Treatment Of Fistula Research Articles

Loose seton in the treatment of transsphincteric anal fistulas complicated by additional fistula tracks (randomized trial)

AIM: to evaluate caudal migration of free seton in patients with anal fistulas complicated by additional fistula tracks.PATIENTS AND METHODS: the prospective randomized single-center study included 115 patients with transshincteric fistulas, who had one of 2 types of seton installed. The decision to choose a seton was made by randomization in 2 groups: 63 patients with a polyester braided ribbon with a fluoropolymer coating 3 mm wide (Polyester-F Braid 3 mm, “Balumed” LLC, Russian Federation) seton “T”, and the 2nd group included 52 patients with a seton polyester braided ribbon with a fluoropolymer coating with a diameter of 0.5 mm of USP conditional number 2 with a diameter of 0.5 mm was installed (Polyester-F Thread USP 2 with a diameter of 0.5 mm, “Balumed” LLC, Russian Federation) — seton “N”.RESULTS: after 12 weeks the largest number of complete caudal migration occurred in 30/63 (47.6%; 95% CI: 34.9–60.6) patients with seton “T”, whereas in patients with seton “N” it occurred significantly less often in 7/52 (13.5%; 95% CI: 5.6–25.8) patients (p = 0.0002). Caudal seton migration with sphincter involvement of more than 1/2 was noted only in 1 patient with seton “T”, and was completely absent in patients with seton “N”.CONCLUSION: in patients with a fistulas involving less than 1/2 of the external sphincter, it is reasonable to use a 3 mm wide fluoropolymer-coated polyester braided band as a seton, expecting caudal migration in almost half of the cases. Whereas the installation of a 0.5-mm diameter fluoropolymer-coated polyester braided thread, when more than 1/2 of the external sphincter is involved, does not lead to caudal migration.

Treatment of both rectovaginal fistula and anal stricture with single skin flap.

Treatment of both rectovaginal fistula and anal stricture with single skin flap.

Quaternized Molecular Brush-Grafted Injectable Microgel with Anti-Inflammatory and Drainage Properties for Efficient Therapy of Anal Fistula.

Anal fistula is a common disease with recurrent inflammation and accumulated exudate. Traditional treatments often fail to effectively eliminate inflammation and ensure adequate drainage, leading to prolonged healing time and a high recurrence rate. Herein, a new class of quaternized molecular brush-grafted injectable microgel (denoted as GAA@CNT-g-PVBTMA) is developed through thermal polymerization and mechanical fragmentation to promote the healing process of anal fistula. Benefiting from the fragmented morphology with a porous structure, the microgel can effectively fill the fistula and facilitate the drainage of exudate. Owing to the electrostatic interactions between the positively charged quaternized carbon nanotube molecular brush (CNT-g-PVBTMA) and the negatively charged inflammatory cytokines, GAA@CNT-g-PVBTMA microgel exhibits excellent anti-inflammatory properties with scavenging rates of 92.6% for tumor necrosis factor-α (TNF-α)and 92.5% for interleukin-1β (IL-1β). Rat inflammatory anal fistula model demonstrates that the microgel can effectively reduce inflammation and epithelialization of the fistula, thereby promoting the healing of the anal fistula. By integrating effective filling, adequate drainage, and excellent anti-inflammatory properties, GAA@CNT-g-PVBTMA microgel provides a promising new direction for the treatment of anal fistula.

Treatment of recurrent priapism using proximal shunt: Quackles technique

IntroductionRecurrent priapism is a rare variant of ischemic priapism that involves recurrent erections typically lasting less than 4 h. The primary goal of treatment is to prevent future episodes, with options ranging from pharmacological treatments to various surgeries.Case presentationA 38‐year‐old man experienced multiple episodes of priapism that were refractory to angioembolization of an arteriocavernous fistula and oral treatment with Cetirizine and Bicalutamide. After the patient refused intracavernous self‐injections, various surgical options were considered. Ultimately, a proximal penile shunt surgery with a cavernosal–spongiosal shunt using the Quackles technique was chosen, which proved effective in preventing episodes and did not affect the patient's erectile function.ConclusionPenile shunt surgery using the Quackles proximal technique is a safe and effective option for the treatment of recurrent priapism.

