Annals of Coloproctology

Original Articles

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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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.

Citations

Citations to this article as recorded by

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

Malignant disease, Rectal cancer, Functional outcomes

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma: Osama Eldamshety, Sherif Kotb, Ashraf Khater, Sameh Roshdy, Mohamed Elashry, Mohamed S. Zahi, Hend M. Hamdey Rashed Elkalla, Waleed Elnahas, Omar Farouk, Adel Fathi, Ahmed Senbel, Emad-Eldeen Hamed, Khaled Abdelwahab, Islam Abdou Elzahby, Ahmed abdallah, Mahmoud Abdelaziz, Emanuele Lezoche; Ann Coloproctol. 2020;36(3):148-154. Published online April 20, 2020; DOI: https://doi.org/10.3393/ac.2018.07.19

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Abstract PDF

Background
The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma.
Methods
In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year.
Results
Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%).
Conclusion
Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function

Citations

Citations to this article as recorded by

Pathologic Implications of Magnetic Resonance Imaging-detected Extramural Venous Invasion of Rectal Cancer
Hyun Gu Lee, Chan Wook Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Clinical Colorectal Cancer.2023; 22(1): 129. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis
Athina A. Samara, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, Alexandros Diamantis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(7): 1385. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Simplification or Accuracy: In Assessing Functional Outcomes After Intersphincteric Resection for Low Rectal Cancer
Kyung Jong Kim
Annals of Coloproctology.2020; 36(3): 129. CrossRef

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients: Jean-David Zeitoun, Pierre Blanchard, Nadia Fathallah, Paul Benfredj, Nicolas Lemarchand, Vincent de Parades; Ann Coloproctol. 2018;34(2):83-87. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.06.12

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173 Download
19 Web of Science
19 Citations

Abstract PDF

Purpose
The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment.
Methods
All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence.
Results
Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score.
Conclusion
A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

Citations

Citations to this article as recorded by

Belgian consensus guideline on the management of anal fissures
P Roelandt, G Bislenghi, G Coremans, D De Looze, M.A. Denis, H De Schepper, P Dewint, J Geldof, I Gijsen, N Komen, H Ruymbeke, J Stijns, M Surmont, D Van de Putte, S Van den Broeck, B Van Geluwe, J Wyndaele
Acta Gastro Enterologica Belgica.2024; 87(2): 304. CrossRef
Use of Botulinum Toxin Injections for the Treatment of Chronic Anal Fissure: Results From an American Society of Colon and Rectal Surgeons Survey
Daniel J. Borsuk, Adam Studniarek, John J. Park, Slawomir J. Marecik, Anders Mellgren, Kunal Kochar
The American Surgeon™.2023; 89(3): 346. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
Pelvic floor physical therapy in patients with chronic anal fissure: long-term follow-up of a randomized controlled trial
Daniëlle A. van Reijn-Baggen, Henk W. Elzevier, H. Putter, Rob C. M. Pelger, Ingrid J. M. Han-Geurts
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?
M. Skoufou, J.H. Lefèvre, A. Fels, N. Fathallah, P. Benfredj, V. de Parades
Journal of Visceral Surgery.2023; 160(5): 330. CrossRef
Fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissures: no advantages in terms of post-operative incontinence
Roberta Tutino, Casimiro Nigro, Flavia Paternostro, Rosa Federico, Giacomo Lo Secco, Gaetano Gallo, Mauro Santarelli, Gianfranco Cocorullo, Sebastiano Bonventre
Techniques in Coloproctology.2023; 27(10): 885. CrossRef
The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Francesca Iacobellis, Luigi Brusciano, Luigi Monaco, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferrer
BMC Surgery.2023;[Epub] CrossRef
La fissurectomie avec anoplastie muqueuse : la fin d’un dogme ?
Maria Skoufou, Jérémie H. Lefèvre, Audrey Fels, Nadia Fathallah, Paul Benfredj, Vincent de Parades
Journal de Chirurgie Viscérale.2023; 160(5): 363. CrossRef
Modified open posterior internal sphincterotomy with sliding skin graft for chronic anal fissure and anal stenosis: Low recurrence rate and no serious faecal incontinence postoperative complication
Y. Iida, K. Honda, R. Iida, H. Saitou, Y. Munemoto, A. Tanaka, H. Tanaka
Journal of Visceral Surgery.2022; 159(4): 267. CrossRef
Sphinctérotomie interne postérieure modifiée avec un lambeau cutané pour fissure anale et sténose anale : peu de récidives et d’incontinence anale
Y. Iida, K. Honda, R. Iida, H. Saitou, Y. Munemoto, A. Tanaka, H. Tanaka
Journal de Chirurgie Viscérale.2022; 159(4): 283. CrossRef
Injection of botulinum toxin significantly increases efficiency of fissurectomy in the treatment of chronic anal fissures
Philip Roelandt, Georges Coremans, Jan Wyndaele
International Journal of Colorectal Disease.2022; 37(2): 309. CrossRef
Clinical Trial Combining Botulinum Toxin A Injection and Fissurectomy for Chronic Anal Fissure: A Dose-Dependent Study
Nuha Alsaleh, Abdullah I. Aljunaydil, Gaida A. Aljamili
Journal of Coloproctology.2022; 42(02): 167. CrossRef
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Updates in Surgery.2021; 73(4): 1575. CrossRef
The comparison between the medical and the surgical management of chronic anal fissures
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Fissurectomy Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Control Trial
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