AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received inf...AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.展开更多
Anal fistula surgery is a commonly performed procedure.The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontine...Anal fistula surgery is a commonly performed procedure.The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence.Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination,endoanal ultrasound or magnetic resonance imaging,on many occasions,unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial.In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.展开更多
BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operate...BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date.展开更多
BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem...BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem cell therapy for the treatment of complex perianal fistula can be an innovative option with potential long-term healing.AIM To evaluate the results of local administration of allogenic,adipose-derived mesenchymal stem cells(darvadstrocel)for complex anal Crohn’s fistula.METHODS All patients with complex anal fistulas associated with Crohn’s disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection(darvadstrocel)if at least one conventional or surgical attempt to close the fistula had failed.Darvadstrocel was only indicated in patients without active Crohn’s disease and without presence of anorectal abscess.Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis,removal of seton drainage,fistula curettage,closure of the internal openings and local stem cell injection.Data collection focusing on healing rates,occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.Data were retrospectively analyzed.RESULTS Between July 2018 and January 2021,12 patients(6 females,6 males)with a mean age of 42.5(range:26-61)years underwent stem cell therapy.All patients had a minimum of one complex fistula,including patients with two complex fistulas in 58.3%(7/12).Two of the 12 patients had horse-shoe fistula and 3 had one complex fistula.According to Parks classification,the majority of fistulas were transsphincteric(76%)or suprasphincteric(14%).All patients underwent removal of seton,fistula curettage,transanal closure of internal opening by suture(11/12)or mucosal flap(1/12)and stem cell injection.At a mean follow-up of 14.3(range:3-30)mo,a healing rate was documented in 66.7%(8/12);mean duration to achieve healing was 12(range:6-30)wk.Within follow-up,4 patients required reoperation due to perianal abscess(33.3%).Focusing on patients with a minimum follow-up of 12 mo(6/12)or 24 mo(4/12),long-term healing rates were 66.7%(4/6)and 50.0%(2/4),respectively.CONCLUSION Data of this single-center experience are promising but limited due to the small number of patients and the retrospective analysis.展开更多
基金Supported by Grants from Priority Academic Program Development of Jiangsu Higher Education Institutions,Jiangsu Provincial Clinical Medicine of Science and Technology Project,No.BL2014100
文摘AIM:To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease(CD).METHODS:The work was performed as a prospective study.All patients received infliximab combined withsurgery to treat perianal fistulizing CD,which was followed by an immunosuppressive agent as maintenance therapy.RESULTS:A total of 28 patients with perianal fistulizing CD were included.At week 30,89.3%(25/28)of the patients were clinically cured with an average healing time of 31.4 d.The CD activity index decreased to70.07±77.54 from 205.47±111.13(P<0.01)after infliximab treatment.The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89(P<0.01).C-reactive protein,erythrocyte sedimentation rate,platelets,and neutrophils all decreased significantly compared with the pretreatment levels(P<0.01).Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up.After a median follow-up of 26.4 mo(range:14-41 mo),96.4%(27/28)of the patients had a clinical cure.CONCLUSION:Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD,and this treatment was associated with better longterm outcomes.
文摘Anal fistula surgery is a commonly performed procedure.The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence.Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination,endoanal ultrasound or magnetic resonance imaging,on many occasions,unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial.In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.
文摘BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date.
文摘BACKGROUND Despite tremendous progress in medical therapy and optimization of surgical strategies,considerable failure rates after surgery for complex anal fistula in Crohn’s disease have been reported.Therefore,stem cell therapy for the treatment of complex perianal fistula can be an innovative option with potential long-term healing.AIM To evaluate the results of local administration of allogenic,adipose-derived mesenchymal stem cells(darvadstrocel)for complex anal Crohn’s fistula.METHODS All patients with complex anal fistulas associated with Crohn’s disease who were amenable for definite fistula closure within a defined observation period were potential candidates for stem cell injection(darvadstrocel)if at least one conventional or surgical attempt to close the fistula had failed.Darvadstrocel was only indicated in patients without active Crohn’s disease and without presence of anorectal abscess.Local injection of darvadstrocel was performed as a standardized procedure under general anesthesia including single-shot antibiotic prophylaxis,removal of seton drainage,fistula curettage,closure of the internal openings and local stem cell injection.Data collection focusing on healing rates,occurrence of abscess and follow-up was performed on a regular basis of quality control and patient care.Data were retrospectively analyzed.RESULTS Between July 2018 and January 2021,12 patients(6 females,6 males)with a mean age of 42.5(range:26-61)years underwent stem cell therapy.All patients had a minimum of one complex fistula,including patients with two complex fistulas in 58.3%(7/12).Two of the 12 patients had horse-shoe fistula and 3 had one complex fistula.According to Parks classification,the majority of fistulas were transsphincteric(76%)or suprasphincteric(14%).All patients underwent removal of seton,fistula curettage,transanal closure of internal opening by suture(11/12)or mucosal flap(1/12)and stem cell injection.At a mean follow-up of 14.3(range:3-30)mo,a healing rate was documented in 66.7%(8/12);mean duration to achieve healing was 12(range:6-30)wk.Within follow-up,4 patients required reoperation due to perianal abscess(33.3%).Focusing on patients with a minimum follow-up of 12 mo(6/12)or 24 mo(4/12),long-term healing rates were 66.7%(4/6)and 50.0%(2/4),respectively.CONCLUSION Data of this single-center experience are promising but limited due to the small number of patients and the retrospective analysis.
