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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): 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
Article in Chinese | WPRIM | ID: wpr-887473


OBJECTIVE@#To evaluate the clinical therapeutic effect of electroacupuncture (EA) at @*METHODS@#The data of 318 patients undergoing anal fistula surgery were analyzed retrospectively. In accordance with whether accepted the combined treatment with EA at bilateral @*RESULTS@#For VAS score, there was an interaction between therapeutic method and treatment duration (@*CONCLUSION@#Electroacupuncture at

Acupuncture Points , Acupuncture, Ear , Electroacupuncture , Humans , Rectal Fistula/therapy , Retrospective Studies
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
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
Rev. argent. coloproctología ; 30(2): 43-50, Jun. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1025463


La enfermedad de Crohn constituye una enfermedad inflamatoria crónica que puede cursar con fistulas complejas en hasta un 20% de los pacientes. A pesar de la intensificación del tratamiento, asociado o no a la cirugía, todavía es considerable el porcentaje de pacientes que no responden al tratamiento. En los últimos años se ha empezado a desarrollar nuevas terapias que permitan conseguir una mayor tasa de curación de estos pacientes, con las mínimas complicaciones posibles. Es cuando aparecen agentes que pretenden de forma directa el sellado o intervienen en la reducción local de la inflamación. Es objetivo de este artículo mostrar el papel de la Medicina Regenerativa en el tratamiento de estos pacientes.

Crohn's disease is a chronic inflammatory disease that can occur with complex fistulas in up to 20% of patients. Despite the intensification of treatment, associated with no surgery, the percentage of patients who do not respond to treatment is still considerable. In recent years, new therapies have been developed to achieve a higher cure rate for these patients, with the minimum possible complications. It is when agents appear to pretend as seal fistula tract as the local reduction of inflammation. The aim of this article is to show the role of Regenerative Medicine in the treatment of these patients.

Humans , Crohn Disease/therapy , Fibrin Tissue Adhesive/therapeutic use , Rectal Fistula/therapy , Regenerative Medicine , Stem Cells/drug effects , Crohn Disease/complications , Platelet-Rich Plasma/drug effects
ABCD arq. bras. cir. dig ; 32(4): e1465, 2019. graf
Article in English | LILACS | ID: biblio-1054591


ABSTRACT Background: Crohn's disease is a pathological condition that has different options of treatment, but there are patients who need other therapeutic approach, such as the use of adipose-derived mesenchymal stem cells. Aim: Systematic literature review to determine the different ways of adipose-derived mesenchymal stem cells administration in humans with luminal refractory and perianal fistulizing Crohn's disease. Methods: It was conducted a search for articles (from 2008 to 2018) on PubMed and ScienceDirect databases using the keywords Crohn's disease, fistulizing Crohn's disease, luminal Crohn's disease and transplantation of mesenchymal stem cells or mesenchymal stem cells or stromal cells. Thirteen publications were selected for analysis. Results: Only one study referred to the luminal Crohn´s disease. The number of cells administered was variable, occurring mainly through subcutaneous adipose tissue by liposuction. It could be highlighted the autologous transplant with exclusive infusion of mesenchymal stem cells. The procedures involved in pre-transplant were mainly curettage, setons placement and stitching with absorbable suture, and conducting tests and drug treatment for luminal Crohn´s disease. During transplant, the injection of mesenchymal stem cells across the fistula path during the transplant was mainly on the intestinal tract wall. Conclusion: Although the use of mesenchymal stem cells is promising, the transplant on the luminal region should be more investigated. The injection of mesenchymal stem cells, exclusively, is more explored when compared to treatment with other products. The preparation of the fistulizing tract and the location of cell transplantation involve standardized health care in most studies.

