Management of Complex Anal Fistulas

Bubbers, Emily J.; Cologne, Kyle G.

doi:10.1055/s-0035-1570392

Cited by 70 publications

(57 citation statements)

References 72 publications

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“…3 cases undergoing fistulectomy, developed complications, in which two of them had postoperative bleeding which was controlled by anal packing and one of them had perianal infection needing additional antibiotics and slough excision. 14,15 There were no complications in patients who underwent VAAFT. When patients were followed up, there was recurrence of disease in 20% of people operated by fistulectomy, whereas there was no recurrence in group who underwent VAAFT.…”

Section: Resultsmentioning

confidence: 89%

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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Section: Resultsmentioning

confidence: 89%

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

Venkatapuram

Sateesh

2017

Int Surg J

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“… Patients with complex FIA which included high trans‐sphincteric, extra‐sphincteric, supra‐sphincteric and horse‐shoe fistulas ; patients with a history of previous surgery for anal fistula or other previous anorectal surgery; patients with coexisting anorectal pathology such as anal fissure, haemorrhoids, rectal prolapse, neoplasm and solitary rectal ulcer; patients with secondary FIA caused by inflammatory bowel disease, tuberculosis, sexually transmitted diseases or malignancy; patients with symptoms of faecal incontinence (FI); patients with diabetes mellitus (DM) and patients receiving long courses of corticosteroids or immunosuppressive drugs. …”

Section: Methodsmentioning

confidence: 99%

A randomized controlled trial on the effect of topical phenytoin 2% on wound healing after anal fistulotomy

et al. 2019

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Aim Laying open fistulotomy is the standard treatment for simple anal fistula. However, healing of the resultant anal wound may be prolonged and may adversely affect a patient's lifestyle and work. This randomized trial aimed to assess the effect of topical phenytoin 2% powder spray on healing of the anal wound following fistulotomy. Method Adult patients with simple anal fistula who underwent anal fistulotomy were divided into two equal groups: group I applied topical phenytoin 2% powder spray on the anal wound regularly with sitz baths until complete healing was confirmed clinically and group II had regular sitz baths only. The primary outcome of the study was time to complete wound healing. Secondary outcomes were postoperative pain, complications, time to return to work and impact on lifestyle. Results Sixty patients (50 of whom were men) with a mean age of 41.4 ± 12.5 years were included. Both groups had comparable pain scores at 1 week after surgery (1 ± 0.83 vs 0.86 ± 0.81; P = 0.51). The duration to complete wound healing was 41.2 ± 2.4 days in group I and 42 ± 2.5 days in group II (mean ± SD, P = 0.21). The time to return to work was 13.5 ± 2.8 days in group I and 14.1 ± 2.6 days in group II (mean ± SD, P = 0.39). No significant differences were noted between the two groups with regard to postoperative complications or impact on lifestyle. Conclusion The use of topical phenytoin 2% powder spray did not promote wound healing, relieve postoperative pain or accelerate patient recovery after anal fistulotomy for simple anal fistula.

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“…EAF The EAF involves mobilizing the partial thickness comprising the rectal mucosa or submucosa to the fistula tract which communicate with the bowel and cover the internal opening with disease-free anorectal wall. To ensure adequate blood supply, the base should be broader than the tip at least of 2:1 ratio (11). Modifications include curved incisions, rhomboid flaps, anorectal flaps with proximal advancement and closure or dissection of the remaining fistula track (6).…”

Section: Afpmentioning

confidence: 99%

Management of anal fistula

Mladenovic¹

2017

Scripta Scientifica Medica

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Anal fistula is a chronic condition that may present de novo or after an acute anorectal abscess. Management goal is to eradicate the fistula and prevent recurrence while maintaining continence. Simple or low anal fistulas are best treated with a primary fistulotomy with excellent healing rates and functional outcomes. The management of complex anal fistulas is more difficult and controversial. No proved surgical procedure has gained acceptable as the gold standard yet. Over the last two decades, many sphincter-preserving procedures were introduced with the common goal of minimizing the injury to the anal sphincter and preserving the optimal function. Recently, a number of new techniques were developed and proposed such as ligation of intersphincteric fistula tract (LIFT); endorectal advancement flap (EAF); video-assisted anal fistula treatment (VAAFT); fistula tract laser closure (FiLAC); fibrin sealants and anal fistula plug (AFP), and adipose-derived stem cells (ASC). There are multiple techniques available for complex anal fistula repair. The best technique is not known yet, and the evidence available suffers from a lack of high-quality data and presents with very few large randomized studies. This review summarizes the management of anal fistulas and the current techniques available. It describes some new technologies, too. Scr

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Management of Complex Anal Fistulas

Cited by 70 publications

References 72 publications

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

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

A randomized controlled trial on the effect of topical phenytoin 2% on wound healing after anal fistulotomy

Management of anal fistula

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