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J. coloproctol. (Rio J., Impr.) ; 41(4): 355-360, Out.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356433


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)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Rectal Fistula/surgery , Colorectal Surgery/methods , Rectal Fistula/therapy
J. coloproctol. (Rio J., Impr.) ; 41(4): 406-410, Out.-Dec. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1356446


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)

Humans , Male , Female , Rectal Fistula/surgery , Rectal Fistula/therapy , Anal Canal/surgery , Recurrence
Prensa méd. argent ; 107(6): 312-317, 20210000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1359107


Antecedentes: la fístula de ano es un problema crónico para los pacientes. Causa angustia debido al mal olor y la suciedad con infecciones y secreciones recurrentes. La recurrencia y la lesión del esfínter anal fueron las complicaciones más críticas después de la cirugía. La colocación de un setón suelto y grueso fue la operación quirúrgica más prometedora. Reducir el tiempo de colocación del setón para disminuir el sufrimiento de los pacientes por la suciedad y múltiples apósitos. Pacientes y métodos: estudio retrospectivo. Cien pacientes con fístula anal alta tratados quirúrgicamente en la ciudad médica de Al-Sader y en la clínica privada diaria de Al-Najaf, ciudad de Najaf, Irak, desde febrero de 2018 hasta marzo de 2019. Se han tomado imágenes de fistulografía y resonancia magnética de todos los pacientes. Después de eso, se realiza una fistulectomía con sutura de setón suelta y gruesa durante tres meses. Los pacientes con persistencia del trayecto de trayecto fistuloso fueron sometidos a una segunda cirugía y una tercera operación hasta su completa curación. Resultados: Cien pacientes con fístula de tipo alto en ano con 96 varones (96%) y mujeres 4 (4%). La tasa de curación completa entre los pacientes masculinos después de la primera operación fue de 90 (93%), mientras que las mujeres mostraron una tasa de curación completa de 4 (100%) después de la primera operación. Tres de los pacientes varones restantes con un tracto de fístula alto persistente mostraron una curación completa después de la segunda operación, mientras que en 3 (3%) la tasa de curación completa fue del 100% después de la tercera operación. Conclusión: Un setón suelto y grueso colocado en un tracto de fístula de tipo alto durante tres meses brinda una excelente protección al esfínter anal externo con una tasa de recurrencia menor y una curación rápida.

Background: Fistula in ano is a chronic problem for the patients. It causes distressing because of foul odour and soiling with recurrent infection and discharge. Recurrence and anal sphincter injury were the most critical complications following surgery. Loose, thick seton placement was the most promising surgical operation. To reduce the time of seton placement, therefore, decreasing the suffering of patients from soiling and multiple dressing. Patients and Methods: A retrospective study. One hundred patients with high type fistula in ano treated surgically in Al-Sader Medical city and Al-Najaf daily private clinic, Najaf city, Iraq from Feb 2018 to March 2019. Fistulography and magnetic resonance imaging have taken from all patients. After that, fistulectomy with loose, thick seton suture placed for three months. Patients with the persistence of high fistula tract underwent a second surgery and third operation until complete healing. Results: One hundred patients with high type fistula in ano with male 96 (96%) and female patients were 4 (4%). The rate of complete healing among male patients after the first operation was 90 (93%), while female patients showed a 4(100%) rate of complete healing after the first operation. Three of the remaining male patients with persistently high fistula tract showed complete healing after the second operation, whereas 3 (3%) the rate of complete healing was 100% after the third operation. Conclusion: A Loose, thick seton placed in high type fistula tract for three months provides excellent protection to the external anal sphincter with less recurrence rate and rapid healing

Humans , Anal Canal/injuries , Recurrence , Reoperation/methods , Sutures , Retrospective Studies , Rectal Fistula/surgery , Rectal Fistula/therapy
J. coloproctol. (Rio J., Impr.) ; 41(3): 308-315, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1346418


Background: There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective: To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design: systematic review and meta-analysis. Data Sources: A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection: Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention: The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures: The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results: Ten studiesmet the criteria for systematic review, all retrospective,with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73-1.43: p=0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27-42.7%), recurrence with the use of setonwas 40%(IQR26.6-51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3-51.3%) Limitations: The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions: Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement. International prospective register of systematic reviews-PROSPERO registration number: CDR42020149173. (AU)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Rectal Fistula/surgery , Recurrence , Treatment Outcome
J. coloproctol. (Rio J., Impr.) ; 41(3): 217-221, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346423


Background: High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods: This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results: Our study showed that 2 patients develop incontinence to flatus ~ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion: Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state. (AU)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Anal Canal/surgery , Rectal Fistula/surgery , Rectal Fistula/therapy , Comorbidity , Treatment Outcome
Int. braz. j. urol ; 47(2): 399-412, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154459


ABSTRACT Purpose: To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies. Material and Methods: Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized non-validated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated. Results: Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04). Conclusions: The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Transsphincteric approach could be advantageous over other procedures regarding HRQoL issues.

