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Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.
Introduction. A fistula is an abnormal connection between two epithelialized surfaces. About 80% of enterocutaneous fistulas are of iatrogenic origin secondary to surgery, and a smaller percentage are related to trauma, malignancy, inflammatory bowel disease or ischemia. The associated morbidity and complications can be significant, such as malnutrition, in which multiple factors intervene. Methods. A literature search was carried out in the PubMed, Google Scholar and SciELO databases using the keywords described and the most relevant articles from recent years were selected. Results. The classification of fistulas is based on their anatomy, their daily secretion output, and their location. There is a classic triad of complications: sepsis, malnutrition and electrolyte abnormalities. Control of fistula output, adequate drainage of the collections and antibiotic therapy are key to the early management of these patients. Recent studies emphasize that sepsis associated with malnutrition are the main causes of mortality. Conclusions. This condition represents one of the most difficult and prolonged complications to treat in abdominal and colorectal surgery, and is related to significant rates of morbidity, mortality and high costs for the health system. Multidisciplinary treatment based on fluid resuscitation, sepsis control, nutritional support, and wound care, among other factors, is necessary.
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Humanos , Procedimientos Quirúrgicos Operativos , Fístula Cutánea , Estado Nutricional , Morbilidad , Fístula Intestinal , Fístula RectalRESUMEN
Introduction: This article describes an unusual case of perianal Paget's Disease in a 42-year-old man, highlighting distinct characteristics about more typical cases. Case report: 42-year-old male patient with persistent perianal lesion, recurrent abscesses, and discomfort. Magnetic resonance imaging indicated a possible fistulous path. Biopsy revealed secondary anal Paget's disease and adenocarcinoma. Chemotherapy and radiotherapy treatment demonstrated a positive response. Discussion: Perianal Paget's Disease is a rare condition of the anal canal that is part of the Extramammary Paget's Disease (EMPD) group. Symptoms include itching, pain, perianal bleeding, and skin lesions. Diagnosis can be challenging and usually involves performing a histopathological biopsy associated with an immunohistochemical study. Treatment varies and may involve surgery, radiotherapy, and chemotherapy. Due to the rarity of the disease, the best therapeutic approach is not yet well defined, and follow-up is essential due to the risk of recurrence. Conclusion: Perianal Paget's Disease is rare and requires differentiation from other conditions. Early detection is essential to prevent malignancy. (AU)
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Humanos , Masculino , Adulto , Adenocarcinoma , Enfermedad de Paget Extramamaria/diagnóstico , Neoplasias de las Glándulas Anales , Enfermedad de Paget Extramamaria/terapiaRESUMEN
Rectourethral fistula (RUF) is a kind of intractable disease with special anatomical site, complex condition, and even serious infection. The common causes are iatrogenic trauma after radical prostatectomy, pelvic trauma and injury after local radiotherapy. At present, surgical approaches for RUF include transperineal approach, transsphincter approach, transabdominal approach and transanal approach.Traditional surgical treatment has the limitations of large trauma, high incidence of complications and slow recovery. Transanal minimally invasive surgery (TAMIS) for RUF has the characteristics of simple operation, small trauma and quick recovery. The purpose of this paper is to introduce the methods and experience of RUF treatment with TAMIS.
