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Hannes S, Kochergin M, Al-Haidary J, Götze T, Habbe N. OTSC Proctology clip as appropriate treatment for complicated anorectal fistula. Int J Colorectal Dis 2023; 38:222. [PMID: 37646885 DOI: 10.1007/s00384-023-04516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Evaluation of the effectiveness and tolerability of the application of an OTSC (Ovesco Endoscopy AG Tuebingen, Germany) Proctology clip as an innovative strategy of anorectal fistulae closure when established treatment strategies had already failed or were not feasible. METHODS Retrospective single-center study including consecutive patients treated between March 2014 and March 2016 with the OTSC Proctology system for anorectal fistula closure, including one rectovaginal and one rectourethral fistula. The primary outcome was the healing rate with a minimum follow up of 6 months. Healing was defined as closure of the internal fistula ostium and absence of secretion or local inflammation during follow up. RESULTS A total of 66 fistula closures by the OTSC Proctology clip were investigated, including cryptoglandular fistulas (45/66 patients, 68%), fistulas associated with CED (19/66 patients, 29%), and other non-cryptoglandular fistulas (2/66 patients, 4%). 47% (31/66 patients) had a failed previous therapy. In that selected collective, a successful fistula closure was achieved in 29/66 cases (44%) after a median follow up time of 40 months (6-61 months). Suprasphincteric and high transsphincteric fistulas showed healing in 63% and 42% in CD associated fistulas. CONCLUSION Fistula closure by the OTSC Proctology clip is an innovative, sphincter protecting treatment strategy in anorectal fistulas that can achieve long-term cure in complex anorecta.
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Affiliation(s)
- Sabine Hannes
- Department of Surgery and Coloproctology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Maxim Kochergin
- Department of Surgery and Coloproctology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Jasmin Al-Haidary
- Department of Surgery and Coloproctology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Thorsten Götze
- Institute for Clinical Oncological Research, North West Hospital, Frankfurt, Germany
| | - Nils Habbe
- Department of Surgery and Coloproctology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany.
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Pérez Lara FJ, Hernández González JM, Prieto-Puga Arjona T, Moya Donoso FJ, Doblas Fernández J. A New, Conservative Treatment for Perianal Fistula that May Halve the Need for Surgical Intervention: Case Series. Surg Innov 2021; 29:50-55. [PMID: 33904796 DOI: 10.1177/15533506211015196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE In the last two decades, many sphincter preservation techniques have been proposed for the treatment of anal fistula. Since 2011, our surgical team has treated fistulas by sealing them with platelet-rich fibrin (PRF). This is performed actually as an outpatient process, without anaesthesia. METHODS Patients were treated with PRF sealant, during the period June 2012-March 2017. The fibrin preparation is applied in the fistulous tract, with no need for any type of anaesthesia, and so the patient can go home immediately afterwards, without further observation. RESULTS After an average follow-up of 26.49 months, the perianal fistula had healed completely in 52.86% of the patients (n = 37), who each received an average of 1.92 sealant operations. In another 10 cases, the sealing was initially successful, but a relapse occurred during the follow-up period. CONCLUSION The outpatient treatment of perianal fistula with PRF is totally harmless, is very low cost and achieves very acceptable results. In our opinion, therefore, this could be considered an appropriate initial treatment for perianal fistula, with surgical treatment being reserved if this approach is unsuccessful, thereby avoiding many complications and producing significant economic savings for the health system.
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Affiliation(s)
| | | | - Tatiana Prieto-Puga Arjona
- Digestive Surgeon, Service of Surgery,16573Hospital de Antequera, 16752University of Malaga, Málaga, Spain
| | | | - Juan Doblas Fernández
- Digestive Surgeon, Service of Surgery,16573Hospital de Antequera, 16752University of Malaga, Málaga, Spain
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Hu J, Yang Y, Ge N, Wang S, Guo J, Liu X, Wang G, Sun S. Long-term assessment of over-the-scope clip (OTSC) behavior after gastric application. MINIM INVASIV THER 2019; 29:86-89. [PMID: 31144550 DOI: 10.1080/13645706.2019.1590417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The aim of this study was to assess the long-term behavior of the over-the-scope clip (OTSC) after gastric application.Material and methods: A database of all patients who had OTSC placement with regular follow-up at a tertiary hospital between November 2013 and September 2016 was retrospectively analyzed. The incidence, time, and related adverse events of clip attachment and detachment were recorded. The relationship between the position of the clip and detachment was assessed by Fisher's exact test.Results: Seventy-two patients who had gastric OTSC placement due to iatrogenic perforations by endoscopic interventions were included in the study. The overall incidence of clip detachment was 27.8% (20/72). Fisher's exact test confirmed a significant association between clip detachment rate and clip position (p = .005): cardia 50% (3/6); gastric fundus 13.2% (5/38); gastric body 75% (9/16); and gastric antrum 25% (3/12). Except for one patient (5%; 1/20) who experienced minor gastric hemorrhage, there were no complications related to spontaneous clip detachment. There was no delayed bleeding, perforation, or obstruction due to clips staying in place in the long-term.Conclusions: Long-term gastric clip attachment appears to be safe even if spontaneous detachment occurs.