RESUMO Racional: Há diferentes opções de tratamento para a doença de Crohn, porém, em alguns casos, há a necessidade de outras abordagens terapêuticas, como o uso de células-tronco mesenquimais derivadas do tecido adiposo. Objetivo: Revisar sistematicamente a literatura para determinar as diferentes formas de administração das células-tronco mesenquimais derivadas do tecido adiposo em seres humanos com doença de Crohn refratária luminal e fistulizante perianal. Método: Buscaram-se artigos publicados entre 2008 e 2018 nas bases de dados PubMed e ScienceDirect, pelos descritores: Crohn's disease, fistulizing Crohns disease, luminal Crohns disease e transplantation of mesenchymal stem cells ou mesenchymal stem cell ou stromal cells. Treze artigos foram selecionados. Resultados: Somente um trabalho se referiu à doença luminal. A quantidade de células administradas foi variável, obtendo-se principalmente do tecido adiposo subcutâneo por lipoaspiração. Destacou-se o transplante autólogo com a infusão exclusiva de células-tronco mesenquimais. Os procedimentos realizados no pré-transplante foram principalmente o de curetagem, colocação de setons e suturas com fio absorvível, e de exames e tratamento medicamentoso para a doença luminal. No transplante, ocorreu a injeção das células por todo o trajeto fistuloso, principalmente nas paredes do trato. Conclusão: Embora o uso de células-tronco mesenquimais seja promissor, o transplante na região luminal deve ser mais investigado. A injeção exclusiva de células-tronco mesenquimais é mais explorada quando comparada ao tratamento conjunto com outros produtos. A forma de preparo do trato fistuloso e o local de transplante envolvem cuidados médicos padronizados na maioria dos estudos.

Humans , Crohn Disease/therapy , Adipose Tissue/cytology , Rectal Fistula/therapy , Mesenchymal Stem Cell Transplantation/methods , Crohn Disease/complications , Adipose Tissue/transplantation , Rectal Fistula/etiology
J. coloproctol. (Rio J., Impr.) ; 38(3): 240-245, July-Sept. 2018.
Article in English | LILACS | ID: biblio-954604


ABSTRACT Crohn's disease has an ever-increasing prevalence and incidence, with about 20% of patients developing perianal fistula with significant impact on their quality of life. Despite the medical and surgical treatments currently used, Crohn's-related fistula treatment continues to pose a challenge due to the low rates of efficacy associated with high recurrence rates. Recent clinical trials have shown promising results regarding safety and efficacy of local treatment of this condition with the use of adipose tissue-derived mesenchymal stem cells. Besides being pluripotent and poorly immunogenic, they have immunomodulatory and anti-inflammatory properties, which combined, may accelerate healing. Our main objective is to summarize the clinical trials we found, highlighting the efficacy rates of this therapy and the main limitations we found in the analysis of the results. We conclude that, in perianal fistulas refractory to conventional therapies, the treatment with adipose tissue-derived mesenchymal cells is safe with promising results that may change the current paradigm of Crohn's related fistula treatment.

RESUMO A incidência e a prevalência da doença de Crohn têm aumentado e, ao longo do decurso da doença, cerca de 20% dos doentes irão desenvolver fístulas perianais com impacto significativo na sua qualidade de vida. Apesar dos tratamentos médicos e cirúrgicos utilizados atualmente, o tratamento destas fístulas continua a constituir um desafio com baixas taxas de eficácia e com elevadas taxas de recorrência. Ensaios clínicos recentes têm demonstrado resultados promissores em termos de segurança e eficácia de tratamentos locais destas fístulas com o recurso a células estaminais mesenquimatosas derivadas do tecido adiposo que, além de pluripotentes e pouco imunogênicas, têm capacidades imunomoduladoras e anti-inflamatórias capazes de promover o processo de cicatrização. O objetivo desta revisão sistemática é sumarizar os ensaios clínicos encontrados, realçando as taxas de eficácia desta terapêutica e as principais limitações na análise dos resultados. Concluímos que, nas fístulas perianais refratárias ás terapias convencionais, o tratamento com com celulas estaminais mesenquimatosas derivadas do tecido adiposo é seguro e com resultados promissores que podem mudar o paradigma atual do tratamento das fistulas complexas associadas à Doença de Crohn.