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Objective:To investigate the effects of video-assisted anal fistula treatment (VAAFT) on stress indicators and anal function in patients with anal fistula.Methods:Ninety-nine patients with anal fistula who received treatment in Lishui City People's Hospital from March 2020 to February 2022 were included in this study. They were randomly divided into a control group ( n = 48, undergoing fistulotomy) and an observation group ( n = 51, undergoing VAAFT). Clinical efficacy and the levels of various indexes during the perioperative period were compared between the two groups. Anal function [anal maximal contraction pressure, anal canal rest pressure, anal longest contraction time, anal incontinence Wexner score], and the levels of serum stress indicators [norepinephrine (NE), β-endorphin (β-EP), nerve growth factor (NGF), substance P (SP), and cortisol (Cor)] were determined before and after treatment. Postoperative complications were recorded. All patients were followed up for 3 months after surgery. Recurrence of anal fistula was compared between the two groups. Results:The total effective rate in the observation group was 94.12% (48/51), which was significantly higher than 79.17% (38/48) in the control group ( χ2 = 4.84, P < 0.05). The operative time, intraoperative blood loss, wound healing time, and length of hospital stay in the observation group were (34.78 ± 4.01) minutes, (34.48 ± 3.86) mL, (19.46 ± 2.05) days, and (12.76 ± 1.50) days, which were significantly shorter or less than those in the control group [(54.86 ± 6.05) minutes, (36.88 ± 4.01) mL, (25.61 ± 2.92) days, (21.05 ± 2.46) days, t = -19.57, -3.03, -12.18, -20.67, all P < 0.05). On the first day after surgery, the Visual Analogue Scale score in the observation was (1.88 ± 0.28) points, which was significantly lower than (3.55 ± 0.41) points in the control group ( t = -23.78, P < 0.05). At 3 months after surgery, anal maximal contraction pressure and Wexner scores in the observation group were (171.86 ± 18.68) mmHg and (0.39 ± 0.07) points, which were significantly lower than (180.37 ± 19.56) mmHg and (0.52 ± 0.09) points in the control group ( t = -2.21, -8.04, both P < 0.05). Anal canal rest pressure in the observation group was (50.77 ± 5.68) mmHg, which was significantly higher than (48.34 ± 5.23) mmHg in the control group ( t = 2.21, P < 0.05). There was no significant difference in anal longest contraction time between the two groups before and after treatment (both P > 0.05). At 3 days after surgery, NE and Cor levels in each group increased compared with those before surgery (both P < 0.05). At 3 days after surgery, NE and Cor levels in the observation group were (252.67 ± 29.16) μg/L and (281.34 ± 31.27) nmol/L, respectively, which were significantly lower than (304.03 ± 32.28) μg/L and (308.72 ± 34.18) nmol/L in the control group ( t = -8.31, -4.16, both P < 0.05). At 3 days after surgery, β-EP, SP, and NGF in each group were decreased compared with those before treatment (all P < 0.05). At 3 days after surgery, β-EP, SP, and NGF in the observation group were (62.37 ± 6.83) ng/L, (1.87 ± 0.23) ng/L, (30.82 ± 4.03) mg/L], respectively, which were significantly higher than (51.09 ± 5.74) ng/L, (2.59 ± 0.51) ng/L, and (38.19 ± 4.24) mg/L in the control group ( t = 8.86, 8.95, 8.85, all P < 0.05). There was no significant difference in the incidence of complications between the two groups ( P > 0.05). The recurrence of anal fistula in the observation group was 1.96% (1/51), which was significantly lower than 12.50% (6/48) in the control group ( χ2 = 4.18, P < 0.05). Conclusion:VAAFT exhibits a significant therapeutic effect on anal fistula, with a small surgical incision and minimal intraoperative bleeding. This procedure greatly shortens operative time and the length of hospital stay, alleviates postoperative pain, improves anal function, reduces postoperative stress response indicators, and has a low postoperative recurrence rate.
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Objective:To evaluate the value of time-signal intensity curve (TIC) combined with apparent diffusion coefficient (ADC) obtained with 1.5T magnetic resonance imaging in the evaluation of anal fistula activity.Methods:The clinical, imaging, and pathological data of 71 patients with pathologically confirmed anal fistula who received treatment in Ningbo Yinzhou No.2 Hospital from June 2018 to February 2020 were retrospectively analyzed. These patients were divided into active phase group ( n = 42) and remission phase group ( n = 29) according to surgical findings and pathological tissue composition. Pearson's chi-square test was used to analyze TIC types. The ADC value was compared between the two groups. Results:TIC types: In the active phase group, the percentage of patients with type I curve (rising enhancement pattern) and type III curve (washout pattern) was 47.6% (20/42) and 35.7% (15/42) respectively, which were significantly higher than that of patients with type III curve [plateau pattern; 16.7% (7/42)], χ2 = 9.22, 3.94, both P < 0.05). In the remission phase group, the percentage of patients with type I and II curves was 34.5% (10/29) and 55.2% (16/29) respectively, which were significantly higher than that of patients with type III curve [10.3% (3/29), χ2 = 4.86, 13.23, both P < 0.05]. ADC value: ADC value in the active phase group was significantly lower than that in the remission phase group [(0.932 ± 0.074) × 10 -3 mm 2/s vs. (1.164 ± 0.061) × 10 -3 mm 2/s, t = -13.87, P < 0.001). Conclusion:TIC combined with ADC value can effectively evaluate anal fistula activity. It can be used as a routine method for preoperative evaluation and postoperative follow-up for patients with anal fistula.
