Surgical treatment trends and outcomes for anal fistula: fistulotomy is still accurate and safe. Results from a nationwide observational study

Cano-Valderrama, Óscar; Miguel, Tamara Fernández; Bonito, Alba Correa; Muriel, Jorge Sancho; Fernández, Francisco Javier Burón; Ros, Emilio; Cabrera, Ana María García; Cerdán-Santacruz, C

doi:10.1007/s10151-023-02842-x

Cited by 4 publications

(4 citation statements)

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“…The included cases represented 6.9% of the cryptoglandular fistulas operated on at our center during the study period. We believe a basic fistulotomy can heal > 70% of fistulas [ 2 ], and other standard procedures like LIFT or “core-out” fistulectomy with mucosal flap can treat a substantial proportion of the remaining, more complex cases.…”

Section: Discussionmentioning

confidence: 99%

“…Another aspect to analyze is the possible beneficial effect of adipose tissue injection on the preservation of continence. Evidence shows that even sphincter-sparing surgical techniques cause high incontinence rates [ 2 ]. Injection of adipose tissue into sphincters has been described as a treatment for fecal incontinence [ 37 – 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Complex fistulas are those that have multiple external openings, involve > 30% of the external anal sphincter, are located above the sphincters (suprasphincteric), have large blind extensions or horseshoe-shaped trajectories, are in patients with pre-existing incontinence or Crohn’s disease (CD), or have an anterior location in women [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgery, the only curative treatment, obtains suboptimal results with high percentages of persistence or recurrence and a high risk of postoperative fecal incontinence [ 2 , 3 ]. Recurrent anal fistulas after previous surgery are usually associated with a higher risk of re-recurrence and continence disturbance [ 2 , 3 ]. In some cases, palliative treatment with long-term setons is considered [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of injection of autologous adipose tissue in the treatment of patients with complex and recurrent fistula-in-ano of cryptoglandular origin

Guillaumes,

Hidalgo,

Bachero

et al. 2024

Tech Coloproctol

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Background Adipose tissue injections, a rich source of mesenchymal stem cells, have been successfully used to promote anal fistula healing. This study aimed to investigate the efficacy of adipose tissue injection in treating patients with complex and recurrent fistulas of cryptoglandular origin. Methods We conducted a prospective, single-center, open-label, non-randomized, interventional clinical trial from January 2020 to December 2022. We enrolled nine patients, who were evaluated after at least 12 months of follow-up. All patients had seton removal, fistula tract excision or curettage, and a mucosal flap if possible or, alternatively, an internal opening suture. We used a commercially available system to collect and process adipose tissue prior to injection. This system allowed the collection, microfragmentation, and filtration of tissue. Results Selected cases included six men and three women with a median age of 42 (range 31–55) years. All patients had an extended disease course period, ranging from 3 to 13 (mean 6.6) years, and a history of multiple previous surgeries, including two to eight interventions (a mean of 4.4 per case). All fistulas were high transsphincteric, four cases horseshoe and two cases with secondary suprasphincteric or peri-elevator tract fistulas. Six cases (66%) achieved complete fistula healing at a mean follow-up of 18 (range 12–36) months. Three cases (33.3%) experienced reduced secretion and decreased anal discomfort. Conclusions In patients with complex and recurrent fistulas, such as the ones described, many from palliative treatments with setons, the adjuvant injection of adipose tissue might help achieve complete healing or improvement in a significant percentage of cases. ClinicalTrials The study protocol was prospectively registered on ClinicalTrials.gov (NCT 04750499).

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Section: Discussionmentioning

confidence: 99%