Innovative Approaches in Fistula-In-Ano Management: Evaluating the Role of Fistula Brush - A Case Study

Introduction: Fistula in ano is one of the most common anorectal diseases. The prevalence is greater in men than women, with the rate of 12.3 cases per 100,000 and 5.6 cases per 100,000, respectively. In Ayurvedic Science Ksharasutra ligation is one of the most popular treatment modality for Bhagandara. Ksharasutra is indeed a well-known treatment in Ayurveda, particularly for managing conditions like pilonidal sinus and anal fistulas. However, it does have some limitations. Hence, an innovative technique is adopted by introducing a new Yantra i.e., Fistula brush in the field of Shalya Tantra for minimizing the unit cutting time in fistulous tract. Methodology: The fistulous tract was curetted using the fistula brush in 4-5 strokes followed by primary threading with barbour thread. Follow up thread change was done after curetting the tract using fistula brush until the tract was cut through. (under local anaesthesia). Result: The intervention results indicated a marked improvement in both subjective and objective parameters, demonstrating the intervention's effectiveness in enhancing patient outcomes. Discussion: The treatment of anal fistula through curettage of the tract using a fistula brush has been demonstrated to be a cost-effective and accessible method. This technique facilitates the removal of unhealthy granulation tissue while ensuring adequate drainage with the use of a drainage seton, thereby promoting the formation of healthy granulation tissue. Ultimately, this process encourages fibrosis of the tract and minimizes the risk of sphincter damage. Mechanical debridement plays a pivotal role throughout the stages of wound healing by promoting a clean, healthy wound environment. By alleviating symptoms associated with each stage - such as pain, burning sensation, discharge and local tenderness - it ultimately enhances the healing process and improves patient comfort.

Pancreaticopleural fistula: you can only find it if you look for it.

We present a case of a 52-year-old man with chronic toxic pancreatitis and history of multiple hospital admissions secondary to pancreatitis exacerbation. Due to persistent respiratory symptoms a thoracoabdominal computerized tomography (CT) was performed. The CT showed a new significant right pleural effusion as well as inflammatory changes secondary to acute pancreatitis. Within these inflammatory changes extending towards the right diaphragmatic crura. The diagnostic thoracentesis showed an amylase level of 4000UI/L. Subsequently, given de suspicion of pancreaticopleural (PPF) fistula treatment with somatostatin 6mg/12h was initiated and endoscopic retrograde cholangiopancreatography (ERCP) was performed. The pancreatic duct could not be cannulated by CPRE so an echoendoscopy was carried out with insertion of a pancreatic stent by pancreatic rendez-vous technique. The evolution was satisfactory with resolution of the fistula.

Comparative outcomes of standard laser fistula closure (filac) versus filac combined with advancement flap in the treatment of complex anal fistulas.

This study aims to compare the clinical outcomes of patients treated for complex anal fistulas using standard laser fistula closure (FiLaC) versus FiLaC combined with an advancement flap (+FLAP). A retrospective review was conducted on patients treated for complex anal fistulas between January 2022 and December 2023. Treatments included standard FiLaC and FiLaC combined with an advancement flap. Main outcome measures included operation duration, hospital stay, postoperative pain [Visual Analog Scale (VAS) score], complications, and success rate. A total of 47 patients were included in the study, with 25 in the standard FiLaC group and 22 in the +FLAP group. The +FLAP group had significantly longer operation times (29.7 ± 4.7min versus 18.7 ± 4.0min, p < 0.001) and hospital stays (16.2 ± 5.04h versus 3.9 ± 2.3h p < 0.001). Postoperative pain scores were similar between groups. The mean follow-up periods for the FILAC and +FLAP groups were 10.5 ± 3.5months and 8.4 ± 4.0months, respectively. The success rate was significantly higher in the +FLAP group (95.5% versus 72%, p = 0.03). In this study, we found that, compared with FiLAC alone, combining FiLaC with an advancement flap may significantly improve primary success rates in the treatment of complex anal fistulas, and we believe this approach could be a valuable option for enhancing treatment outcomes in complex cases. The increased operation and hospital stay durations appear to be balanced by the higher success rates.