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Objective:To investigate the clinical effect of transsphincter fistulectomy in the treatment of anal fistula.Methods:Seventy-three patients with anal fistula who received treatment in Zhoushan Hospital from March 2016 to March 2020 were included in this study. They were randomly assigned to undergo either conventional incision combined with thread-drawing drainage (control group, n = 35) or transsphincter fistulectomy (observation group, n = 38). Operative time, wound healing time, length of hospital stay, Visual Analogue Scale (VAS) score 24 and 48 hours after surgery, complications, the improvement in anal sphincter function before and 3 months after surgery were compared between the two groups. Results:Operative time, wound healing time and length of hospital stay in the observation group were (49.83 ± 7.67) minutes, (20.78 ± 3.54) days and (5.31 ± 1.27) days, which were significantly shorter than those in the control group [(62.31 ± 5.45) minutes, (25.87 ± 3.10) days, (7.78 ± 1.32) days, t = 8.063, 6.512, 8.133, all P < 0.05). The VAS score 24 and 48 hours after surgery in the observation group were (2.43 ± 0.64) points and (1.21 ± 0.36) points, respectively, which were significantly lower than those in the control group [(3.87 ± 1.23) points, (2.83 ± 0.97) points, t = 6.347 and 9.607, both P < 0.05]. The incidence of complication in the observation group was significantly lower than that in the control group [5.26% (2/38) vs. 28.57% (10/35), χ2 = 7.206, P < 0.05]. Conclusion:Transsphincter fistulectomy in the treatment of anal fistula has good therapeutic effects, can reduce pain and has little impact on the function of anal sphincter. It is innovative and scientific.
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ABSTRACT Objective: To compare proctological diseases in HIV-positive and -negative patients. Method: Prospective study conducted in the proctology outpatient clinic at Instituto de Infectologia Emílio Ribas from 2013 through 2019. All of them underwent anamnesis and proctological examination and were divided into two groups (HIV+ and HIV−). The groups were then compared with regard to age, sex, diagnosis, and whether or not there was any indication for surgery. Results: 485 HIV + patients (41.9%) (Group I) and 672 HIV− (58.1%) (Group II). The mean age in Group I was 42.8 years, and 404 (83.3%) of the patients were males. In Group II, the mean age was 48.3 years, and 396 (59%) patients were females. In comparing the groups, a statistically significant difference was found regarding sex, age, and diagnosis. The incidence of hemorrhoid and anal skin tags was higher in group II and that of condyloma acuminata was higher in in Group I (p < 0.001). In Group I, condyloma acuminata was more prevalent, but in those with CD4 levels above 500 cells/mm3, the diagnoses were more similar to those in the population without HIV. Conclusions: Proctological diseases were found to be similar but have different incidences. The incidences of diseases in HIV− and + patients tend to approach each other as CD4 level increases.
RESUMO Objetivo: Comparar as doenças proctológicas nos pacientes HIV positivos e negativos. Método: Estudo prospectivo realizado no ambulatório de proctologia do Instituto de Infectologia Emílio Ribas de 2013 a 2019. Todos foram submetidos a anamnese e exame proctológico, e divididos em dois grupos (HIV+ e HIV−) sendo comparados em relação a idade, sexo, diagnóstico e se havia ou não indicação cirúrgica. Resultados: 485 pacientes HIV+ (41.9%) (Grupo I) e 672 HIV negativos (58.1%) (Grupo II). A média de idade do Grupo I foi 42.8 anos sendo 404 (83.3%) do masculino. No grupo II, a média de idade foi de 48.3 anos, sendo 396 (59%) do sexo feminino. Comparando os grupos, houve diferença estatisticamente significante em relação ao sexo, idade e diagnóstico. Houve maior incidência de hemorróida e plicoma no Grupo II e condilomas acuminados no Grupo I (p < 0.001). No Grupo I, o condiloma acuminado foi mais prevalente, porém naqueles com CD4 acima de 500 células/mm3, os diagnósticos se aproximaram da população sem HIV. Conclusão: As doenças proctológicas foram semelhantes, com incidências diferentes. A incidências das doenças de pacientes HIV− e + tendem a se aproximar na medida que o nível do CD4 aumenta.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cirugía Colorrectal/estadística & datos numéricos , Infecciones por VIH/complicaciones , VIHRESUMEN
RESUMEN Introducción: el infliximab es un fármaco, un anticuerpo monoclonal con una potente acción antiinflamatoria. Su mecanismo de acción disminuye el efecto del factor de necrosis tumoral, por otra, induce la apoptosis (muerte celular) de linfocitos que se encuentran de manera anormal activados. Es uno de los llamados tratamientos biológicos, desarrollados para el tratamiento de diversas enfermedades, entre ellas la enfermedad de Crohn la cual se caracteriza por inflamación granulomatosa segmentaria del tracto intestinal y suele afectar los tejidos cutáneos. Presentación del caso: paciente de 42 años masculino, blanco, que asiste a consulta desde el año 2006, recibió diferentes tratamientos con pocos resultados. Se toma una nueva conducta terapéutica en el 2018 con el anticuerpo monoclonar infliximab. Conclusiones: los resultados con la nueva terapéutica fueron satisfactorios.
ABSTRACT Introduction: Infliximab is a drug, a monoclonal antibody with a potent anti-inflammatory action. Its mechanism of action decreases the effect of tumor necrosis factor, on the other hand, it induces apoptosis (cell death) of abnormally activated lymphocytes. It is one of the so-called biological treatments, developed for the treatment of various diseases, including Crohn's disease which is characterized by segmental granulomatous inflammation of the intestinal tract and usually affects the skin tissues. Case report: 42-year-old white race male with a history of treatment since 2006, he underwent different treatments with few results. A new therapeutic behavior is taken in 2018 with the monoclonal antibody Infliximab. Conclusions: results with the new therapy were satisfactory.
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RESUMEN Fundamento: la enfermedad de Crohn se caracteriza por inflamación granulomatosa segmentaria del tracto intestinal y suele afectar los tejidos cutáneos. Su desarrollo incluye la compleja interacción entre la predisposición genética, la exposición al medio ambiente, la disfunción de la barrera epitelial y la respuesta inmunitaria anormal a bacterias patógenas y comensales. Las lesiones específicas de la enfermedad son manifestaciones extraintestinales, las más comunes: aftas orales y las fístulas perianales. Objetivo: exponer un caso con enfermedad de Crohn perianal fistulizante. Presentación del caso: paciente de 42 años masculino, blanco con antecedentes de haber sido atendido desde el año 2006 por estomatitis aftosa recurrente. Llega al Hospital Universitario Manuel Ascunce Domenech por primera vez en el 2013, donde fue valorado y seguido por el servicio de Coloproctología. Conclusiones: se realizó colonoscopia evolutiva y toma de biopsia, se sospechó por el cuadro en la enfermedad de Crohn con localización perianal.
ABSTRACT Background: Crohn's disease is characterized by segmental granulomatous inflammation of the intestinal tract and usually affects the cutaneous tissues. Its development includes the complex interaction between genetic predisposition, exposure to the environment, dysfunction of the epithelial barrier and the abnormal immune response to pathogenic and commensal bacteria. The specific lesions of the disease are extra-intestinal manifestations, the most common: oral aphthae and perianal fistulas. Objective: to report a case with fistulizing perianal Crohn's disease. Case report: 42-year-old male patient, white; with a history of having been treated since 2006 for recurrent aphthous stomatitis. He arrives at the Manuel Ascunce Domenech University Hospital for the first time in 2013, where he was evaluated and followed by the Coloproctology service. Conclusions: an evolutionary colonoscopy and biopsy was performed, it was suspected by the symptoms in Crohn's disease with perianal localization.
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SUMMARY OBJECTIVE Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%-50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs. METHODS The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared. RESULTS Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004). CONCLUSIONS After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.
RESUMO OBJETIVO Abscessos perianais são vistos com freqüência na clínica e uma fístula perianal se desenvolve em 30% a 50% dos casos após o tratamento. Este estudo investigou se o tipo de curativo aplicado após a drenagem do abscesso está correlacionado com o desenvolvimento da fístula. A prevenção da formação de fístulas reduziria a perda de trabalho e os custos com saúde. MÉTODOS Os prontuários de pacientes com drenagem de abscessos perianais entre janeiro de 2015 e janeiro de 2018 foram revisados retrospectivamente. Os pacientes com curativos pós-operatórios trocados com a lavagem da área no hospital foram incluídos no grupo 1. Os pacientes com curativos trocados em casa e a área banhada em 10% de banho de povidona com iodo povidona-Sitz foram incluídos no grupo 2. A frequência e o tempo de fístula formação, idade, sexo, custo e dias de trabalho perdidos nos dois grupos foram comparados. RESULTADOS As diferenças entre os grupos em idade, sexo, índice de massa corporal e o tipo de fístula que se desenvolveu após 3 meses e 1 ano após a drenagem do abscesso não foram estatisticamente significantes (p> 0,05). Durante o acompanhamento, o desenvolvimento da fístula foi significativamente menor no grupo 1 do que no grupo 2 (p <0,001). O risco de desenvolvimento de fístula perianal aumentou significativamente naqueles com índice de massa corporal (IMC)> 30 (p = 0,004). CONCLUSÕES Após a drenagem do abscesso perianal, a lavagem hospitalar e o curativo da área do abscesso até o fechamento do abscesso reduziram o risco de fístula perianal, perda de tempo de trabalho e custo. O risco de desenvolvimento de fístula perianal pareceu aumentar com o IMC. Um grande estudo prospectivo é necessário para confirmação.
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Humanos , Absceso , Drenaje , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Fisura AnalRESUMEN
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.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Fístula Rectal/cirugía , Fístula Rectal/epidemiología , Enfermedad de Crohn/complicaciones , ComorbilidadRESUMEN
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.
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Animales , Ratas , Fístula Rectal , Fístula Rectal/cirugía , Canal Anal , Incontinencia FecalRESUMEN
Abstract Rationale: Considering that anal fistulae are still challenging regarding their treatment due to the risk of fecal incontinence in the most complex cases and the increasing use of phytotherapeutic drugs such as Aloe Vera in medicine, even with proven healing effectiveness, there is interest in researching this drug in the treatment of anal fistulae. Objective: To evaluate the efficacy of Aloe Vera extract in the treatment of anal fistulae in rats. Method: Thirty male Wistar rats weighing 250-300 g were submitted to anal fistula and after 30 days were divided into three groups: Control Group (GCo) (n = 5), Carbopol Group (GCa) (n = 5), and Aloe Vera Group (GAV) (n = 10). In the GCo no treatment was performed, while in the others a daily infusion of 0.3 mL of solution (Carbopol only in GCa and Carbopol plus Aloe Vera extract in the GAV) was performed through the external orifice of the fistula for 30 days. Afterwards, euthanasia was performed and specimens were removed for histological study. It was evaluated the closure of the fistulous tract, the area of the remaining tract, the inflammatory infiltrate and the degree of vascular congestion. The results were submitted to statistical treatment by Kruskall-Wallis test, considering p<0.05. Results: There was no complete closure of the fistulous tract in any of the animals. The mean area of the remaining tract was 847.2 µm in the GCo, 565.6 µm in the GCa and 377.8 µm in the GAV (p<0.05). The mean of the inflammatory infiltrate score was 2.4 in the GCo, 2.4 in the GCa and 2.3 in the GAV (p<0.05), while in the evaluation of vascular congestion, we observed a mean of 1.6 in the GCo, 1.4 in GCa and 1.1 in GAV (p<0.05). Conclusion: The extract of Aloe vera was able to reduce the lumen of the fistulous tract and reduce the degree of vascular congestion; however, it did not allow the complete closure of the fistulous tract nor diminished the inflammatory process.
Resumo Racional: Considerando que o tratamento das fístulas anais tem risco de incontinência fecal e o crescente uso do Aloe Vera na medicina, há interesse em se pesquisar este fármaco. Objetivo: Avaliar a eficácia do extrato de Aloe vera no tratamento das fístulas anais em ratos. Método: Utilizou-se 30 ratos Wistar, os quais foram submetidos à criação de fístula anal e após 30 dias distribuídos em três grupos: Controle (GCo), Carbopol (GCa) e Aloe Vera (GAV). No GCo nenhum tratamento foi realizado, enquanto nos outros realizou-se infusão diária de 0,3 mL de Carbopol GCa e Carbopol mais extrato de Aloe Vera no GAV por 30 dias. Foram retirados os espécimes para estudo histológico, avaliou-se o fechamento do trajeto fistuloso, a área do trajeto remanescente, o infiltrado inflamatório e o grau de congestão vascular. Resultados: Não houve fechamento completo do trajeto fistuloso em nenhum dos animais. A média da área do trajeto remanescente foi 847,2 µm no GCo; 565,6 µm no GCa e 377,8 µm no GAV (p<0,05). A média do escore de infiltrado inflamatório foi 2,4 no GCo; 2,4 no GCa e 2,3 no GAV (p<0.05), enquanto na avaliação da congestão vascular observou-se média 1,6 no GCo; 1,4 no GCa e 1,1 no GAV (p<0,05). Conclusão: O extrato de Aloe Vera foi capaz de diminuir o lumen dos trajetos fistulosos e reduzir o grau de congestão vascular, porém, não permitiu o fechamento completo dos trajetos fistulosos nem diminuiu o processo inflamatório.
Asunto(s)
Animales , Ratas , Fístula Rectal/tratamiento farmacológico , Preparaciones de Plantas , Aloe , Aloe/efectos de los fármacos , Fitoterapia , Plantas Medicinales , Fístula Rectal , Ratas WistarRESUMEN
Abstract Rationale: Very often magnetic resonance imaging is used in the study of complex anal fistulae, but conventional reports may contribute little to what really matters to the coloproctologist. Objective: To compare the clarity and usefulness of the conventional report compared to structured magnetic resonance imaging in cases of anal fistula. Method: 30 magnetic resonance exams already performed with an evaluation of anal fistula were again evaluated without the radiologist having access to the old report and a new structured report was prepared. Five proctologists evaluated the 30 conventional and 30 structured reports and answered questionnaires with eight questions comparing their practical aspects. The results were tabulated and submitted to statistical treatment considering a significant p<0.05. Results: There was a statistically significant difference in favor of the structured report in the questions "clearly defines whether it is an active fistula or fibrosis", "clearly states whether the tract is single or multiple", "whether the patient has anal fistula or not". The other questions did not present differences between the groups. Conclusion: The structured magnetic resonance report presented clearer information and was better evaluated in relation to the conventional one in the analysis of proctologists in the study of anal fistulae.
Resumo Racional: Com muita frequência utiliza-se ressonância magnética no estudo de fístulas anais complexas, porém, laudos convencionais podem contribuir pouco para o que realmente importa ao coloproctologista. Objetivo: Comparar a clareza e utilidade do laudo convencional com uma proposta de laudo estruturado de ressonância magnética em casos de fístula anal. Método: 30 exames de ressonância magnética já com laudo realizados para avaliação de fístula anal foram novamente avaliados sem que o radiologista tivesse acesso ao laudo antigo e foi confeccionado novo laudo estruturado. Cinco médicos proctologistas avaliaram os 30 laudos convencionais e os 30 estruturados e responderam a questionários com oito questões comparando aspectos práticos dos mesmos. Os resultados foram tabulados e submetidos a tratamento estatístico considerando-se significante p<0,05. Resultados: Houve diferença estatisticamente significante em favor do laudo estruturado nos quesitos "define claramente se é fistula ativa ou fibrose", "declara claramente se o trajeto é único ou múltiplo", "fica clara a informação se o paciente tem ou não fistula anal". Os demais quesitos não apresentaram diferença entre os grupos. Conclusão: O laudo estruturado de ressonância magnética apresentou informações mais claras e foi melhor avaliado em relação ao convencional na análise dos proctologistas no estudo de fístulas anais.
Asunto(s)
Imagen por Resonancia Magnética , Fístula Rectal , Fístula Rectal/diagnóstico por imagen , Diagnóstico por ImagenRESUMEN
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.
Asunto(s)
Animales , Ratas , Procedimientos Quirúrgicos del Sistema Digestivo , Extractos Vegetales/uso terapéutico , Fístula Rectal/cirugía , Fabaceae/química , Canal Anal/cirugía , Resultado del Tratamiento , Ratas WistarRESUMEN
Objective: To explore the value of high frequency probe combined with end scan convex array probe transperineal ultrasonography for diagnosis of anal fistula. Methods: Data of 87 patients with anal fistula who underwent surgical treatment were retrospectively analyzed. All patients were examined with ultrasonography using 5-12 MHz linear array probe combining with palpation and visual examination for detection of external mouth and fistula before operation, also perineum ultrasound using 3-10 MHz end scan convex array probe for detection of internal mouth and typing and location of anal fistula. The consistency between results of ultrasound and surgical operation was analyzed. Results: Among 87 patients, 73 cases were diagnosed as simple anal fistula and 14 as complex anal fistula, with a total of 93 internal mouths, 101 fistula canals and 94 internal mouths were detected with surgical operation. Ultrasound correctly diagnosed anal fistula in 66 patients, missed anal fistula in 15 cases and misdiagnosed 6 cases, the coincidence rate of ultrasound and operation was 75.86% (66/87), the Kappa value was 0.344 (P<0.001).The accuracy of ultrasonography in diagnosing internal mouth, fistula canal and external mouth of anal fistula was 80.65% (75/93), 83.17% (84/101) and 87.23% (82/94), respectively, the Kappa value of consistency with operation results was 0.298, 0.407 and 0.626, respectively (all P<0.001). Conclusion: High frequency probe combined with end scan convex array probe transperineal ultrasonography is helpful to diagnosis of anal fistula.
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Twelve patients with complex anal fistulas were treated in the Affiliated Hospital of Medical School of Ningbo University from June to December 2018. All the patients were successfully operated, and after the operation the wound was rinsed twice a day by buried drainage tube. Patients were followed up for 3 months, the wound was healed in 11 cases and relapsed in 1 case with a mean wound healing time of (25.2±7.0) d; the pain scores at 1 d, 3 d and 5 d after surgery were 3.21±1.27, 2.34±1.22 and 1.89±0.78, respectively. There was no significant difference in preoperative and postoperative Wexner scores, anal resting pressure, and anal maximum systolic pressure (P>0.05).This innovative technique with buried drainage tube is safe and effective, which can shorten the recovery time and reduce the recurrence rate.
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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.
Asunto(s)
Animales , Ratas , Poliglactina 910 , Polipropilenos , Suturas , Fístula Rectal/cirugía , EsfinterotomíaRESUMEN
RESUMO Objetivo: avaliar a eficácia do extrato de Baccharis dracunculifolia no tratamento de fístulas anais em ratos. Métodos: vinte ratos Wistar machos foram submetidos à confecção de fístula anal e, após 30 dias, foram distribuídos em três grupos: Grupo Controle, com cinco animais; Grupo Carbopol, com cinco animais; e Grupo Baccharis dracunculifolia, com dez animais. No Grupo Controle, não se realizou nenhum tratamento. No Grupo Carbopol, realizou-se infusão diária de carbopol, e no Grupo Baccharis dracunculifolia, infusão de extrato de Baccharis dracunculifolia com carbopol, ambos por 30 dias. Foram retirados espécimes para análise histológica após a eutanásia. Resultados: não houve fechamento completo do trajeto fistuloso em nenhum dos animais. A média da área do trajeto resultante foi de 847,2µm2, 565,6µm2 e 372,7µm2, respectivamente, nos Grupos Controle, Carbopol e Baccharis dracunculifolia (p=0,001). A média do escore de processo inflamatório foi de 2,4, 2,4 e 2,1, respectivamente, nos Grupos Controle, Carbopol e Baccharis dracunculifolia (p=0,285), enquanto a média de congestão vascular foi de 1,6, 1,4 e 1,1, respectivamente, nos Grupos Controle, Carbopol e Baccharis dracunculifolia (p=0,031). Conclusão: o extrato de Baccharis dracunculifolia foi capaz de reduzir o lúmen dos trajetos fistulosos e a congestão vascular, sem reduzir, no entanto, o processo inflamatório local ou fechar totalmente os trajetos fistulosos.
ABSTRACT Objective: to evaluate the efficacy of Baccharis dracunculifolia extract in the treatment of anal fistulas in rats. Methods: twenty male Wistar rats were submitted to anal fistula and, after 30 days, were divided into three groups: Control Group, with five animals; Carbopol Group, with five animals; and Baccharis dracunculifolia Group, with ten animals. In the Control Group, no treatment was performed. In the Carbopol Group, a daily infusion of Carbopol was performed for 30 days. In the Baccharis dracunculifolia Group, a daily infusion of Carbopol plus Baccharis dracunculifolia extract was performed for 30 days. Specimens were taken for histological analysis after euthanasia. Results: there was no complete closure of the fistulous tract in any of the animals. The mean area of the remaining tract was of 847.2µm2, 565.6µm2 and 372.7µm2, in the Control Group, Carbopol Group, and Baccharis dracunculifolia Group, respectively, (p=0.001). The mean of the inflammatory process score was of 2.4, 2.4, and 2.1, in the Control Group, Carbopol Group, and Baccharis dracunculifolia Group, respectively, (p=0.285), while the mean values of vascular congestion were of 1.6, 1.4, and 1.1, in the Control Group, Carbopol Group, and Baccharis dracunculifolia Group, respectively, (p=0.031). Conclusion: Baccharis dracunculifolia extract was able to reduce the lumen of the fistulous tracts and the degree of vascular congestion, without, however, reducing the local inflammatory process or totally closing the fistulous tracts.
Asunto(s)
Animales , Masculino , Ratas , Extractos Vegetales/farmacología , Fístula Rectal/rehabilitación , Baccharis , Plantas Medicinales , Fístula Rectal/patología , Ratas Wistar , Modelos Animales de EnfermedadRESUMEN
Objective: To explore the value of transvaginal or perineal ultrasonography end-scan convex array probe in localization of internal orifice of female anal fistula. Methods: Seventeen patients with anal fistulas (case group) and 15 women in control group were examined with 3-10 MHz end-scan convex array ultrasound probe before operation, and the findings were compared with surgical results. Results: All subjects could tolerate ultrasonic examinations. There were totally 18 anal fistula internal orifices among 17 patients in case group, among which 16 were found with ultrasound before operation, and the coincidence rate of ultrasonic diagnosis with surgical operation was 88.89% (16 /18). In control group, three-layer structure of anal canal could be clearly displayed. Conclusion: Transvaginal or perineal ultrasonography end-scan convex array probe has high clinical value in localization of internal orifice of female anal fistula.