Does Ligation of the Intersphincteric Fistula Tract Raise the Bar in Fistula Surgery?

Wallin, Ulrik; Mellgren, Anders; Madoff, Robert D.; Goldberg, Stanley M.

doi:10.1097/dcr.0b013e318266edf3

Cited by 95 publications

(75 citation statements)

References 19 publications

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“…The failure rate is approximately 30-60 % for established surgical procedures such as the endorectal advancement flap (ERAF) [3,4] and injection of biological glues [5,6]. Also the initial enthusiasm for even newer techniques, such as anal fistula plug [7,8] and ligation of the intersphincteric fistula tract (LIFT) [9,10], decreased at the long-term follow-up, with a recurrence rate of about 70-80 % and 30-60 %, respectively [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

et al. 2015

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There is still no clear consensus about surgical treatment of anal fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex anal fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex anal fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex anal fistulas.

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Section: Introductionmentioning

confidence: 99%

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

et al. 2015

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“…Several newer methods have come into vogue like injection of foam into the tract, seton application, MAFT (minimally invasive anal fistula treatment), plugging the tract, LIFT, VAAFT etc. [18][19][20][21][22] Fistula plugging is being practiced in some centres. A. Herold A. Ommer A. Fürst et al In their study, "Results of the Gore Bio-A fistula plug implantation in the treatment of anal fistula", showed the effectiveness of plugging over conventional fistulectomy.…”

Section: Discussionmentioning

confidence: 99%

VAAFT versus fistulectomy in the management of anorectal fistulae: a comparative study?

Venkatapuram

Sateesh

2017

Int Surg J

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Background: Among the perianal diseases Fistula in ano is a very common condition bringing lot of discomfort to the patient with a high rate of recurrence as well. Conventionally fistulectomy has been the treatment of choice for fistula-in-ano. But the procedure is associated with lot of recurrence, morbidity and sphincter incontinence. Among several recent procedures VAAFT-video assisted anal fistula treatment is gaining popularity. So, we conducted this study to know the effectiveness of VAAFT over conventional fistulectomy. Methods: This prospective comparative study was undertaken to compare VAAFT and fistulectomy in the management of fistula-in-ano. A one-year study was carried out on 50 patients from mid-2015 to 2016. A visual analogue scale (VAS) was used to assess pain in the postoperative period. All patients were observed for one-year period for any recurrence of disease. Results were statistically analysed by SPSS 15.0 software. Results: two groups were formed among the 50 patients selected for study. There was male preponderance in both the groups. majority of patients belonged to 31-40 years of age group. Majority of the patients had low anal fistulae followed by patients with high anal fistulae and anorectal fistulae in that order. There was recurrence of disease in 12% of people operated by fistulectomy whereas it was only 1% in group who underwent VAAFT. Conclusions: VAAFT procedure offered significantly less recurrence rates in comparison with fistulectomy. There was less postoperative pain and nil complications after surgery. Patient satisfaction was high. Our study concluded VAAFT as a safe and effective procedure alternative to conventional fistulectomy.

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“…So beobachten 12 Publikationen keinerlei Beeinträchtigung der Kontinenzleistung, was vor dem Hintergrund der Tatsache, das jede Analoperation allein durch die Narbenbildung eine Beeinträchtigung der Kontinenz bedeutet, mit einem Fragezeichen zu versehen ist. Analog zu dieser Aussage zeigte eine Studie bei einer Heilungsrate von lediglich 40 % bei 31 % der Nachuntersuchten Kontinenzstörun-gen [28]. Es bleiben also weitere und insbesondere Langzeitbeobachtungen abzuwarten.…”

Section: Introductionunclassified

Komplikationsmanagement in der Fissur- und Fistelchirurgie

Ommer¹

2015

Chirurg

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Options for the treatment of postoperative fecal incontinence are limited. Treatment of postoperative incontinence should first be conservative. Surgical repair of damaged sphincter muscles is often of limited success and sacral nerve stimulation might be an option in selected patients. Especially in patients with fissure-in-ano the indications for surgery should be strictly adhered to. For fistula-in-ano the least invasive and most sphincter-preserving procedure should be selected.

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Does Ligation of the Intersphincteric Fistula Tract Raise the Bar in Fistula Surgery?

Abstract: The present study indicates that the ligation of the intersphincteric fistula tract procedure for transsphincteric fistulas has a significant risk for failure but good functional outcome in patients with no recurrence.

Cited by 95 publications

References 19 publications

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

VAAFT versus fistulectomy in the management of anorectal fistulae: a comparative study?

Komplikationsmanagement in der Fissur- und Fistelchirurgie

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