Results at one year of the TROPIS technique in the treatment of complex anal fistula

Results at one year of the TROPIS technique in the treatment of complex anal fistula

Prediction, Prevention and Treatment of Pancreatic Fistula after Pancreatoduodenalectomy

Панкреатический свищ является самым частым и опасным осложнением после хирургического лечения рака поджелудочной железы. Развитие свища значительно ухудшает как ближайшие, так и отдаленные результаты лечения этой патологии, снижает качество жизни пациентов. В данной работе освещены основные исследования, которые посвящены изучению панкреатических фистул после панкреатодоуденальных резекций. Основной упор сделан на понятии и современной классификации панкреатических фистул, возможностях ее прогнозирования, методах профилактики и лечения данного осложнения. Изучена роль инструментальных методов лечения в прогнозировании свища после операции, их корреляции с клиническими данными. Рассмотрены различные консервативные и хирургические способы профилактики свища, роль формирования наружной вирсунгостомы. Приведены основные способы лечения панкреатической фистулы. Причины и механизмы панкреатического свища многогранны, а ее последствия могут оказать значительное негативное влияние на продолжительность и качество жизни пациента. В связи с этим роли прогнозирования панкреатического свища и применению методов профилактики следует уделять особое внимание.

Minimally Invasive Endovascular Treatment of Bilateral Indirect Carotid-Cavernous Fistula.

Minimally Invasive Endovascular Treatment of Bilateral Indirect Carotid-Cavernous Fistula.

Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling.

Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs. The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic follow-up over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE. Key reasons for selecting TVCOE included improvement in immediate complete obliteration (CO) of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (PVR, n = 22, 22.7%), and redirection of fistula flow to PVR (n = 2, 2.1%). The average volume of Onyx used in TVCOE was 1.7 ml per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 cm and 228 cm, respectively, with a statistically significant difference (p < 0.05). Immediate digital subtraction angiography showed CO or nearly CO of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate CO (p < 0.05). Transient hemodynamic instability occurred in 81 (90.0%) patients due to Onyx toxicity, and 1 patient (1.1%) experienced hemorrhagic complications during TVCOE. The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate CO. This technique is viable for patients with PVR. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.

Thoracic Endovascular Aortic Repair For The Management of Aorto-Esophageal Fistulae: A Systematic Review.

Aorto-esophageal fistula (AEF) is a rare condition consisting in a fistula between the aorta and the esophagus. The thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for initial AEF management, but large series are not available and outcomes are questionable. This study aims at evaluating the current evidence of TEVAR in AEF. A search on PubMed/MEDLINE and EMBASE was conducted up to June 2023. Data on article type, patients' demographics, cause and type of AEF, clinical presentation, time from clinical presentation to TEVAR, strategies, mortality, and follow-up were analyzed. 106 reports published between 1997 and 2023 were deemed eligible for this study (92 case reports; 14 case-series). A total of 163 patients (mean age: 58.9±16.5 years), diagnosed with AEF and treated with TEVAR (with or without staged surgical repair of the esophagus or the aorta) were included. A thoracic aortic aneurysm (34.4%) was the most common cause of AEF, followed by esophageal cancer (25.2%), foreign body in esophagus (13.5%) and post-TEVAR complication (9.8%). Primary AEF were 129 (79.1%), and secondary AEF were 34 (20.9%). TEVAR alone was performed 80 times (49.1%), while TEVAR with staged esophageal or aortic surgery 83 times (50.9%). The overall 30-day mortality was 11.7% (n=19): 18.8% in TEVAR alone and 4.8% in TEVAR with staged surgery, respectively (p=0.006). Mean follow-up time was 12.3±14.7 months. The overall 6-month mortality was 34.4% (n=56): 48.8% in TEVAR alone and 20.5% in TEVAR with staged surgery (p<0.001). Bleeding for recurrence of AEF and sepsis were the main causes of death. In case of AEF, TEVAR can be urgently performed for bleeding management and hemodynamic control. TEVAR alone is a valuable yet not definitive procedure. Instead, TEVAR followed by surgical repair may provide better outcomes and should be recommended, when possible. This review summarizes the published papers on endovascular aortic repair for the treatment of aorto-esophageal fistulae. The clinicians can find several important details on how to manage the presence of an esophageal fistulae wich represents a potential life-threatening problem for the patients. The implantation of a thoracic endovascular aortic prosthesis represents a fast and reliable procedure in case of emergency but a second step surgical repair provides better outcomes and should be recommended in suitable patients.

In Situ Treatment of Refractory Perianal Fistulas in Dogs with Low-Dose Allogeneic Adipose-Derived Mesenchymal Stem Cells.

Stem cell therapy in dogs has increased considerably in recent years; however, there are few publications on the treatment of perianal fistulas (PF) in this species. The aim of this open-label clinical trial was to demonstrate the efficacy and safety of a new protocol for the in situ administration of low-dose adipose-derived allogeneic stem cells (ASCs) for the treatment of refractory spontaneous perianal fistula. The methodology consisted of applying one to three doses of 5 × 106 cryopreserved allogeneic ASCs to each fistula. The study was performed in 14 dogs regardless of sex, breed, or age, with a clinical diagnosis of refractory PF. Cells diluted in phosphate-buffered saline were applied to five sites of the PF in an amount of 1 × 106 per application site. Efficacy was determined by the complete closure of the fistula, which was observed in 100% of the cases studied one month after therapy, with a subsequent follow-up of 12 to 48 months after therapy. Furthermore, safety was demonstrated by the absence of local or systemic adverse effects. In conclusion, the protocol used in this work demonstrates the efficacy without adverse effects of the in situ application of low doses of allogeneic ASCs, providing a simple, non-invasive, long-lasting and low-cost therapeutic option.

Comparative Analysis of Directional Snare vs Cutting Seton for High Anal Fistula Treatment

Comparative Analysis of Directional Snare vs Cutting Seton for High Anal Fistula Treatment

Botulinum toxin type A treatment for a parotid gland injury in two adult horses

SummaryThe most common disorder affecting the salivary glands in horses is trauma to the parotid gland or duct. Several management techniques have been described, each with their own set of complications. The objective of this case report was to describe the direct injection of botulinum toxin type A into the parotid gland and its outcome in two clinical cases involving damage to either the parotid salivary gland or its duct. Both cases involved iatrogenic damage to either the parotid salivary gland or its duct. Treatment for both cases involved the injection of 200 units of botulinum toxin type A into the parotid gland in order to reduce salivary production and to prevent the potential development of a chronic fistula. Follow‐up assessment after the treatment was conducted via telephone consultation and photographs from the owners. In both clinical cases, a marked reduction in saliva production from the parotid gland was noted within 2 days after toxin injection and the wounds healed without complication. In the first case, the treatment was repeated after 3 weeks. No short‐ or long‐term side effects after injection were reported by the owners. Limitations were the small number of cases and the lack of literature regarding the dose and treatment regime for botulinum toxin type A in horses. It was concluded that the administration of botulinum toxin type A appears to be a safe and effective therapeutic alternative or complementary procedure for the treatment and prevention of parotid gland or duct fistulas in horses.

Magnetic resonance imaging changes in spinal arteriovenous fistulae treated by endovascular means: are they reliable to predict complete cure of the fistula?

BackgroundRegression or disappearance of MRI abnormalities is usually observed after treatment of spinal dural arteriovenous fistulae (sDAVF).ObjectiveTo assess the correlation between spinal MRI (sMRI) changes with sDAVF exclusion and clinical...

Retrospective clinical study on the efficacy and complications of interventional embolization in the treatment of scalp arteriovenous fistula.

Scalp arteriovenous fistula (AVF) is a rare and intricate vascular anomaly characterized by a direct connection between an artery and a vein, without an intervening capillary system. This anomaly can induce significant local hemodynamic changes and is associated with various complications, such as pain, a pulsatile mass, increasing swelling, and venous hypertension skin ulcerations which may be non-healing. This study aimed to evaluate the efficacy and safety of interventional embolization treatments for scalp AVF at Shandong Provincial Hospital. This retrospective clinical analysis assessed 21 patients who underwent interventional embolization between 2018 and 2024. Patients included were those treated in the vascular surgery department at Shandong Provincial Hospital, who had comprehensive medical records and follow-up data. Treatment methods, outcomes, and complications were thoroughly analyzed through patient medical records. Among the patients studied, direct puncture was the most prevalent treatment method, employed in 42.86% (9/21) of cases, followed by various combinations of arterial, venous, and direct approaches. Ethanol, used in 85.71% (18/21) of the cases, demonstrated its broad efficacy and application in clinical settings. Immediate imaging post-treatment confirmed a cure rate of 85.71% (18/21). The main postoperative complications included swelling, with some patients also experiencing nodules, scabbing, or hair loss. Interventional embolization has proven to be a safe and effective method for managing scalp AVF, significantly minimizing complications. Future research should focus on further optimizing these treatment methods to enhance efficacy and improve patient quality of life.

