New Techniques for Treating an Anal Fistula

Abstract

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

Clinical efficacy of anal fistula plug treatment regimens in anal fistula patients

“…The results uncovered that the NRS scores in AFP group were notably less than these in incision-thread-drawing group at every day of the first month after operations, implying that AFP treatment could further alleviate postoperative pain as compared to incision-thread-drawing treatment. Furthermore, during the incision-thread-drawing procedure, surgeons should carefully cut the sphincter, made a long fusiform incision at the external orifice and remove the damaged tissues around fistulas [4,20]. Nevertheless, the above processes were not done in AFP procedure.…”

“…Hence, AFP was regarded as a good therapeutic option for anal fistula patients [10]. It changed the therapeutic pattern from traditional cutting surgeries to invasive conservative methods [4]. Even though many surgeons have been turning to the use of AFP to occlude the fistula tract, support tissue remodelling and promote healing, there has been no systematic assessment between AFP procedure and traditional incision-threaddrawing procedure on the clinical efficacy.…”

“…Although traditional therapeutic options, such as fistulectomy, thread-drawing therapy, fibrin glue application etc., were used for the management of anal fistula with good healing rates, the clinical efficacy of these operations was not entirely satisfactory primarily due to long healing time, large size wounds and impaired anal function which seriously affect life quality of patients [2,3]. Moreover, high recurrence rate and high incontinence rate followed by the above operations are still enormous challenges, even for experienced anorectal surgeons [4,5]. Currently, according to the latest anal fistula treatment guidelines of American Society of Colon and Rectal Surgeons (ASCRS), it clearly pointed that it was equally important for treated patients in healing anal fistula and maintaining anal function, meanwhile it also must be balanced among the degree of sphincter incision, cure rate and postoperative anal function [6].…”

Lift procedure for long complex ano-scrotal fistula and review of literature

“…The main limitation of application of the anal fistula plug in the treatment of anal fistulae is the high cost. 14 The relatively more recent use of endoanal rectal advancement flaps and subsequently Perianal dermal-island anoplasty has shown some promise. Major limitation of endoanal rectal advancement flap is that it frequently results in a mucosal ectropion, which produces mucus and gives patients the false sensation of incontinence due to spontaneous discharge and soiling.…”

“…Because of the risk of a change in continence with these conventional techniques, sphincter-preserving techniques for the management of complex anal fistulae have been evaluated. 14 Anal fistula plug is one of the novel techniques to treat fistula-in-ano, as it preserves anal continence. The main limitation of application of the anal fistula plug in the treatment of anal fistulae is the high cost.…”