Injection of freshly collected adipose tissue for the treatment complex cryptoglandular anal fistula: case report

Introduction: Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective: To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion: Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF. (AU)

Cutting of sphincter in fistulectomy with primary closure in complex fistula-in-ano: is it feasible?

Introduction: Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas. Material and Methods: There were 60 patients with complex fistulae involving the sphincter, with 56 male and 4 female, mean age 40.6 years, operated by fistulectomy and primary sphincter repair over a period of 7 years. Patients were followed up for 6months for any complications, recurrence, and incontinence. Results: The majority of patients (50, 83.3%) had complete wound healing in 2 weeks, while 4 (6.6%) patients had hematoma and superficial wound dehiscence, which were managed conservatively and healed in 4 weeks. There was one recurrence. All patients had good continence postoperatively, except for mild fecal incontinence (FI, score 3), seen in 6 (10%) patients. However, all these patients regained continence within 6 weeks. Conclusions: Primary reconstruction of anal sphincter with fistulectomy is a safe option for complex fistula-in-ano. (AU)

Management of Recurrent Fistula-in-Ano (Bhagandara) Extending upto Thigh, by Partial Fistulectomy and Ksharasutra Application: A Case Report

In the present modern day's world, anorectal disorders are increasing in number due to sedentary lifestyle. They cause great discomfort and make one’s life miserable. Among these fistula in ano is most common. It is challenging to treat due to its recurrent nature. Fistula-in-ano is an inflammatory tract that is lined by unhealthy granulation tissue and has two openings, an external opening present in perianal skin and an internal opening in the anal canal or rectum. Fistula in ano is correlated with Bhagandara in Ayurveda. Acharya Sushruta has mentioned it among Ashta Mahagada and explained five types of Bhagandara. Many treatment modalities have been given for the treatment of fistula in ano, Ksharasutra application is one of them. It is a minimally invasive para-surgical procedure and induces both mechanical as well as chemical cutting and healing of the fistulous tract. This technique has a high success rate but it is time-consuming and causes minimal complication. A 73 years old male patient came to RGGPG Ayurvedic College and Hospital, with a complaint of pain and pus discharge from his left thigh for 7-8 years, he has been diagnosed with a case of recurrent fistula in ano. The patient was treated with partial fistulectomy along with Ksharsutra application and recovered well with complete excision of the tract.

Management of complex fistula-in-ano by interception of fistula track with application of ksharasutra (IFTAK): a novel technique

Objective: Despite all the technological advances, successful management of complex fistula-in-ano is still a challenge due to recurrence and incontinence. The present study evaluates the outcomes of a novel technique, Interception of Fistula Track with Application of Ksharasutra (IFTAK) in terms of success rate and degree of incontinence. Methods: In the present prospective study, 300 patients with complex fistula-inano were treated by the IFTAK technique, whose surgical steps include: incision at the anterior or posterior midline perianal area, identification and interception of the fistulous track at the level of the external sphincter, rerouting the track (and extensions) at the site of interception, and application of a ksharasutra (medicated seton) in the proximal track (from the site of interception to the internal opening) that is laid open gradually, with the resulting wound healing with minimum scarring. The distal track is allowed to heal spontaneously. Results: There were 227 transsphincteric and 73 intersphincteric varieties of fistula with supralevator extension in 23 cases, of which 130 were recurrent fistulas, 29 had horseshoe track, while 25 had blind fistula with no cutaneous opening. The mean duration of the ksharasutra application was 8.11 ± 3.86 weeks with an overall success rate of 93.33% at the 1-year follow-up. A total of 3.67% of the cases reported with a mild impairment of continence on the Wexner incontinence scoring system. Pre- and postoperative anal manometry evaluation showed minimal reduction in median basal and squeeze pressures. Conclusion: The IFTAK technique is a minimally invasive, daycare surgical procedure for the management of complex fistula-in-ano with low recurrence and minimal sphincter damage. (AU)

