Internal Orifice Alloy Closure—A New Procedure to Treat Anal Fistula

Abstract

BackgroundThe internal orifice plays an important role in the pathogenesis and treatment of the most complex fistula-in-ano. The treatment of the internal orifice is considered to be the key to the success of anal fistula surgery. The objective of this study is to evaluate the feasibility of a new sphincter-sparing surgical approach for anal fistula.Materials and MethodsAll hospitalized anal fistula patients were included in this study. Preoperative anorectal ultrasound was done on all the patients. Transanal internal orifice alloy closure (IOAC) was performed through a disposable titanium nickel alloy anal fistula stapler. The external sphincter was not cut. An anal fistula brush was used to curette and clean fistulas. Postoperative anorectal color ultrasound was used for evaluation 2 months postoperatively.ResultsTwenty-one patients (male/female: 18/3, age: 39.7 ± 10.5 years) with fistula-in-ano were included (follow-up: 6–11 months).In total, 38.1% (8) had multiple tracts, and 9.5% (2) belonged to a high anal fistula. In total, 23.8% (5) of anal fistula patients were complicated by Crohn’s disease. The fistula healed completely in 85.7% (18/21) and did not heal in 14.3% (3/21). Three patients who did not heal had conventional surgery reperformed and eventually healed. Except for three patients undergoing additional traditional anal fistula surgery, the Wexner incontinence scores of other patients did not change after surgery compared with before surgery.ConclusionsIOAC is a novel sphincter-saving technique that is simply effective in treating anal fistula containing Crohn’s anal fistula.

Evaluation of the mechanical properties and clinical application of nickel–titanium shape memory alloy anal fistula clip

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The Effects of Phellodendron Decoction on Wound Healing of Anal Fistula after Anal Fistulotomy

“…The complete healing time of the anal fistula wound was recorded. Cure standard according to “Traditional Chinese Medicine disease diagnosis and Curative effect standard.” The absence of tenderness and scarring of surgical wounds on the skin of all fistula areas, and the absence of any drainage of pus from conduits or anus, are considered criteria for complete clinical healing of anal fistulas [ 14 ].…”

Effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula: A meta‐analysis

“…High anal fistulas, located above the levator ani muscle and the anorectal ring, are especially prevalent in young and middle‐aged adults and are closely associated with dietary and lifestyle factors 3 . These fistulas often involve the anal sphincter and lead to repeated infections, pain, discharge, anal itching, and scarring, causing significant discomfort and psychological stress to patients, making them among the more challenging colorectal conditions to manage 4,5 …”

“… 3 These fistulas often involve the anal sphincter and lead to repeated infections, pain, discharge, anal itching, and scarring, causing significant discomfort and psychological stress to patients, making them among the more challenging colorectal conditions to manage. 4 , 5…”