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Techniques in Coloproctology Apr 2022
Topics: Humans; Magnetic Resonance Imaging; Rectal Fistula
PubMed: 35224686
DOI: 10.1007/s10151-022-02605-0 -
World Journal of Gastroenterology Sep 2021Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the... (Review)
Review
Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.
Topics: Anal Canal; Humans; Magnetic Resonance Imaging; Postoperative Period; Radionuclide Imaging; Rectal Fistula
PubMed: 34588745
DOI: 10.3748/wjg.v27.i33.5460 -
International Journal of Colorectal... Sep 2021Treatment of ano-cutaneous fistulas remains a therapeutic challenge. Fistula Laser Closure (FiLaC™) is a relatively new technique for the treatment of ano-cutaneous...
PURPOSE
Treatment of ano-cutaneous fistulas remains a therapeutic challenge. Fistula Laser Closure (FiLaC™) is a relatively new technique for the treatment of ano-cutaneous fistulas. This study aimed to determine the success rate of fistula closure using FiLaC™. Secondary endpoints included adverse events and patient characteristics associated with treatment success.
METHODS
This was a retrospective cohort study of consecutive patients subjected to FiLaC™ at Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, between March 2017 and July 2019. All patients had a one-track fistula not suitable for fistulotomy. All were treated with a draining seton for at least 8 weeks prior to laser closure. Fistulas were ablated with a 360-degree emitting 12-watt 1470 nm laser probe. The inner fistula opening was closed with absorbable suture. All patients were followed with clinical examination including MRI or EAUS 1 year after the procedure.
RESULTS
In total, 66 patients with 68 fistulas were included. Two patients had a high intersphincteric, 20 had low transsphincteric, 41 high transsphincteric and 5 had suprasphincteric fistulas. Fistula aetiology was cryptoglandular in 83.8%, whereas the rest were due to Crohn's disease. Thirty-one (45.6%) were subjected to a second FiLaC™ procedure. Follow-up was median 19 months (12-26 months). Ultimately, 30 of 68 (44.1%) of the fistulas healed. No cases of incontinence following FiLaC™ were observed, but a single patient developed an abscess.
CONCLUSION
Fistula closure with FiLaC™ had success rates comparable to that of other sphincter-sparing techniques. The technique seems safe with respect to adverse events and risk of incontinence.
Topics: Anal Canal; Humans; Lasers; Organ Sparing Treatments; Rectal Fistula; Retrospective Studies; Treatment Outcome
PubMed: 33881573
DOI: 10.1007/s00384-021-03932-8 -
Journal of the American Geriatrics... Apr 1986
Topics: Aged; Female; Humans; Indomethacin; Rectal Fistula; Suppositories
PubMed: 3950305
DOI: 10.1111/j.1532-5415.1986.tb04232.x -
Diseases of the Colon and Rectum Sep 1994A study of 523 fistulas of cryptoglandular origin operated on between January 1985 and December 1991 at the Lehigh Valley Hospital was undertaken for the purpose of... (Review)
Review
PURPOSE
A study of 523 fistulas of cryptoglandular origin operated on between January 1985 and December 1991 at the Lehigh Valley Hospital was undertaken for the purpose of establishing whether the "so-called" simple fistula-in-ano has a favorable outcome. High transsphincteric fistulas with or without high blind tract, suprasphincteric, extrasphincteric, and horseshoe fistulas as well as fistulas associated with inflammatory bowel disease were excluded.
METHODS
Four-hundred sixty-one patients with anal fistulas classified as simple fistulas-in-ano (uncomplicated transsphincteric, low and high blind track intersphincteric) were studied retrospectively. There were 310 males and 151 females with an average age of 42 years and mean follow-up of 34 months.
RESULTS
Thirty (6.5 percent) patients developed recurrent fistulas: 16 (53.3 percent) because of missed internal openings at initial surgery, six (20 percent) attributed to missed secondary tracks, five (16.7 percent) because of premature fistulotomy wound closure, and three (10 percent) because of miscellaneous factors.
CONCLUSION
All so-called simple fistulas-in-ano may not have readily detectable primary openings and may possess secondary tracks which preclude their behavior as simple fistulas.
Topics: Adult; Aged; Electrocoagulation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Rectal Fistula; Recurrence; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Wound Healing
PubMed: 8076487
DOI: 10.1007/BF02052593 -
Cirugia Espanola Dec 2017Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the... (Review)
Review
INTRODUCTION
Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex.
METHODS
A systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included.
RESULTS
From 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low- level evidence. Results in a series with follow-up from 8,4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results.
CONCLUSION
The review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.
Topics: Crohn Disease; Digestive System Surgical Procedures; Humans; Rectal Fistula; Surgical Flaps
PubMed: 29037747
DOI: 10.1016/j.ciresp.2017.09.002 -
World Journal of Gastroenterology Jul 2011Fistula-in-ano is a difficult problem that physicians have struggled with for centuries. Appropriate treatment is based on 3 central tenets: (1) control of sepsis; (2)...
Fistula-in-ano is a difficult problem that physicians have struggled with for centuries. Appropriate treatment is based on 3 central tenets: (1) control of sepsis; (2) closure of the fistula; and (3) maintenance of continence. Treatment options continue to evolve - as a result, it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options. This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.
Topics: Anal Canal; Disease Management; Fibrin Tissue Adhesive; Humans; Rectal Fistula; Surgical Flaps; Treatment Outcome
PubMed: 21876615
DOI: 10.3748/wjg.v17.i28.3286 -
Therapeutische Umschau. Revue... Jul 2013In patients with Crohn's disease, perianal lesions can be found at presentation in 20 - 30 % of all cases and a majority will have fistulas or abscesses. If a fistula is... (Review)
Review
In patients with Crohn's disease, perianal lesions can be found at presentation in 20 - 30 % of all cases and a majority will have fistulas or abscesses. If a fistula is suspected, careful inspection of the perianal region will often confirm the diagnosis. Further investigation should be done by magnet-resonance imaging or anal endosonography to guide preoperative planing and minimize recurrence rates. Simple, uncomplicated fistulas are primarily treated with antibiotics. For complex fistulas combined with medication and surgical treatment usually offers the best treatment. Treatment of complex fistulas by surgery alone is rarely curative and may have significant morbidity, while medical treatment has the disadvantage of high recurrence rates and significant costs for long-term therapy. In trans-, supra- and extrasphincteric fistulas, immunosuppressants or anti-TNF alpha blockers will lead to sustained clinical remission with fistula closure in 30 - 50 %. However, 25 % of all patients with perianal Croh's disease will still need surgery during the course of their disease. Fistulotomy is used for subcutaneous or short intersphincteric fistulas while it should be avoided in fistulas with significant involvmenet of the sphincter muscles to avoid fecal incontinence. Seton drainage may be used as definitve treatment or as a bridge to a secondary surgical therapy. Minimally invasive precedures, such as the anal fistula plug have also been used in Crohn's disease. Although recurrence rates are high, the procedure is easy to perform and carries a low risk of incontinence and may therefore be used as primary treatment option for complex fistulas. The fistulectomy and closure of the inner fistula opening, e. g. with a mucosal advancement flap, is still considered the standard procedure, especially for complex fistulas. Anal fissures, ulcers and strictures are non-fistulating perianal lesions of Crohn's disease.
Topics: Crohn Disease; Drainage; Humans; Plastic Surgery Procedures; Rectal Fistula
PubMed: 23798025
DOI: 10.1024/0040-5930/a000427 -
Postgraduate Medicine Apr 2015Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of... (Review)
Review
Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of life. The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them. Antibiotics are commonly used despite a lack of controlled trials to validate their use and should be used as a bridge to maintenance therapy. The anti-metabolites azathioprine and 6-MP have shown a positive response in terms of fistula closure, although these data are mostly from trials looking at this as a secondary endpoint. Infliximab is an effective agent for induction and maintenance of treatment of fistulizing CD. Further studies to evaluate the use of subcutaneous anti-tumor necrosis factors are needed to convincingly prove their efficacy for perianal fistulizing disease. In CD, clinicians should avoid surgery as a first-line approach for skin tags, hemorrhoids or fissures in the setting of proctitis. Surgery, particularly lateral internal sphincterotomy, in combination with medical therapy is associated with higher fissure healing rates in the absence of proctitis. Fistulotomy is curative for most simple low perianal fistulae, but complex fistulas often require sphincter-sparing surgical procedures. Less invasive approaches such as a chemical sphincterotomy should be used first, with therapy escalated only if this fails.
Topics: Anus Diseases; Crohn Disease; Humans; Rectal Fistula
PubMed: 25746229
DOI: 10.1080/00325481.2015.1023160 -
Pediatric Dermatology 2015Infantile fistula-in-ano is a well-known entity to pediatric surgeons but less recognized by dermatologists. Because these patients may initially present to a... (Review)
Review
Infantile fistula-in-ano is a well-known entity to pediatric surgeons but less recognized by dermatologists. Because these patients may initially present to a dermatologist or pediatric dermatologist, familiarity with the presentation is important. We present two infants with fistula-in-ano and review the literature on this condition.
Topics: Biopsy, Needle; Follow-Up Studies; Humans; Immunohistochemistry; Infant; Male; Rectal Fistula; Risk Assessment; Severity of Illness Index; Surgical Procedures, Operative; Treatment Outcome
PubMed: 26205239
DOI: 10.1111/pde.12638