Effect of Agnikarma in Perianal Subcutaneous Fistula- A Case Report

Fistula-in-ano is a debilitating disease affecting anorectal region. It is an abnormal tract lined with fibrous tissue and unhealthy granulation tissue. It usually begins from a perianal abscess caused by cryptoglandular infection. The abscess burst spontaneously and forms fistula-in-ano. It may also seen in association with other diseases like Crohn’s disease, lymphogranuloma venereum, actinomycosis, malignancy and TB. It is distressing to the patient and the surgeon due to its recurrent nature and the complications like postoperative incontinence. The disease can be classified as low anal and high anal fistulae on the basis of its internal opening. Perianal subcutaneous fistula is included under low anal fistula. Generally, the modern treatment measures for fistula-in-ano include fistulectomy, fistulotomy, advancement flaps, fistula clip closure, LIFT technique, VAAFT procedure, anal fistula plug repair, fibrin glue and seton technique. The prime aim of the treatment is to eradicate the tract and drain the site of infection while preserving anal continence. In Ayurveda, Fistula-in-ano can be correlated with Bhagandara on the basis of signs and symptoms. Since it is difficult to treat, Acharya Susruta considered it as one among Ashtamahagada. He described the treatment as Shastra Karma, Kshara Karma, Agni Karma. In the present case study, a 35-year old male patient visited the OPD with perianal subcutaneous fistula was selected for Agnikarma after fistulotomy to reduce the treatment period and to improve the quality of living. Daily dressing was done with Jathyadi ghrta and the patient was cured within 21 days of intervention. The follow up was done for next 3 months and no complications were noted.

IFTAK KSHARA SUTRA TECHNIQUE FOR THE MANAGEMENT OF INTERSPHINCTERIC PERIANAL FISTULA–IN–ANO–A CASE STUDY

An internal opening (primary opening) in the anal canal or rectum and an exterior opening (secondary opening) in the perianal skin combine to form a ?stula-in-ano, an infiammatory track. Unhealthy fibrous tissue and granulation tissue line this tract. Intersphicteric fistulas are ones that cross the internal sphincter and then have a tract to the outside of the anus leading1. The prevalence of an anal abscess-induced fistula-in-ano ranged from 26% to 38%.In men,the prevalence is 12.3 cases per 100,000 population and in women, it is 5.6 cases per 100,000 population2. Fistula-in-ano is a complicated disease, its signs and symptoms which resembles bhagandara disease described in ?yurved?. ?c?rya su?ruta mentioned this disease under aa mah?gad?s which means difficult to cure. For the management of this painful disease many treatment modalities are enumerated in ?yurved? classics and k?ra s?tra therapy is one among them which is proved to be gold standard. Though k?ra s?tra therapy is a big revolution in the field of fistula in ano, but it has some disadvantages like it is time consuming process, severe post-procedural pain, and big scar marks. In the present case report,A 24yr old male p/t c/o pain and swelling in perianal region since three months and successfully managed with IFTAK (Interception of Fistulous tract and application of Ksharsutra) technique. which showed a greatpotential in management by minimizing the duration of treatment, mild post procedural pain and minimum scar mark

Treatment of Trans-Sphincteric Fistula-In-Ano with Combined Therapy of Laser and Kshara Sutra

Fistula-in-ano is most infectious disease among all the ano-rectal disorders since ancient times. Over the past few decades, various techniques are being evaluated in terms to prevent its recurrence and complications; it is still a challenging surgical disease. The sign and symptoms of fistula in ano resembles with Bhagandar described in Ayurvedic classics. Kshara sutra therapy (medicated thread) practiced in Ayurveda Since ancient time for the management of Naadi Vrana and Bhagandar. Kshara sutra therapy has revolutionized the treatment of fistula-in-ano, as it treat the main culprit of fistula that is cryptoglandular origin but the drawback of Kshara sutra therapy are as it takes more number of hospital visit, long anxiety period and discomfort. In present time LASER therapy is used in various medical surgery and also in proctology like in fistula as FILAC, DLPL etc. Diode LASER 980nm (Radial Fibre) burns unhealthy granulation tissues in 360° manner with less or minimal pain, LASER act as photo evaporation effect and leads to the shrinkage of the fistula tract. But if we do LASER in internal opening of fistula it provides a bare area for microbes and creates a chance to re-infects the crypts and anal glands, which further leads recurrent fistula formation. Therefore a novel technique for sphincter preserving surgery proposed as combined therapy of Kshara sutra ligation for main culprit that is cryptoglandular infection as SMAK (Sub Mucosal Application of Kshara Sutra) and LASER, shrink the remaining fistula tract instantly