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Affiliation(s)
- Jinlong Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
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Prosst R. Minimally invasive surgical clip closure of anorectal fistulas: current status of OTSC Proctology. MINIM INVASIV THER 2018; 28:261-267. [PMID: 30307342 DOI: 10.1080/13645706.2018.1521837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OTSC Proctology is a minimally invasive sphincter-preserving technique for the surgical treatment of anorectal fistulas. It is based on a super-elastic Nitinol clip which closes the internal fistula opening to allow healing of the fistula tract. A systematic search of the literature was undertaken to identify publications about OTSC Proctology. All studies and reports identified were reviewed and evaluated to determine the feasibility, efficacy and safety of clip surgery. The assessment of all available studies with a total of more than 200 surgical cases strongly suggests that the clip procedure is safe and effective with a low rate of complications. The technique rendered convincing short and long term results with an overall healing rate of approximately 63%. Best results were achieved when OTSC Proctology was used as first-line treatment (healing rate 74%) and for cryptoglandular fistulas (healing rate 64%). However, its future clinical role for IBD-associated recurrent and anorecto-vaginal fistulas remains to be determined, due to a relatively low number of these patients in the evaluated studies. OTSC Proctology is part of the novel armamentarium for the treatment for anorectal fistulas, which is based on high-technology devices. They can be repeatedly used and even combined without causing irreversible sphincter damage.
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Naldini G, Sturiale A, Fabiani B, Giani I, Menconi C. Micro-fragmented adipose tissue injection for the treatment of complex anal fistula: a pilot study accessing safety and feasibility. Tech Coloproctol 2018; 22:107-113. [PMID: 29453515 DOI: 10.1007/s10151-018-1755-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 12/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the safety and efficacy of autologous, micro-fragmented and minimally manipulated adipose tissue injection associated closure of the internal opening in promoting healing of complex anal fistula. METHODS A pilot study was conducted on patients referred to our center with anal fistula, from April 2015-December 2016. Inclusion criteria were age over 16 years old and a diagnosis of complex anal fistula according to the American Gastroenterological Association classification The patients were divided into 2 groups; the "first time group" (Group I) in which micro-fragmented adipose tissue injection with closure of the internal opening was the first sphincter-saving procedure, and the "recurrent group" (Group II) consisting of patients who had failed prior sphincter-saving procedures. The procedure was carried out 4-6 weeks after seton placement. Follow-up visits were scheduled at 7 days, and 1, 3, 6 and 12 months after surgery. Fistula healing was defined as the closure of the internal and external openings without any discharge. RESULTS Out of 47 patients with complex transsphincteric anal fistula, 19 met the inclusion criteria and were selected to undergo the procedure. Twelve of these patients (Group I) had micro-fragmented adipose tissue injection as first-line treatment, and 7 (Group II) had failed previous sphincter-saving procedures. The mean operative time was 55 ± 6 min (range 50-70 min). The mean postoperative pain score measured with the visual analog pain scale was 2 ± 1.4 (range 0-4). No intraoperative difficulties related to the use of the kit were recorded. There were no cases of postoperative fever or abdominal sepsis related to the procedure and no post-treatment perianal bleeding or impaired anal continence. Only 3 cases of minor abdominal wall hematoma that did not require any treatment and 1 case of perianal abscess were observed. Patients were evaluated for a mean follow-up time of 9 ± 3.1 months (range 3-12 months). The overall healing rate was 73.7, 83.3% for Group I and 57.1% for Group II. CONCLUSIONS The injection of autologous, micro-fragmented and minimally manipulated adipose tissue associated with closure of the internal opening is a safe, feasible and reproducible procedure and may enhance complex anal fistula healing.
