Annals of Coloproctology

Review

Anorectal benign disease

Recent advances in the diagnosis and treatment of complex anal fistula: Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak; Ann Coloproctol. 2024;40(4):321-335. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00325.0046

1,737 View
325 Download

Abstract PDF: Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Original Article

Anorectal benign disease

Immediate sphincter repair following fistulotomy for anal fistula: does it impact the healing rate and septic complications?: Maher A. Abbas, Anna T. Tsay, Mohammad Abbass; Ann Coloproctol. 2024;40(3):217-224. Published online June 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01144.0163

1,277 View
184 Download

Abstract PDF: Purpose
Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair.
Methods
This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications.
Results
In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42).
Conclusion
Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

Case Report

Anorectal benign disease

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature: Nalini Kanta Ghosh, Ashok Kumar; Ann Coloproctol. 2024;40(Suppl 1):S1-S5. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.00752.0107

803 View
85 Download

Abstract PDF: The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

Technical Note

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

2,330 View
235 Download
2 Citations

Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

Citations

Citations to this article as recorded by

Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Original Articles

Anorectal benign disease

Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study: In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong; Ann Coloproctol. 2024;40(2):169-175. Published online February 6, 2023; DOI: https://doi.org/10.3393/ac.2022.00486.0069

2,492 View
146 Download
1 Citations

Abstract PDF

Purpose
Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes.
Methods
In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment.
Results
In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure.
Conclusion
We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Citations

Citations to this article as recorded by

Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study: Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg; Received May 19, 2022 Accepted June 24, 2022 Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00346.0049 [Epub ahead of print]

2,077 View
74 Download
5 Citations

Abstract PDF

Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting non-healing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting non-healing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by

Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024;[Epub] CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
Health Science Reports.2023;[Epub] CrossRef
Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16. CrossRef

Reviews

Gene and protein expression of epithelial to mesenchymal transition for intestinal and anal fistula: a systematic review: Nadila Haryani Osman, Ruhi Fadzlyana Jailani, Hayati Abd Rahman, Nazefah Abdul Hamid; Ann Coloproctol. 2023;39(2):106-114. Published online December 3, 2021; DOI: https://doi.org/10.3393/ac.2021.00584.0083

3,428 View
170 Download
2 Web of Science
2 Citations

Abstract PDF

Purpose
Intestinal fibrosis is a common complication of inflammatory bowel diseases. However, the possible involvement of epithelial-mesenchymal transition (EMT) has been scarcely investigated. This systematic review aims to search through research papers that are focusing on messenger RNA (mRNA) and protein expression profile in EMT in fistula or in intestinal fibrosis.
Methods
Electronic exploration was performed until April 24, 2019 through PubMed, Ovid, Science Direct, and Scopus databases with the terms of “fistula” OR “intestinal fibrosis” AND “epithelial-mesenchymal transition”. Two independent reviewers scrutinized the suitability of the title and abstract before examining the full text that met the inclusion criteria. For each study, the sample types that were used, methods for analysis, and genes expressed were identified. The list of genes was further analyzed using DAVID (Database for Annotation, Visualization, and Integrated Discovery) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway.
Results
There were 896 citations found; however, only 3 studies fulfilled the requirements. Among the EMT-related genes, 5 were upregulated genes at mRNA level while 6 were at protein level. However, only 2 downregulated genes were found at each mRNA and protein level. Of the 4 inflammation-related genes found, 3 genes were upregulated at mRNA level and 1 at protein level. These genes were confirmed to be involved in the development of inflammatory induced fibrosis and fistula through EMT. Results from quantitative real-time polymerase chain reaction analysis were consistent with the process of EMT, confirmed by the western blot protein analysis.
Conclusion
Many significant genes which are involved in the process of EMT in fistula and intestinal fibrosis have been identified. With high-end technology many more genes could be identified. These genes will be good molecular targets in the development of biomarkers for precision drug targeting in the future treatment of intestinal fibrosis and fistula.

