Efficacy of Anal Fistula Plug in Closure of Crohn's Anorectal Fistulas

O’Connor, Lynn; Champagne, Bradley J.; Ferguson, Martha A.; Orangio, Guy R.; Schertzer, Marion; Armstrong, David N.

doi:10.1007/s10350-006-0695-y

Cited by 208 publications

(127 citation statements)

References 13 publications

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“…The results of fibrin glue treatment have been disappointing and the technique has largely been abandoned [12]. Furthermore, treatment is changing, the introduction of the fistula plug has had initial satisfactory results [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Incontinence rates after cutting seton treatment for anal fistula

2009

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Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

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Section: Introductionmentioning

confidence: 99%

Incontinence rates after cutting seton treatment for anal fistula

2009

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“…The authors concluded that the mesh plug could be used as an adjunct to traditional advancement flap repair or muscle interposition, or possibly it could be used as an initial operation [41] . In a study by O'Connor et al [42] , the use of the fistula plug was studied in patients with Crohn's fistulae (2 with RVF) with an 80% success rate. The success of the two RVF was not specifically addressed.…”

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confidence: 99%

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Valente

Hull

2014

WJGP

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Rectovaginal fistula is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Rectovaginal fistula; Crohn's disease; Fistula; Advancement flap; Sleeve advancement; Episioproctotomy Core tip: Rectovaginal fistula secondary to Crohn's disease is a devastating and disabling condition with a significant negative impact on quality of life. Furthermore, these fistulae pose an extremely challenging dilemma for the clinician with unique and often frustrating management challenges. Medical management is often futile and surgery may offer the only chance for cure. In this article, we aim to review the various treatment options to close these difficult to treat fistulae, with an emphasis on surgical technique and complex decision making. INTRODUCTIONFistula-in-ano is the most common perianal manifestation of Crohn's disease (CD) and was first reported by Gabriel [1] in 1921, nine years before Crohn et al [2] identified regional enteritis as a clinical entity. These fistulae are classified by their relationship to the sphincter complex as either high (supra-or extra-sphincteric vs low (inter-or trans-sphincteric). Low fistulae that transverse the anal sphincter are more appropriately named anovaginal fistulae, but by convention, all such fistulae are termed rectovaginal fistula (RVF). After obstetrical trauma, CD is the most common etiological factor for RVF, and will occur in up to 10% of women with CD [3,4] . Rectovaginal fistulae secondary to CD are associated with significant morbidity and carry an increased risk for proctectomy [5,6] . It is a devastating and disabling condition and is a source of considerable social embarrassment Contemporary surgical management of rectovaginal fistula in Crohn's diseaseMichael A Valente, Tracy L Hull and has a significant negative impact on quality of life. Furthermore, CD associated RVF are an extremely challenging dilemma for the clinician and present unique and often frustrating management challenges. In this article, we aim to review the various treatment options to close these difficult to treat fistulae, with an emphasis on surgical technique and decision making. PRESENTATION AND DIAGNOSISThe presence of a fis...

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“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Study design included one RCT56, six prospective cohort studies48 50, 51 54, 55 57 and four retrospective cohort studies14 49, 52 53. In the cohort studies, follow‐up ranged from 0·75 to 29 months after the procedure.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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Efficacy of Anal Fistula Plug in Closure of Crohn's Anorectal Fistulas

Abstract: Closure of Crohn's anorectal fistula tracts using Surgisis anal fistula plug is safe and successful in 80 percent of patients and 83 percent of fistula tracts. Closure rates were higher with single tracts than complex fistulas with multiple primary openings.

Cited by 208 publications

References 13 publications

Incontinence rates after cutting seton treatment for anal fistula

Incontinence rates after cutting seton treatment for anal fistula

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Systematic review of surgical interventions for Crohn's anal fistula

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