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The British Journal of Surgery Jan 1976A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past 15 years, based on the pathogenesis of the disease...
A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past 15 years, based on the pathogenesis of the disease and the normal muscular anatomy of the pelvic floor. Four main types were found but numerous variations of each occur, which are described. It is hoped that this will alert the surgeon to the various complex situations that he may encounter.
Topics: Abscess; Anal Canal; Humans; Muscles; Pelvis; Rectal Fistula; Rectum
PubMed: 1267867
DOI: 10.1002/bjs.1800630102 -
World Journal of Gastroenterology Mar 2017To establish and evaluate an experimental porcine model of fistula-in-ano. (Comparative Study)
Comparative Study
AIM
To establish and evaluate an experimental porcine model of fistula-in-ano.
METHODS
Twelve healthy pigs were randomly divided into two groups. Under general anesthesia, the experimental group underwent rubber band ligation surgery, and the control group underwent an artificial damage technique. Clinical magnetic resonance imaging (MRI) and histopathological evaluation were performed on the 38 d and 48 d after surgery in both groups, respectively.
RESULTS
There were no significant differences between the experimental group and the control group in general characteristics such as body weight, gender, and the number of fistula ( > 0.05). In the experimental group, 15 fistulas were confirmed clinically, 13 complex fistulas were confirmed by MRI, and 11 complex fistulas were confirmed by histopathology. The success rate in the porcine complex fistula model establishment was 83.33%. Among the 18 fistulas in the control group, 5 fistulas were confirmed clinically, 4 complex fistulas were confirmed by MRI, and 3 fistulas were confirmed by histopathology. The success rate in the porcine fistula model establishment was 27.78%. Thus, the success rate of the rubber band ligation group was significantly higher than the control group ( < 0.05).
CONCLUSION
Rubber band ligation is a stable and reliable method to establish complex fistula-in-ano models. Large animal models of complex anal fistulas can be used for the diagnosis and treatment of anal fistulas.
Topics: Animals; Disease Models, Animal; Ligation; Magnetic Resonance Imaging; Random Allocation; Rectal Fistula; Sus scrofa; Swine; Treatment Outcome
PubMed: 28348488
DOI: 10.3748/wjg.v23.i10.1828 -
Expert Review of Gastroenterology &... Jun 2015Perianal fistula is a complication of Crohn's disease that carries a high morbidity. It is a channel that develops between the lower rectum, anal canal and perianal or... (Review)
Review
Perianal fistula is a complication of Crohn's disease that carries a high morbidity. It is a channel that develops between the lower rectum, anal canal and perianal or perineal skin. The development of perianal fistulas typically connotes a more aggressive disease phenotype and may warrant escalation of treatment to prevent poor outcomes over time. Based on fistula anatomy, debris can form inside these tracts and cause occlusion, which subsequently leads to abscess formation, fever and malaise. The clinical presentation is often with complaints of pain, continuous rectal drainage of fecal matter as well as malodorous discharge. Considering that the presence of fistulas often indicates refractory and aggressive disease, early identification of its presence is important. Some patients may not have the classic symptoms of fistulizing disease at presentation and others may have significant scarring and/or pain from previous fistulizing episodes, which can make an accurate assessment on physical exam alone problematic. As a result, utilizing diagnostic imaging is the best means of identifying the early signs of perianal fistulas or abscess formation in these patients. Several imaging modalities exist which can be used for diagnosis and management. Endoscopic ultrasound and pelvic MRI are considered the most useful in establishing the diagnosis. However, a combination of multiple imaging modalities and/or examination under anesthesia is probably the most ideal. Incomplete characterization of the fistula tract(s) extent or the presence of abscess carries a high morbidity and far-reaching personal expense for the patient - promoting worsening of the disease.
Topics: Crohn Disease; Diagnostic Imaging; Endosonography; Humans; Magnetic Resonance Imaging; Predictive Value of Tests; Prognosis; Rectal Fistula; Tomography, X-Ray Computed
PubMed: 25816833
DOI: 10.1586/17474124.2015.1031110 -
The Indian Veterinary Journal May 1966
Topics: Animals; Poultry Diseases; Rectal Fistula
PubMed: 5949915
DOI: No ID Found -
Journal of Gastroenterology and... Apr 2023A perianal fistula is an abnormal tract that connects anal canal to skin. Current medical and surgical interventions have a high failure rate particularly in complex and...
Safety and efficacy of injection of human placenta mesenchymal stem cells derived exosomes for treatment of complex perianal fistula in non-Crohn's cases: Clinical trial phase I.
BACKGROUND AND AIM
A perianal fistula is an abnormal tract that connects anal canal to skin. Current medical and surgical interventions have a high failure rate particularly in complex and refractory cases. MSC-derived exosomes have demonstrated immunomodulatory effects without the conventional complications; hence, in this study, we evaluated the safety of their application for complex perianal fistula.
METHODS
Placenta-derived MSCs were cultured, and exosomes were isolated using ultracentrifugation. Exosome injections were administered in the operating room to 11 patients with complex perianal fistula (presence of fistulas for at least 1 year alongside medical and surgical treatment). The patients were followed for 6 months, and the patients were evaluated using physical examination, face-to-face interviews, and magnetic resonance imaging (MRI).
RESULTS
Among 11 patients only one did not show any improvement upon physical examination. Five patients showed complete tract resolve. While the discharge was stopped in eight patients, two patients showed only reduction. None of the patients showed any acute or latent allergic reaction or injection related complications.
CONCLUSION
Administration of exosomes isolated from MSCs demonstrates safety and a satisfactory therapeutic effect in treatment complex perianal fistulae; therefore, it can be a candidate for future studies and might play a significant role in treatment.
Topics: Humans; Crohn Disease; Exosomes; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Rectal Fistula; Treatment Outcome
PubMed: 36640153
DOI: 10.1111/jgh.16110 -
The American Journal of Gastroenterology Sep 2019
Topics: Abscess; Adult; Colonoscopy; Crohn Disease; Endoscopic Mucosal Resection; Female; Humans; Ileostomy; Osteitis; Rectal Fistula; Sacrococcygeal Region; Sacrum; Surgical Instruments
PubMed: 31397677
DOI: 10.14309/ajg.0000000000000366 -
Tidsskrift For Den Norske Laegeforening... Aug 2016
Topics: Famous Persons; France; History, 17th Century; History, 18th Century; Humans; Rectal Fistula
PubMed: 27554569
DOI: 10.4045/tidsskr.15.0312 -
Journal of Pediatric Gastroenterology... Dec 2022Perianal fistulas are among the most severe complications of Crohn disease, but limited data regarding their outcomes are available in children. Our objective was to...
OBJECTIVES
Perianal fistulas are among the most severe complications of Crohn disease, but limited data regarding their outcomes are available in children. Our objective was to determine predictors of perianal fistula healing among pediatric patients newly diagnosed with Crohn disease.
METHODS
This single-center retrospective study followed patients with perianal fistulas at Crohn disease diagnosis until fistula healing. Time to healing was analyzed using Cox proportional hazard regression models considering relevant covariates including patient demographics, disease characteristics, medical therapies [no anti-tumor necrosis factor (TNF)α therapy, anti-TNFα therapy ±therapeutic drug monitoring], and perianal surgical procedures including fistulotomy, fistulectomy, removal of perianal lesions, seton placement, and incision and drainage.
RESULTS
Of 485 patients identified, 107 (22%) had a perianal fistula at Crohn disease diagnosis. Multivariate analysis identified that perianal fistulotomy, fistulectomy, and lesion removal [hazard ratio (HR) 0.46; P = 0.028], non-White race (HR 0.30, P < 0.01), and male sex (HR 0.42; P = 0.02) were associated with delayed fistula healing. Faster fistula healing was associated with treatment with anti-TNFα with therapeutic drug monitoring (HR 1.78, P = 0.009). There were no other differences in healing by treatment.
CONCLUSIONS
Fistulotomy, fistulectomy, and perianal lesion removal as well as non-White race were associated with delayed fistula healing. Anti-TNFα therapy was associated with faster fistula healing when combined with therapeutic drug monitoring, compared to all other medical treatment groups, including anti-TNFα therapy without therapeutic drug monitoring.
Topics: Humans; Child; Male; Crohn Disease; Retrospective Studies; Treatment Outcome; Rectal Fistula; Wound Healing
PubMed: 36399175
DOI: 10.1097/MPG.0000000000003595 -
ANZ Journal of Surgery May 2010
Topics: Humans; Rectal Fistula
PubMed: 20557496
DOI: 10.1111/j.1445-2197.2010.05299.x -
Gastroenterology Clinics of North... Mar 1987Complex anal fistulas challenge the judgment and operative skills of the surgeon in effecting a cure without compromise of anorectal function. This chapter outlines the... (Review)
Review
Complex anal fistulas challenge the judgment and operative skills of the surgeon in effecting a cure without compromise of anorectal function. This chapter outlines the classification, pathogenesis, methods of investigation and alternatives of management of a variety of complex fistulas. Also reviewed are the advantages and disadvantages of both traditional and newer methods of management, with special reference to staged fistulotomy and advancement rectal flap procedures.
Topics: Anal Canal; Humans; Rectal Fistula
PubMed: 3298058
DOI: No ID Found