Citations

Citations to this article as recorded by

Role of Adipose Tissue Hormones in Pathogenesis of Cryptoglandular Anal Fistula
Marcin Włodarczyk, Jakub Włodarczyk, Kasper Maryńczak, Anna Waśniewska-Włodarczyk, Urszula Doboszewska, Piotr Wlaź, Łukasz Dziki, Jakub Fichna
International Journal of Molecular Sciences.2024; 25(3): 1501. CrossRef
Exosomes Derived from Colon Cancer Cells Promote Tumor Progression and Affect the Tumor Microenvironment
Minsung Kim, Il Tae Son, Gyoung Tae Noh, So-Youn Woo, Ryung-Ah Lee, Bo Young Oh
Journal of Clinical Medicine.2023; 12(12): 3905. CrossRef

Benign proctology,Rare disease & stoma

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature: Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith; Ann Coloproctol. 2021;37(5):269-274. Published online October 29, 2021; DOI: https://doi.org/10.3393/ac.2021.00332.0047

3,776 View
79 Download
3 Web of Science
3 Citations

Abstract PDF

Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Letter to the Editor: Actinomyces turicensis Causing Fournier Gangrene
Kaiying Wang, Thomas Zheng Jie Teng, Vishal G. Shelat
Surgical Infections.2022; 23(4): 411. CrossRef
Fungal perianal abscess as the initial presentation of disseminated coccidioidomycosis
Christian Olivo-Freites, Oscar E. Gallardo-Huizar, Christopher J. Graber, Kevin Ikuta
IDCases.2022; 30: e01636. CrossRef

Original Articles

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain: Zahra Abdulla Isa Yusuf Hasan, Bayan Mohamed, Rawaa AlSayegh, Raed AlMarzooq; Ann Coloproctol. 2023;39(1):27-31. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00962.0137

4,998 View
172 Download
2 Web of Science
2 Citations

Abstract PDF

Purpose
Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice.
Methods
A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software.
Results
The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas.
Conclusion
The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

Citations

Citations to this article as recorded by

Anal Cryptoglandular Suppuration
Oladapo Akinmoladun, Quinton M. Hatch
Surgical Clinics of North America.2024; 104(3): 491. CrossRef
Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
永罡秦
Advances in Clinical Medicine.2023; 13(01): 180. CrossRef

Benign proctology,Minimally invasive surgery

Endofistula laser ablation of fistula-in-ano: a new minimally invasive technique for the treatment of fistula-in-ano: Samuel Lalhruaizela; Ann Coloproctol. 2022;38(4):301-306. Published online July 29, 2021; DOI: https://doi.org/10.3393/ac.2020.00668.0095

5,723 View
205 Download
7 Web of Science
7 Citations

Abstract PDF

Purpose
Many techniques are used to treat fistula-in-ano (FIA). The major problems associated with conventional surgical techniques are postoperative complications like sepsis, incontinence, etc. Therefore, several sphincter-saving techniques have been developed in recent years including laser diodes.
Methods
This study presents an early experience of the use of diode lasers with a capacity of 360° radial energy emission endofistula laser ablation (EFLA) of FIA to treat patients with primary low anal fistulas. The primary and secondary success rates were assessed and the factors affecting these rates were evaluated in patients (n=31) who presented with primary, uncomplicated, and low anal fistulas.
Results
Out of 31 patients, 19 (61.3%) were males and 12 (38.7%) were females with a mean age of 38.6±11.5 years. Twenty-one patients (67.7%) had intersphincteric fistula, 9 (29.0%) had transsphincteric fistula, and 1 (3.2%) had suprasphincteric fistula. Thirteen patients (41.9%) had undergone some surgery in the past for FIA. Eleven patients (35.5%) developed postoperative complications. The patients had a low median pain score of 3 on the numeric pain rating scale. The primary success rate was 67.7% (21 of 31) and the secondary success rate was 80.0% (8 of 10) over a median follow-up of 2 years. A significantly higher primary healing rate was observed in patients who did not undergo any prior surgical treatments (P=0.01).
Conclusion
EFLA resulted in moderate primary and high secondary success rates and was not associated with major postoperative complications. Therefore, EFLA can be considered as a preferred noninvasive efficient technique for FIA treatment.

