The treatment of anal fistula: second<scp>ACPGBI</scp>Position Statement – 2018

Williams, G.; Williams, Andrew B.; Tozer, P; Phillips, R. K. S.; Ahmad, Arshad; Jayne, David; Maxwell-Armstrong, Charles

doi:10.1111/codi.14054

Cited by 71 publications

(79 citation statements)

References 218 publications

(317 reference statements)

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“…It is used almost for all types of anal fistulae and is showing a high healing rate between 80-100% 19,20 . However there is a lot of controversy regarding this type of operation and generally, nowadays it is not anymore recommended for anal fistula treatment because of a relevant incontinence rate in some studies with numbers fluctuating between 0-63% 10,21,22 .…”

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confidence: 99%

Longterm outcome of anal fistula – A retrospective study

Andreou

Zeindler

Oertli

et al. 2020

Sci Rep

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This retrospective observational study analyses the outcomes of patients undergoing surgery for anal fistula at a single centre in order to assess recurrence and re-operation rates after different surgical techniques. During January 2005 and May 2013, all patients with anal fistula were included. Baseline characteristics, details of presentation, fistula anatomy, type of surgery, post-surgical outcomes and follow-up data were collected. The primary endpoints were long-term closure rate and recurrence rate after 2 years. Secondary endpoints were persistent pain, postoperative complications and continence status. A total of 65 patients were included. From a total amount of 93 operations, 65 were fistulotomies, 13 mucosal advancement flaps, 7 anal fistula plugs and 8 cutting-setons. The mean follow up was 80 months. Healing was achieved in 85%. The highest recurrence rate was seen in anal fistula plug with 42%. On the other hand, no recurrence was observed in the cutting-seton procedures. For all included operation no persistent postoperative pain nor incontinence was observed. In conclusion, despite all existing anal fistula operations up to date, the optimal technique with low recurrence rate and assured safety for the anal sphincter is still lacking. Nonetheless, according to our promising results for the cutting-seton technique, this technique, otherwise considered obsolete, should be further evaluated in a prospective study.

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confidence: 99%

Longterm outcome of anal fistula – A retrospective study

Andreou

Zeindler

Oertli

et al. 2020

Sci Rep

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“…LIFT puede actuar como "downstaging", ya que una proporción de pacientes que recidivan pasan de una fístula transesfintérica a una interesfinteriana, permitiendo fistulotomía preservando indemne el esfínter externo que originalmente pudo estar comprometido 8 .…”

Section: Ligadura Interesfinteriana Del Trayecto Fistuloso (Lift)unclassified

“…Diversos materiales han sido utilizados, desde la propia sangre del paciente hasta una mezcla de factores de coagulación, aprotinina y calcio como también pegamentos sintéticos (cianocrilato). Dado el mínimo riesgo de incontinencia, su uso repetido es una opción atractiva en pacientes de alto riesgo de disfunción de esfínter 8 . La tasa de curación en los diferentes trabajos revisados por Williams tiene un rango de 14% al 94%, con resultados contradictorios sobre beneficios a diferentes longitudes de trayecto 8 .…”

Section: Sellanteunclassified

“…Dado el mínimo riesgo de incontinencia, su uso repetido es una opción atractiva en pacientes de alto riesgo de disfunción de esfínter 8 . La tasa de curación en los diferentes trabajos revisados por Williams tiene un rango de 14% al 94%, con resultados contradictorios sobre beneficios a diferentes longitudes de trayecto 8 . Los principales estudios clínicos randomizados muestran una tasa de curación entre 40%-50% 6 .…”

Section: Sellanteunclassified

“…El plug provee la matriz necesaria para generar respuesta inmune y regenerativa promoviendo la reparación y curación. Los plug se degradan durante varias semanas, tiempo en el cual el proceso de reparación es establecido 8 .…”

Section: Anal Fìstula Plugunclassified

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Manejo de la fístula anorrectal compleja. LIFT, colgajo de avance y otras técnicas.

Vallejos

Ocaranza

2020

Rev. Cirugia

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Las fístulas anorrectales complejas son un desafío para el coloproctólogo. Son una patología frecuente que afecta la calidad de vida de los pacientes. La patogénesis aún no esta clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold estandar para su estudio es la resonancia nuclear magnética, su uso por si mismo disminuye la recurrencia. El objetivo del tratamiento es lograr la curación sin afectar la función del esfínter evitando las recidivas. Existen múltiples técnicas, siendo la de mayor aceptación la ligadura interesfinteriana del trayecto fistuloso, con tasa de curación sobre el 70%, con mínimo impacto en continencia. Esta revisión incluye otras técnicas como el colgajo endorrectal de avance, uso de sellante, Permacol, células madres, Anal fistula plug, Video asisted anal fistula treatment, Over the scope clip y Fístula laser closure.

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Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double‐blinded randomized controlled trial

Low,

Rajandram,

Aziz

et al. 2024

World j. surg.

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BackgroundPrior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient‐reported outcomes, such as postoperative pain, which could influence surgical choice.ObjectiveTo compare pain scores at 6 and 24 h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula.DesignProspective, double‐blinded randomized controlled trial.SettingsA quaternary hospital in Malaysia.PatientsPatients aged 18–75 years with high transsphincteric fistulas.InterventionFistula laser closure versus ligation of the fistula tract (LIFT) treatment.Main Outcome MeasuresPain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi‐square, Fisher's exact test, student t‐test, or Mann–Whitney with p < 0.05 denoting statistical significance.ResultsFifty‐six patients were recruited (laser, n = 28, LIFT, n = 28). Median pain scores for laser versus LIFT at 6 h postoperatively were 1.0 versus 2.0 (Rest, p = 0.213) and 3.0 versus 4.0 (Movement, p = 0.448), respectively. At 24 h, this reduced to 2.5 in both arms at rest (p = 0.842) but increased to 4.8 versus 3.5 on movement (p = 0.383). Median operative time for laser was significantly shorter (32.5 min) than LIFT (p < 0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p = 0.181) but treatment failure was similar (54% vs. 50%, p = 0.71). No patients developed postoperative incontinence. Mean SF‐36 scores increased from baseline (67.1 ± 17.0; 95% CI 63.6–82.4 vs. 71.3 ± 11.4; 95% CI 64.0–75.0) to 6 months postoperatively (77.7 ± 21.0; 95% CI 57.0–80.3 vs. 74.0 ± 14.3; 95% CI 67.6–81.4) regardless of the type of surgery (P > 0.05).LimitationsPatients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy.ConclusionLaser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL.Trial RegistrationClinicalTrials.gov: NCT06212739.

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The treatment of anal fistula: secondACPGBIPosition Statement – 2018

Cited by 71 publications

References 218 publications

Longterm outcome of anal fistula – A retrospective study

Longterm outcome of anal fistula – A retrospective study

Manejo de la fístula anorrectal compleja. LIFT, colgajo de avance y otras técnicas.

Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double‐blinded randomized controlled trial

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