A Role of Udumbara Ksheer Sutra in Ano Rectal Fistula: An Ayurvedic Review

Acharya Sushrut has involved Bhagandara among the Ashtamahagad (8 dreadful diseases). At first it is present as Pidika (boil/abscess) in Apakwa (non-suppurated) state, become Bhagandara when it becomes Pakwa (suppurated). As defined in modern science, it is associated with fistula in ano. An anal fistula is an abnormal track having an external opening in the perianal region and internal opening in the anal canal and/or rectum. Ayurveda has a special approach to fistula management. All anal fistulas counter well to different forms of Kshar and Ksheer Sutra therapy. They are nothing but the medicated seton. The Ksheer sutra mechanical and chemical action of drugs coated on the thread work jointly to cut, cure, drain and clean the fistulous tract, thereby promoting track/wound healing. Though Bhrihattrayi, (chief three texts of Ayurveda) stated the use of Kshar Sutra, there is no proper description of their method of preparation. In eleventh century, Chakrapani Datta mentioned the preparation method of Ksheer sutra in his book Chakradatta for the first time which is indicated in Arsha and Bhagandara. Apamarga Kshar Sutra is the standard Kshar Sutra, and but it has some disadvantages. A variety of other Kshar Sutra, as well as Ksheer Sutra, have been prepared to resolve these inconveniences of Apamarga Kshar Sutra. One of them is Udumbara Ksheer Sutra which was founded by Prof. P.J Deshpande and M.K Jalan in 1984. Udumbara is one among the Nyagradhadi Gana Dravya mentioned by Acharya Sushrut. He described in Bhagandara Chikitsa that the Nyagradhadi Gana Dravyas are Bhagandaranashak.

Is fistulotomy with marsipulization more effective than fistulectomy alone for low fistula in ano?

Background: Fistula in ano is a very common perianal condition seen in outpatient departments. Fistulotomy and fistulectomy are two conventional options of surgery. The present study is designed to observe wound healing time and mean postoperative pain score in the comparison of outcome of the fistulectomy to fistulotomy with marsupialization. Methods: This prospective randomized trial was conducted in the surgical department of the Civil Hospital Karachi for a period of 12 months, in which 60 patients with low anal fistula were divided into 2 groups. Thirty patients in group A were treated with fistulectomy, and 30 in group B were treated with fistulotomy with marsupialization. The postoperative pain severity was assessed after 24 hrs through a visual analogue scale and on weekly and fortnightly follow-ups for 6 weeks. Wound healing was assessed by clinical examination on weekly and fortnightly follow-ups for 6 weeks to estimate the mean healing time. Results: The mean pain score was significantly lower in group B in comparison to group A (3.6±1.99 versus 2.40±1.52; p=0.01). The mean wound healing time was shorter in group B in comparison to group A (4.23±0.77 versus 5.80±0.41 weeks; p=0.0005). Conclusion: Fistulotomy with marsupialization is a simple, easy, and more effective method than fistulectomy for the treatment of simple perianal fistula. (AU)

The ligation of the intersphincteric fistula tract (LIFT) technique for simple and complex fistula-in-ano

