Annals of Coloproctology

Original Articles

Anorectal benign disease

Antibiotic use during the first episode of acute perianal sepsis: a still-open question: Stanislas Blondin, David Lobo, Axel Egal, Saliha Ysmail-Dahlouk, Milad Taouk, Josée Bourguignon, David Blondeel, Isabelle Etienney; Ann Coloproctol. 2025;41(1):40-46. Published online February 3, 2025; DOI: https://doi.org/10.3393/ac.2024.00472.0067

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Abstract PDF: Purpose
The role of antibiotics in preventing fistula formation following an initial abscess remains a subject of debate. This study compared the incidence of fistula in ano in patients experiencing their first episode of acute perianal sepsis, with and without antibiotic therapy, and evaluated the prevalence of fistula in ano necessitating surgical intervention at 1 year.
Methods
This retrospective cohort study was conducted at a tertiary care hospital with a dedicated proctology department. All patients who presented to the emergency proctology unit with a first episode of acute perianal sepsis were eligible for inclusion.
Results
This study included 276 patients. At 1 year, fistula formation was identified in 65.6% of all patients, 54.0% of those who had received antibiotics, and 75.0% of those who had not (P<0.001). This finding remained significant after weighted propensity analysis (odds ratio, 0.53; 95% confidence interval, 0.31–0.92; P=0.025).
Conclusion
The rate of fistula formation was relatively high in this study. However, it was lower among patients with perianal sepsis who were treated with antibiotics, although a causal relationship could not be established. Prolonged follow-up is needed to clarify the role of antibiotic therapy in preventing or delaying fistula development in patients with acute perianal sepsis.

Benign proctology,Complication,Biomarker & risk factor

Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study: Sarah Taieb, Patrick Atienza, Jean-David Zeitoun, Milad Taouk, Josée Bourguignon, Christian Thomas, Nabila Rabahi, Saliha Dahlouk, Anne-Carole Lesage, David Lobo, Isabelle Etienney; Ann Coloproctol. 2022;38(5):370-375. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00122.0017

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Abstract PDF

Purpose
The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment.
Methods
All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery.
Results
Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10^–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding.
Conclusion
Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

Citations

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Efficacy of Endoscopic Evaluation and Hemostatic Intervention for Post-hemorrhoidectomy Bleeding
Katsuhisa Ohashi, Katsuhide Ohashi, Akinori Sasaki, Kazuyoshi Ota, Kazutomo Kitagawa
Journal of the Anus, Rectum and Colon.2025; 9(1): 162. CrossRef
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study
Francesco Pata, Luigi M. Bracchitta, Bruno Nardo, Gaetano Gallo, Giancarlo D’Ambrosio, Salvatore Bracchitta
Frontiers in Surgery.2023;[Epub] CrossRef
Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects
Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysz
Polish Journal of Surgery.2023; 95(5): 14. CrossRef

Benign proctology,Surgical technique

Endorectal Advancement Flap With Muscular Plication in Anovaginal and Anterior Perineal Fistulas: Axel Egal, Isabelle Etienney, Patrick Atienza; Ann Coloproctol. 2021;37(3):141-145. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.10.1

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Abstract PDF

Purpose
Endorectal mucosal advancement flap with muscular plication can ensure complete closure of anovaginal fistulas and preserve continence. The aim of this retrospective study was to show indications might be broadened to include anoperineal fistulas.
Methods
This retrospective study gathered all available data from patients with anovaginal or anterior perineal fistulas who underwent transanal advancement flap repair with muscular plication. A loose seton was passed in the fistula track prior to surgery in all patients. Fistula healing was defined as fistula closure during proctological examination associated with complete resolution of symptoms.
Results
Thirty-five patients were included from January 2011 to March 2017. Causes of fistula were various, mostly post-operative (34.3%, n = 12), obstetrical (17.1%, n = 6) and inflammatory (14.3%, n = 5). Success rate was 65.2%. Fistula healing was obtained in 60.0% of patients with Crohn disease in remission. Closure rate was higher in anterior perineal fistulas (89.0%) than in anovaginal fistulas (63.6%) even if it did not reach statistical significance. Slight fecal continence disorders were noted in 2 women (5.7%).
Conclusion
This study demonstrates the efficacy of transanal advancement flap repair with muscular plication for anovaginal and anterior perineal fistulas. Similar closure rates and smaller postoperative incontinence rates compared to the classical technique make this surgery an optimal solution whose efficacy appears to be sustainable over time.

