1
|
Arkenbosch JHC, van Ruler O, de Vries AC, van der Woude CJ, Dwarkasing RS. The role of MRI in perianal fistulizing disease: diagnostic imaging and classification systems to monitor disease activity. Abdom Radiol (NY) 2024:10.1007/s00261-024-04455-w. [PMID: 39180667 DOI: 10.1007/s00261-024-04455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 08/26/2024]
Abstract
Perianal fistulizing disease, commonly associated with Crohn's disease, poses significant diagnostic and therapeutic challenges due to its complex anatomy and high recurrence rates. Radiological imaging plays a pivotal role in the accurate diagnosis, classification, and management of this condition. This article reviews the current radiological modalities employed in the evaluation of perianal fistulizing disease, including magnetic resonance imaging (MRI), endoanal ultrasound, and computed tomography (CT). MRI, recognized as the gold standard, offers superior soft tissue contrast and multiplanar capabilities, facilitating detailed assessment of fistula tracts and associated abscesses. CT, although less detailed than MRI, remains valuable in acute settings for detecting abscesses and guiding drainage procedures. This article discusses the advantages and limitations of each modality, highlights the importance of standardized imaging protocols, and underscores the need for interdisciplinary collaboration in the management of perianal fistulizing disease. Future directions include advancements in imaging techniques and the integration of artificial intelligence to enhance diagnostic accuracy and treatment outcomes.
Collapse
Affiliation(s)
- Jeanine H C Arkenbosch
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oddeke van Ruler
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roy S Dwarkasing
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
2
|
Sirikurnpiboon S. The risk factors for failure and recurrence of LIFT procedure for fistula in ano. Turk J Surg 2023; 39:27-33. [PMID: 37275932 PMCID: PMC10234717 DOI: 10.47717/turkjsurg.2023.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/23/2023] [Indexed: 06/07/2023]
Abstract
Objectives Fistula in ano (FIA) is a common anorectal problem. There are several techniques that have been used for treatment; however, all of them carry risks of recurrence and incontinence. Ligation intersphincteric fistula tract (LIFT) is a type of treatment with a promising result of preserving the anal sphincter function. This study aimed to evaluate the outcome and risk factor of LIFT failure and to demonstrate the pattern of recurrence. The research funding was supported by Rajavithi Hospital. Material and Methods From January 2015 to January 2020, there were 250 cases of fistula in ano operations. A total of 148 patients underwent LIFT operation. The patients' average age was 39.72 ± 10.55 years and the average follow-up period was 111.86 ± 79.73 days. The average time to diagnose the recurrence was 99.12 ± 30.08 days. In addition, average time to perform a surgery after the diganosis was 64.67 ± 25.76 days. The study's analyses used data on age, sex, type of fistula, operative intervention, healing time, reinterventions, and recurrence. Results There were 22.97% of recurrence among 148 LIFT patients. Half of the patients who underwent the operation had a preoperative imaging study with MRI or endoanal ultrasonography in the first time due to the complexity of the disease. Factors associated with operation failure were collection, fistula tract size more than 5 millimeters, and the failure of ligating the tract in one attempt. Conclusion LIFT procedure is one of the several sphincter saving procedures to treat FIA. Recurrence is related with the complexity of the disease. Most of the recurrence is diseases that are easier to treat, such as performing a re-operation or fistulotomy.
Collapse
Affiliation(s)
- Siripong Sirikurnpiboon
- Clinic of Colorectal Surgery, Rajavithi Hospital, Rangsit University College of Medicine, Bangkok, Thailand
| |
Collapse
|
3
|
Fugita FR, Santos CHMD, Ribeiro CODS. Epidemiological profile of patients with fistula in ano. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Rationale There is a lack of consistent national data on the evaluation of the epidemiological profile of patients with anal fistula.
Objective To evaluate the epidemiological profile of patients with anal fistula at a center specialized in coloproctology.
Method A cross-sectional, retrospective study was carried out between 2016 and 2018 of patients who underwent surgical procedures for the treatment of fistula in ano by the Department of Coloproctology of the Regional Hospital of Mato Grosso do Sul. Age, gender, disease duration, number of procedures, association with Crohn's disease and other comorbidities were evaluated. The data were tabulated and submitted to statistical treatment considering p < 0.05.