Background: Fistula-in-ano is one of the most common clinical condition encountered in a surgical outpatient department. Many treatment modalities have been described with variable outcomes but gold standard surgical treatment is yet to be agreed upon. The aim of the present study is to evaluate the treatment outcomes of ligature of intersphincteric fistula tract (LIFT) technique in the treatment of simple and complex fistula-in-ano with the primary objective of recurrence rate and broad objective of other postoperative complications during the period of study and after long-term follow-up. Methods: It is a retrospective study of prospectively collected data from the patients who havebeen operated for fistula-in-ano using the LIFT technique at our institute from February 2018 to March 2020 and followed-up until September 2020. Results: A total of 56 patients with fistula-in-ano were treated with the LIFT procedure during the study period, of which 20 patients had simple fistula and 36 had complex fistula. A success rate of 83% was obtained with completely healed fistulas in 46 patients. No patient developed postoperative incontinence. Conclusion: Ligature of intersphincteric fistula tract is an effective treatmentmodality for fistula-in-ano with less procedure-related morbidity, but it is associated with a higher recurrence rate in simple fistula than in complex fistula. (AU)

Clinical and diagnostic profile of patients with anal fistula: a cross sectional study from Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra

Background: Anal fistulas are one of the commonest causes for a persistent discharge seropurulent in nature that irritates the skin in the neighbourhood and leads to discomfort. Fistula-in-ano is seen quite frequently in perirectal perianal suppuration. The objective of this study to study the clinical profile and diagnosis of anal fistula at surgical OPD of VDGIMS.Methods: The present cross-sectional observational study was carried out in patients with fistula-in-ano admitted at surgical department of VDGIMS, Latur during the period of 2017-19 in 50 diagnosed patients. Data was analysed by using SPSS 24.0 version IBM USA.Results: Majority of the patients with anal fistula were from 41-50 years age group i.e. 15 (30%) and males were predominantly affected 40 (80%) compared to females i.e. 10 (20%). Male to female ratio was 4:1. Perianal discomfort was the commonest symptom in all patients i.e. 100%. It is followed by perianal discharge complained by 54% and perianal itching in 38% cases. The anterior position of external opening is found to be significant (p<0.05). Fistulogram showed external opening in all patients i.e. 50 cases whereas internal opening in 46 (92%) cases. Findings of MRI revealed that anal fistula was intra sphincteric in 28 cases i.e. 56%, extra sphincteric in 2 cases i.e. 4% and trans sphincteric in 20 cases i.e. 40%.Conclusions: Commonest age group affected in our study was 40-50 years with male predominance. Perianal discomfort and discharge were the commonest symptom. E. coli was the predominant organism isolated. Fistulogram and MRI is useful in detecting the aetiology of fistula in ano.

A Retrospective Study of Fistula in Ano & Primary Sphincter Repair (Sphincteroplasty) in Complex Fistulas

Fistula in ano is a common perianal disease of the mankind. It is secondary to mainly cryptoglandular infections & abscess. Persistence of chronic infection will lead to fistula formation.1 Management of high-level fistulas is complicated due to incontinence, which is troublesome; hence, many procedures have been tried by many surgeons, but without any supremacy over others. Immediate reconstruction of divided sphincter muscle will give good result.2 We have done fistulectomy & repair of the external anal sphincter & followed for the last two decades with no incontinence & minimal recurrences.METHODS192 cases of fistula in ano for the last 20 years operated by a single surgeon (1st author) were studied & were followed up to now. The differences, in the selection of cases, surgical skill & post-operative management are excluded in the study by including cases done by a single surgeon (first author) only. 136 males & 56 females were operated. Intersphincteric 45.8%, trans-sphincteric 49%, high level fistulas 5.2%, trans-sphincteric & high fistulas with considerable external sphincter loss (54 cases) were repaired with 1–0 Vicryl. Fistula in ano is associated with haemorrhoids in 24/192 & ano rectal abscess (20/192). Fistulotomy done in 16/192, simple & subcutaneous tracts - fistulectomy done in 65%. Curetting of the high tracts done in 16/192.RESULTSMales are predominantly affected 70.8%. This is more common in 3rd, 4th & 5th decades (80.1%). Single external opening was seen in (90%). Posterior & lateral fistula tracts are more commonly seen in (89.6%). Non-specific pyogenic infective pathology is seen 99%. Recurrences- 6/192. Time taken to heal is 3–6 weeks. Incontinence is not seen in any case. No recurrence or incontinence seen in primary sphincter repair of 54 cases.CONCLUSIONSPrimary sphincter repair is simple & best procedure with minimal or no recurrence & decreases the healing time. It is more suitable & advised in fistulas with considerable external sphincter loss.