Citations

Citations to this article as recorded by

Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double‐blinded randomized controlled trial
Jolynn Qian Lin Low, Retnagowri Rajandram, Mohamed Rezal Abdul Aziz, April Camilla Roslani
World Journal of Surgery.2024; 48(8): 1990. CrossRef
Use of Non-Thermal Plasma as Postoperative Therapy in Anal Fistula: Clinical Experience and Results
Régulo López-Callejas, Pasquinely Salvador Velasco-García, Mario Betancourt-Ángeles, Benjamín Gonzalo Rodríguez-Méndez, Guillermo Berrones-Stringel, César Jaramillo-Martínez, Fernando Eliseo Farías-López, Antonio Mercado-Cabrera, Raúl Valencia-Alvarado
Biomedicines.2024; 12(8): 1866. CrossRef
34/w mit perianaler Schwellung und Schmerzen
Philipp Rhode, Ines Gockel, Sigmar Stelzner
Die Chirurgie.2023; 94(S1): 98. CrossRef
Newer procedures need to demonstrate efficacy in high complex anal fistulas
Pankaj Garg
Annals of Coloproctology.2023; 39(4): 371. CrossRef
Comprehensive literature review of the applications of surgical laser in benign anal conditions
Ahmed Hossam Elfallal, Mohammad Fathy, Samy Abbas Elbaz, Sameh Hany Emile
Lasers in Medical Science.2022; 37(7): 2775. CrossRef

Case Reports

Benign bowel disease

A fecalith mimicking a bladder calculus secondary to an appendicovesical fistula: a case report: Mauricio Gonzalez-Urquijo, Andrea Romero-Davila, MaryCarmen Mendoza-Silva, Antonio Nassim Halun Treviño, Mario Rodarte-Shade, Gerardo Gil-Galindo; Ann Coloproctol. 2023;39(4):362-365. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2020.00311.0044

4,328 View
40 Download

Abstract PDF: An appendicovesical fistula is defined as an abnormal communication between the appendix and the urinary bladder, with only a few cases reported in the literature. It is very challenging to make an early diagnosis, due to the inability of conventional imaging modalities to detect this unique pathology. The symptoms are often mild, and there are not any specific signs or symptoms that might suggest this type of anomalous communication. We report a case of a 27-year-old male patient who presented difficulty for initiating urination, dysuria, and persistent urinary tract infections. An abdominal x-ray showed a large calculus inside the bladder. A cystoscopy was performed, where the tip of the appendix was seen protruding inside the bladder with a large fecalith adhered to the bladder wall. An appendectomy and partial cystectomy with primary repair were auspiciously achieved. A review of the literature is also presented.

Benign proctology,Complication,Surgical technique

Rectal perforation and perirectal abscess following stapled hemorrhoidectomy for prolapsed hemorrhoids successfully managed with Endo-SPONGE endoluminal vacuum-assisted wound closure system: Emanuele Rosati, Manuel Valeri, Luigina Graziosi, Lavinia Amato, Stefano Avenia, Annibale Donini; Ann Coloproctol. 2022;38(5):387-390. Published online June 9, 2021; DOI: https://doi.org/10.3393/ac.2021.02.07

3,730 View
174 Download
1 Web of Science
1 Citations

Abstract PDF

Active drains, which work by negative pressure, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum-assisted wound closure dressings. Gastrointestinal leaks may be difficult to treat by surgical approach because of their association with high morbidity and mortality. Recently, endoscopic approaches have been applied with several degrees of success. Most recently, endoluminal vacuum-assisted wound closure (EVAC) has been employed with high success rates in decreasing both morbidity and mortality. In the present paper, the authors describe the successful use of Endo-SPONGE (B. Braun Medical B.V.) EVAC system therapy to drain an open rectal wound, following a perforation occurred during stapled hemorrhoidectomy.

Citations

Citations to this article as recorded by

Endoluminal Vacuum Therapy (EVT) for the Treatment of Rectal Perforation Following Cleansing Enema Application
Alper Sozutek, Ekin Y Tas, Kemal Yener, Julia Ozcomert
Cureus.2023;[Epub] CrossRef

Original Article

Benign proctology

Long-term outcomes after anal fistula surgery: results from two university hospitals in Thailand: Weeraput Chadbunchachai, Varut Lohsiriwat, Krisada Paonariang; Ann Coloproctol. 2022;38(2):133-140. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2021.01.06