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Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Initial Clinical Outcomes Using Umbilical Cord–Derived Tissue Grafts to Repair Anovaginal Fistula
Gala M. Godoy-Brewer, Oluwafemi P. Owodunni, Alyssa M. Parian, Leonardo C. Duraes, Florin M. Selaru, Susan L. Gearhart
Diseases of the Colon & Rectum.2023; 66(2): 299. CrossRef
Modern opportunities for treatment of patients with rectovaginal fistulas: literature review
P. N. Myshentsev, S. E. Katorkin, A. I. Kuzmina
Meditsinskiy sovet = Medical Council.2023; (13): 184. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
A case report: Trans-Anal mucosal trapezoid flap for repair of Ano-vaginal fistula
Ratna Chopra, Yadav Pramod, Garg Ankit, Pandey Shruti
Indian Journal of Colo-Rectal Surgery.2020; 3(3): 71. CrossRef

Benign proctology

Increased Long-term Risk of Anal Fistula After Proctologic Surgery: A Case-Control Study: Julie Assaraf, Elsa Lambrescak, Jérémie H Lefèvre, Vincent de Parades, Josée Bourguignon, Isabelle Etienney, Milad Taouk, Patrick Atienza, Jean-David Zeitoun; Ann Coloproctol. 2021;37(2):90-93. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.06.18

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2 Citations

Abstract PDF

Purpose
Anal fistula is a common condition in proctology, usually requiring surgical treatment. Few risk factors have been clearly identified based on solid evidence. Our research objective was to determine whether history of anal surgery was a risk factor for subsequent anal fistula.
Methods
We conducted a case-control study from January 1, 2012 through December 31, 2013 in our tertiary center, comprising 280 cases that underwent surgery for anal fistula and 123 control patients seeking a consultation for upper gastrointestinal symptoms. Patients with inflammatory bowel disease were excluded. For both cases and controls, the following variables were recorded: sex, any prior anal surgery, diabetes mellitus, infection with human immunodeficiency virus, and smoking status. For each variable, confidence interval and odds ratio (OR) were calculated.
Results
In univariate analysis, male sex (73.2% vs. 31.7%, P < 0.0001), active smoking (38.1% vs. 22%, P = 0.0015), and prior anal surgery (16.0% vs. 4.1%, P = 0.0008) were associated with higher risk of anal fistula. In multivariate analysis, only male sex (OR, 5.5; 95% confidence interval [CI], 5.42 to 9.10; P < 0.0001) and previous anal surgery (OR, 4.48; 95% CI, 1.79 to 13.7; P = 0.0008) remained independently associated with anal fistula occurrence.
Conclusion
The epidemiology of anal fistula is poorly assessed despite the high frequency at which it is diagnosed. Our findings suggest that history of any kind of anal surgery is a risk factor for further onset of anal fistula. Surgeons and patients must be informed of this issue.

Citations

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Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study
Sarah Taieb, Patrick Atienza, Jean-David Zeitoun, Milad Taouk, Josée Bourguignon, Christian Thomas, Nabila Rabahi, Saliha Dahlouk, Anne-Carole Lesage, David Lobo, Isabelle Etienney
Annals of Coloproctology.2022; 38(5): 370. CrossRef

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

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3 Web of Science
3 Citations

Abstract PDF

Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

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