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Affiliation(s)
- G Naldini
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
| | - A Sturiale
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy.
| | - B Fabiani
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
| | - I Giani
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
| | - C Menconi
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
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Abstract
BACKGROUND The treatment of complex anocutaneous fistulas remains a major therapeutic challenge balancing the risk of incontinence against the chance of permanent closure. OBJECTIVE The purpose of this study was to investigate the efficacy of a nitinol proctology clip for closure of complex anocutaneous fistulas. DESIGN This is a single-center cohort study with retrospective analysis of all of the treated patients. SETTINGS Data were obtained from patient records and MRI reports, as well as follow-up telephone calls and clinical follow-up with endoanal ultrasonography. PATIENTS All of the patients were treated for high transsphincteric and suprasphincteric anocutaneous fistulas at the Digestive Disease Center, Bispebjerg Hospital, between May 2013 and February 2015. INTERVENTIONS All of the patients were treated with the nitinol proctology clip. MAIN OUTCOME MEASURES Primary outcome was fistula healing after proctology clip placement, as evaluated through clinical examination, endoanal ultrasonography, and MRI. RESULTS The fistula healing rate 1 year after the clip procedure was 54.3% (19 of 35 included patients). At the end of follow-up, 17 (49%) of 35 patients had persistent closure of the fistula tracks. No impairment of continence function was observed. Treatment outcome was not found to be statistically associated with any clinicopathological characteristics. LIMITATIONS The study is limited by its retrospective and nonrandomized design. Selection bias may have occurred, because treatment options other than the clip were available during the study period. The small number of patients means that there is a nonnegligible risk of type II error in the conclusion, and the follow-up may be too short to have detected all of the failures. CONCLUSIONS Healing rates were comparable with those of other noninvasive, sphincter-sparing techniques for high-complex anocutaneous fistulas, with no risk of incontinence. Predictive parameters for fistula healing using this technique remain uncertain. See Video Abstract at http://links.lww.com/DCR/A347.
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Dango S, Antonakis F, Schrader D, Radzikhovskiy A, Ghadimi MB, Hesterberg R. Long-term efficacy and safety of a nitinol closure clip system for anal fistula treatment. MINIM INVASIV THER 2017; 26:227-231. [PMID: 28151035 DOI: 10.1080/13645706.2017.1282521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Treatment failure of anal fistula results in high re-occurrence rate. MATERIAL AND METHODS Efficacy and safety of a nitinol closure clip system (bear-claw clip) were evaluated for anal fistulae treatment in a 36-month long-term follow-up study. RESULTS Twenty-two patients were included. No patient had been treated with a bear-claw clip system before. All patients were fully continent before treatment. Follow-up time was 36 months (range 19-48 months). We observed a re-occurrence rate of 41% (nine patients) with presence of an active fistula. Time to recurrence was on average 6.9 months (range 3-11 months). Thirteen patients (59%) showed a complete healing of the fistula. Placed clip was removed in all patients on average after almost 5.8 months (3-12 months), in three cases the clip was left in situ. We did not observe any incontinence; one patient reported recurrent burning after defecation once the clip system was removed. DISCUSSIONS Clip placement is a minimally invasive sphincter-preserving procedure with minimal complications and with an acceptable recurrence rate in the long term. However, bear-claw clip placement should probably be offered patients as a treatment option before more invasive procedures with higher perioperative morbidity are taken into consideration.
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Affiliation(s)
- Sebastian Dango
- a Clinic for General- and Visceral Surgery , Rotes Kreuz Krankenhaus Kassel , Kassel , Germany.,b Department of General, Visceral and Pediatric Surgery , University Medical Center Goettingen , Goettingen , Germany
| | - Fillimon Antonakis
- a Clinic for General- and Visceral Surgery , Rotes Kreuz Krankenhaus Kassel , Kassel , Germany
| | - Dirk Schrader
- a Clinic for General- and Visceral Surgery , Rotes Kreuz Krankenhaus Kassel , Kassel , Germany
| | - Arkadiy Radzikhovskiy
- a Clinic for General- and Visceral Surgery , Rotes Kreuz Krankenhaus Kassel , Kassel , Germany
| | - Michael B Ghadimi
- b Department of General, Visceral and Pediatric Surgery , University Medical Center Goettingen , Goettingen , Germany
| | - Rudolf Hesterberg
- a Clinic for General- and Visceral Surgery , Rotes Kreuz Krankenhaus Kassel , Kassel , Germany
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Ommer A, Herold A, Berg E, Farke S, Fürst A, Hetzer F, Köhler A, Post S, Ruppert R, Sailer M, Schiedeck T, Schwandner O, Strittmatter B, Lenhard BH, Bader W, Krege S, Krammer H, Stange E. S3-Leitlinie: Kryptoglanduläre Analfisteln. COLOPROCTOLOGY 2016. [DOI: 10.1007/s00053-016-0110-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Honegger C, Valli PV, Wiegand N, Bauerfeind P, Gubler C. Establishment of Over-The-Scope-Clips (OTSC®) in daily endoscopic routine. United European Gastroenterol J 2016; 5:247-254. [PMID: 28344792 DOI: 10.1177/2050640616657273] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alongside the evolution of interventional endoscopy, the need for a more sophisticated closure tool tailored to the treatment of new challenging indications has been increasing rapidly. METHODS We here present our collected data on 262 Over-The-Scope-Clip (OTSC®) placements in a total of 233 interventions at our institution. Follow-up was focused on clinically lasting success with regards to different indications. RESULTS Immediate success of OTSC® treatment was observed in 87.1% of all sessions (203/233). The success rates per indication were as follows: spontaneous bleeding 84.8% (28/33); iatrogenic bleeding 100% (20/20); acute perforation 90.3% (65/72); prophylaxis for perforation 100% (24/24); anastomotic leakage 61.1% (11/18); fistulae 80.7% (46/57); diameter reduction of the gastrojejunal anastomosis 100% (6/6); and stent fixation 100% (3/3). At 30-day follow-up, the overall success rate was 67.4% (157/233). The success rates per indication were as follows: spontaneous bleeding 69.7% (23/33); iatrogenic bleeding 90% (18/20); acute perforation 86.1% (62/72); prophylaxis for perforation 100% (24/24); anastomotic leakage 33.3% (6/18); fistulae 29.8% (17/57), diameter reduction of the gastrojejunal anastomosis 83.3% (5/6); and stent fixation 66% (2/3). CONCLUSIONS Our cohort confirms previous data on the clinical usefulness of the OTSC® in daily routine practice.
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Affiliation(s)
- C Honegger
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - P V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - N Wiegand
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - P Bauerfeind
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - C Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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Zhao QM, Yang HL, Wang L, Liu ZT, Gu XF. Treatment of comminuted patellar fracture with the nitinol patellar concentrator. MINIM INVASIV THER 2016; 25:171-5. [PMID: 26796538 DOI: 10.3109/13645706.2015.1134577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the clinical effect of the nitinol (NiTi)-patellar concentrator (NT-PC) for the treatment of comminuted patellar fractures. MATERIAL AND METHODS A total of 32 patients with acute comminuted patellar fracture accepted open reduction and internal fixation with the NT-PC, and the curative effects were evaluated using the Böstman clinical grading scale. RESULTS All fractures were anatomically reduced by surgery and all cases were followed-up for six to 18 months. The mean score of patients according to the Böstman clinical grading scale was 25.6, with 29 of 32 (90.7%) patients achieving excellent or good results. Two patients had traumatic arthritis, one had slippage of the NT-PC, and all patients received pharmacotherapy. CONCLUSIONS The application of the NT-PC is a satisfactory approach to the treatment of comminuted patellar fractures.
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Affiliation(s)
- Quan-ming Zhao
- a Department of Orthopaedics , Wuxi People 's Hospital, Nanjing Medical University , Wuxi City , Jiangsu Province , China
| | - Hui-lin Yang
- b Department of Orthopaedics , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Ling Wang
- a Department of Orthopaedics , Wuxi People 's Hospital, Nanjing Medical University , Wuxi City , Jiangsu Province , China
| | - Zhong-tang Liu
- c Department of Orthopaedics , Changhai Hospital, The Second Military Medical University , Shanghai , China
| | - Xiao-feng Gu
- a Department of Orthopaedics , Wuxi People 's Hospital, Nanjing Medical University , Wuxi City , Jiangsu Province , China
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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.
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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
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Endoscopic treatment of a rectovesical fistula following radical prostatectomy by over-the-scope clip (OTSC). Wideochir Inne Tech Maloinwazyjne 2015; 10:486-90. [PMID: 26649101 PMCID: PMC4653265 DOI: 10.5114/wiitm.2015.54101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/15/2015] [Accepted: 08/13/2015] [Indexed: 01/02/2023] Open
Abstract
The successful management of a rectovesical fistula after radical prostatectomy is difficult. Minimally invasive treatment by over-the-scope clip (OTSC) is a novel method. The authors present results with the use of OTSC. This method was used in 2 patients. The first patient had a rectovesical fistula detected on the fifth day after a prostatectomy. The second patient experienced rectal perforation during prostatectomy and a recurrent fistula after fistulorrhaphy. Both patients had a small fistula located in the vesicourethral anastomosis. Both patients underwent endoscopic OTSC placement. The median follow-up was 26 months. The success rate was 50%. The first patient healed successfully and the second patient had a relapse. The York-Mason procedure was eventually successful. According to our initial experience, the OTSC is suitable for small fistulas detected shortly after a prostatectomy. A more complex fistula, though small, carries a higher recurrence risk.
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Gautier M, Godeberge P, Ganansia R, Bozio G, Godart B, Bigard MA, Barthet M, Siproudhis L. Easy clip to treat anal fistula tracts: a word of caution. Int J Colorectal Dis 2015; 30:621-4. [PMID: 25675886 DOI: 10.1007/s00384-015-2146-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. MATERIALS AND METHODS Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. RESULTS Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion. CONCLUSION Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.
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The OTSC® proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol 2015; 19:241-6. [DOI: 10.1007/s10151-015-1284-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 01/10/2015] [Indexed: 01/03/2023]
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Prosst RL, Joos AK, Ehni W, Bussen D, Herold A. Prospective pilot study of anorectal fistula closure with the OTSC Proctology. Colorectal Dis 2015; 17:81-6. [PMID: 25175824 DOI: 10.1111/codi.12762] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/03/2014] [Indexed: 12/12/2022]
Abstract
AIM The OTSC Proctology is a surgical device for anorectal fistula closure. It consists of a super-elastic nitinol clip, which is placed (with the aid of a transanal applicator) on the internal fistula opening to achieve healing of the fistula track. A prospective, two-centre clinical pilot study was undertaken to assess the efficacy and safety of the OTSC Proctology in patients with a complex high anorectal fistula. METHOD In patients with a complex anorectal fistula the primary track was debrided using a special brush and the clip was applied to the internal fistula opening. After 6 months the postoperative clinical course and fistula healing were assessed. RESULTS Twenty patients with a cryptoglandular anorectal fistula (14 with a transsphincteric fistula and six with a suprasphincteric fistula) were included in the study. There were no intra-operative technical or surgical complications. Postoperatively no patient reported intolerable discomfort or a sensation of a foreign body in the anal region. At 6 months after surgery, 18 (90%) patients had no clinical signs or symptoms of fistula and were considered healed, whereas in two the fistula persisted. In 13 (72%) of these 18 patients, the clip was still in place without causing problems, whereas in three patients the clip had spontaneously detached. In the two remaining patients it was necessary to remove the clip due to discomfort and delayed wound healing. CONCLUSION Anorectal fistula closure with the OTSC Proctology is an innovative, sphincter-preserving minimally invasive procedure with promising initial results and a high rate of patient satisfaction.
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Affiliation(s)
- R L Prosst
- Proctological Institute Stuttgart, Stuttgart, Germany
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DeBarros M, Sohn VY, Steele SR. Future directions in the management of anal fistula. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of postoperative incontinence. Different methods have been proposed to overcome the need for dividing part or all of the sphincter, so-called "sphincter saving techniques" (SST), such as flap advancement, intrafistular injection of glue, or the insertion of a bio-prosthesis (collagen plug). However, the success rate of SSTs is lower than that of fistulotomy. Ligation of the Intersphincteric Fistula Tract (LIFT) is one of the most recent SSTs. It aims to ligate and transect the fistula by an approach through the intersphincteric space. The methodological quality of most published studies has been only average, but several studies have reported attractive success rates of 70 to 95% without postoperative incontinence. Other techniques such as endo-anal clip or injection of autologous stem cells are still anecdotal.
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Affiliation(s)
- E Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - P Benfredj
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - D Soudan
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V de Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
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