Photodynamic Therapy for the Treatment of Complex Anal Fistula

Arroyo, Antonio; Sánchez‐Guillén, Luis; Parra, Pedro; García-Catalá, Luis; Peña-Ros, Emilio; Ferrer-Márquez, Manuel; Riera, Carmen Nofuentes; Barber, Xavier; Romero-Simó, Manuel

doi:10.1002/lsm.23162

“…However, the different shapes of some CAFs, the easy omission of branch fistulas, and the difficulty of displaying the internal mouth all increase the difficulty of diagnosis, so choosing an examination method that clearly shows the main points of diagnosis is beneficial to the design of operation. Maximize the protection of anal function, and reduce the occurrence of sequelae [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study

Zhang

¹

,

Zhang

²

,

Zhao

³

et al. 2022

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

Objective. A case-control study was employed to retrospectively analyze the value of transrectal ultrasound in the preoperative diagnosis of complex anal fistula (CAF). Methods. The clinical data of 128 patients with CAF treated in our hospital from March 2019 to June 2021 were analyzed retrospectively. All patients were examined by transrectal ultrasound and MRI with Hitachi HI Vision Ascendus ultrasound diagnostic apparatus and MRI. The general data of the patients (age, sex, course of disease, complications, and previous operation history) and ultrasonic image characteristics were recorded. The consistency of internal orifice, head, branch/abscess, and abscess detected by ultrasound, MRI, and ultrasound combined with MRI were compared, and the sensitivity, accuracy, and specificity of ultrasound, MRI, and the combination of ultrasound and MRI (ultrasound+MRI) in the diagnosis of different Parks classification of anal fistula (AF) were compared. Results. The ultrasound images of the rectal probe in typical cases were compared with the MRI images. The characteristics of the ultrasound images were as follows: the outer orifice of AF was a thin strip of mixed echo or low echo leading to the skin side, and the inner orifice showed local dilated low echo, mixed echo, or interruption of mucosal continuity. The following are the MRI image features: abnormal long bar signal shadow from the dorsal side of the end of the coccyx to the S5 plane, low signal on T1WI, high signal on T2WI, blurred boundary, uneven signal, bifurcation in the lower end of the tail for “Y” shape, one branch opening at the body surface at about 6 o’clock, the other walking horizontally, passing through the levator ani muscle to the right posterior position of the rectum at about 6:00 o’clock, and penetrating the inner mouth of the rectum at 6 o’clock. The detection of internal orifice, head, branch/abscess, and abscess were compared by three examination methods. There was significant difference in the detection rate of internal orifice and branch/purulent cavity among the three methods ( P < 0.05 ). The detection rates of internal mouth and branch/abscess cavity by ultrasound and MRI (94.77% and 94.94%) were higher than those by single ultrasound (75.16% and 79.78%) and MRI (81.05% and 83.15%) ( P < 0.05 ). There was no significant difference in the detection rate of ultrasound, MRI internal orifice, and branch/purulent cavity ( P > 0.05 ). There was no significant difference in the detection rate of supervisor and abscess among the three methods ( P > 0.05 ). The results of operation included transsphincter type ( n = 53 ), intersphincter type ( n = 45 ), and superior sphincter type ( n = 30 ). Analysis of transsphincter type AF detected by three methods: 42 cases of transsphincter type AF and 86 cases of nonsphincter type AF were detected by ultrasound, 36 cases of transsphincter type AF and 92 cases of nontranssphincter type AF were detected by MRI, 57 cases of transsphincter type AF and 71 cases of nonsphincter type AF were detected by ultrasound and MRI. The comparison of the efficacy of the three methods in the diagnosis of transsphincter AF and the sensitivity of the three methods in the diagnosis of transsphincter AF showed significant difference ( P < 0.05 ). The sensitivity of ultrasound and MRI in the diagnosis of transsphincter AF (96.23%) was higher than those of single ultrasound (67.92%) and MRI (64.15%) ( P < 0.05 ). There was no significant difference in the accuracy and specificity of the three methods in the diagnosis of transsphincter AF ( P > 0.05 ). There were 41 cases of intersphincter type AF and 87 cases of nonsphincter type AF detected by ultrasound, 38 cases of intersphincter type AF and 90 cases of nonsphincter intersphincter type AF detected by MRI, and 45 cases of intersphincter type AF and 83 cases of nonsphincter intersphincter type AF detected by ultrasound and MRI. The sensitivity and accuracy of the three methods in the diagnosis of intersphincter AF were statistically significant ( P < 0.05 ). The sensitivity and accuracy (100.00% and 100.00%) of ultrasound and MRI in the diagnosis of intersphincter AF were higher than those of single ultrasound (66.67% and 79.69%) and MRI (71.11% and 85.16%) ( P < 0.05 ). There was no significant difference in the specificity of the three methods in the diagnosis of intersphincter AF ( P > 0.05 ). The results of three methods were compared, including 24 cases of superior sphincter type AF and 89 cases of nonsuperior sphincter type AF, 21 cases of superior sphincter type AF, and 107 cases of nonsuperior sphincter type AF detected by MRI and 93 cases of superior sphincter type AF and 128cases of nonsuperior sphincter type AF detected by ultrasound and MRI. There was no significant difference in the sensitivity, accuracy, and specificity of the three methods in the diagnosis of superior sphincter AF ( P > 0.05 ). Conclusion. The sphincter, anorectal, and surrounding tissues were clearly demonstrated by transrectal ultrasound. The internal orifice, head, branch/abscess, abscess, and the relationship between abscess and sphincter in the diagnosis of CAF were in good agreement with the surgical results. Ultrasound+MRI can take into account the advantages of ultrasound and MRI, make up for each other, and improve the detection rate of internal orifice and branch/abscess. It can improve the sensitivity of diagnosis of transsphincter AF and the sensitivity and accuracy of intersphincter AF, which can provide intuitive and valuable imaging information for surgical intervention.

