple fistula tracts. Other significant risk factors leading to failure were duration of symptoms ≥12wk, a history of previous surgery for anal sepsis, the presence of baseline incontinence, complex fistula type, and non-fistulotomy procedures. This study suggests the need for comparative, randomized controlled studies that investigate methods and their outcomes, particularly in complex fistulas.

Video-assisted anal fistula treatment (VAAFT): A decade experience

The most ideal management for anal fistula has continued to evade surgical practitioners through the years. Video-assisted anal fistula treatment (VAAFT) is a relatively novel technique introduced as a minimally invasive surgical treatment of anal fistula. Based on published studies on VAAFT in the past decade, healing rates have varied worldwide, ranging from 54.4 to 92.5%. The published recurrence rates are at overall similar to other sphincter-sparing procedures. The primary advantage of VAAFT is the ability to use videoendoscopic technology to accurately visualize the fistula anatomy and manage the tracts while preserving sphincter function, resulting in minimal complications and faster recovery. Higher quality comparative studies with longer follow-up are still needed in order for this procedure to gain more widespread acceptance among colorectal surgeons in the future.

Ligature method for the treatment of anal fistula: a modern view on the old approach (literature review)

Despite a thousand-year history of anal fistula treatment, long-term outcomes have not been optimal, which encourages us to explore new surgical approaches. One of the methods of surgical treatment of anal fistulas is the use of ligature (Seton) in its different modifications. This review analyzes the literature data on the use of different modifications of seton treatment of anal fistulas. The analysis of publications showed the great interest in the use of the method, yet there is neither clear scheme nor systematic approach to applying it in clinical practice. Further study, as well as randomized researches, are required to find the optimal treatment and improve surgery results of using seton when dealing with anal fistula.

Long-term outcomes of (Gore) fistula plug versus ligation of intersphincteric fistula tract for anal fistula

BackgroundThe surgical treatment of anal fistula is complex due to the possibility of fecal incontinence. Fistulotomy and cutting Setons have the same incidence of fecal incontinence depending on the complexity of the fistula. Sphincter-preserving procedures such as anal fistula plug and ligation of intersphincteric fistula tract procedure may result in more recurrence requiring repeated operations. The aim of this study was to evaluate and compare the outcomes of treating fistula in Ano utilizing two methods: Fistula plug (Gore Bio-A) and ligation of intersphincteric tract (LIFT). MethodsFifty four patients (33 males; 21 female, median ages 42 [range 32–47] years) with high anal inter-transphenteric fistula were treated with LIFT and fistula plug procedures from September 2011 until August 2016 by a single surgeon and were retrospectively evaluated. All were followed for a median of 23.9 (range 4–54) months with clinical examination. Twenty one patients underwent fistula plug and 33 patients underwent LIFT procedure (4 patients of the LIFT group underwent LIFT and rectal mucosa advancement flap). The healing rate and complications were evaluated clinically and through telephone calls. ResultsThe mean operative time for the Plug was 25 ± 17 min and for the LIFT was 40 ± 20 min (p = 0.017) and the mean hospital stay was 2.4 ± 1.1 and 1.9 ± 0.3 (p = 0.01) respectively. The early complications of the plug and LIFT procedures included; anal pain (33.3%, 66.6%, p = 0.13), perianal discharge (77.8%, 91%, p = 0.62), anal pruritus (38.9%, 50.0%, p = 0.71) and bleeding per rectum (16.7%, 33.3%, p = 0.39) respectively. The overall mean follow-up was 20.9 ± 16.8 months, p = 0.68. There was no statistically significant difference between the two groups (21.9 ± 7.5 months, 19.9 ± 16.1 months, p = 0.682). The healing rate was 76.2% (16/21 patients) in the fistula plug group and 81.1% (27/33 patients) in the LIFT group (p = 0.73). Patients who had LIFT procedure and a mucosal advancement flap had 100% healing rate (4 out of 4 patients). No incontinence of stool or feces and no fistula plug expulsion were seen in our patients. The healing time ranged from 1 to 6 months after surgery. There was no post-operative perianal abscess, cellulitis or pain. ConclusionsLIFT and anal plug are safe procedures for patients with primary and recurrent anal fistula. Both techniques showed excellent results in terms of healing and complication rate. None of our patients had incontinence after 5 years follow-up. The best success rate in our patients was seen after LIFT procedure with mucosal advancement flap. Larger and controlled randomized trials are needed for better assessment of treatment options.

Effect of Fistula in Ano Surgery on Anorectal Manometric Study

AbstractBackground: Surgical treatment of anal fistula is associated with a significant risk of impaired continence. Anorectal manometry is the most widely available tool for investigating anorectal function.Patients and Methods: Twenty patients of age ranging from twenty to sixty years old underwent treatment of anal fistula. They did anorectal manometry before and two months after management.Results: Significant decrease noted in the resting and squeezes pressure and maximal tolerable volume in the rectum.Conclusion: Anorectal manometry is a valuable tool in detecting the effect of anal fistula surgery on anorectal function even in subclinical conditions that may be helpful in opening the way for studies predicting high risk patient after anal fistula surgery to start treatment before reaching the clinical condition.

Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger

Bakground: Anal and perianal sepsis is common anorectal disorders found in surgical practice. This study aims to report epidemiological aspects and outcomes of management of anal and perianal suppuration. Methods: This was a retrospective study from January 2011 to June 2016 at Niamey National Hospital. Patients operated on for anal and perianal suppuration of non-specific anorectal origin were included. Results: During the study period, we collected 141 cases of anal and perianal suppurations. The average age of our patients was 42±8.8 years. The sex ratio was 3.27 in favor of men. The origin of the patients was urban in 73.8% of the cases. The history of diabetes mellitus was found in 14.2% (n=20). Anal fistulas and anal abscesses (n=115) were simple in 46% (n=53) and complex in 54% (n=62). A fistulectomy with the placement of an elastic seton was performed for 41.13% of cases (n=58) and fistulotomy in 29.78%. The evolution of 6 months was marked by a recurrence in 10.63% (n = 15), the anal incontinence of gas at 9.21% (n=13). Deaths (n=4) were recorded in patients with Fournier’s gangrene. Uncomplicated therapeutic success was 80.13% (n=113). Conclusion: The surgical treatment of anal fistula (the main cause of anal and perianal suppuration) aims to eradicate the suppuration and to preserve the anal continence. The fistulotomy done in the context of the management of a simple fistula gives a better outcome. Incontinence-related complications and relapses must impose thoroughness and patience in the surgical treatment of complex fistulas.

The best surgical strategy for anal fistula based on a network meta-analysis.

ObjectiveTo determine a superior surgical treatment for anal fistula through a network meta-analysis and to provide the best direction for development in this field.MethodsWe conducted a systematic literature search of the PubMed, Embase and Cochrane Library databases and extracted data from randomized controlled trials, which compared healing time, incontinence and recurrence associated with surgical strategies for anal fistula. A network meta-analysis was conducted using ADDIS software by evaluating the 3 parameters. Cumulative probability values were utilized to rank the strategies under examination. Inconsistencies were also tested using node-splitting models.ResultsTwenty articles with 1663 patients were included. Fistulotomy plus marsupialisation had the shortest healing time (P = 0.69). Seton placement was the best procedure to avoid postoperative incontinence (P = 0.66). Fistulectomy exhibited the lowest recurrence rate (Probability P = 0.40). In general, fistulotomy plus marsupialisation and surgical ligation plus biomaterial plugging revealed superior clinical efficacy. Node-splitting model testing revealed that no significant inconsistency existed in this research.ConclusionsFistulotomy plus marsupialisation exhibited preliminary superior surgical utility for anal fistula. Additionally, combination of surgical treatment with biomaterials may provide better clinical efficacy. These techniques may warrant consideration for future development in this field.

Selected Techniques of Anal Fistula Surgery from Antiquity Through the Early 20th Century Illustrated

This article highlights surgical approaches to the surgical treatment of anal fistula from antiquity to the early 20th century. Primary translations and other authoritative commentaries on the subject are included. Selected surgical techniques have been reconstructed and illustrated in contemporary interpreted images.

The limitations and difficulties of anal ultrasonography in diagnosis of anal fistulae

Conventional surgical treatment of anal fistula is associated not only with a high recurrence rate, but also with a complication that patients find very difficult to tolerate,namely deterioration of fecal and gas continence.The anatomical course of the fistulous tract with regard to the sphincter musclesin combination with the results of function tests constitute the most important elements which decide about the selection of the surgical technique. In Poland, endoanalultrasonography (EUS) is much more readily available than magnetic resonance imaging (MRI). In order to plan properly the extent of the surgical field, and limit the riskof incontinence, it is essential to determine the height of the fistula and whether it isanterior or posterior. The other significant anatomical features that have an impacton the choice of the surgical method include the number and the kind of branching,the location of the internal opening, and presence of purulent cisterns. Like everydiagnostic procedure, endoanal ultrasonography (EUS) has its limitations, and imaging of fistulae is not free of difficulties. The article discusses the diagnostic problemsrelated to endoanal ultrasonography, and the improvements of the method introducedover the years. Close cooperation between the ultrasonographer and the surgeon isessential. Besides details with regard to the fistula itself, the surgeon expects information if any damage of the sphincter muscles or any other visible pathologies arepresent. Despite the fact that EUS is not a function test, a contraction of the externalsphincter muscle imaged during this procedure provides the surgeon with valuableinformation, hence relevant description should always be provided. Attaching theEUS description with a schematic drawing also helps the surgeon to understandthe course of the fistulous tract better, especially in the case of especially complexfistulae. The surgeon, on the other hand, should provide the ultrasonographer withreliable, conscientiously filled in information when formally referring the patient tothe EUS laboratory for the tes

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review.

There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex anal fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9months, the overall success rate was 93.2%, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4% (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex anal fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex anal fistulas.