Long-term seton drainage for high anal fistulas in Crohn's disease—A sphincter-saving operation?

Faucheron, Jean‐Luc; Saint‐Marc, Olivier; Guibert, L; Parc, R

doi:10.1007/bf02068077

Cited by 113 publications

(63 citation statements)

References 23 publications

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“…Seton use in this situation has been shown to successfully preserve fecal continence and delay or avoid a permanent stoma in those women who cannot undergo local surgical repair [3,7,18,19] .…”

Section: Surgical Managementmentioning

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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Section: Surgical Managementmentioning

confidence: 99%

Contemporary surgical management of rectovaginal fistula in Crohn's disease

Valente

Hull

2014

WJGP

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“…Short‐term healing was successful in 72–100 per cent of patients22 24, 27 28. Longer‐term (6 months or more after treatment) fistula recurrence occurred in five of 28 patients30 and three of nine patients46 at 12 months.…”

Section: Resultsmentioning

confidence: 96%

“…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%

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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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“…Ректовагинальные и параректальные свищи встречаются у 25-75% пациентов [5]. Наличие свищей нередко приводит к формированию абсцессов, затеков в параректальной клетчатке, что обу-словливает необходимость вскрытия и дренирования за-тека, а также установки дренирующей лигатуры (seton), эффективность которой составляет 79% [8][9][10][11][12].…”

Section: терапевтический архив 6 2015unclassified