A study on outcome of primary closure versus open fistulectomy in low level fistula in ano

Background: Fistula-in-ano is one of the common ano-rectal disorder which causes appreciable morbidity and inconvenience to the patient. Different surgical techniques have been described in literature from time to time. Open fistulectomy though considered as the standard treatment for fistula in-ano, fistulectomy with primary closure has its merits of short hospital stay, early wound healing and lower costs. The objectives of this study was to compare the period of stay, period of healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique.Methods: Patients admitted in all surgical units of NIMRA Hospital, were included in the study without bias on a serial basis. This is a study comprising 50 patients over a period of 12 months from Febrauary 2019 to January 2020.Results: The patients were divided into two equal and comparable groups. Patients who underwent open fistulectomy were classified under Group I and those who underwent fistulectomy with primary closure were classified as Group II. The patient’s characteristics of the two groups were well matched.Conclusions: In patients treated by classical method because of long time taken to heal, number of hospital visits for dressings were more and more antibiotics were prescribed when compared to cases treated by excision of fistula tract and primary closure. From this study it can be concluded that fistulectomy with primary closure is ideal for low anal fistulaures.

Clinical study of fistula in ano with special reference to its surgical management

Background: The present study was undertaken to evaluate the results of “Lay open method” fistulectomy technique in treating fistula-in-ano in terms of relief of symptoms, healing of wound, recurrence rate and post-operative complications.Methods: Total 45 cases with definite history of fistula and clinically diagnosed cases of fistula in ano selected for the study. A final diagnosis was made after proctoscopic examination under anaesthesia during operation and by histopathological examination after completion of operation.  In all the patients, lay open method fistulectomy was done. Post-operative period was closely monitored and all the cases were meticulously followed for a variable period of time.Results: The common fistulas were low anal type (80%). External opening was mostly located in the posterior mid zone (44.44%). Internal opening was found in 30 cases (66.66%) during per rectal digital examination while proctoscopic examination revealed internal opening in 26 cases (57.77%). Pain (22.22%), retention of urine (8.88%) were the commonest immediate as well as incontinence (1; 2.22%) and recurrence (1; 2.22%) were the delayed post-operative complications. 90% of cases had a satisfactory healing of their wounds within 21 days. Excellent results were achieved in 77.77% cases and only one case of recurrence (2.22%).Conclusions: Encouragingly high success rates were achieved in our patients, but this series comprised a very small number of patients in a short period of time with limited amenities; also follow up of very short duration and irregular for which a definite conclusion is difficult to arrive at.

Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

Anal mycobacterial infections / Infecções micobacterianas do ânus

Abstract Background Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn's disease. Objectives To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Resumo Introdução Infecções micobacterianas constituem um grave problema de saúde pública a nível mundial. As manifestações anoperineais são raras, mas constituem um importante diagnóstico diferencial com outras patologias igualmente graves que podem acometer a região, como as neoplasias malignas e a doença de Crohn. Objetivos Realizar um levantamento da literatura sobre infecções micobacterianas da região anoperineal, considerando as informações mais atuais para orientação diagnóstica e terapêutica dessa enfermidade. Métodos Foi realizada pesquisa nos bancos de dados PUBMED e LILACS com as expressões Mycobacterium, Anal, Infection e Tuberculosis. Foram revisados artigos referentes a séries de casos tratados, relatos clínicos e revisão da literatura publicada a partir de 2005. Resultados Foram compiladas informações sobre a epidemiologia das infecções micobacterianas; o comportamento clínico dos indivíduos afetados; opções diagnósticas e sua validade na prática clínica; e, por fim, opções terapêuticas. Conclusões Infecções micobacterianas da região anoperineal são raras. As apresentações clínicas mais comuns são a formação de ulceras e a fistulização. O diagnóstico envolve mais de um procedimento para identificação dos bacilos, e deve considerar a presença de manifestações em mais de um órgão. O tratamento é principalmente medicamentoso, sendo a cirurgia recomendada nas complicações agudas ou sequelas crônicas da doença.