Efficacy and safety of stem cell therapy for fistula management: An overview of existing systematic reviews.

Fistulas, abnormal connections between two anatomical structures, significantly impact the quality of life and can result from a variety of causes, including congenital defects, inflammatory conditions, and surgical complications. Stem cell therapy has emerged as a promising alternative due to its potential for regenerative and immunomodulatory effects. This overview of systematic reviews aimed to assess the safety and efficacy of stem cell therapy in managing fistulas, drawing on the evidence available. This umbrella review was conducted following the Joanna Briggs Institute (JBI) methodology to assess the efficacy and safety of stem cell therapy for treating various types of fistulas. A comprehensive search was performed across multiple electronic databases including PubMed, Embase, Cochrane Register, and Web of Science up to May 5th, 2024. Systematic reviews focusing on stem cell therapy for fistulas were included, with data extracted on study design, stem cell types, administration methods, and outcomes. The quality of the reviews was assessed using the AMSTAR 2 tool, and meta-analyses were conducted using R software version 4.3. Nineteen systematic reviews were included in our umbrella review. The stem cell therapy demonstrated by significant improvements in clinical remission rates, with a relative risk (RR) of 1.299 (95% CI: 1.192 to 1.420). Stem cell therapy enhanced fistula closure rates, both short-term (RR=1.481; 95% CI: 1.036 to 2.116) and long-term (RR=1.422; 95% CI: 1.091 to 1.854). The safety analysis revealed no significant increase in the risk of adverse events with stem cell therapy, showing a pooled RR of 0.972 (95% CI: 0.739 to 1.278) for general adverse events and 1.136 (95% CI: 0.821 to 1.572) for serious adverse events, both of which indicate a safety profile comparable to control treatments. Re-epithelialization rates also improved (RR=1.44; 95% CI: 1.322 to 1.572). Stem cell therapy shows promise as an effective and safe treatment for fistulas, particularly in inducing remission and promoting closure of complex fistulas. The findings advocate for further high-quality research to confirm these benefits and potentially incorporate stem cell therapy into standard clinical practice for fistula management. Future studies should focus on long-term outcomes and refining stem cell treatment protocols to optimize therapeutic efficacy.

Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template (SMART): An interdisciplinary Delphi consensus.

There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging (MRI) and endoanal ultrasound (EAUS) are relevant to surgical decision-making. As a consequence, the quality and completeness of the report are highly dependent on the training and experience of the examiners. To develop a structured MRI and EAUS template (SMART) reporting the minimum dataset of information for the treatment of anal fistulas. This modified Delphi survey based on the RAND-UCLA appropriateness for consensus-building was conducted between May and August 2023. One hundred and fifty-one articles selected from a systematic review of the literature formed the database to generate the evidence-based statements for the Delphi study. Fourteen questions were anonymously voted by an interdisciplinary multidisciplinary group for a maximum of three iterative rounds. The degree of agreement was scored on a numeric 0-10 scale. Group consensus was defined as a score ≥ 8 for ≥ 80% of the panelists. Eleven scientific societies (3 radiological and 8 surgical) endorsed the study. After three rounds of voting, the experts (69 colorectal surgeons, 23 radiologists, 2 anatomists, and 1 gastroenterologist) achieved consensus for 12 of 14 statements (85.7%). Based on the results of the Delphi process, the six following features of anal fistulas were included in the SMART: Primary tract, secondary extension, internal opening, presence of collection, coexisting lesions, and sphincters morphology. A structured template, SMART, was developed to standardize imaging reporting of fistula-in-ano in a simple, systematic, time-efficient way, providing the minimum dataset of information and visual diagram useful to referring physicians.

Treatment of Oroantral Communication and Fistulas with the Use of Blood-Derived Platelet-Rich Preparations Rich in Growth Factors: A Systematic Review.

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90-100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence.