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Kim HC, Simianu VV. Contemporary management of anorectal fistula. Surg Open Sci 2024; 17:40-43. [PMID: 38268776 PMCID: PMC10806345 DOI: 10.1016/j.sopen.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Anorectal fistula is a common, chronic condition, and is primarily managed surgically. Herein, we provide a contemporary review of the relevant etiology and anatomy anorectal fistula, treatment recommendations that summarize relevant outcomes and alternative considerations, in particular when to refer to a fistula expert.
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Affiliation(s)
- Hyung Chan Kim
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, United States of America
| | - Vlad V. Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, United States of America
- Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA, United States of America
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Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. JOURNAL OF INTEGRATIVE MEDICINE 2023:S2095-4964(23)00041-9. [PMID: 37225613 DOI: 10.1016/j.joim.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/26/2022] [Indexed: 05/26/2023]
Abstract
Kaiy (medieval cautery) is an ancient method of heat therapy in traditional Persian medicine (TPM). Some of its important applications have been neglected during the medical revolution. Meanwhile, different treatment modalities that incorporate heat, including moxibustion, have progressed in traditional Chinese medicine. In this study, we reviewed the main TPM textbooks that were written specifically in the field of kaiy. We considered the traditional teachings in the context of contemporary information, gathered from the scientific literature about moxibustion and modern cauterization. Some surgical therapeutic indications of kaiy (e.g., debridement and coagulative procedures) have been advanced by the innovation of electro-cauterization. However, those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains-which are similar to moxibustion usages-have not received the same attention. Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications, there is a striking correspondence between kaiy point mapping and acupoints. Therefore, further research on different kaiy aspects is recommended. Please cite this article as: Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. J Integr Med. 2023; Epub ahead of print.
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Affiliation(s)
- Amir Mohammad Jaladat
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran
| | - Mahdi Alizadeh Vaghasloo
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Fatemeh Atarzadeh
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran
| | - Mohammad Hossein Ayati
- Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Amir Hooman Kazemi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; International School, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Emine Akin
- Alkali Life Center, Healthy Life & Consultancy and Education, Ataşehir-İstanbul 34750, Turkey
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran.
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Yin G, Wang J, Wang X, Zhan Y, Tang X, Wu Q, Wang X, Du L, Lu X. Multifunctional all-in-one adhesive hydrogel for the treatment of perianal infectious wounds. Front Bioeng Biotechnol 2022; 10:989180. [PMID: 36246359 PMCID: PMC9561363 DOI: 10.3389/fbioe.2022.989180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Postoperative wound of perianal infectious disease represents a common but unique refractory wound in clinical practice. The reasons that hinder the wound healing process include not only the severe bacterial infection of the wound itself and the narrow and deep shape of the wound, but also its frequent bacterial contact. Therefore, the development of biofunctional dressings to aid in therapy is essential. In this study, we synthesized a new type of dressing comprising a hydrogel host based on the Schiff base principle and catechol groups between polydopamine, oxidized dextran, and quaternized chitosan, and then loaded it with traditional Chinese medicine molecules. These formed an integrated hydrogel for accelerated wound repair in a perianal infection model. The prepared hydrogels exhibited excellent wet tissue adhesion, antifouling, morphological variability, suitable swelling properties, and complete degradability, as well as remarkable contact antibacterial ability and the ability to rapidly scavenge free radicals. Hemostatic experiments showed excellent hemostatic properties, as the integrated hydrogel could instantly gel to seal the hemorrhage. Hemocompatibility and in vitro cell experiments showed that the integrated hydrogel had good biosafety and significantly promoted cell proliferation, which in turn accelerated the repair of infected whole cortexes in rats. A histomorphological evaluation showed that the integrated hydrogel promoted the recovery of normal anatomical tissue in rats by promoting the formation of collagen fibers and inhibiting inflammation. The results showed that this multifunctional integrated hydrogel has great potential for the treatment of continuously infected skin regeneration, providing a promising therapeutic strategy for postoperative wound healing in perianal infectious diseases.
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Affiliation(s)
- Ge Yin
- Department of Anorectal, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
- Department of Anorectal, Chengdu Thrid People’s Hospital, Chengdu, China
| | - Jingyue Wang
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Xiao Wang
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yu Zhan
- Department of Anorectal, Affiliated of Integrative Chinese and Western Medicine of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Anorectal, Chengdu First People’s Hospital, Chengdu, China
| | - Xuegui Tang
- Department of Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qie Wu
- Department of Anorectal, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
- Department of Anorectal, Chengdu Thrid People’s Hospital, Chengdu, China
| | - Xian Wang
- Department of Anorectal, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
- Department of Anorectal, Chengdu Thrid People’s Hospital, Chengdu, China
| | - Lijuan Du
- Department of Anorectal, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
- Department of Anorectal, Chengdu Thrid People’s Hospital, Chengdu, China
- *Correspondence: Lijuan Du, ; Xiong Lu,
| | - Xiong Lu
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
- *Correspondence: Lijuan Du, ; Xiong Lu,
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Parwez M, Huda T, Yadav MS, Gupta K, Mital K, Pandya B. A PILOT STUDY on the Clinical and Functional Outcomes of an Improvised Technique of Core-cut Fistulectomy for Fistula-in-ano. Surg Innov 2022; 29:426-437. [PMID: 35341401 DOI: 10.1177/15533506221081134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anal fistulae are difficult to treat entities and minimally invasive procedures are evolving with promises. Our improvised technique is a simple and easy day-care procedure for simple fistulae. AIM To evaluate the outcomes of a technical modification in the procedure of core-cut fistulectomy in simple cryptoglandular fistula-in-ano. METHODS 47 patients of fistula-in-ano presenting to the out-patient of the General Surgery department at All India Institute of Medical Sciences, Bhopal, from November 2018 to March 2020 were selected. A complete history, physical examination followed by relevant investigations were meticulously performed and recorded. They were operated using an improvised core-cut technique, under a pudendal nerve block. Patients were kept on follow-up for a minimum of 6 months period to note the outcome of the surgery. RESULTS The mean age was 37 ± 13.17 years with a male: female ratio of 5.1:1. The most common clinical presentation was perianal discharge in 96% of patients followed by pain and pruritus ani in 45% and 32%, respectively. 93.62% were inter-sphincteric, and 6.38% were trans-sphincteric. Extra-sphincteric and supra-levator fistulae were excluded from the study. The mean operative time was 17 ± 10.19 minutes. The mean healing time was 19.21 ± 5.99 days. The success rate of this novel technique of core-cut was calculated to be 89.37%. The rate of recurrence was calculated to be 10.63% (5 out of 47 patients). None of our patients developed incontinence. CONCLUSION Our pilot study results for simple fistulae-in-ano had less morbidity, postoperative pain, better wound healing, patient satisfaction, and compliance with low risk of recurrence, and no incontinence. It could hence be recommended for larger groups and more complicated fistulae in the future.
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Affiliation(s)
- Masoom Parwez
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Tanweerul Huda
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Moorat S Yadav
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
| | - Kamal Gupta
- Department of General Surgery, Karan Hospital, Jalandhar, India
| | - Kushal Mital
- Department of General Surgery, Rajeev Gandhi Medical College, Thane, India
| | - Bharati Pandya
- Department of General Surgery, 390706AIIMS Bhopal, Bhopal, India
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Garg P, Kaur B, Goyal A, Yagnik VD, Dawka S, Menon GR. Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review. World J Gastrointest Surg 2021; 13:340-354. [PMID: 33968301 PMCID: PMC8069067 DOI: 10.4240/wjgs.v13.i4.340] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A complex anal fistula is a challenging disease to manage.
AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.
METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed. Preoperative magnetic resonance imaging was done in all patients. Four procedures were performed: fistulotomy; two novel sphincter-saving procedures, proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts (PERFACT) and transanal opening of intersphincteric space (TROPIS), and anal fistula plug. PERFACT was initiated before TROPIS. As per the institutional GFRI algorithm, fistulotomy was done in simple fistulas, and TROPIS was done in complex fistulas. Fistulas with associated abscesses were treated by definitive surgery. Incontinence was evaluated objectively by Vaizey incontinence scores.
RESULTS A total of 1351 anal fistula operations were performed in 1250 patients. The overall fistula healing rate was 19.4% in anal fistula plug (n = 56), 50.3% in PERFACT (n = 175), 86% in TROPIS (n = 408), and 98.6% in fistulotomy (n = 611) patients. Continence did not change significantly after surgery in any group. As per the new algorithm, 1019 patients were operated with either the fistulotomy or TROPIS procedure. The overall success rate was 93.5% in those patients. In a subgroup analysis, the overall healing rate in supralevator, horseshoe, and fistulas with an associated abscess was 82%, 85.8%, and 90.6%, respectively. The 90.6% healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess (94.5%, P = 0.057, not significant).
CONCLUSION Fistulotomy had a high 98.6% healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously. The sphincter-sparing procedure, TROPIS, was safe, with a satisfactory 86% healing rate for complex fistulas. This is the largest anal fistula series to date.
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Affiliation(s)
- Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
- Department of Colorectal Surgery, Indus International Hospital, Mohali 140201, Punjab, India
| | - Baljit Kaur
- Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh 160011, Chandigarh, India
| | - Ankita Goyal
- Department of Pathology, Gian Sagar Medical College and Hospital, Patiala 140601, Punjab, India
| | - Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive 744101, Mauritius
| | - Geetha R Menon
- Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India
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Ji L, Zhang Y, Xu L, Wei J, Weng L, Jiang J. Advances in the Treatment of Anal Fistula: A Mini-Review of Recent Five-Year Clinical Studies. Front Surg 2021; 7:586891. [PMID: 33644110 PMCID: PMC7905164 DOI: 10.3389/fsurg.2020.586891] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
Anal fistula, with its complicated pathogenesis, has been considered as a clinical challenge for centuries. The risk of frequent recurrence and incontinence constitutes a considerable threat in the long-term treatment of anal fistula. In this work, we narratively reviewed the scientific literature of new techniques that have been used for anal fistula treatment over the recent 5 years, objectively evaluated the pros and cons of each technique on the basis of clinical outcomes, and tried to disclose the effective strategies for anal fistula treatment. Up to date, surgery is the main method used for treating anal fistula, but there is no simple technique that can completely heal complex anal fistula. In the course of surgery treatment, the healing outcome, and the protection of anal function should be weighed comprehensively. Among the innovative techniques that have emerged in recent years, combined techniques based on drainage Seton and LIFT-plug seem to be the relatively effective therapies, but their effectiveness requires more multi-center prospective randomized controlled trials with large sample size and long-term follow-up to be validated.
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Affiliation(s)
- Lijiang Ji
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Yang Zhang
- Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Liang Xu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jun Wei
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Liping Weng
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jie Jiang
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
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El-Said M, Emile S, Shalaby M, Abdel-Razik MA, Elbaz SA, Elshobaky A, Elkaffas H, Khafagy W. Outcome of Modified Park's Technique for Treatment of Complex Anal Fistula. J Surg Res 2018; 235:536-542. [PMID: 30691840 DOI: 10.1016/j.jss.2018.10.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of complex anal fistula (CAF) can be associated with high rates of recurrence and fecal incontinence (FI). Park suggested drainage of the affected intersphincteric anal gland for treatment of cryptoglandular anal fistula; however, recurrence after this technique was high. We modified the original Park's technique by extending the internal sphincterotomy to ensure adequate drainage of the intersphincteric space. The aim of this study was to evaluate the incidence of recurrence and FI after modified Park's technique in treatment of CAF. METHODS Adult patients of both genders with CAF were evaluated before undergoing modified Park's technique with Wexner continence score, clinical examination, and endoanal ultrasonography or MRI. Postoperatively, patients were examined every 2 wk until complete wound healing. The continence state was evaluated with Wexner continence score, and quality of life was assessed before surgery and at 6 mo postoperatively by Short Form-36 questionnaire. RESULTS Thirty-two patients (27 male) of a mean age of 38 y were included. Median follow-up was 12 mo. Two patients (6.25%) experienced recurrence and 5 (15.6%) developed complications. One patient (3.1%) developed new-onset FI postoperatively. Twenty-eight (87.5%) patients were completely satisfied with the procedure. Quality of life showed significant improvement at 6 mo postoperatively. CONCLUSIONS The modified Park's technique is a promising procedure for the treatment of CAF with low recurrence and FI rates, and improved quality of life.
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Affiliation(s)
- Mohammed El-Said
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Sameh Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt.
| | - Mostafa Shalaby
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Mohamed Anwar Abdel-Razik
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Samy Abbas Elbaz
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Ayman Elshobaky
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Haitham Elkaffas
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Wael Khafagy
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
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Garg Classification for Anal Fistulas: Is It Better than Existing Classifications?—a Review. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1788-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Garg P. Is fistulotomy still the gold standard in present era and is it highly underutilized?: An audit of 675 operated cases. Int J Surg 2018; 56:26-30. [PMID: 29886281 DOI: 10.1016/j.ijsu.2018.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/17/2018] [Accepted: 06/06/2018] [Indexed: 12/11/2022]
Abstract
AIM Due to fear of incontinence, fistulotomy perhaps remains highly underutilized. The aim was to analyze the efficacy of fistulotomy in a large cohort, to assess the magnitude of underutilization of fistulotomy by current classifications and to identify the subgroup in whom the fistulotomy should be done. METHODS All consecutive operated patients of fistula-in-ano were included in the study retrospectively. The fistulas were classified as per existing classifications-Parks, St James University Hospital (SJUH) and Garg classification. Smaller grades of each classification (Parks I, SJUH I-II, Garg I-II) were expected to be simple fistulas and thus amenable to fistulotomy. Objective incontinence scores were done preoperatively and postoperatively. RESULTS 675 patients were operated over a 5.5 year period (median-27 months). 25 patients were excluded. Fistulotomy was done in 353/650 (54.3%) patients and sphincter-saving procedures (SSP) performed in 297/650 (45.7%) patients. After fistulotomy, 346/353 (98%) fistulas healed after the first operation. Seven patients with recurrent fistula were cured after a repeat fistulotomy surgery. Thus the overall healing rate was 353/353 (100%). There was no significant change in continence scores. The 353 fistulotomy patients were classified as per different classifications- Parks (I-225,II-112,III-16,IV-0), SJUH(I-138,II-87,III-47,IV-65,V-16) and Garg (I-188,II-165,III-0,IV-0,V-0). 123 (36.3%) patients who could undergo fistulotomy successful were erroneously classified as complex fistula by Parks and SJUH classifications. Garg classification accurately identified all 353/353 (100%) patients were amenable to fistulotomy. CONCLUSIONS Fistulotomy is a safe procedure with remarkably high success rate (100%) and is gold-standard in majority of patients (>50%). Parks and SJUH classifications are inaccurate in selecting patients for fistulotomy. Garg classification predicts amenability to fistulotomy with very high accuracy.
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Affiliation(s)
- Pankaj Garg
- Colorectal Surgery Division, Indus Super Specialty Hospital, Mohali, Punjab, India; Garg Fistula Research Institute, Panchkula, Haryana, India.
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Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature. Dis Colon Rectum 2018; 61:612-621. [PMID: 29578914 DOI: 10.1097/dcr.0000000000001051] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Supralevator fistulas are highly complex. The delineation of the supralevator fistula has become accurate because of MRI. OBJECTIVE The aim of the study was to analyze the pathophysiology and treatment of different types of supralevator fistulas. DESIGN This was a prospective study. SETTINGS The study was conducted at a specialized fistula treatment center in North India. PATIENTS All of the patients with fistula-in-ano who presented in the outpatient department were assessed with a physical examination and MRI scan. The patients in whom the supralevator extension was confirmed on MRI were included in the study. MAIN OUTCOME MEASURES The MRI scans of patients included in the study were analyzed in detail to assess the types of supralevator fistulas and other characteristics of these fistulas. The patients who were operated on were followed for cure rate and deterioration in incontinence. RESULTS Of 702 patients with fistula-in-ano who were analyzed by MRI over a period of 3 years, 51 patients with supralevator fistula-in-ano were identified. The mean age was 44.3 ± 12.1 years and the male:female ratio was 16:1. The incidence of supralevator fistulas was 7.26% (51 of 702). In supralevator fistulas, the supralevator extension (upper part) was found to be in the intersphincteric plane in all of the patients. This upper part could be successfully managed by laying it open through the transanal route. The infralevator (lower) part could be of 3 types: intersphincteric (n = 13), low transsphincteric (n = 3), or high transsphincteric (n = 35). The lower part could be managed conventionally. There were no extrasphincteric fistulas. An extensive review of the literature revealed only 2 studies (total fistulas = 16) in which supralevator fistula was studied. LIMITATIONS This was a retrospective study. CONCLUSIONS The upper supralevator extension in all of the supralevator fistulas is almost always in the intersphincteric plane. This upper part could be laid open through the transanal route. The lower infralevator part could be of 3 types, intersphincteric, low transsphincteric, or high transsphincteric, which could be managed conventionally. Thus, supralevator fistulas could be managed successfully and easily. See Video Abstract at http://links.lww.com/DCR/A630.
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Ghahramani L, Minaie MR, Arasteh P, Hosseini SV, Izadpanah A, Bananzadeh AM, Ahmadbeigi M, Hooshanginejad Z. Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial. Surgery 2017; 162:1017-1025. [PMID: 28822559 DOI: 10.1016/j.surg.2017.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Much controversy exists regarding the role of antibiotics in the development of fistula in-ano after incision and drainage. We evaluated the role of postoperative antibiotics in the prevention of fistula in-ano after incision and drainage of perianal abscess. METHODS In a randomized single blind clinical trial study, 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran, during September 2013 to September 2014. Patients were allocated randomly either to receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care or to only receive standard care without any antibiotics after they were discharged from the hospital. Patients were followed for 3 months and final results were evaluated. The study was registered at the clinical trial registry (www.irct.ir; Irct201311049936n7). RESULTS Seven patients were lost to follow-up. Those who used prophylactic antibiotics (n = 155) had significantly lower rates of fistula formation compared with those who did not use any medication (n = 144; P < .001). Men had higher rates of fistula formation (P = .002). Patients who used more cigarettes had higher rates of fistula development (P = .001). In the univariate analysis, only postoperative antibiotic use showed a protective role against fistula formation (odds ratio = 0.426; confidence interval, 0.206-0.881). In the regression analysis postoperative antibiotic use remained protective against fistula development (odds ratio = 0.371; confidence interval, 0.196-0.703), furthermore male sex presented as a risk factor for developing fistula in-ano (odds ratio = 3.11; confidence interval, 1.31-7.38). CONCLUSION Postoperative prophylactic antibiotic therapy including ciprofloxacin and metronidazole play an important role in preventing fistula in-ano formation. Considering the complications of fistula in-ano formation and the minor side effects of antibiotic therapy, based on our results, a 7-10 course of postoperative antibiotics is advised after incision and drainage of perianal abscess.
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Affiliation(s)
- Leila Ghahramani
- Department of surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Minaie
- Department of surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Non communicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran; MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Vahid Hosseini
- Department of surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Izadpanah
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Bananzadeh
- Department of surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobe Ahmadbeigi
- Post Graduate Dental Student, Student Research Committee, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
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Oldfield F, Gilbert T, Skaife P. Is modern management of fistula-in-ano acceptable? Br J Hosp Med (Lond) 2016; 77:388-93. [PMID: 27388377 DOI: 10.12968/hmed.2016.77.7.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fistula-in-ano has been managed by a number of techniques and there remains no consensus on the most appropriate management for all patients. The mainstay of any treatment balances the need to control sepsis vs the risk of potential incontinence post-intervention. Management should focus on the primary source of sepsis.
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Affiliation(s)
- Frances Oldfield
- General Surgical Registrar in the Department of Surgery, University Hospital Aintree, Liverpool
| | - Timothy Gilbert
- Core Surgical Trainee in the Department of Surgery, University Hospital Aintree, Liverpool
| | - Paul Skaife
- Consultant Colorectal Surgeon in the Department of Surgery, University Hospital Aintree, Liverpool L9 7AL
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Garg P. PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure. World J Gastrointest Surg 2016; 8:326-334. [PMID: 27152140 PMCID: PMC4840173 DOI: 10.4240/wjgs.v8.i4.326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/22/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.
METHODS: Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts (PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal (close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores (Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.
RESULTS: Seventeen patients were prospectively enrolled and followed for a median of 13 mo (range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F - 15:2. Fourteen (82.4%) had a recurrent fistula, 8 (47.1%) had an associated abscess, 14 (82.4%) had multiple tracts and 5 (29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen (73.3%) were cured and 26.7% (4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80% (12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores (Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano (SLF) published to date.
CONCLUSION: PERFACT procedure is an effective single step sphincter saving procedure to treat SLF with minimal risk of incontinence.
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Garg P. Tube in tract technique: a simple alternative to a loose draining seton in the management of complex fistula-in-ano--a video vignette. Colorectal Dis 2016; 18:107. [PMID: 26452075 DOI: 10.1111/codi.13143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/12/2015] [Indexed: 02/08/2023]
Affiliation(s)
- P Garg
- Department of General Surgery, Indus Super Specialty Hospital, 1042, Sector-15 Panchkula, Haryana, Mohali, Punjab, 134113, India.
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