Transsphincteric Perianal Fistulas Research Articles

Evaluation of One Stage Lay Open Operation with Primary Sphincter Repair versus Staged Rerouting Operation in Case of High Transsphincteric Perianal Fistula

Evaluation of One Stage Lay Open Operation with Primary Sphincter Repair versus Staged Rerouting Operation in Case of High Transsphincteric Perianal Fistula

Protocol of the LATFIA trial (Laser Assisted Treatment of Fistula in Ano): a multicentre, prospective, randomized controlled trial comparing fistula-tract laser closure (FiLaC™) with rectal advancement flap for high trans-sphincteric fistulas.

Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF. We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.

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.

Evaluation of Outcomes of Ligation of Intersphincteric Fistula Tract in Treatment of Transsphincteric Perianal Fistula

Evaluation of Outcomes of Ligation of Intersphincteric Fistula Tract in Treatment of Transsphincteric Perianal Fistula

Long-term results of minimally invasive surgical treatment of extra- and transsphincteric perianal fistulas using postoperative rehabilitation programs

Introduction. A modern promising trend in coloproctology is the use of minimally invasive surgical technologies in the surgical treatment of extra- and transsphincteric perianal fistulas, in particular laser technology FiLaC (Fistula Laser Closure). Surgical treatment of patients with extra- and transsphincteric perianal fistulas requires proper routing, stratification of the used methods of surgical treatment, postoperative rehabilitation and dynamic evaluation of the obtained results, including in the long-term period. Purpose of the study. In a comparative aspect, to evaluate the long-term results of surgical treatment of trans- and extrasphincteric perianal fistulas using the standard FiLaC technology and the developed modified FiLaC technology and the use of 2 or 4-component complex programs of physiotherapeutic postoperative rehabilitation. Material and methods. The study included 180 operated patients with trans- and extrasphincteric perianal fistulas, who were divided into two groups depending on the method of surgical intervention. In the 1st group (90 patients), the standard FiLaC technology was used for minimally invasive surgical treatment of fistulas; in the 2nd group (90 patients), a modified FiLaC technology, which provides for the opening of purulent streaks and laser coagulation of the intrasphincteric part of the fistula with a Biolitec laser (power 12 W, 100 J/cm), was applied. Each group was divided into 3 subgroups depending on the postoperative rehabilitation program used: in the 1st (main group), a 4-component program of postoperative rehabilitation was used, in the 2nd (comparison group) — a 2-component program, and in the 3rd (control group), the program of postoperative rehabilitation was not used. To evaluate the results obtained, the authors used a basic set (clinical examination with an assessment of the general condition, laboratory tests, high-resolution anoscopy, examination of the fistula tract with a button probe), additional instrumental methods (transrectal ultrasound (TRUS) with sonoelastometry, examination of the functional state of the rectal obturator), as well as a subjective assessment of the degree of improvement after treatment on the Clinical Global Impression Scale (Srikrishna S., Robinson D., Cardozo L. (2010)) and an assessment of the quality of life according to the SF-36 questionnaire (Ware JE et al. SF-36 Health Survey. Manual and interpretation guide. The Health Institute, New England Medical Center. Boston, Mass. 1993), which allow assessing the dynamics of the patient’s clinical and functional status in the process of rehabilitation, which is an urgent topic of scientific research. Long-term results were tracked over a period of 19 months up to 3 years (median 31 months). Results and discussion. The comparative analysis of the long-term results (up to 3 years), depending on the type of minimally invasive surgical treatment and the postoperative rehabilitation program used, showed that in the group of patients operated on using the FiLaC technology, the majority had good results — 96.7% of patients in the main group, 90,1% in the comparison group and 84% in the control group. In the comparative analysis of the long-term results of treatment (up to 3 years) in the patients with chronic paraproctitis after performing surgery using a modified FiLaC technology under the influence of the developed postoperative rehabilitation programs, it was found that: 59 people (65,5%) had good characteristics, 19 people (21.1%) had satisfactory characteristics, and 12 people (13,4%) had unsatisfactory characteristics. The differences were statistically significant p=0,002, which indicates that the long-term results were statistically significantly better in the main group than in patients of the control group who did not have rehabilitation measures. Conclusions. The obtained results demonstrated the benefits of using the modified FiLaC technology in the surgical treatment of transsphincteric and extrasphincteric fistulas of the rectum, which was confirmed by a 1,3-fold decrease in the incidence of relapses compared with the data obtained using the traditional FiLaC technology. The proportion of relapses in the main group of patients (when using a 4-component program of postoperative rehabilitation) decreased by 5,8 (comparison group) and 16,1 (control group) times, respectively (median observations 31 months), which allows us to recommend the developed modified FiLaC technology and comprehensive postoperative rehabilitation programs for wide introduction into the clinical practice of coloproctologists in the surgical treatment of transsphincteric and extrasphincteric perianal fistulas.

Molecular differences of adipose-derived mesenchymal stem cells between non-responders and responders in treatment of\xa0 transphincteric perianal fistulas

BackgroundInjection of autologous adipose tissue (AT) has recently been demonstrated to be an effective and safe treatment for anal fistulas. AT mesenchymal stem cells (AT-MSCs) mediate the healing process, but the relationship between molecular characteristics of AT-MSCs of the injected AT and fistula healing has not been adequately studied. Thus we aimed to characterize the molecular and functional properties of AT-MSCs isolated from autologous AT injected as a treatment of cryptogenic high transsphincteric perianal fistulas and correlate these findings to the healing process.Methods27 patients (age 45 ± 2 years) diagnosed with perianal fistula were enrolled in the study and treated with autologous AT injected around the anal fistula tract. AT-MSCs were isolated for cellular and molecular analyses. The fistula healing was evaluated by MRI scanning after 6 months of treatment. AT-MSC phenotype was compared between responders and non-responders with respect to fistula healing.Results52% of all patients exhibited clinical healing of the fistulas as evaluated 6 months after last injection. Cultured AT-MSCs in the responder group had a lower short-term proliferation rate and higher osteoblast differentiation potential compared to non-responder AT-MSCs. On the other hand, adipocyte differentiation potential of AT-MSCs was higher in non-responder group. Interestingly, AT-MSCs of responders exhibited lower expression of inflammatory and senescence associated genes such as IL1B, NFKB, CDKN2A, TPB3,TGFB1.ConclusionOur data suggest that cellular quality of the injected AT-MSCs including cell proliferation, differentiation capacity and secretion of proinflammatory molecules may provide a possible mechanism underlying fistula healing. Furthermore, these biomarkers may be useful to predict a positive fistula healing outcome.Trial registration: NTC04834609, Registered 6 April 2021. https://clinicaltrials.gov/ct2/show/NCT04834609

Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence

BackgroundThe length of sphincter which can be divided during fistulotomy for perianal fistula is unclear. The aim was to quantify sphincter damage during fistulotomy and determine the relationship between such damage with symptoms and severity of faecal incontinence and long-term quality of life (QOL).MethodsA prospective cohort study was performed over a 2-year period. Patients with intersphincteric and mid to low transsphincteric perianal fistulas without risk factors for faecal incontinence were scheduled for fistulotomy. All patients underwent 3D endoanal ultrasound (3D-EAUS) pre-operatively and 8 weeks postoperatively. Measurements were taken of pre- and postoperative anal sphincter involvement and division. Anal continence was assessed using the Jorge-Wexner scale and QOL scores pre, 6 and 12 months postoperatively.ResultsForty-nine patients were selected. A strong correlation between pre- and postoperative measurements was found p < 0.001. A median length of 41% of the external anal sphincter and 32% of the internal anal sphincter was divided during fistulotomy. Significant differences in mild symptoms of anal continence were found with increasing length of external anal sphincter division. But there was no significant deterioration in continence, soiling, or quality of life scores at the 1-year follow-up. Division of over two-thirds of the external anal sphincter was associated with the highest incontinence rates.Conclusions3D-EAUS is a valuable tool for quantifying the extent of sphincter involvement pre- and postoperatively. Post-fistulotomy faecal incontinence is mild and increases with increasing length of sphincter division but does not affect long-term quality of life.

Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula

Abstract Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

Comparative study between intersphinecteric ligation of perianal fistula versus conventional fistulotomy with or without seton in the treatment of perianal fistula: A prospective randomized controlled trial

BackgroundFistula-in-ano is one of the most common benign anal conditions in daily surgical practice.The goals in the treatment of an anal fistula are to eradicate sepsis and to eliminate the primary fistula opening, any associated tracts, and any secondary openings without a change in continence. Conventional fistulotomy (lay open of the fistula tract) is a commonly used procedure and is still relied on by the majority of surgeons as the gold standard for the treatment of perianal fistula. Ligation of the Intersphincteric Fistula Tract (LIFT) is a new sphincter-preserving technique for the treatment of anal fistula. ObjectiveTo compare the efficacy of open fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure based on its post-operative outcomes. Patients and methodsThe Present study is A prospective randomized controlled trial which included 30 patients presented with low transsphincteric perianal fistula 27 (90%) males and 3 (10%) females divided into two groups each group consisted of 15 patients. Group, I subjected to inter sphincteric ligation of perianal fistula (LIFT) procedure. Group II patients subjected to conventional fistulotomy. The study lasts 2 years from May 2017 to May 2019 with Follow up for 6 months duration. Operative time in our study was significantly higher in group (I) Managed by LIFT with a mean of 32.53 min than group (II) managed by fistulotomy with a mean of 20.87mins. Wound healing was faster in a group (I) managed by LIFT than group (II) managed by fistulotomy, as the mean time for complete wound healing was (4.53) weeks after LIFT and (5.67) weeks after fistulotomy. ResultsThere was no case of incontinence after performing the LIFT technique in all our patients in group I. there were 2 cases of incontinence to gases only after fistulotomy in group II. The healing rate after LIFT was 80% (12/15 patients). The healing rate after fistulotomy was 93.3% (14/15 patients). ConclusionLIFT procedure is an effective and preferred sphincter-saving technique for fistula-in-ano with shorter healing time and lower incidence of postoperative anal incontinence, as compared to open fistulotomy.

Ligation of intersphincteric fistula tract versus fistulectomy in transsphincteric perianal fistula: a randomized, clinical trial

Background Management of transsphincteric perianal fistula is mainly surgical; fistulectomy, fistulotomy, or ligation of intersphincteric fistula tract LIFT technique shows diversity in their outcome. Continence status is considered the most important point in the treatment outcome followed by recurrence rate and local wound complications. The emerged LIFT technique was claimed for a better outcome.. In this study, our aim is to compare between LIFT technique and fistulectomy in transsphincteric perianal fistulas. Patients and methods In all, 78 patients with transsphincteric perianal fistula were randomly allocated into group A: 39 patients who underwent LIFT and group B 39 patients who underwent fistulectomy. The patient follow-up and operative data were recorded and properly analyzed. Results The preoperative and demographic data between both groups show nonsignificant differences. Operative time was significantly shorter in the fistulectomy group. In the LIFT group recurrence and nonhealing of fistula were significantly higher (six cases) versus one in the fistulectomy group. Incontinence is significantly higher in the fistulectomy group (four cases) and zero in the LIFT group. Wound infection and dehiscence were more in the LIFT group. Conclusion In the treatment of transsphincteric fistula, LIFT technique led up to a lower incontinence rate than fistulectomy, but fistulectomy has proved to have a lower recurrence rate.

Long-term effect of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula and risk factors associated with anal function

Objective: To evaluate the long-term effects of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula, and identify risk factors associated with anal function. Methods: A case-control study was conducted. Clinical and follow-up data of 123 patients with trans-sphincteric perianal fistula receiving anal fistula plug treatment in Beijing Chaoyang Hospital from August 2008 to September 2012 were retrospectively analyzed. The follow-up deadline was April 30, 2020. The Wexner score for incontinence was used to evaluate pre-and postoperative anal function (range from 0 to 20, with higher score representing worse function). The potential risk factors affecting postoperative anal function, including gender, age, fasting blood glucose, diabetes, smoking, alcoholism, location of external opening of anal fistula, surgeon expertise and operation time, were statistically analyzed. Results: Among the 123 patients, 114 were male and 9 were female, the median age was 39 (15-69) years, body mass index (BMI) was (26.2±3.9) kg/m(2), and the median distance between the external opening of anal fistula and the anal verge was 2.6 (1.0-5.0) cm. The median operation time was 30.4 (15.0-60.0) minutes. The median follow-up time was 120 (93-141) months. Sixty-nine patients (56.5%) were healed. The assessment of anal function by Wexner incontinence score showed that 33 (26.8%) patients had anal functional decline after surgery, and the postoperative median Wexner score was 1.34 (0-8), which was significantly higher than preoperative score of 0.17 (0-4) (Z=-5.057, P<0.001). Compared with preoperative levers, postoperative subscores of flatus incontinence, liquid incontinence, solid incontinence and alteration in lifestyle were increased significantly (all P<0.05). Subgroup analysis showed that both in the healed and unhealed groups, the postoperative Wexner scores were higher than those before surgery [healed group: 1.22 (0-8) vs. 0.17 (0-1), Z=-3.796, P<0.001; unhealed group: 1.5 (0-8) vs.0.17 (0-3), Z=-3.422, P=0.001]. Univariate analysis revealed that 33 patients with postoperative anal functional decline had higher BMI, higher fasting blood glucose, higher proportion of alcoholism, longer distance between external opening of anal fistula and the anal verge, and longer operation time (all P<0.05). Multivariate logistic regression analysis testified that higher BMI (OR=1.485, 95% CI: 1.220-1.807, P<0.001) and longer distance between external opening and anal verge (OR=2.207, 95% CI: 1.276-3.220, P=0.003) were independent risk factors for postoperative anal functional decline. Conclusions: The treatment for trans-sphincteric anal fistula with anal fistula plug leads to long-term postoperative anal function decline. For patients with obesity and longer distance between external opening of anal fistula and the anal verge, this procedure should be performed with particular caution, and the anal sphincter should be preserved as much as possible during the operation.

Predictive Factors for the High Perianal Fistula Recurrence After Placement of Seton

Background: The placement of seton is one of the common sphincter-saving procedures for high fistula-in-ano (FIA). It has been described since Hippocrates who first used horse hair as a seton for the treatment of anal fistula. Objective: The aim of this study is to investigate the predictive factors for recurrence and to evaluate the efficacy and complications of seton treatment for high transsphincteric perianal fistula. Patients and methods: Our study was a prospective study, on a sample size of 50 patients (43 males and 7 females) of high perianal fistula, carried out in Bab-Alsharia University Hospital. Results: In our study 66.7 % of recurrent cases had history of previous fistula surgery. Fecal incontinence was recorded in 3/50 (6%) patients in our study. Factors associated with higher rates of fecal incontinence (FI) after fistula surgery included high transsphincteric or suprasphincteric fistula, horse-shoe fistula, female patients, and patients older than 45 years. Conclusion: Factors that significantly predicted the recurrence of FIA were previous fistula surgery, anterior anal fistula, and presence of secondary tracks or branches as with supralevator extension, and horse-shoe fistula. Female patients and horse-shoe fistula were the significant risk factors for developing FI after the placement of seton.

LIFT and BioLIFT: a 10-Year Single-Centre Experience of Treating Complex Fistula-In-Ano With Ligation of Intersphincteric Fistula Tract Procedure With or Without Bio-prosthetic Reinforcement (BioLIFT)

PurposeTo assess the outcome of ligation of intersphincteric fistula tract (LIFT) and bioprosthetic graft (BioLIFT) in the management of transsphincteric perianal fistula. MethodsA single-institution retrospective analysis of all patients undergoing LIFT and BioLIFT from January 2009 to June 2018 was performed. Only patients who had LIFTs and BioLIFT performed as their primary sphincter-preserving procedure was included. Primary outcome measured was primary healing. Secondary outcomes measured were secondary healing, morbidity, time to recurrence, and pre- and post-operative anorectal manometry. Chi-square analysis was used to determine predictive factors. ResultsA total of 116 patients were identified. One hundred five had LIFT and 11 had BioLIFT. The total primary healing rate was 60.3% (62.9% and 34.9% for LIFT and BioLIFT respectively). The overall secondary healing rate was 80.2% (80.0% and 81.9% for LIFT and BioLIFT respectively). There was no inpatient morbidity or post-procedural faecal incontinence reported. There was no significant change in the pre- and post-operative manometries in either group (P = 0.417 and P = 0.834 for LIFT and BioLIFT respectively). The only predictor for primary failure identified was anteriorly located fistula. ConclusionLIFT and BioLIFT compare favourably with other sphincter-preserving procedures. LIFT and BioLIFT can be performed safely, with minimal morbidity and with no reported loss of sphincteric function.

Long-Term Outcomes of Ligation of the Inter-Sphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug (LIFT-Plug) in the Treatment of Trans-Sphincteric Perianal Fistula.

BackgroundThe ligation of the inter-sphincteric fistula tract plus bioprosthetic anal fistula plug (LIFT-plug) is a new procedure in the treatment of trans-sphincteric perianal fistulas. The aim of this study was to evaluate its long-term outcomes.Material/MethodsClinical data of 78 patients with trans-sphincteric perianal fistula who were managed by the LIFT-plug technique between March 2014 to October 2016 were analyzed retrospectively. The operation time, healing rate, postoperative complications, recurrences, and length of stay were reviewed.ResultsNo serious complications occurred during the operation in all patients. The median follow-up was 30 months (16 to 47 months), clinical healing of the anal fistula occurred in 75 patients (96.2%). The median operative time was 25 minutes (18 to 45 minutes). The mean complete healing time was 16 days (9 to 46 days). The median healing time for the external anal fistula opening was 2 weeks (range, 2 to 3 weeks), and the inter-sphincteric groove incision healing time was 4 weeks (range, 3 to 7 weeks). The median hospital stay after operation was 5 days. Fistula recurred in 2 patients because of spontaneous expulsion of the plug at 7 days post-surgery; perianal abscess occurred in 1 patient. The anal function was evaluated in 70 patients of the 78 patients. Perfect control of continence was recorded for 97.1% of the patients (68 out of 70 patients). Two patients were identified to a rare complication of gas incontinence (Wexner score 1).ConclusionsLIFT-plug procedure for the treatment of trans-sphincteric fistulas is a simple procedure with a high healing rate, minimal invasiveness, quick healing, and without disturbance to anal function. LIFT-plug is an ideal procedure for trans-sphincteric fistula.

Comparative Study between Surgical Outcomes of Fistula Tract LASER Closure (FiLaCTM) Versus Fistulotomy with Primary Sphincter Reconstruction in Management of High Trans-Sphincteric Perianal Fistula

Comparative Study between Surgical Outcomes of Fistula Tract LASER Closure (FiLaCTM) Versus Fistulotomy with Primary Sphincter Reconstruction in Management of High Trans-Sphincteric Perianal Fistula

RECTAL ADVANCEMENT FLAP TREATMENT COMPARED WITH SETON FOR HIGH TRANSSPHINCTERIC PERIANAL FISTULA

Treatment of anal fistula is a balance between maximizing the chances of successful healing and avoidingcomplications particularly incontinence from division of the anal sphincters. Many surgical procedures have been usedin the treatment of anal fistula, with varying success. Endorectal advancement flap can be a useful tool for the surgeonfaced with an anal fistula. This study aims to compare outcomes for rectal flap advancement in comparison to setonplacement in treating high transsphincteric perianal fistula.

Su1801 - Total Fistulectomy, Anoplasty, Sphincteroplasty and Partial Closure of Residual Cavity for Trans-Sphincteric Perianal Fistula

Su1801 - Total Fistulectomy, Anoplasty, Sphincteroplasty and Partial Closure of Residual Cavity for Trans-Sphincteric Perianal Fistula

Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient.

Perianal fistula is a complex and frequent disease. At present, no treatment nor technique has shown an absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between faecal continence preservation and disease eradication. Rarely concomitant perianal abscess and fistula are treated at the same time, and often time to complete recovery is long. The aim of this study was to evaluate the possibility of treating the abscess and the fistula tract in one procedure with total fistulectomy, sphincteroplasty and an almost complete closure of the residual cavity, thus reducing the healing time in older patients. A non-randomized single-centre series of 86 patients from 2007 to 2012 with low-medium trans-sphincteric perianal fistula (< 30% of external sphincter involvement) with or without synchronous perianal abscess were treated with total fistulectomy, sphincteroplasty and closure of the residual cavity technique. Success rate was 97.7% with a healing time of 4weeks; overall morbidity was 16.2%; recurrence rate was 2.3%; no major alterations of continence were observed. Fistulectomy, sphincteroplasty and closure of the residual cavity are associated with a low rate of recurrence and good faecal continence preservation in older patients. This technique can be safely used even with a concomitant perianal abscess, with reduction in healing time and in the number of surgical procedures needed. Total fistulectomy with sphincteroplasty and partial closure of the residual cavity, as described, is a safe procedure but has to be performed by dedicated colorectal surgeons.

Modified ligation of the intersphincteric fistula tract in the treatment of simple transsphincteric perianal fistula

To assess the efficacy and safety of modified ligation of the intersphincteric fistula tract for simple transsphincteric perianal fistula. Seventy patients with simple transsphincteric perianal fistula between October 2012 and January 2014 in our department were prospectively enrolled. According to the random number table, patients were divided into two groups: modified-LIFT group (37 cases, from the external opening close to the fistula, dissect the external sphincter fistula to the intersphincteric groove by tunneling technique, resect the lateral free fistula) and LIFT group (33 cases). Clinical parametres before and after operation were compared, and results of pelvic electromyogram (EMG) and anorectal manometry three months after operation were analyzed to evaluated anal function. The operative time, pain score, hospital stay, and healing time were not significantly different between the two groups (all P>0.05). During the median follow-up of 12 months (3-20 months), the healing rate in modified-LIFT group was 83.8% (31/37), which was significantly higher than 60% (20/33) in LIFT group (P=0.029). After operation, 4 patients had persistent unhealed wound, 2 recurred in modified-LIFT group, while 8 patients had persistent unhealed wound, and 5 recurred in LIFT group. No patients developed anal incontinence. By the pelvic EMG and anorectal manometry 3 months after operation, the duration of motor unit potential, occurrence of simple phase, mean resting pressure and maximun squeeze pressure were not significantly different. Modified-LIFT procedure for the management of simple transsphincteric perianal fistulas is a simple and effective operation with higher healing rate and similar anal function as LIFT.

To Evaluate and Explain the Consequences of Abnormal Anal Sphincter Morphology Using the 3-Dimensional Endosonography

The Objective of the Study. To evaluate and explain the consequences of different morphological abnormalities of anal sphincters including the sphincter damage and its extent using the 3-dimensional endosonography. Material and Methods. 56 patients suffering from fecal incontinence all were subjected to analysis of patient symptoms, scoring the severity of symptoms, digital examination, electromyography, and 3D endoanal ultrasonography. Results. 5 patients showed intact anal sphincters and puborectalis muscle. 4 patients found with thick IAS &gt; 4 mm, 4 patients with thin IAS &lt; 2 mm. 3 patients with thin EAS, 12 patients with IAS defects, 15 patients with EAS defects, 8 patients with combined IAS and EAS defects, 2 patients with puborectalis muscle defects and 3 patients with high levels transsphincteric perianal fistulas. Conclusion. No significant relationship was observed between sphincter damage except for combined internal and external sphincter injury and the severity score of FI symptoms. Puborectalis muscle injury and abnormal sphincter thickness are unlikely causes of severe FI.