7,044 View
210 Download
4 Web of Science
2 Citations

Abstract PDF

Purpose
This study aimed to evaluate long-term outcomes after anal fistula surgery from university hospitals in Thailand.
Methods
A prospectively collected database of patients with cryptoglandular anal fistula undergoing surgery from 2011 to 2017 in 2 university hospitals was reviewed. Outcomes were treatment failure (persistent or recurrent fistula), fecal continence status, and chronic postsurgical pain.
Results
This study included 247 patients; 178 (72.1%) with new anal fistula and 69 (27.9%) with recurrent fistula. One hundred twenty-one patients (49.0%) had complex fistula; 53 semi-horseshoe (21.5%), 41 high transsphincteric (16.6%), 24 horseshoe (9.7%), and 3 suprasphincteric (1.2%). Ligation of intersphincteric fistula tract (LIFT) was the most common operation performed (n=88, 35.6%) followed by fistulotomy (n=79, 32.0%). With a median follow-up of 23 months (interquartile range, 12–45 months), there were 18 persistent fistulas (7.3%) and 33 recurrent fistulae (13.4%)—accounting for 20.6% overall failure. All recurrence occurred within 24 months postoperatively. Complex fistula was the only significant predictor for recurrent fistula with a hazard ratio of 4.81 (95% confidence interval, 1.82–12.71). There was no significant difference in healing rates of complex fistulas among seton staged fistulotomy (85.0%), endorectal advancement flap (72.7%), and LIFT (65.9%) (P=0.239). Four patients (1.6%) experienced chronic postsurgical pain. Seventeen patients (6.9%) reported worse fecal continence.
Conclusion
Overall failure for anal fistula surgery was 20.6%. Complex fistula was the only predictor for recurrent fistula. At least 2-year period of follow-up is suggested for detecting recurrent diseases and assessing patient-reported outcomes such as chronic pain and continence status.

Citations

Citations to this article as recorded by

Exploring Health-Related Quality of Life in Patients with Anal Fistulas: A Comprehensive Study
Tudor Mateescu, Lazar Fulger, Durganjali Tummala, Aditya Nelluri, Manaswini Kakarla, Lavinia Stelea, Catalin Dumitru, George Noditi, Amadeus Dobrescu, Cristian Paleru, Ana-Olivia Toma
Life.2023; 13(10): 2008. CrossRef
Lower Fistula Recurrence with Pulling Seton: A Retrospective Cohort Study
Ahmad Izadpanah, Ali Reza Safarpour, Mohammad Rezazadehkermani, Ali Zahedian, Reza Barati-Boldaji
Shiraz E-Medical Journal.2022;[Epub] CrossRef

Review

Benign GI diease, Inflammatory bowel disease,Benign diesease & IBD

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View: Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu; Ann Coloproctol. 2021;37(1):5-15. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2021.02.08

5,791 View
217 Download
8 Web of Science
9 Citations

Abstract PDF

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

Citations

Citations to this article as recorded by

Insights into treatment of complex Crohn's perianal fistulas
Gregor Norčič, Nataša Smrekar, Srđan Marković, Goran Barišić, Gediminas Kiudelis, Henrikas Paužas, Tamás Molnár, Attila Szijarto, Zuzana Šerclová, Tina Roblek, Viktor Uršič, Ian White
BMC Proceedings.2024;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Management of Perianal Fistulas Associated with Crohn Disease
Kay Greveson, Ola Haj, Ailsa Hart, Parnia Geransar, Oded Zmora
Gastroenterology Nursing.2024;[Epub] CrossRef
Real-World Long-Term Persistence and Surgical Procedure-Free Period Among Bio-naïve Patients with Crohn’s Disease and Fistula Initiated on Ustekinumab
Maryia Zhdanava, Sumesh Kachroo, Porpong Boonmak, Sabree Burbage, Aditi Shah, Patrick Lefebvre, Caroline Kerner, Dominic Pilon
Advances in Therapy.2024; 41(10): 3922. CrossRef
Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease
Sebastián Jeri‐McFarlane, Álvaro García‐Granero, Aina Ochogavía‐Seguí, Gianluca Pellino, Anaí Oseira‐Reigosa, Alejandro Gil‐Catalan, Leandro Brogi, Daniel Ginard‐Vicens, Margarita Gamundi‐Cuesta, Francisco Xavier Gonzalez‐Argente
Colorectal Disease.2023; 25(6): 1279. CrossRef
Risk of anorectal cancer in patients with Crohn's disease and perianal fistula: a nationwide Danish cohort study
Alaa El‐Hussuna, Camilla Engel Lemser, Aske Thorn Iversen, Kristine Højgaard Allin, Tine Jess
Colorectal Disease.2023; 25(7): 1453. CrossRef
The Impact of Crohn’s Perianal Fistula on Quality of Life: Results of an International Patient Survey
Antonino Spinelli, Henit Yanai, Paolo Girardi, Slobodan Milicevic, Michele Carvello, Annalisa Maroli, Luisa Avedano
Crohn's & Colitis 360.2023;[Epub] CrossRef
A Prospective, Single-Arm Study to Evaluate the Safety and Efficacy of RD2-Ver.02, an Autologous Blood Clot, in the Treatment of Anal Fistula
Edward Ram, Yaniv Zager, Dan Carter, Olga Saukhat, Roi Anteby, Ido Nachmany, Nir Horesh
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Crohn disease
Elizabeth F. Snyder, Stephanie Davis, Kristina Aldrich, Manjakkollai Veerabagu, Tiziana Larussa, Ludovico Abenavoli, Luigi Boccuto
The Nurse Practitioner.2021; 46(12): 22. CrossRef

Original Article

Benign proctology,Surgical technique

Two-Stage Complete Deroofing Fistulotomy Approach for Horseshoe Fistula: Successful Surgery Leaving Continence Intact: Asami Usui, Gentaro Ishiyama, Akihiko Nishio, Maiko Kawamura, Yukiko Kono, Yuji Ishiyama; Ann Coloproctol. 2021;37(3):153-158. Published online January 12, 2021; DOI: https://doi.org/10.3393/ac.2020.06.08

5,148 View
129 Download
2 Web of Science
3 Citations

Abstract PDF

Purpose
Surgery of the horseshoe fistula is challenging due to its complex configuration and sphincter muscle involvement. Complete deroofing fistulotomy for horseshoe fistula is highly curative with the eradication of all fistulous lesions but has been discredited for its high incontinence rate. It was replaced with the more conservative Hanley’s procedure leaving the lateral tracts intact, despite its issue of recurrence. Our study aimed to report the outcomes of a procedure dividing complete deroofing fistulotomy for horseshoe fistula into 2 stages to avoid impairment of sphincter function.
Methods
We retrospectively reviewed 139 patients who underwent surgery for horseshoe fistula using the 2-stage complete deroofing fistulotomy method between 2014 and 2017. The first surgery deroofed the lateral tracts with an arch-like incision severing the anococcygeal ligament. The primary lesion was also drained and curetted. A seton was placed in the primary tract which was laid open in the second surgery after the lateral wound had partially healed.
Results
Recurrence was observed in 12 patients. All were superficial recurrences except for 1, in which recurrence was confirmed in the primary lesion. Those with blind intersphincteric upward extensions had a significantly higher recurrence rate. Furthermore, patients who resided far from the hospital and could not make visits for frequent wound inspections also had a significantly higher recurrence rate. No patient had any continence issues at the end of the follow-up period.
Conclusion
Managing horseshoe fistula with the 2-stage deroofing fistulotomy approach allows for eradication of the fistula tract without compromising anal sphincter function.

Citations

Citations to this article as recorded by

Clinical efficacy of the bared external anal sphincter (BEAS) in high horseshoe-shaped anal fistulas: Protocol for a real-world, prospective cohort study
Qianqian Ye, Ye Han, Peixin Du, Min Yang, De Zheng, Zubing Mei, Qingming Wang
Heliyon.2024; 10(15): e35024. CrossRef
Evaluating the efficacy of multi-incision and tube-dragging therapy combined with laser closure for high horseshoe-shaped anal fistula: Protocol of a prospective, randomized, controlled trial
Min Yang, Zubing Mei, Qingming Wang, Ye Han, De Zheng, James Mockridge
PLOS ONE.2024; 19(9): e0307653. CrossRef
A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son
Annals of Coloproctology.2022; 38(3): 183. CrossRef

First
Prev
Page of 5
Next
Last

Search