show abstract

“…The diagnostic criteria for anal stula are from the guideline for the treatment of perianal abscesses and anal stulas formulated by the American College of Colorectal Surgeons in 2016 (28). Inclusion criteria: ( (5) with mental disorders, and is di cult to cooperate with the research; (6) pregnant or breasting women; (7) in ammatory bowel disease, diabetes, tuberculosis, acquired immunode ciency syndrome or anorectal malignant tumor. Recruitment of subjects in this study will be conducted by publishing subject recruitment information on the Internet and advertisement subject recruitment in outpatient clinics.…”

Section: Study Population and Recruitmentmentioning

confidence: 99%

“…The disease brings great physical discomfort to the patient, signi cantly affects the quality of normal daily life, and causes a great psychological burden. Surgery is the main treatment method for anal stulas, but there is a certain recurrence rate after surgery, especially for complex anal stulas, and the postoperative recurrence rate is as high as 10%, and sequelae such as anal incontinence and mucosal eversion are easily left (5)(6)(7)(8). In particular, high complex anal stulas can lead to repeated perianal infection.…”

Section: Introductionmentioning

confidence: 99%

Two-Fingers digital rectal examination for anal diseases: protocol of a prospective, diagnostic study

Zhi

¹

,

Guo

²

,

Li

³

et al. 2023

Preprint

0

View full text Add to dashboard Cite

Purpose Anal fistula is an anorectal infectious disease caused by perianal abscess or perianal disease. Surgery is the main treatment method for anal fistula. Accurate anorectal examination is of great significance to reduce the missed diagnosis rate of anal fistula, especially the misdiagnosis of anal fistula with no clear external opening. Two-Fingers digital rectal examination (TF-DRE) is a method improved by Professor Zheng Lihua on the basis of traditional digital anus examination. It has been used since 2012 and has accumulated a lot of clinical experience. However, there is a lack of comprehensive research on the value of TF-DRE for the diagnosis of anal fistula. The main purpose of this study is to compare the difference in the diagnostic value of TF-DRE, traditional digital rectal examination, and anorectal ultrasonography in the diagnosis of anal fistula. Methods For patients who met the inclusion criteria, TF-DRE was performed to explore the number and location of the external orifice, internal orifice, the number of fistula and the relationship with the perianal sphincter, as well as the data recorded by digital rectal examination and anorectal ultrasonography To make a comparison, the final diagnosis results from clinicians during the operation was taken as the gold standard, the diagnostic accuracy of TF-DRE for anal fistula is calculated, and the significance of TF-DRE in the preoperative diagnosis of anal fistula is studied and analyzed. All statistical results were analyzed using SPSS22.0, and P < 0.05 indicated that the difference was statistically significant. Conclusion The research protocol details the advantages of TF-DRE compared with digital rectal examination and anorectal ultrasonography in the diagnosis of anal fistula, and provides clinical evidence for the diagnostic value of TF-DRE in anal fistula. As an innovative anorectal examination method, there is still a lack of high-quality research using scientific methods in the current literature. This study will provide rigorously designed clinical evidence for TF-DRE.

show abstract

“…However, although success rates range from 59.6% to 70.0%, 6 this technique also shows variable incontinence rates (0%-45%). 2,7 Several sphincter-preserving techniques, such as ligation of intersphincteric fistula tract, 4,8 FiLaC, 9,10 photodynamic therapy, 11 fibrin glue, 2 fistula plugs, 12 and others, have been proposed to avoid this incontinence and generally report high recurrence rates (30%-60%). 3 However, there is no consensus on a gold-standard treatment for complex anal fistulas.…”

Section: Principales Medidas De Valoracionmentioning

confidence: 99%

Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula

Aguilar-Martínez

¹

,

Sánchez‐Guillén

²

,

Barber

³

et al. 2021

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Fistulotomy with immediate sphincteroplasty is a technique that can heal fistulas and decrease fecal incontinence more effectively than fistulotomy alone, in selected patients. OBJECTIVE: We aimed to perform a long-term evaluation of fecal incontinence after fistulotomy and immediate sphincteroplasty in patients with complex anal fistula. DESIGN: This prospective study included patients undergoing fistulotomy and immediate sphincteroplasty for complex anal fistula from January 2000 to December 2010. SETTINGS: The study was conducted by 2 colorectal surgeons in the coloproctology unit of the General Hospital of Elche. PATIENTS: We included patients aged ≥18 years with complex anal fistulas of cryptoglandular origin. MAIN OUTCOME MEASURES: Main outcomes were recurrence and continence after fistulotomy and immediate sphincteroplasty, according to fistula tract height and preoperative continence status. RESULTS: A total of 107 patients were included; 68.2% were men, with a mean age of 48 years and mean fistula duration of 12.8 months. The range and median follow-up period were 84 to 204 and 96 months. Thirty-seven fistulas were not primary. The overall healing rate was 84.1%. Primary fistulas healed by the end of follow-up in 58 (82.9%) of 70 patients; recurrent fistulas healed in 32 (86.5%) of 37; high tracts healed in 31 (83.8%) of 37, and nonhigh fistulas healed in 59 (84.3%) of 70. Male sex (OR = 0.66 (95% CI, 0.20–2.13); p > 0.05) and recurrent fistulas (OR = 0.43 (95% CI, 0.11–1.68); p > 0.05) could have a protective effect against postoperative fecal incontinence; however, more studies with larger sample sizes are necessary to confirm this result, whereas high fistulas showed a 4-fold increased risk of incontinence (range, 1.22–13.06; p < 0.01). One in 5 high-tracts patients experienced continence deterioration. LIMITATIONS: This was a prospective study, and randomized clinical trials with more patients and longer follow-up are needed to compare fistulotomy and immediate sphincteroplasty with other sphincter-preserving techniques. CONCLUSIONS: Fistulotomy and immediate sphincteroplasty are good options for treating complex anal fistulas, especially for recurrent fistulas, men, and patients with nonhigh tracts, with acceptable recurrence and incontinence rates. See Video Abstract at http://links.lww.com/DCR/B498. EVALUACIÓN A LARGO PLAZO DE LA FISTULOTOMÍA Y LA ESFINTEROPLASTIA INMEDIATA COMO TRATAMIENTO PARA LA FÍSTULA ANAL COMPLEJA ANTECEDENTES: La fistulotomía y la esfinteroplastia inmediata es una técnica que puede curar las fístulas y disminuir la incontinencia fecal de manera más efectiva que la fistulotomía sola, en pacientes seleccionados. OBJETIVO: Nuestro objetivo fue realizar una evaluación a largo plazo de la incontinencia fecal después de la fistulotomía y la esfinteroplastia inmediata en pacientes con fístula anal compleja. DISEÑO: Este estudio prospectivo incluyó pacientes sometidos a fistulotomía y esfinteroplastia inmediata por fístula anal compleja, desde enero d...

show abstract

Photodynamic Therapy for the Treatment of Complex Anal Fistula

Cited by 13 publications

References 25 publications

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study

Two-Fingers digital rectal examination for anal diseases: protocol of a prospective, diagnostic study

Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula

Contact Info

Product

Resources

About