Humans , Male , Female , Crohn Disease/pathology , Rectal Fistula/therapy , Mesenchymal Stem Cells/cytology , Adipose Tissue/cytology , Treatment Outcome
Rev. cuba. hematol. inmunol. hemoter ; 34(1): 89-95, ene.-mar. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-978414


La enfermedad pilonidal o fístula pilonidal es una afección que se presenta a lo largo del pliegue entre los glúteos, desde el hueso sacro hasta el ano. Esta afección involucra los folículos pilosos de la región presacra, los cuales penetran en el tejido celular subcutáneo y forman un quiste alrededor. Se presenta como una o varias fositas o depresiones de diámetro pequeño, puntiforme por la que emergen pelos. Como parte del tratamiento médico se describen medidas locales, la antibióticoterapia de amplio espectro y tratamiento quirúrgico, en el cual se describen técnicas de resección abiertas y cerradas. Se presenta el caso de una adolescente femenina de 16 años de edad, diagnosticada hace año y medio con una fístula pilonidal que requirió tratamiento con vitaminoterapia, medidas locales e intervención quirúrgica en tres ocasiones. En la última de ellas se produjo dehiscencia del sitio quirúrgico, escaso tejido de granulación y pobre cicatrización. Por tal motivo se decidió la aplicación de lisado de plaquetas en toda el área de la fístula a razón de 1 mL en días alternos, durante dos semanas, se continuó una aplicación semanal durante las 4 semanas siguientes hasta que se obtuvo el cierre total. La utilización del lisado de plaquetas favorece el tejido de granulación y la cicatrización en la fistula pilonidal(AU)

Intergluteal pilonidal disease or pilonidal fistula is a condition presenting along the cleft between the buttocks, which runs from the bone at the bottom of the spine (sacrum) to the anus. This condition involves the hair follicles of the presacral region, which penetrates into the subcutaneous tissue and forms a cyst around. It is presented as one or more pits or depressions of small diameter emerging punctuate by hairs. As part of medical treatment local measures, broad-spectrum antibiotic therapy and surgical treatment, which may be open and closed resection techniques, are described. We present a case of a 16- year- old female teenager, diagnosed a year and half ago, with a pilonidal fistula that required surgical treatment in 3 occasions, with local measures and vitamin therapy; dehiscence of the surgical site, poor tissue granulation and poor healing. It was applied platelet lysate throughout the area of the fistula at 1 mL alternate days, for two weeks, infiltration was continued for 4 weeks obtaining the total closure of the same. Therefore the use of platelet lysate promotes granulation tissue and scarring in pilonidal fistula(AU)

Female , Adolescent , Platelet Activating Factor/therapeutic use , Rectal Fistula/therapy , Intercellular Signaling Peptides and Proteins/therapeutic use , Case Reports , Regenerative Medicine
Gastroenterol. latinoam ; 29(supl.1): S53-S57, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-1117789


Crohn's disease is an inflammatory bowel disease that affects the intestinal bowel in a transmural way presenting with fistulizing phenotypes with abnormal communication between two epithelial surfaces. In perianal Crohn's disease, there are fistulizing tracts between the anal canal and perianal skin that can complicate with abscess formation. Symptoms include pain, perianal discharge and fluctuating lesions, requiring combined clinical and surgical management. The disease is difficult to treat and is associated with significant reduction in quality of life, requiring a multidisciplinary approach for the management of these patients. The following review describes clinical concepts of perianal Crohn's disease, with emphasis on diagnosis and treatment.

La enfermedad de Crohn es una enfermedad inflamatoria del tubo digestivo con compromiso transmural de la pared que puede manifestarse con fenotipos fistulizantes mediante el desarrollo de comunicaciones anormales entre dos superficies epiteliales. En el caso de la enfermedad de Crohn perianal se establecen trayectos fistulosos entre el epitelio del canal anal y la piel alrededor del ano, que pueden complicarse con la formación de abscesos. Clínicamente se presenta con descarga perianal, dolor y masa fluctuante requiriendo un manejo conjunto médico-quirúrgico para el tratamiento de las complicaciones, el control de las fístulas y el compromiso luminal asociado. Es necesario un enfoque multidisciplinario dado que es una enfermedad de difícil manejo que afecta la calidad de vida de los pacientes. En la siguiente revisión se exponen conceptos acerca de la enfermedad de Crohn fistulizante perianal y sus complicaciones, con énfasis en el diagnóstico y tratamiento.

Humans , Crohn Disease/complications , Rectal Fistula/diagnosis , Rectal Fistula/etiology , Rectal Fistula/therapy , Magnetic Resonance Imaging , Inflammatory Bowel Diseases/complications , Rectal Fistula/classification , Abscess
Rev. Asoc. Méd. Argent ; 129(1): 20-25, mar. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-835481


La fístula anal de etiología tuberculosa es una afección rara. Presentamos un caso en una paciente HIV (-), revisamos datos epidemiológicos y discutimos la fisiopatología, manifestaciones clínicas, nuevos desarrollos diagnósticos y brevemente su tratamiento.

Tubercular fistula in-ano is a rare condition. In addition to presenting a case in a HIV (-) patient, in this paper we review epidemiologic data, pathophysiology, clinical manifestations and new developments in diagnosis and their treatment is discussed briefly.

Humans , Adolescent , Female , Rectal Fistula/diagnosis , Rectal Fistula/etiology , Tuberculosis, Pulmonary/complications , Diagnostic Imaging , Rectal Fistula/therapy , HIV
Brasília; Ministério da Saúde; Versão Preliminar; 2016. 15 p. ilus.
Monography in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: lil-783970


Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

Humans , Adult , Primary Health Care/standards , Secondary Care/standards , Colorectal Surgery/standards , Rectal Fistula/diagnosis , Colorectal Neoplasms/diagnosis , Clinical Protocols/standards , Rectal Fistula/therapy , Health Care Coordination and Monitoring , Colorectal Neoplasms/therapy
s.l; Chile. Ministerio de Salud; [2016].
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-833916


Entregar orientaciones a los equipos de salud para estandarizar el manejo clínico farmacológico en el tratamiento con medicamentos biológicos para la Enfermedad de Crohn grave corticorefractarios o inmunorefractarios.Entregar orientaciones para el manejo clínico farmacológico en el tratamiento con medicamentos biológicos en pacientes con Enfermedad de Crohn grave o con Enfermedad de Crohn con fístulas perianales complejas. Dirigido a profesionales multidisciplinarios del equipo de salud que atienden personas con Enfermedad de Crohn grave o con Enfermedad de Crohn con fístulas perianales complejas. Población del objetivo - adultos y niños con diagnóstico de Enfermedad de Crohn grave o con Enfermedad de Crohn con fístulas perianales complejas. La garantía explícita de protección financiera para el tratamiento biológico para la Enfermedad de Crohn grave o con fístulas perianales complejas comprende el tratamiento con Infliximab o Adalimumab. Seguimiento: Enfermedad de Crohn Grave y Enfermedad de Crohn con fístulas perianales complejas: El seguimiento de los pacientes puede ser realizado por médicos gastroenterólogos, (adulto o pediátrico según corresponda) o coloproctólogo. También podrá ser realizado por médicos que no tienen la especialidad de gastroenterología, pero cuentan con capacitación o con experiencia en el manejo de estos pacientes, los que deberán ser autorizados por el Comité de Expertos.

Humans , Child , Adult , Adalimumab/therapeutic use , Crohn Disease/complications , Crohn Disease/therapy , Infliximab/therapeutic use , Rectal Fistula/complications , Rectal Fistula/therapy , Clinical Protocols/standards , Health Planning Guidelines
Arq. gastroenterol ; 51(4): 284-289, Oct-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-732201


Background Perianal fistulizing Crohn’s disease is one of the most severe phenotypes of inflammatory bowel diseases. Combined therapy with seton placement and anti-TNF therapy is the most common strategy for this condition Objectives The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing Crohn’s disease. Methods This was a retrospective observational study with perianal fistulizing Crohn’s disease patients submitted to combined therapy from four inflammatory bowel diseases referral centers. We analyzed patients’ demographic characteristics, Montreal classification, concomitant medication, classification of the fistulae, occurrence of perianal complete remission and recurrence after remission. Complete perianal remission was defined as absence of drainage from the fistulae associated with seton removal. Discussion A total of 78 patients were included, 44 (55.8%) females with a mean age of 33.8 (±15) years. Most patients were treated with Infliximab, 66.2%, than with Adalimumab, 33.8%. Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5%-63.6%). Recurrence occurred in four (9.8%) patients (95% CI: 0.7%-18.8%) in an average period of 74.8 months. Conclusions Combined therapy lead to favorable and durable results in perianal fistulizing Crohn’s disease. .

Contexto A doença de Crohn perianal fistulizante é uma das formas mais graves das doenças inflamatórias intestinais. A terapia combinada com sedenhos e agentes biológicos é a estratégia mais comumente empregada para essa condição. Objetivo O objetivo deste estudo foi analisar as taxas de remissão perianal completa com a terapia combinada na doença de Crohn perianal fistulizante. Métodos Trata-se de um estudo retrospectivo e observacional com portadores de doença de Crohn perianal fistulizante submetidos à terapia combinada provenientes de quatro centros de referência do Brasil. Foram analisadas as características de base dos pacientes, classificação de Montreal, medicamentos concomitantes, classificação das fístulas, ocorrência de remissão perianal completa e recorrência. Remissão perianal completa foi definida como ausência de drenagem das fístulas associada à retirada dos sedenhos. Discussão Foram incluídos 78 pacientes, 44 (55,8%) mulheres, com média de idade de 33,8 (±15) anos. A maior parte dos pacientes foi tratada com Infliximabe, 66,2%, do que com Adalimumabe, 33,8%. Fístulas complexas foram observadas em 52/78 (66,7%) pacientes. Após um seguimento médio de 48,2 meses, 41/78 (52,6%) pacientes apresentaram remissão perianal completa (IC 95%: 43,5%-63,6%). Recorrência foi observada em quatro (9,8%) pacientes (IC 95%: 0,7%-18,8%) em um período médio de 74,8 meses para sua ocorrência. Conclusão A terapia combinada trouxe resultados favoráveis e duradouros em portadores de doença de Crohn perianal fistulizante. .

Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Crohn Disease/therapy , Rectal Fistula/therapy , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Combined Modality Therapy , Recurrence , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitors
Gastroenterol. latinoam ; 25(1): 9-16, 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-765143


Background: Perianal fistula (PF) may be present in 40 percent of patients with Crohn´s Disease (CD). Due to its complexity, its management should be multidisciplinary. Purpose: To describe clinical treatment in patients with CD and PF in our institution. Materials and Methods: This is a descriptive retroprospective study, using a registry of CD patients. We selected patients with PF and further characterized those patients that received their treatment at Clínica las Condes (CLC). Results: From a total of 74 patients with CD in the registry, 23 (31 percent) had PF, 61 percent male, median of 7 years of disease and half with colonic extension. Twelve patients were treated in CLC, from these, seven had concomitant proctitis. Optimal diagnostic study (magnetic resonance imaging/endorectal ultrasound plus examination under anesthetic) was performed in eleven (92 percent) patients. Ten (83 percent) patients received an optimal treatment (drainage and installation of a loose seton + start or optimization of medical therapy). Complete clinical response was achieved in more than half of the patients under optimal treatment within the first 6 months. Six (50 percent) patients had one or more recurrences of PF with similar study and management in a median of 13 months. With a median follow-up of 29 months, eight out of 12 patients had complete clinical response. There was one patient with unfavorable course who required a proctectomy and terminal diversion. Conclusion: Treatment of PF in CD is complex and in our population, the first-line treatment includes the installation of a loose seton and medical therapy to achieve clinical response even though fistulous tracts may persist.

Introducción: La fístula perianal (FP) puede presentarse hasta en 40 por ciento de los pacientes con Enfermedad de Crohn (EC). Dada su complejidad el tratamiento debe ser multidisciplinario. Objetivo: Describir el tratamiento de los pacientes portadores de EC con FP. Métodos: Estudio descriptivo, utilizando un registro de pacientes con EC. Se seleccionaron los pacientes con FP y se caracterizaron aquellos que recibieron el tratamiento en Clínica Las Condes (CLC). Resultados: De un total de 74 pacientes con EC, 23 (31 por ciento) presentaban FP asociada, 61 por ciento de sexo masculino, mediana de duración de enfermedad 7 años y la mitad con extensión colónica. Doce pacientes fueron tratados en CLC, de ellos, siete presentaban proctitis al momento de la FP. En 11 (92 por ciento) pacientes se realizó un estudio diagnóstico óptimo (resonancia magnética/ endosonografía transrrectal y exploración bajo anestesia). Diez (83 por ciento) pacientes recibieron tratamiento óptimo biasociado (drenaje e instalación de sedal no cortante + inicio u optimización de terapia médica). Siete pacientes con tratamiento óptimo presentaron mejoría clínica completa dentro de los primeros 6 meses. Seis (50 por ciento) pacientes presentaron una o más recurrencia de FP con estudio y manejo similar en una mediana de 13 meses. Con una mediana de seguimiento de 29 meses, ocho de los 12 pacientes obtuvieron mejoría clínica completa. Una paciente evolucionó desfavorablemente, requiriendo proctectomía y ostomía terminal. Conclusión: El manejo del FP en EC es complejo, en nuestra población el tratamiento biasociado (sedal + fármacos) fue de elección para lograr una mejoría clínica aun cuando persistieron los trayectos fistulosos.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Crohn Disease/complications , Rectal Fistula/etiology , Rectal Fistula/therapy , Antibodies, Monoclonal/therapeutic use , Azathioprine/therapeutic use , Biological Therapy , Combined Modality Therapy , Anal Canal/pathology , Drainage/methods , Crohn Disease/therapy , Follow-Up Studies , Retrospective Studies , Treatment Outcome
Rev. argent. coloproctología ; 24(1): 19-23, mar. 2013.
Article in Spanish | LILACS | ID: lil-748641


Introducción: Existen distintitas alternativas quirúrgicas para el tratamiento de las fístulas complejas, todas ellas tienen el objetivo de eliminar la fístula sin ocasionar cambios en la continencia del paciente. En el año 2006, Johnson y col. reportaron el uso de un nuevo biomaterial para la fístula anal (PLUG Cook Surgical), alcanzando como resultados tasas de cierre del 87% en un seguimiento a 13 semanas. Objetivo: Relatar nuestra experiencia temprana con este material bioprotésico, como alternativa para el tratamiento de las fístulas perianales. Material y Método:Se realizó un análisis observacional y prospectivo de un total de 21 procedimientos quirúrgicos ambulatorios de fístulas perianales complejas, con el uso de un nuevo biomaterial. El resultado fue considerado exitoso si el orificio interno se cerró, si el paciente no tenía secreción en el último seguimiento y la ausencia de formación de abscesos. Resultados: 21 pacientes con fístulas transesfinterianas altas, fueron sometidos a la colocación del plug. La tasa de éxito global fue de 52,38% (11 pacientes). Los motivos del fracaso fueron infección y expulsión del tapón. Conclusión:Las series de casos publicadas hasta la fecha con el uso de este material reportan tasas de éxito que van desde un 13,8 hasta un 85%. En nuestra experiencia inicial con esta prótesis biológica fue del 52,38%. Este tipo de cirugía con prótesis tiene la ventaja de volver a realizarse sin afectar la continencia. Dada la baja morbilidad y la relativa simplicidad del procedimiento, el PLUG es un tratamiento alternativo para los pacientes con fístulas complejas, sin embargo su uso está limitado por el alto precio del material.

Introduction: There are many surgical alternatives for the treatment of complex fistulas, they all aim to eliminate fistula without causing changes in the patient’s anal continence. In 2006, Johnson & col reported using a Biodesign® Fistula Plug to repair anal fistulas, reaching closure rates of 87% in a 13-week follow-up. Objective: To report our experience in perianal fistulas treated with The Anal Fistula Plug, and to use this material as an alternative for the treatment. Methods: We performed a prospective observational analysis of a total of 21 patients with complex perianal fistulas, using the Fistula Plug. The result was considered successful if the internal os was closed, if the patient had no fistula discharge and the absence of an abscess. Results: 21 patients with high transsphincteric fistulas where treated with Fistula Plug. The success rate was 52.38% (11 patients). The reasons for failure were infection and plug ejection. Conclusion:The case series published with the use of Biodesign® Fistula Plug, reported success rates ranging from 13.8 to 85%. In our initial experience was 52.38%. This type of prosthetic surgery has the advantage that the patient can be reoperated without affecting anal continence; a low morbidity and relative simplicity of the procedure. However its use is limited by the high price of the material.

Humans , Male , Female , Rectal Fistula/therapy , Ambulatory Surgical Procedures/methods , Bioprosthesis/trends , Ambulatory Surgical Procedures/instrumentation
Gastroenterol. latinoam ; 24(supl.1): S33-S40, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-763717


The development of fistulas during the evolution of Crohn’s Disease represents a severe situation that affects quality of life and requires a multidisciplinary care approach that involving gastroenterologists, surgeons and radiologists. Fistulizing Crohn’s disease can be divided in perianal and not perianal disease. Perianal disease can also be divided in simple or complicated disease depending on the fistula’s characteristics that will guide the clinical and therapeutic approach. Fistulizing not perianal disease can be internal when it communicates the bowel with other organs (colovesical, rectovaginal or enteroenteric fistulas), and external when it communicates the bowel with the abdominal wall (enterocutaneous fistula), either as a spontaneous or post-surgical phenomenon. Given the variety of fistula presentation, it is necessary to give an individualized approach, taking into account the fistula’s route, the inflammatory bowel activity, the presence of abscesses, and the nutritional status of the patient. This review is focused on the current management of fistulizing Crohn’s disease in our country.

El desarrollo de fistulas durante la evolución de la enfermedad de Crohn es una situación grave que condiciona una peor calidad de vida, así como mayor complejidad en el enfrentamiento, debiendo involucrar la colaboración multidisciplinar entre gastroenterólogos, cirujanos y radiólogos. La enfermedad fistulizante se divide en aquella que afecta la zona perianal (enfermedad perianal) y en aquella que no afecta la zona perianal. La enfermedad perianal a la vez se dividirá en simple o compleja dependiendo de las características de las fistulas, lo cual condiciona variaciones en el enfrentamiento y tratamiento. La enfermedad fistulizante no perianal se divide en interna cuando comunica al intestino con otros órganos (fistulas entero-vesicales, entero-vaginales, entero-entérico) y externas cuando se comunica al intestino con la pared abdominal (fistulas entero-cutáneas) tanto de forma espontánea como postquirúrgica. Debido a la gran diversidad de presentación de las fistulas es necesario individualizar cada grupo de trayectos fistulosos, valorar la asociación a actividad inflamatoria luminal, descartar la presencia de abscesos y valorar el estado nutricional de los pacientes para definir el manejo integral adecuado. Este artículo se centra en el manejo actual de la enfermedad de Crohn fistulizante en nuestro país.

Humans , Crohn Disease/complications , Rectal Fistula/etiology , Rectal Fistula/therapy , Crohn Disease/therapy , Intestinal Fistula/etiology , Intestinal Fistula/therapy