Results 93.2% of the patients were less than 60 years old, 66.7% were male, 88.9% had the disease less than one year, the most frequent procedures were fistulotomy (55.6%) and fistulectomy (36.8%), with a greater percentage of patients having undergone only one procedure (74.4%), 8.5% had Crohn’s disease, 7.7% systemic hypertension and 3.4% had diabetes mellitus.
Conclusion In the studied group, there was a predominance of anal fistulae in men under 60 years old and without comorbidities, diagnosed for up to one year, most of them submitted to fistulotomy or fistulectomy at one time. Patients operated after one year of illness and also those with Crohn’s disease were submitted mainly to curettage + seton and multiple procedures.
Collapse
Affiliation(s)
- Fabiano Roberto Fugita
- Hospital Regional de Mato Grosso do Sul, Serviço de Coloproctologia, Campo Grande, MS, Brazil
| | | | | |
Collapse
|
4
|
Ding W, Sun YR, Wu ZJ. Treatment of Perianal Abscess and Fistula in Infants and Young Children: From Basic Etiology to Clinical Features. Am Surg 2020; 87:927-932. [PMID: 33284051 DOI: 10.1177/0003134820954829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Perianal abscess and anal fistula are 2 common anorectal diseases in infants and young children. However, their causes, clinical diagnosis, and treatment remain controversial. Compared to adults, infants with these 2 diseases exhibit unique clinical characteristics. Blind pursuit of conservative treatment or surgery may worsen the condition, resulting in increased pain in young patients and greater economic burden and psychological harm to parents. Therefore, it is crucial to select correct and effective treatments. This review summarizes the relevant literature from the past 10 years and systematically explains the pathogenesis, clinical characteristics, and treatment measures of perianal abscess and anal fistula in infants with the goal of providing clinicians a deeper understanding of perianal abscess and anal fistula in infants and summarizing safe and effective treatment methods.
Collapse
Affiliation(s)
- Wei Ding
- North Sichuan Medical College, Nanchong, China
| | - Yao-Ran Sun
- North Sichuan Medical College, Nanchong, China
| | - Zhi-Jiu Wu
- Department of Anorectal, 117913The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| |
Collapse
|
5
|
Scholtes V, Ardon C, Straalen K, Dwarkasing R, Boer J, Zee H. Characterization of perianal fistulas in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 33:e337-e338. [DOI: 10.1111/jdv.15629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V.C. Scholtes
- Department of Dermatology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - C.B. Ardon
- Department of Dermatology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - K.R. Straalen
- Department of Dermatology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - R.S. Dwarkasing
- Department of Radiology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - J. Boer
- Department of Dermatology Deventer Hospital Deventer The Netherlands
| | - H.H. Zee
- Department of Dermatology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| |
Collapse
|
6
|
Zhang H, Xu T, Zhang XD. Efficacy of flap repair for anal fistula: study protocol for a systematic review of randomized controlled trial. Medicine (Baltimore) 2019; 98:e16856. [PMID: 31415418 PMCID: PMC6831420 DOI: 10.1097/md.0000000000016856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinical trials have reported that flap repair (FR) can treat anal fistula (AF) effectively. However, no study systematically investigated its efficacy and safety for patients with AF. This study will systematically assess its efficacy and safety of AF. METHODS We will retrieve MEDLINE, EMBASE, Cochrane Library, Elsevier, Springer, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from their inceptions to May 1, 2019 without any language limitations. The primary outcome is fistula cure rate. The secondary outcomes consist of fistula recurrence rate, fecal continence, quality of life, and complications. RevMan 5.3 software will be used for methodological quality assessment, data synthesis, subgroup analysis and sensitivity analysis. RESULTS The results of this study will summarize a high-quality synthesis of current evidence for the treatment of FR for patients with AF. CONCLUSION The findings of this proposed study will provide evidence for judging whether FR is an effective and safety intervention for AF or not.PROSPERO registration number: PROSPERO CRD42019135507.
Collapse
Affiliation(s)
- Hao Zhang
- Department of Plastic Burn and Cosmetic Center
| | - Tao Xu
- Department of Medical Imaging, First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | | |
Collapse
|
7
|
Abstract
Anal fistula, or fistula-in-ano, is a condition involving the anal region that is common yet debilitating. Surgery is the mainstay of treatment for an anal fistula and the chances of recurrence are quite high even after corrective surgical procedures. The risk factors for recurrence can be broadly classified into four categories: 1) risk factors related to the fundamental anatomy of the fistula and presence of comorbidities, 2) lack of proper preoperative assessment of the fistula, which includes failure to recognize the internal opening and overall structure of the fistula and not supplementing the proctologic examination with sufficient imaging, 3) intraoperative loopholes that include improper procedure selection, inexperience of the surgeon, and failure to get rid of the entire tract along with its ramifications, and 4) lack of proper postoperative care in the early and late periods following the surgery. The aim of this paper, therefore, is to highlight the factors that could increase the risk of recurrence in different types of anal fistulae. Once surgeons know these risk factors, they can anticipate any complication and detect recurrence early.
Collapse
|
8
|
Abstract
Pediatric anal fistulae commonly result from recurrent perianal abscesses, of which nearly 50 per cent develop an anal fistula. The purpose of this study was to report the results of using fibrin glue to treat anal fistula in pediatric patients. Infants and children with recurrent perianal abscesses and anal fistulae were treated with either fistulectomy or fibrin glue. Demographic and clinical characteristics and outcomes were compared between the groups. A total of 34 children were included; 27 received fistulectomy (median age eight months) and seven received fibrin glue treatment (median age 14 months). No significant differences in demographic or clinical characteristics were found between the two groups (all, P > 0.05). Median follow-up duration was significantly higher in the fibrin glue group compared with that in the fistulectomy group (five months vs one month, P = 0.003). There was one recurrence in the fistulectomy group, and no recurrences in the fibrin glue group (P = 1.0). No complications occurred in either group. Fibrin glue treatment is a simple and effective treatment alternative in the management of anal fistula in children, offering the advantage of sphincter muscle-sparing and reduced risk of fecal incontinence.
Collapse
Affiliation(s)
- Fan-Ting Liao
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Jen Chang
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| |
Collapse
|
9
|
Lefrançois P, Zummo-Soucy M, Olivié D, Billiard JS, Gilbert G, Garel J, Visée E, Manchec P, Tang A. Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI for assessment of anal fistula activity. PLoS One 2018; 13:e0191822. [PMID: 29370278 PMCID: PMC5784995 DOI: 10.1371/journal.pone.0191822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) sequences for quantitative characterization of anal fistula activity. Methods This retrospective study was approved by the institutional review board. One hundred and two patients underwent MRI for clinical suspicion of anal fistula. Forty-three patients with demonstrable anal fistulas met the inclusion criteria. Quantitative analysis included measurement of DCE and IVIM parameters. The reference standard was clinical activity based on medical records. Statistical analyses included Bayesian analysis with Markov Chain Monte Carlo, multivariable logistic regression, and receiver operating characteristic analyses. Results Brevity of enhancement, defined as the time difference between the wash-in and wash-out, was longer in active than inactive fistulas (p = 0.02). Regression coefficients of multivariable logistic regression analysis revealed that brevity of enhancement increased and normalized perfusion area under curve decreased with presence of active fistulas (p = 0.03 and p = 0.04, respectively). By cross-validation, a logistic regression model that included quantitative perfusion parameters (DCE and IVIM) performed significantly better than IVIM only (p < 0.001). Area under the curves for distinguishing patients with active from those with inactive fistulas were 0.669 (95% confidence interval [CI]: 0.500, 0.838) for a model with IVIM only, 0.860 (95% CI: 0.742, 0.977) for a model with IVIM and brevity of enhancement, and 0.921 (95% CI: 0.846, 0.997) for a model with IVIM and all DCE parameters. Conclusion The inclusion of brevity of enhancement measured by DCE-MRI improved assessment of anal fistula activity over IVIM-DWI only.
Collapse
Affiliation(s)
- Philippe Lefrançois
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mathieu Zummo-Soucy
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Guillaume Gilbert
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada
| | - Juliette Garel
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Emmanuel Visée
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre Hospitalier Départemental de Vendée, Les Oudairies, La Roche-Sur-Yon, France
| | - Perrine Manchec
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Norimagerie, 1,3 chemin du Penthod, Caluire et Cuire, France
| | - An Tang
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- * E-mail:
| |
Collapse
|
10
|
Mascagni D, Pironi D, Pontone S, Tonda M, Eberspacher C, Panarese A, Miscusi G, Grimaldi G, Catania A, Santoro A, Filippini A, Sorrenti S. Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient. Aging Clin Exp Res 2017; 29:101-108. [PMID: 27830517 DOI: 10.1007/s40520-016-0652-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND 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. AIMS 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. METHODS 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. RESULTS Success rate was 97.7% with a healing time of 4 weeks; overall morbidity was 16.2%; recurrence rate was 2.3%; no major alterations of continence were observed. DISCUSSION 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University, Rome, Italy.
| | - Stefano Pontone
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Maya Tonda
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | | | | | | | | | - Antonio Catania
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | | |
Collapse
|
11
|
Zawadzki A, Johnson LB, Bohe M, Johansson C, Ekelund M, Nielsen OH. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas. Int J Colorectal Dis 2017; 32:509-512. [PMID: 27878619 PMCID: PMC5355500 DOI: 10.1007/s00384-016-2726-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal fistulas without any concomitant medication. METHODS An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted. RESULTS Of 28 patients included, 10 patients (35.7%) showed complete fistula healing (closed, no discharge on palpation) after 8 weeks; seven of these patients, corresponding to 25% of the enrolled patients, remained in remission for up to 31 weeks. At week 8, there was a statistically significant reduction in the discharge visual analog scale (p = 0.04), a significant improvement in the patient-perceived quality of life for the category of embarrassment (p = 0.002), and a trend toward improvement in the other assessment categories. CONCLUSIONS The treatment was well tolerated, and patient acceptance was high. The results support the efficacy and safety of locally administered activated carbon for the treatment of patients with chronic uncomplicated perianal fistulas not receiving any other medication for fistula problems.
Collapse
Affiliation(s)
- Antoni Zawadzki
- Department of Clinical Sciences, Division of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Louis Banka Johnson
- Department of Clinical Sciences, Division of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Måns Bohe
- Department of Clinical Sciences, Division of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Claes Johansson
- Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Ekelund
- Department of Clinical Sciences, Division of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ole Haagen Nielsen
- Department of Gastroenterology D112, Medical Section, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| |
Collapse
|
12
|
Hermann J, Eder P, Banasiewicz T, Kołodziejczak B, Łykowska-Szuber L. Palliative treatment of anal fistulas in Crohn's disease. ANZ J Surg 2016; 86:148-51. [PMID: 26861622 DOI: 10.1111/ans.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anal fistula in Crohn's disease is frequently an intractable condition. Methods of treatment are still debated because the results of various procedures are unsatisfactory. Available studies show that results can be improved using a combination of surgical and medical methods. Most patients undergo rather palliative than radical, curative procedures such as incision and drainage of abscesses and prolonged non-cutting seton placement. Surgery is combined today with biological therapy using infliximab, a murine-human chimeric monoclonal antibody against TNF-α or adalimumab a human monoclonal anti-TNF antibody to increase the healing process and in an attempt to prevent fistula recurrence. METHODS Medical records of 23 patients who were treated for anal fistulas in Crohn's disease between 2012 and 2014 were retrospectively evaluated. RESULTS There were 10 (43%) males and 13 females. The mean age was 39 years (range 29-60 years). Median duration of CD before present treatment was 6 years (range 1-15 years). Closure of all fistulas in 6 months was achieved in eight (35%) patients, whereas reduction of at least 50% from base line in the number of draining fistulas occurred in four (17%) patients. CONCLUSION Palliative and combined therapy for anal fistulas in Crohn's disease with surgery and infliximab or adalimumab therapy is an effective treatment for some patients.
Collapse
Affiliation(s)
- Jacek Hermann
- Department of General and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | - Piotr Eder
- Department of Gastroenterology, Human Nutrition, and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Tomasz Banasiewicz
- Department of General and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | - Barbara Kołodziejczak
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznań, Poland
| | - Liliana Łykowska-Szuber
- Department of Gastroenterology, Human Nutrition, and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
| |
Collapse
|
13
|
Dubois A, Carrier G, Pereira B, Gillet B, Faucheron JL, Pezet D, Balayssac D. Therapeutic management of complex anal fistulas by installing a nitinol closure clip: study protocol of a multicentric randomised controlled trial--FISCLOSE. BMJ Open 2015; 5:e009884. [PMID: 26674505 PMCID: PMC4691740 DOI: 10.1136/bmjopen-2015-009884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Complex anal fistulas are responsible for pain, faecal incontinence and impaired quality of life. The rectal mucosa advancement flap (RMAF) procedure to cover the internal opening of the fistula remains a strategy of choice. However, a new procedure for closing anal fistulas is now available with the use of a nitinol closure clip (OTSC Proctology, OVESCO), which should ensure a better healing rate. This procedure is currently becoming more widespread, though without robust scientific validation, and it is therefore essential to carry out a prospective evaluation in order to determine the efficacy and safety of this new medical device for complex anal fistulas. METHODS AND ANALYSIS The FISCLOSE trial is aimed at evaluating the efficacy and safety of a nitinol closure clip compared to the RMAF procedure for the management of complex anal fistulas. This trial is a prospective, randomised, controlled, single-blind, bicentre and interventional study. Patients (n=46 per group) will be randomly assigned for management with either a closure clip or RMAF. The main objectives are to improve the healing rate of the anal fistula, lessen the postoperative pain and faecal incontinency, enhance the quality of life, and lower the number of reinterventions and therapeutic management costs. The primary outcome is the proportion of patients with a healed fistula at 3 months. The secondary outcomes are anal fistula healing (6 and 12 months), proctological pain (visual analogue scale), the faecal incontinence score (Jorge and Wexner questionnaire), digestive disorders and quality of life (Gastrointestinal Quality of Life Index and Euroqol EQ5D-3 L) up to 1 year. ETHICS AND DISSEMINATION The study was approved by an independent medical ethics committee 1 (IRB00008526, CPP Sud-Est 6, Clermont-Ferrand, France) and registered by the competent French authority (ANSM, Saint Denis, France). The results will be disseminated in a peer-reviewed journal and presented at international congresses. TRIAL REGISTRATION NUMBER NCT02336867; pre-result.
Collapse
Affiliation(s)
- Anne Dubois
- CHU Clermont-Ferrand, service de Chirurgie Digestive, Clermont-Ferrand, France
| | - Guillaume Carrier
- CHU Clermont-Ferrand, service de Chirurgie Digestive, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
| | - Brigitte Gillet
- CHU Clermont-Ferrand, service de Chirurgie Digestive, Clermont-Ferrand, France
| | | | - Denis Pezet
- CHU Clermont-Ferrand, service de Chirurgie Digestive, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
- INSERM, U1071, Clermont-Ferrand, France
- Université d'Auvergne, Clermont-Ferrand, France
| | - David Balayssac
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
- Université d'Auvergne, Clermont-Ferrand, France
- INSERM, U1107 NEURO-DOL, Clermont-Ferrand, France
| |
Collapse
|
14
|
Kumar N, Agarwal Y, Chawla AS, Jain R, Thukral BB. MRI of perianal fistulae: a pictorial kaleidoscope. Clin Radiol 2015; 70:1451-61. [PMID: 26455651 DOI: 10.1016/j.crad.2015.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 08/09/2015] [Accepted: 09/03/2015] [Indexed: 12/18/2022]
Abstract
Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A seemingly benign condition, it can be a cause of considerable distress to the patient if it is not mapped out adequately before embarking upon surgical correction. The persistence of residual disease complicates and up-stages the grade of the remnant fistula with increased risk of anal incontinence following surgery secondary to damage to the anal sphincter complex. Magnetic resonance imaging (MRI) can play a critical role in mapping the fistulae tract in relation to the anal sphincter complex and hence, act as a reliable guide for the surgeon to chart the optimised management of perianal fistulae. This review illustrates the role of MRI in the imaging evaluation of perianal fistulae, to facilitate a well-planned surgical course.
Collapse
Affiliation(s)
- N Kumar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
| | - Y Agarwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - A Singh Chawla
- Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - R Jain
- Department of Radiology, Primus Super Speciality Hospital, Chandragupt Marg, Chanakyapuri, New Delhi 110021, India
| | - B Bhushan Thukral
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| |
Collapse
|
15
|
Jhun P, Cologne K, Aguilera P, Bright A, Herbert M. Probing the Utility of the Rectal Examination. Ann Emerg Med 2015; 66:240-2. [PMID: 26304249 DOI: 10.1016/j.annemergmed.2015.07.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Jhun
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA.
| | - Kyle Cologne
- Division of Colorectal Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Pablo Aguilera
- Department of Emergency Medicine, P. Universidad Católica de Chile, Santiago, Chile
| | - Aaron Bright
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Mel Herbert
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
16
|
Fibrin Sealant: The Only Approved Hemostat, Sealant, and Adhesive-a Laboratory and Clinical Perspective. ISRN SURGERY 2014; 2014:203943. [PMID: 24729902 PMCID: PMC3960746 DOI: 10.1155/2014/203943] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/18/2013] [Indexed: 02/07/2023]
Abstract
Background. Fibrin sealant became the first modern era material approved as a hemostat in the United States in 1998. It is the only agent presently approved as a hemostat, sealant, and adhesive by the Food and Drug Administration (FDA). The product is now supplied as patches in addition to the original liquid formulations. Both laboratory and clinical uses of fibrin sealant continue to grow. The new literature on this material also continues to proliferate rapidly (approximately 200 papers/year). Methods. An overview of current fibrin sealant products and their approved uses and a comprehensive PubMed based review of the recent literature (February 2012, through March 2013) on the laboratory and clinical use of fibrin sealant are provided. Product information is organized into sections based on a classification system for commercially available materials. Publications are presented in sections based on both laboratory research and clinical topics are listed in order of decreasing frequency. Results. Fibrin sealant remains useful hemostat, sealant, and adhesive. New formulations and applications continue to be developed. Conclusions. This agent remains clinically important with the recent introduction of new commercially available products. Fibrin sealant has multiple new uses that should result in further improvements in patient care.
Collapse
|
17
|
Bakari AA, Ali N, Gadam IA, Gali BM, Tahir C, Yawe K, Dahiru AB, Mohammed BS, Wadinga D. Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria. Niger J Surg 2014; 19:56-60. [PMID: 24497752 PMCID: PMC3899549 DOI: 10.4103/1117-6806.119237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. METHODS OF STUDY Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. RESULTS A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. CONCLUSION Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.
Collapse
Affiliation(s)
- Abubakar A Bakari
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria ; Department of Surgery, Federal Medical Centre Yola, Yola, Adamawa State, Nigeria
| | - Nuhu Ali
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Ibrahim A Gadam
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria ; Department of Surgery, Federal Medical Centre Gombe, Gombe, Nigeria
| | - Bata M Gali
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Chubado Tahir
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Kdt Yawe
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Adamu B Dahiru
- Department of Surgery, Federal Medical Centre Yola, Yola, Adamawa State, Nigeria
| | - Baba S Mohammed
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Dauda Wadinga
- Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| |
Collapse
|
18
|
Lee JH, Kim MG, Lee S, Leem KH. Effects of Bletillae Rhizoma on the Elastase, Collagenase, and Tyrosinase Activities and the Procollagen Synthesis in Hs68 Human Fibroblasts. ACTA ACUST UNITED AC 2013. [DOI: 10.6116/kjh.2013.28.1.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|