Humans , Male , Urinary Incontinence , Rectal Fistula/surgery , Urinary Fistula/surgery , Urinary Fistula/etiology , Quality of Life , Retrospective Studies , Treatment Outcome
ABCD arq. bras. cir. dig ; 34(1): e1572, 2021. tab, graf
Article in English | LILACS | ID: biblio-1248505


ABSTRACT Background: Treating anal fistulae is still a great challenge due to the possibility of fecal incontinence after surgery and that the use of laser has been gaining space in medicine, including as an inducing method of healing. Aim: To evaluate the efficacy of low-level laser therapy on fistula-in-ano treatment in rats. Methods: Fifteen male Wistar rats weighing approximately 250-300g were used, which were subjected to the anal fistula induction procedure and after 30 days were distributed into two groups: control group (CG, n=5) and laser group (LG, n=10) observed for another 30 days. In the CG no treatment was performed and, in the LG, low-level laser therapy was applied in fistulous tracts daily. The closure of the fistulous tract, the area of the remaining tract, the inflammatory infiltrate and vascular congestion were evaluated. Results: There was no complete closure of the tract in any of the animals. The mean area of the remaining tract was 847.2 µm2 in the CG and 248.5 µm2 in the LG (p=0.001). The mean inflammatory infiltrate score was 2.4 in the CG and 1.3 in the LG (p=0.0285), while in the evaluation of vascular congestion, 1.6 was observed in the CG and 0.6 in the LG (p=0.031). Conclusions: Low-level laser therapy was able to reduce the area of the fistulous tracts as well as decrease the inflammatory process and local vascular congestion.

RESUMO Racional: Tratamento de fístulas anais ainda é grande desafio devido à possibilidade de incontinência fecal pós-operatória; o uso do laser vem ganhando espaço na medicina, inclusive como método indutor de cicatrização. Objetivo: Avaliar a eficácia da terapia a laser de baixa potência no tratamento de fístula perianal em ratos. Métodos: Foram utilizados 15 ratos Wistar machos com peso aproximado de 250-300 g, os quais foram submetidos à indução da fístula anal e após 30 dias foram distribuídos em dois grupos: grupo controle (GC, n=5) e grupo laser (GL, n=10) observado por mais 30 dias. No GC nenhum tratamento foi realizado e no LG laserterapia de baixa intensidade foi aplicada nos trajetos fistulosos diariamente. Foram avaliados o fechamento do trajeto fistuloso, a área do trajeto remanescente, o infiltrado inflamatório e a congestão vascular. Resultados: Não houve fechamento completo do trajeto fistuloso em nenhum dos animais. A área média do trajeto remanescente foi de 847,2µm2 no GC e 248,5µm2 no GL (p=0,001). O escore médio do infiltrado inflamatório foi de 2,4 no GC e 1,3 no GL (p=0,0285), enquanto na avaliação da congestão vascular foi observado 1,6 no GC e 0,6 no GL (p=0,031). Conclusões: A terapia a laser de baixa potência foi capaz de reduzir a área dos trajetos fistulosos, bem como diminuir o processo inflamatório e a congestão vascular local.

Animals , Male , Rats , Rectal Fistula/surgery , Low-Level Light Therapy , Fecal Incontinence , Anal Canal , Wound Healing , Treatment Outcome , Rats, Wistar
Rev. cir. (Impr.) ; 72(3): 250-256, jun. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1115551


Resumen 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 está clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold standard para su estudio es la resonancia nuclear magnética, su uso por sí 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 fistula laser closure.

Complex anal fistula are a challenge for colorectal surgeons. It is a common pathology in population. Pathogenesis is still unclear, it would be involved citokines and the process of epitelial to eesenchymal transition. The gold standard for study is MRI, its use reduces recurrences. The goal of treatment is heal the fistula without damaging the function of the sphincter and avoid recurrences. There are multiple techniques, the most accepted is ligation of intersphincteric fistula tract with cure rate over 70%, with minimal impact in continence. This review includes other techniques like rectal advancement flap, fibrin glue, permacol, stem cells, anal fistula plug, video asisted anal fistula treatment, over the scope clip and fistula laser closure.

Humans , Surgical Flaps/surgery , Rectal Fistula/surgery , Rectal Fistula/therapy , Ligation/methods , Anal Canal/surgery , Rectal Diseases/surgery , Rectal Diseases/therapy , Digestive System Surgical Procedures/methods , Video-Assisted Surgery
J. coloproctol. (Rio J., Impr.) ; 40(2): 143-148, Apr.-Jun. 2020. tab
Article in English | LILACS | ID: biblio-1134967


ABSTRACT Background Post-operative pain is the major consequence of Ksarasutra, Seton technique employed in Ayurvedic management of Low anal fistula. Surgeons are forced to prescribe Opioids and NSAIDs with pronounced untoward effects. Non pharmacological measures like Balneotherapy are used to improve circulation and relieve spasm in contemporary sciences. Aim To compare the efficacy of Khadira (Acacia catechu) and Sphatika (Potash alum) hot sitzbath with plain hot sitzbath in patients of low anal fistula treated with Ksarasutra. Method The study was single blind, double armed; prospective, randomized control clinical trial in which 30 patients were randomly allocated into two groups of 15 each on the basis of inclusion and exclusion criteria. Group A received hot sitzbath using Acacia catechu and alum infusion twice daily for 21 days. Group B received hot sitzbath using warm water for 21 days. The assessments were made on pain, post-surgical satisfaction burning sensation, tenderness, discharge, constipation, itching and incontinence. Result The disease was prevalent in the 4th decade of life, more in males (86.67%) involved in sedentary work (53.33%) residing in urban domicile, consuming mixed diet (100%). Both groups showed statistically significant improvement in outcome measures like pain, burning sensation, tenderness, discharge, constipation and itching. Conclusion On comparative analysis Acacia and Alum hot sitzbath was more effective in outcomes like pain, surgical satisfaction, burning sensation and discharge. There was no difference in the effect of both interventions with respect to outcome measures like constipation, itching and incontinence.