Clinical and Radiological Study of Fistula in Ano in Tertiary Care Centre and Management

Introduction: Fistula-in-ano form a good majority of treatable benign lesions of the rectum and anal canal. About 90% or soof these cases are end results of crypto glandular infections.Materials and Methods: Patient placed in the lateral position and the external opening of the fistula is identified and cannulated,and saline is injected. The patient is then placed in a supine position in magnetic resonance (MR) gantry.Results: Clinical examination less accurate to detect internal opening while MR fistulogram could detect most of the internalopenings which were confirmed in surgical findings.

Study on Clinical Profile of Cases of Fistula-In-Ano Admitted at VIMS, Pawapuri

Fistula-in-ano is one of the common anorectal conditions. Knowledge of its pattern is helpful in proper management of cases. Methods: The present hospital baed study was conducted upon 55 cases to assess the profile and surgical outcome. Background details of patients, the details of their illness, the treatment given and the details of postoperative period were recorded. Results: Most of the patients belonged to the age group of 31-40 years with male: female ratio of 3.59:1. All the patients suffered from discharge and had external opening. Most of the patients had low anal fistula (78.2%). External opening was located posteriorly in 72.7% patients. Mean healing time was 3.7 ± 1.1 weeks. 14.5% patients had wound infection and 7.3% suffered from headache. Conclusion: Fistula-in-ano has male preponderance. Fistulectomy is the usual procedure and the post operative complications tend to be minimal.

Fibrin Glue Injection a Promising Option in the Treatment of Patients with Anal Fistula

Background: Fistula in ano is a public perianal illness and as a long-lasting inflammatory illness which does not cure naturally. There are several surgical procedures for treatment of fistula in ano, but these surgical interventions have little degrees of success, long time of wound healing after surgery and prolonged pain, especially in complex and difficult fistulas are observed. Novel sphincter-saving methods have been used in the management of perianal fistula in order to evade the risk of fecal incontinence. Among them, the fibrin adhesive method is popular because of its ease and repeatability. Objective: The objective of the present study is to evaluate the effect of fibrin-glue injection in the treatment of anal fistula (low/high as well as primary/secondary). Method: A prospective, planned experiment was conducted on 322 patients who were established to have fistulas in ano. They were assessed by sorting them into high fistula (172/322) and low anal fistula type (150/322). The fibrin glue was instilled in their anal tracts. The character of the anal tract, whether it was simple or complex and primary or secondary, was analyzed. The outcome in terms of a postoperative discharge (failure) was noted at 3 months, 6 months, 9 months, 1 year, and 2 years. Results: Total 322 patients were involved in this study. The general success rate was 275/322 (85.4%) after a mean follow-up of 1.5 years. All patients with a complex fistula (for low/high fistula, primary/secondary) had failure of healing (success rate 0%) either through first or second injection of fibrin-glue while all patients with simple fistula had successive rate of healing (for low/high fistula, primary/secondary) either through first or need the second injection of fibrin-glue. None of the patients had postoperative continence problems, and no other complications were noted. Conclusion: Fibrin glue is a novel attractive approach, easy, safe, minimally invasive, repeatable and cost effective for treatment of anal fistula simple (low/high and primary/secondary) and promising option for treatment of high fistula, and do not have a role for healing the complex anal fistula.

The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience

PURPOSE: Surgery is the only treatment for anal fistula. Many surgical techniques have been described. The aim of this study was to communicate the authors' preliminary experience in the use of a recently proposed, simplified technique. METHODS: This was a prospective study of 28 patients admitted from January 13, 2016 through July 20, 2017. Patients were managed with the ligation of intersphincteric fistula tract (LIFT) technique and results were observed and documented, including recurrence rate, incontinence rate, and other postoperative complications. RESULTS: A total of 28 patients were studied. The mean operation time was 31 minutes (range, 23–44 minutes), and there were no intra- and postoperative complications. The overall complete healing rate was 85.7%, and the recurrence rate was 14.2%. Follow-up was conducted at 1, 3, and 6 months. CONCLUSION: Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors' experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition.