BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures ...BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.展开更多
AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included ...AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.展开更多
Anal fistula is one of the three greatest anorectal diseases with a high prevalence. The traditional treatments（e.g., surgery） for fistula have limitations due to damage to the internal anal sphincter of patients. W...Anal fistula is one of the three greatest anorectal diseases with a high prevalence. The traditional treatments（e.g., surgery） for fistula have limitations due to damage to the internal anal sphincter of patients. With recent advances in biomaterials, treatments based on biomaterial filling （e.g., scleraprotein injection, fistula plug） have emerged as novel therapies for fistula. The anal fistula plug （e.g., based on small intestinal submucosa （SIS）） has attracted increasing attention because of short term healing rate and biocompatibility. However, challenges remain for this method such as plug falling as observed in clinics. To address this, this paper analyzes the case of SIS falling under physiological condition from mechanical point of view using ANSYS simulation. It then proposes three new geometrical structures for fistula plug and compares their mechanical behavior （e.g., axial stress, reaction of constraint） with that of clinically used structure （cone shape）. Based on the simulation, it optimizes the geometric parameters of fistula plug. The approach developed here can help to improve the design of fistula plug for better clinical treatments.展开更多
Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitt...Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.展开更多
Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears th...Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.展开更多
AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hosp...AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results.展开更多
Fistula-in-ano is the most common form of perineal sepsis.Typically,a fistula includes an internal opening,a track,and an external opening.The external opening might acutely appear following infection and/or an absces...Fistula-in-ano is the most common form of perineal sepsis.Typically,a fistula includes an internal opening,a track,and an external opening.The external opening might acutely appear following infection and/or an abscess,or more insiduously in a chronic manner.Management includes control of infection,assessment of the fistulous track in relation to the anal sphincter muscle,and finally,definitive treatment of the fistula.Fistulotomy was the most commonly used mode of management,but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps,fibrin glue,collagen fistula plug,ligation of the intersphincteric fistula track,and stem cells.Many descriptive and comparative studies have evaluated these different techniques with variable outcomes.The lack of consistent results,level I evidence,or long-term follow-up,as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm.This article will review the most commonly available modalities and techniques for managing idiopathic fistula-in-ano.展开更多
Background: Ligation of the inter-sphincter fistula tract associated with anal plug (LIFT-Plug) is a new anal fistula treatment procedure at the Yaoundé Central Hospital. A two-sided prosthesis piece bent in the ...Background: Ligation of the inter-sphincter fistula tract associated with anal plug (LIFT-Plug) is a new anal fistula treatment procedure at the Yaoundé Central Hospital. A two-sided prosthesis piece bent in the shape of a cone is used here as an anal plug. The aim of this work was to evaluate the therapeutic results and the safety of this device. Patients and Methods: The clinical data of patients operated by the LIFT-Plug technique from January 1, 2020 to June 30, 2021 for a high anal fistula were analyzed prospectively. The variables evaluated were operative time, cure rate, postoperative complications and recurrence rate. Results: We included 28 patients with a mean age of 42 years. The sex ratio was 1.15. No patient presented preoperative continence disorder. The fistula was high trans-sphincteric in 89.3% of cases. The average duration of surgery was 55.2 minutes (45 to 66 minutes). The postoperative course was straightforward, although 60.7% of the patients had experienced tingling that resolved spontaneously. Three patients (10.7%) presented with transient gas incontinence (WIS of 4) which completely resolved after one month. All patients healed within a mean of 63.21 days (25 to 95 days). At the end of the 6-month follow-up, no case of recurrence had been recorded. Conclusion: The LIFT-Plug is a simple, safe and effective technique for the treatment of upper anal fistula without major impairment of continence despite delayed healing. The adapted two-sided prosthesis is a good alternative to the conventional anal plug.展开更多
文摘BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.
文摘AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.
基金supported by the Major International (Regional) Joint Research Program of China (11120101002)the National Natural Science Foundation of China(10825210 and 31050110125)the National 111 Project of China(B06024)
文摘Anal fistula is one of the three greatest anorectal diseases with a high prevalence. The traditional treatments（e.g., surgery） for fistula have limitations due to damage to the internal anal sphincter of patients. With recent advances in biomaterials, treatments based on biomaterial filling （e.g., scleraprotein injection, fistula plug） have emerged as novel therapies for fistula. The anal fistula plug （e.g., based on small intestinal submucosa （SIS）） has attracted increasing attention because of short term healing rate and biocompatibility. However, challenges remain for this method such as plug falling as observed in clinics. To address this, this paper analyzes the case of SIS falling under physiological condition from mechanical point of view using ANSYS simulation. It then proposes three new geometrical structures for fistula plug and compares their mechanical behavior （e.g., axial stress, reaction of constraint） with that of clinically used structure （cone shape）. Based on the simulation, it optimizes the geometric parameters of fistula plug. The approach developed here can help to improve the design of fistula plug for better clinical treatments.
文摘Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.
文摘Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.
文摘AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results.
文摘Fistula-in-ano is the most common form of perineal sepsis.Typically,a fistula includes an internal opening,a track,and an external opening.The external opening might acutely appear following infection and/or an abscess,or more insiduously in a chronic manner.Management includes control of infection,assessment of the fistulous track in relation to the anal sphincter muscle,and finally,definitive treatment of the fistula.Fistulotomy was the most commonly used mode of management,but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps,fibrin glue,collagen fistula plug,ligation of the intersphincteric fistula track,and stem cells.Many descriptive and comparative studies have evaluated these different techniques with variable outcomes.The lack of consistent results,level I evidence,or long-term follow-up,as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm.This article will review the most commonly available modalities and techniques for managing idiopathic fistula-in-ano.
文摘Background: Ligation of the inter-sphincter fistula tract associated with anal plug (LIFT-Plug) is a new anal fistula treatment procedure at the Yaoundé Central Hospital. A two-sided prosthesis piece bent in the shape of a cone is used here as an anal plug. The aim of this work was to evaluate the therapeutic results and the safety of this device. Patients and Methods: The clinical data of patients operated by the LIFT-Plug technique from January 1, 2020 to June 30, 2021 for a high anal fistula were analyzed prospectively. The variables evaluated were operative time, cure rate, postoperative complications and recurrence rate. Results: We included 28 patients with a mean age of 42 years. The sex ratio was 1.15. No patient presented preoperative continence disorder. The fistula was high trans-sphincteric in 89.3% of cases. The average duration of surgery was 55.2 minutes (45 to 66 minutes). The postoperative course was straightforward, although 60.7% of the patients had experienced tingling that resolved spontaneously. Three patients (10.7%) presented with transient gas incontinence (WIS of 4) which completely resolved after one month. All patients healed within a mean of 63.21 days (25 to 95 days). At the end of the 6-month follow-up, no case of recurrence had been recorded. Conclusion: The LIFT-Plug is a simple, safe and effective technique for the treatment of upper anal fistula without major impairment of continence despite delayed healing. The adapted two-sided prosthesis is a good alternative to the conventional anal plug.