RESUMO Justificativa A dor pós-operatória é a principal consequência da técnica que utiliza seton de Ksarasutra no tratamento ayurvédico de fístula anal baixa. Os cirurgiões são impelidos a prescrever opiáceos e AINEs que possuem efeitos indesejáveis pronunciados. Medidas não farmacológicas como a balneoterapia são usadas nas ciências contemporâneas para melhorar a circulação e aliviar o espasmo. Objetivo Comparar a eficácia do banho quente de assento com Khadira (Acacia catechu) e Sphatika (Potash alum) com apenas banho de assento em pacientes com fístula anal baixa tratados com Ksarasutra. Método Estudo clínico prospectivo, cego e controlado de dois braços randomizados, no qual 30 pacientes foram alocados aleatoriamente em dois grupos de 15 pacientes cada com base nos critérios de inclusão e exclusão. O Grupo A recebeu banho de assento com Acacia catechu e infusão de alume duas vezes ao dia por 21 dias. O Grupo B recebeu banho de assento com água morna por 21 dias. Os desfechos avaliados foram dor, satisfação pós-cirúrgica, sensação de queimação, sensibilidade, corrimento, constipação, prurido e incontinência. Resultado A doença foi prevalente na 4ª década de vida, mais frequente no sexo masculino (86,67%), nos envolvidos em trabalho sedentário (53,33%), nos residentes em domicílios urbanos e nos que consumiam dieta mista (100%). Ambos os grupos apresentaram melhora estatisticamente significativa na avaliação dos resultados, tais como dor, sensação de queimação, sensibilidade, corrimento, constipação e prurido. Conclusão Na análise comparativa, o banho quente de assento com acácia e alume foi mais eficaz nos desfechos de dor, satisfação cirúrgica, sensação de queimação e corrimento. Não houve diferença em relação ao efeito de ambas as intervenções sobre os desfechos de constipação, prurido e incontinência.

Humans , Male , Female , Pain, Postoperative , Baths , Rectal Fistula/surgery , Areca , Potassium , Aluminum Sulfate , Acacia
J. coloproctol. (Rio J., Impr.) ; 40(1): 1-7, Jan.-Mar. 2020. tab
Article in English | LILACS | ID: biblio-1090844


Abstract Rationale There is a lack of consistent national data on the evaluation of the epidemiological profile of patients with anal fistula. Objective To evaluate the epidemiological profile of patients with anal fistula at a center specialized in coloproctology. Method A cross-sectional, retrospective study was carried out between 2016 and 2018 of patients who underwent surgical procedures for the treatment of fistula in ano by the Department of Coloproctology of the Regional Hospital of Mato Grosso do Sul. Age, gender, disease duration, number of procedures, association with Crohn's disease and other comorbidities were evaluated. The data were tabulated and submitted to statistical treatment considering p < 0.05. Results 93.2% of the patients were less than 60 years old, 66.7% were male, 88.9% had the disease less than one year, the most frequent procedures were fistulotomy (55.6%) and fistulectomy (36.8%), with a greater percentage of patients having undergone only one procedure (74.4%), 8.5% had Crohn's disease, 7.7% systemic hypertension and 3.4% had diabetes mellitus. Conclusion In the studied group, there was a predominance of anal fistulae in men under 60 years old and without comorbidities, diagnosed for up to one year, most of them submitted to fistulotomy or fistulectomy at one time. Patients operated after one year of illness and also those with Crohn's disease were submitted mainly to curettage + seton and multiple procedures.

Resumo Racional Faltam dados nacionais sobre a avaliação do perfil epidemiológico dos pacientes com fístula anal. Objetivo Avaliar o perfil epidemiológico dos pacientes portadores de fístula anal em um centro especializado em coloproctologia. Método Estudo retrospectivo, transversal, realizado no período de 2016 a 2018 dos pacientes que realizaram procedimentos cirúrgicos para o tratamento da fístula anal pelo serviço de Coloproctologia do Hospital Regional de Mato Grosso do Sul. Avaliou-se idade, gênero, tempo de doença, procedimento realizado, número de procedimentos, associação com doença de Crohn e outras comorbidades. Os dados foram tabulados e submetidos a tratamento estatístico considerando-se significativo p < 0,05. Resultados 93,2% dos pacientes tinham menos de 60 anos, 66,7% eram do gênero masculino, 88,9% tinham a doença a menos de um ano, os procedimentos mais realizados foram a fistulotomia (55,6%) e a fistulectomia (36,8%, sendo que um percentual maior de pacientes havia sido submetido a apenas um procedimento (74,4%); 8,5% tinham doença, 7,7% hipertensão arterial sistêmica e 3,4% diabetes mellitus. Conclusão Na amostra estudada houve predomínio de fístulas anais em homens com menos de 60 anos e sem comorbidades, com diagnóstico de até um ano, a maioria submetida à fistulotomia ou fistulectomia em um tempo. Pacientes operados após um ano de doença e também os com Doença de Crohn foram submetidos principalmente à curetagem + sedenho e múltiplos procedimentos.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Rectal Fistula/surgery , Rectal Fistula/epidemiology , Crohn Disease/complications , Comorbidity
J. coloproctol. (Rio J., Impr.) ; 40(1): 56-60, Jan.-Mar. 2020. tab, ilus
Article in English | LILACS | ID: biblio-1090836


Abstract Rationale: Fistulotomy is a procedure widely used in the treatment of anal fistulas but is associated with varying degrees of fecal incontinence that could be minimized by previous use of sedentum, and the material used may influence the outcome. Purpouse: To compare cotton and silastic used as setons in the spacing of the sphincter cables of rats subjected to fistulotomy. Method: Thirty Wistar rats were used, which after 30 days of fistula production were distributed in: Control Group (GC): the steel wire was removed, followed by fistulotomy; Cotton Group (GA) and Silastic Group (GS), in which were applied cotton and silastic setons respectively for 30 days when fistulotomy was performed; after seven days, euthanasia and removal of the specimens were performed for histological study, and the results were submitted to statistical assessment using Kruskal-Wallis non-parametric test, establishing a significance level of p < 0.05. Results The distance between the muscular cables was 107.9 µm in the GC, 82.4 µm in the GA and 53.5 µm in the GS (p = 0.00001). The mean inflammation scores were 1.9 in the CG, 1.0 in the GA and 0 in the GS (p < 0.05). The fibrosis scores were 1.1 in GC, 0.9 in GA and 0.6 in GS (p > 0.05). Conclusion The silastic seton prior to fistulotomy caused less detachment of the muscular cables and less local inflammatory process.

Resumo Racional: A fistulotomia é um procedimento muito utilizado no tratamento das fístulas anais mas está associado a graus variáveis de incontinência fecal que poderia ser minimizado pelo uso prévio de sedenho, sendo que o material utilizado pode ter influência no resultado. Objetivo: Comparar os fios de algodão e sonda de silastic utilizados como sedenhos no afastamento dos cabos musculares do esfíncter anal de ratos submetidos a fistulotomia. Método: Utilizou-se 30 ratos Wistar, que após 30 dias da confecção da fístula foram distribuídos em: Grupo Controle (GC): foi retirado o fio de aço seguido por fistulotomia; Grupo Algodão (GA) e Grupo Silastic (GS), nos quais aplicou-se sedenho de algodão e silastic respectivamente por 30 dias quando foi realizada fistulotomia; após sete dias realizou-se eutanásia e remoção dos espécimes para estudo histológico, sendo os resultados submetidos a tratamento estatístico pelo teste não-paramétrico de Kruskal-Wallis, estabelecendo-se como significante p < 0,05. Resultados O afastamento entre os cabos musculares foi 107,9 µm no GC; 82,4 µm no GA e 53,5 µm no GS (p = 0,00001). As médias dos escores de inflamação foram 1,9 no GC; 1,0 no GA e 0 no GS (p < 0,05). Os escores de fibrose foram 1,1 no GC; 0,9 no GA e 0,6 no GS (p > 0,05). Conclusão O sedenho de silastic previamente à fistulotomia causou menor afastamento dos cabos musculares e menor processo inflamatório local.

Animals , Rats , Rectal Fistula , Rectal Fistula/surgery , Anal Canal , Fecal Incontinence
In. Machado Rodríguez, Fernando; Liñares, Norberto; Gorrasi, José; Terra Collares, Eduardo Daniel. Manejo del paciente en la emergencia: patología y cirugía de urgencia para emergencistas. Montevideo, Cuadrado, 2020. p.199-212, ilus.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1343004
Article in Chinese | WPRIM | ID: wpr-880386


Anal fistula is one of the most common diseases in colorectal and anal surgery. Most of them are formed after the abscess of perianal space reptures. Due to the complexity and diversity of pathological changes, the clinical efficacy of some patients is not optimistic, and there may even be serious surgical complications, including delayed healing of anal fistula or varying degrees of fecal incontinence, which significantly affect the quality of life of patients and even lead to disability. The Working Committee of Clinical Guidelines of Anorectal Physicians Branch of Chinese Medical Association organized some domestic experts to discuss and prepare this expert consensus. It is suggested that comprehensive evaluation of anal fistula, including detailed medical history, physical examination and necessary auxiliary examination should be conducted before treatment. Auxiliary examinations include fistulography, ultrasound, CT or MRI. The purpose of the auxiliary examination is to accurately determine the position of the internal orifice of the anal fistula, the direction of the fistula and its relationship with the anal sphincter. Adenogenic anal fistula needs surgical treatment after diagnosis. The operation methods can be divided into two types: operations breaching sphincter and operations preserving sphincter function. The former includes anal fistulectomy, anal fistulotomy and seton placement; the latter includes ligation of intersphincteric fistula (LIFT), rectal mucosal muscle flap advancement repair, anal fistula laser closure, video-assisted anal fistula treatment, etc. It is suggested to select or combine the application according to the specific condition of patients. Bioabsorbable materials include anal fistula plug and fibrin glue. Due to the characteristics of retaining sphincter function and reusability, it is recommended to be used selectively by qualified and experienced doctors. Proper wound management after anal fistula surgery can reduce the pain of patients, promote healing and reduce the recurrence of anal fistula. Because there is a certain risk of recurrence and fecal incontinence after anal fistula surgery, for some patients with complex condition, repeated operations or impaired anal function, we must be careful when choosing reoperation, and weigh the benefits of patients and the risk of fecal incontinence.

Anal Canal/surgery , China , Consensus , Fecal Incontinence/prevention & control , Humans , Quality of Life , Rectal Fistula/surgery , Reoperation/adverse effects , Treatment Outcome
ABCD arq. bras. cir. dig ; 33(3): e1540, 2020. tab, graf
Article in English | LILACS | ID: biblio-1141905


ABSTRACT Background: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. Aim: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. Methods: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with "U" stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. Results: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). Conclusions: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.

RESUMO Racional: Há ainda necessidade de avanço no tratamento das fístulas transesfincterianas e o uso de fitoterápicos parece promissor. Objetivo: Avaliar a eficácia da Stryphnodendron adstringens associada à fistulotomia e esfincteroplastia primária no tratamento de fístulas transesfincterianas em ratos. Métodos: Utilizou-se 30 ratos Wistar submetidos à confecção de fístulas transesfincterianas com fio de aço 0; após 30 dias realizou-se tratamento de acordo com o grupo. O grupo A (n=10) foi submetido à fistulotomia; o grupo B (n=10) fistulotomia seguida de esfincteroplastia primária com ponto em "U" com poliglactina 911 4-0; o grupo C (n=10), semelhante ao grupo B, porém com a interposição entre os cotos musculares de esponja hemostática embebida em extrato de Stryphnodendron adstringens. Realizou-se eutanásia após 14 dias, ressecando-se segmento do canal anal para análise histológica, que objetivou avaliar o fechamento da fístula, a área de afastamento dos cabos musculares, o processo inflamatório e o grau de fibrose. Resultados: Nenhum animal apresentou trajeto fistuloso remanescente. Quanto ao afastamento entre os cabos musculares observou-se média 106,3 µm2 no grupo A, 82,8 µm2 no grupo B e 51,8 µm2 no grupo C (p<0,05). Não houve diferença entre os grupos quanto ao processo inflamatório e, em relação à fibrose; no grupo A observou-se média 0,6, no grupo B 0,7 e no grupo C 0,2 (p<0,05). Conclusões: O extrato de Stryphnodendron adstringens foi capaz de permitir menor afastamento entre os cabos musculares em ratos submetidos à fistulotomia seguida por esfincteroplastia primária, além de proporcionar menor fibrose local.

Animals , Rats , Digestive System Surgical Procedures , Plant Extracts/therapeutic use , Rectal Fistula/surgery , Fabaceae/chemistry , Anal Canal/surgery , Treatment Outcome , Rats, Wistar
Rev. argent. cir ; 112(2): 197-202, 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125803


Paciente masculino con diagnóstico de enfermedad inflamatoria intestinal (colitis ulcerosa), corticodependiente, que consulta en nuestro servicio por fístula perianal compleja con extenso compromiso inflamatorio crónico de la región perianal, el cual fue tratado exitosamente con la aplicación local de plasma rico en plaquetas como única terapéutica. Se presentan los beneficios que se podrían obtener mediante la aplicación de plasma rico en plaquetas autólogo en el tratamiento de este tipo de fístulas. De ese modo se evitan los procedimientos quirúrgicos en un terreno inflamatorio crónico que implican altas tasas de complicaciones y recurrencia, afectando la calidad de vida.

A male patient with a diagnosis of steroid dependent inflammatory bowel disease (ulcerative colitis) sought medical care due to complex perianal fistula with extended chronic inflammation of the perianal region that was successfully treated with platelet-rich plasma as a single therapy. The benefits of autologous platelet-rich plasma for the treatment of this type of fistulas are presented. In this way, there is no need to perform surgery in a chronic inflammatory territory with high rate of complications and recurrence affecting patients' quality of life.

Humans , Male , Adult , Young Adult , Rectal Fistula/surgery , Platelet-Rich Plasma , Inflammatory Bowel Diseases , Colitis, Ulcerative/diagnosis , Rectal Fistula/diagnosis
J. coloproctol. (Rio J., Impr.) ; 39(3): 242-248, June-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040322


ABSTRACT Rationale: Fistulotomy followed by primary sphincteroplasty is one of the therapeutic options in transsphincteric fistulae; however, it was not known which suture would present a better result. Objective: To compare polypropylene and polyglactin sutures in primary sphincteroplasty in rats subjected to fistulotomy. Method: Thirty Wistar rats were subjected to peritoneal anesthesia with ketamine and xylazine, followed by transfixation of the anal sphincter with steel thread, which remained for 30 days to develop the anal fistula. After this period, the steel thread was removed and four groups were formed: A - Control (n = 5), without treatment; B - Fistulotomy (n = 5), performed fistulotomy only; C - Polypropylene (n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polypropylene suture; D - Polyglactin (n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polyglactin suture; after 30 days the animals were anesthetized again and submitted to euthanasia by deepening the anesthetic plane to remove the specimens, analyzing fistula closure, muscle fiber distance, and inflammatory process. Results: The fistula persisted in all animals of the control group and in none of the other groups; the distances between the muscle fibers were 1620 µm, 4665 µm, and 2520 µm, respectively in Groups B, C, and D (p = 0.067); in relation to fibrosis, the means were 2.4, 2.8, and 3.6, respectively in Groups B, C, and D, showing greater fibrosis in the latter group (p = 0.041). Conclusion: There was no persistence of the fistula in any of the treated animals; there was no difference in the distance between the muscle fibers between the groups subjected to primary sphincteroplasty with polypropylene or polyglactin, or between these groups and the one treated only by fistulotomy. There was greater fibrosis in animals treated with primary sphincteroplasty with polyglactin.

RESUMO Racional: A fistulotomia seguida de esfincteroplastia primária é uma das opções terapêuticas nas fístulas transesfincterianas, porém, não se sabe ao certo qual fio poderia apresentar melhor resultado. Objetivo: Comparar os fios de polipropileno e poliglactina na esfincteroplastia primária em ratos submetidos a fistulotomia. Método: Utilizou-se 30 ratos Wistar, confeccionada fístula por transfixação do esfíncter anal com fio de aço, que permaneceu por 30 dias. Após, o fio de aço foi removido e foram formados quatro grupos: A - Controle (n = 5), sem tratamento; B - Fistulotomia (n = 5), realizada fistulotomia apenas; C - Polipropileno (n = 10), em que foi realizada fistulotomia seguida por esfincteroplastia primário com fio de polipropileno; D - Poliglactina (n = 10), mesmo procedimento com fio de poliglactina; após 30 dias analisou-se o fechamento da fístula, afastamento dos cabos musculares e processo inflamatório. Resultados: A fístula persistiu em todos animais do grupo controle e em nenhum dos demais grupos; dos grupos tratados a área de afstamento dos cabos musculares foi 1620 µm, 4665 µm e 2520 µm, respectivamente nos Grupos B, C e D (p = 0,067); em relação à fibrose as médias foram 2,4; 2,8 e 3,6; respectivamente nos Grupos B, C e D, demonstrando maior fibrose neste último grupo (p = 0,041). Conclusão: Não houve persistência da fístula em nenhum dos animais tratados, não houve diferença no afastamento dos cabos musculares entre os grupos submetidos a esfincteroplastia primária com polipropileno ou poliglactina, e nem destes com o grupo tratado apenas por fistulotomia. Houve maior fibrose nos animais tratados por esfincteroplastia primária com poliglactina.

Animals , Rats , Polyglactin 910 , Polypropylenes , Sutures , Rectal Fistula/surgery , Sphincterotomy
Rev. argent. coloproctología ; 30(2): 65-70, Jun. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1025568


Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.

Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Rectal Fistula/surgery , Rectal Fistula/diagnosis , Video-Assisted Surgery/methods , Postoperative Complications , Recurrence , Fecal Incontinence/etiology
Rev. chil. cir ; 71(1): 42-46, feb. 2019. tab
Article in Spanish | LILACS | ID: biblio-985377


Resumen Introducción: Las técnicas quirúrgicas para la fístula perianal compleja han tenido altas tasas de recidiva asociado al riesgo de incontinencia fecal. La técnica de LIFT (Ligadura Interesfintérica del trayecto fistuloso) ha logrado menores tasas de recidiva con casi nulo riesgo de incontinencia según reportes inter-nacionales. Sin embargo, aún no está consolidada como técnica estándar para esta patología. Objetivo: Presentar los resultados (éxito clínico e incontinencia según escala de Wexner) de nuestros pacientes con fístula perianal compleja operados con técnica de LIFT. Materiales y Método: Estudio descriptivo de cohorte prospectiva no aleatoria, con pacientes operados por fístula perianal compleja en el Hospital del Salvador, entre los años 2015 al 2017. Resultados: Se incluyen 22 pacientes operados. En un 77% se obtiene éxito terapéutico en la primera cirugía y hasta un 90% con una segunda cirugía más simple. Ninguno de los pacientes modificó su Wexner preoperatorio. Conclusiones: En pacientes con fístula perianal compleja la técnica de LIFT es una alternativa que ofrece igual o mejores tasas de curación clínica con bajo riesgo de incontinencia fecal.

Introduction: Surgical techniques for complex perianal fistula have high recurrence and fecal incontinence rates. The technique of LIFT (ligation of the intersphincteric fistula tract) has achieved lower rates of recurrence with almost no risk of incontinence according to international reports. However, it is not yet consolidated as a standard technique for this pathology. Objective: To present the results (clinical success and incontinence according to the Wexner scale) of our patients with complex perianal fistula operated with the LIFT technique. Materials and Method: Descriptive study of a non-randomized prospective cohort, with patients operated for complex perianal fistula at the Hospital del Salvador, between 2015 and 2017. Results: 22 operated patients are included. In 77%, therapeutic success is obtained in the first surgery and up to 90% with a second surgery. None of this patients modified their preoperative Wexner. Conclusions: In patients with complex perianal fistula, the LIFT technique is an alternative that offers high cure rates with low risk of fecal incontinence.

Humans , Male , Female , Adult , Middle Aged , Aged , Rectal Fistula/surgery , Ligation/adverse effects , Ligation/methods , Anal Canal/surgery , Postoperative Complications/etiology , Reoperation , Treatment Outcome , Organ Sparing Treatments/methods
J. coloproctol. (Rio J., Impr.) ; 38(4): 314-319, Oct.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-975980


ABSTRACT Background: The surgical treatment of anal fistula is complex due to the possibility of fecal incontinence. Fistulotomy and cutting Setons have the same incidence of fecal incontinence depending on the complexity of the fistula. Sphincter-preserving procedures such as anal fistula plug and ligation of intersphincteric fistula tract procedure may result in more recurrence requiring repeated operations. The aim of this study was to evaluate and compare the outcomes of treating fistula in Ano utilizing two methods: Fistula plug (Gore Bio-A) and ligation of intersphincteric tract (LIFT). Methods: Fifty four patients (33 males; 21 female, median ages 42 [range 32-47] years) with high anal inter-transphenteric fistula were treated with LIFT and fistula plug procedures from September 2011 until August 2016 by a single surgeon and were retrospectively evaluated. All were followed for a median of 23.9 (range 4-54) months with clinical examination. Twenty one patients underwent fistula plug and 33 patients underwent LIFT procedure (4 patients of the LIFT group underwent LIFT and rectal mucosa advancement flap). The healing rate and complications were evaluated clinically and through telephone calls. Results: The mean operative time for the Plug was 25 ± 17 min and for the LIFT was 40 ± 20 min (p = 0.017) and the mean hospital stay was 2.4 ± 1.1 and 1.9 ± 0.3 (p = 0.01) respectively. The early complications of the plug and LIFT procedures included; anal pain (33.3%, 66.6%, p = 0.13), perianal discharge (77.8%, 91%, p = 0.62), anal pruritus (38.9%, 50.0%, p = 0.71) and bleeding per rectum (16.7%, 33.3%, p = 0.39) respectively. The overall mean follow-up was 20.9 ± 16.8 months, p = 0.68. There was no statistically significant difference between the two groups (21.9 ± 7.5 months, 19.9 ± 16.1 months, p = 0.682). The healing rate was 76.2% (16/21 patients) in the fistula plug group and 81.1% (27/33 patients) in the LIFT group (p = 0.73). Patients who had LIFT procedure and a mucosal advancement flap had 100% healing rate (4 out of 4 patients). No incontinence of stool or feces and no fistula plug expulsion were seen in our patients. The healing time ranged from 1 to 6 months after surgery. There was no post-operative perianal abscess, cellulitis or pain. Conclusions: LIFT and anal plug are safe procedures for patients with primary and recurrent anal fistula. Both techniques showed excellent results in terms of healing and complication rate. None of our patients had incontinence after 5 years follow-up. The best success rate in our patients was seen after LIFT procedure with mucosal advancement flap. Larger and controlled randomized trials are needed for better assessment of treatment options.

RESUMO Introdução: O tratamento cirúrgico da fístula anal é complexo devido à possibilidade de incontinência fecal. A fistulotomia e o seton de corte têm a mesma incidência da incontinência fecal, dependendo da complexidade da fístula. Procedimentos de preservação do esfíncter, como o tampão da fístula anal e o procedimento LIFT (ligadura do trato da fístula interesfincteriana), podem resultar em mais recorrência, exigindo cirurgias repetidas. O objetivo deste estudo foi avaliar e comparar os desfechos do tratamento da fístula anal utilizando dois métodos: Tampão de fístula (Gore Bio-A) e Ligadura do Trato Interesfincteriano (LIFT). Métodos: Cinquenta e quatro pacientes (33 homens; 21 mulheres, com mediana de idade de 42 [variação 32-47] anos) foram tratados com LIFT e procedimentos com tampão de fístula de setembro de 2011 até agosto de 2016 por um único cirurgião e foram avaliados retrospectivamente. Todos foram acompanhados por uma mediana de 23,9 (variação de 4 a 54) meses com exame clínico. Vinte e um pacientes foram submetidos a tampão de fístula e 33 pacientes foram submetidos ao procedimento LIFT (4 pacientes do grupo LIFT foram submetidos a LIFT e retalho de avanço da mucosa retal). A taxa de cicatrização e as complicações foram avaliadas clinicamente e por meio de ligações telefônicas. Resultados: O tempo cirúrgico médio para o Tampão foi de 25 ± 17 minutos e para o LIFT foi de 40 ± 20 minutos (p = 0,017) e o tempo médio de internação foi de 2,4 ± 1,1 e 1,9 ± 0,3 (p = 0,01), respectivamente. As primeiras complicações dos procedimentos de tampão e LIFT incluíram: dor anal (33,3%, 66,6%, p = 0,13), secreção perianal (77,8%, 91%, p = 0,62), prurido anal (38,9%, 50,0%, p = 0,71) e sangramento pelo reto (16,7%, 33,3 %, p = 0,39) respectivamente. A média geral de acompanhamento foi de 20,9 ± 16,8 meses, p = 0,68. Não houve diferença estatisticamente significativa entre os dois grupos (21,9 ± 7,5 meses, 19,9 ± 16,1 meses, p = 0,682). A taxa de cicatrização foi de 76,2% (16/21 pacientes) no grupo com tampão de fístula e 81,1% (27/33 pacientes) no grupo LIFT (p = 0,73). Pacientes submetidos ao procedimento LIFT e um retalho de avanço da mucosa tiveram 100% de taxa de cura (4 de 4 pacientes). Nenhuma incontinência fecal e nenhuma expulsão do tampão da fístula foram observadas em nossos pacientes. O tempo de cicatrização variou de 1 a 6 meses após a cirurgia. Não houve abscesso perianal, celulite ou dor no pós-operatório. Conclusões: LIFT e tampão anal são procedimentos seguros para pacientes com fístula anal primária e recorrente. Ambas as técnicas apresentaram excelentes resultados em termos de cicatrização e taxa de complicações. Nenhum de nossos pacientes teve incontinência após 5 anos de acompanhamento. A melhor taxa de sucesso em nossos pacientes foi observada após o procedimento LIFT com retalho de avanço da mucosa. Ensaios clínicos randomizados de maior porte e controlados são necessários para melhor avaliação das opções de tratamento.

Humans , Male , Female , Adult , Middle Aged , Digestive System Surgical Procedures/adverse effects , Surgical Instruments/statistics & numerical data , Rectal Fistula/surgery , Absorbable Implants/statistics & numerical data , Treatment Outcome , Sphincterotomy/methods
J. coloproctol. (Rio J., Impr.) ; 38(4): 324-336, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975968


ABSTRACT Purpose: Treatment of anal fistulae is regarded as a challenge due to the diverse nature of this disease and its countless complications. Ligation of the intersphincteric fistula tract procedure and its modifications have been popularized among many surgeons worldwide due to their simplicity and promising outcomes. The main purpose of this article was to conduct a comprehensives review of the published literature on ligation of the intersphincteric fistula tract procedure and its modifications. Method: PubMed, the Cochrane database and Ovid were searched from January 2007 to June 2017. Fully published peer-reviewed studies which applied ligation of the intersphincteric fistula tract procedure and its modifications for the treatment of anal fistulae of cryptogenic origin with follow-up of median 12 months were eligible. Uncompleted studies, case reports, reviews, abstracts, letters, short communication, comments, and studies which did not fulfill inclusion criteria were excluded. The primary outcome was to measure primary healing, overall healing, failure, and recurrence of ligation of the intersphincteric fistula tract procedure and its modifications. Results: Twenty-two studies were identified with only ten studies meeting criteria of inclusion. Original ligation of the intersphincteric fistula tract was performed in five studies with a population of 199 patients while the remaining five studies showed four different modifications of the ligation of the intersphincteric fistula tract with a total number of 147 patients. Both original LIFT and its modifications have promising as well as potentially similar outcomes; primary healing in the original ligation of the intersphincteric fistula tract (73.95%) (95% CI 60.3-85.6) performed less than the modifications (82.3%) (95% CI 64.8-94.7). Overall healing in the original ligation of the intersphincteric fistula tract (78.9%) (95% CI 58.5-93.7) performed relatively less than in the modifications (93.6%) (95% CI 81.4-99.6). Failure in the original ligation of the intersphincteric fistula tract (17.9%) (95% CI 4.9-36.5) performed almost the same as the modifications (17.7%) (95% CI 5.3-35.2). Recurrence in the original ligation of the intersphincteric fistula tract was 9.7% (95% CI 1.7-23.2). However, there was no recurrence in the modifications. Conclusion: Ligation of the intersphincteric fistula tract and its modifications are effective and simple procedures in treating simple anal fistulae, especially high transsphincteric ones. However, more trials should be performed to evaluate its effectiveness regarding complex fistulae.

RESUMO Objetivo: O tratamento de fístulas anais é considerado um desafio devido à natureza diversa dessa doença e suas incontáveis complicações. O procedimento de ligadura do trato da fístula interesfincteriana e suas modificações foi popularizado entre cirurgiões em todo o mundo devido a sua simplicidade e desfechos promissores. O principal objetivo deste artigo foi conduzir uma revisão abrangente da literatura publicada sobre o procedimento de ligadura do trato da fístula interesfincteriana e suas modificações. Método: as bases de dados PubMed, Cochrane e Ovid foram pesquisadas de janeiro de 2007 a junho de 2017. Estudos publicados com revisão por pares que aplicaram o procedimento de ligadura do trato da fístula interesfincteriana e suas modificações para o tratamento de fístulas anais de origem criptogênica com acompanhamento de mediana de 12 meses foram elegíveis. Estudos incompletos, relatos de casos, revisões, resumos, cartas, comunicação breve, comentários e estudos que não preenchiam os critérios de inclusão foram excluídos. O desfecho primário foi medir a cicatrização primária, a cicatrização geral, falhas e recorrência do procedimento de ligadura do trato da fístula interesfincteriana e suas modificações. Resultados: Vinte e dois estudos foram identificados com apenas dez estudos atendendo aos critérios de inclusão. A ligadura original do trato da fístula interesfincteriana foi realizada em cinco estudos com uma população de 199 pacientes, enquanto os cinco estudos restantes apresentaram quatro modificações diferentes da ligadura do trato da fístula interesfincteriana com um total de 147 pacientes. Tanto o LIFT original quanto suas modificações têm resultados promissores e desfechos potencialmente semelhantes; cicatrização primária na ligadura original do trato da fístula interesfincteriana de 73,95% (IC 95% 60,3-85,6) menos realizada que as modificações de 82,3% (IC 95% 64,8-94,7). Cicatrização geral na ligadura original do trato da fístula interesfincteriana de 78,9% (IC 95% 58,5-93,7) realizada relativamente menos do que as modificações (93,6%, IC 95% 81,4-99,6). A falha na ligadura original do trato da fístula interesfincteriana (17,9%; IC 95% 4,9-36,5) realizada quase tanto quanto as modificações (17,7%; IC 95% 5,3-35,2). Recidiva na ligadura original do trato da fístula interesfincteriana em 9,7% (IC 95% 1,7-23,2). No entanto, não houve recorrência nas modificações. Conclusão: A ligadura do trato da fístula interesfincteriana e suas modificações são procedimentos eficazes e simples no tratamento de fístulas anais simples, especialmente as transesfincterianas altas. No entanto, mais estudos devem ser realizados para avaliar sua eficácia em relação às fístulas complexas.

Humans , Male , Female , Rectal Fistula/surgery , Ligation/methods , Anal Canal/surgery , Digestive System Surgical Procedures/methods , Treatment Outcome