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

492 View
59 Download

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.

Anorectal benign disease

Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up: Leichang Zhang, Chuanyu Zhan, Lu Li, Wanjin Shao, Guidong Sun, Yugen Chen, Guanghua Chen, Yulei Lang, Zenghua Xiao, Xiao Xiao; Ann Coloproctol. 2025;41(1):77-83. Published online January 17, 2025; DOI: https://doi.org/10.3393/ac.2024.00024.0003

524 View
51 Download

Abstract PDF: Purpose
This study aimed to evaluate the long-term efficacy of the ligation of the intersphincteric fistula tract (LIFT) procedure in treating high transsphincteric fistulas.
Methods
We conducted a retrospective study to evaluate the success rate of LIFT treatment in 82 patients with high transsphincteric fistulas involving at least one-third of the external sphincter. This study was carried out across 2 centers from November 2009 to February 2023.
Results
All patients underwent successful surgery with a median operative time of 48.9 minutes (range, 20–80 minutes), and no intraoperative or postoperative complications were reported. The median follow-up duration was 85.5 months (range, 4–120 months), with 5 patients (6.1%) lost to follow-up. Treatment was successful in 62 patients, whose symptoms disappeared and both the external opening and the intersphincteric incision completely healed, yielding an overall efficiency rate of 80.5%. There were 15 cases (19.5%) of treatment failure, including 6 (7.8%) that converted to intersphincteric anal fistula and 9 (11.7%) that experienced persistent or recurrent fistulas. Only 1 patient reported minor overflow during the postoperative follow-up, but no other patients reported any significant discomfort. There were no statistically significant differences between patients with surgical success and those with treatment failure in terms of fistula length, history of previous abscess or anal fistula surgery, number of external orifices or fistulas, and location of fistulas (all P>0.05).
Conclusion
LIFT is a safe and effective sphincter-preserving procedure that yields satisfactory healing outcomes and has minimal impact on anal function.

Technical Note

Anorectal benign disease

Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery: Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya; Ann Coloproctol. 2024;40(6):610-612. Published online December 2, 2024; DOI: https://doi.org/10.3393/ac.2023.00696.0099

1,388 View
111 Download

PDF Supplementary Material

Review

Anorectal benign disease

Recent advances in the diagnosis and treatment of complex anal fistula: Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak; Ann Coloproctol. 2024;40(4):321-335. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00325.0046

9,411 View
655 Download
3 Web of Science
4 Citations

Abstract PDF

Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Citations

Citations to this article as recorded by

Understanding the anatomical basis of anorectal fistulas and their surgical management: exploring different types for enhanced precision and safety
Asim M. Almughamsi, Yasir Hassan Elhassan
Surgery Today.2025;[Epub] CrossRef
Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Surgeon oriented reporting template for magnetic resonance imaging and endoanal ultrasound of anal fistulas enhances surgical decision-making
Si-Ze Wu
World Journal of Radiology.2024; 16(12): 712. CrossRef

Technical Note

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

3,378 View
262 Download
5 Web of Science
5 Citations

Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

Citations

Citations to this article as recorded by

Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Annals of Coloproctology.2024; 40(5): 521. CrossRef
Comparative Evaluation Between Cutting of the Intersphincteric Space vs Cutting Seton in High Anal Fistula: A Randomized Controlled Trial
Jiawei Qin, Yanlan Wu, Xueping Zheng, Kunlan Wu, Gongjian Dai, Yanyan Tan, Xu Yang, Yuqing Sun
Journal of the American College of Surgeons.2024; 239(6): 563. CrossRef
Invited Commentary: The Quest for the Panacea Treatment for Anal Fistula
Steven D Wexner
Journal of the American College of Surgeons.2024; 239(6): 573. CrossRef

Original Article

Anorectal benign disease

Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study: In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong; Ann Coloproctol. 2024;40(2):169-175. Published online February 6, 2023; DOI: https://doi.org/10.3393/ac.2022.00486.0069

3,175 View
156 Download
2 Web of Science
2 Citations

Abstract PDF

Purpose
Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes.
Methods
In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment.
Results
In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure.
Conclusion
We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Citations

Citations to this article as recorded by

Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Reviews

Benign proctology,Rare disease & stoma

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature: Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith; Ann Coloproctol. 2021;37(5):269-274. Published online October 29, 2021; DOI: https://doi.org/10.3393/ac.2021.00332.0047

4,451 View
81 Download
4 Web of Science
5 Citations

Abstract PDF

Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

Citations

Citations to this article as recorded by

Actinomyces Species As Emerging Pathogens: An Observational Study of Clinical Infections and Microbiological Implications
Abraham A Ayantunde, Joanne Kiang, Nadeem S Raja, Javeed Ahmed, Anjali Sanghera, Saumya Venkatesha, Andrew C Ekwesianya
Cureus.2025;[Epub] CrossRef
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
Colonic actinomycosis masquerading a cancer resulting complete bowel obstruction-a case report
Lilamani Rajthala, Santosh Sirpaili, Krishna Mohan Adhikari
International Journal of Surgery Case Reports.2024; 125: 110563. CrossRef
Letter to the Editor: Actinomyces turicensis Causing Fournier Gangrene
Kaiying Wang, Thomas Zheng Jie Teng, Vishal G. Shelat
Surgical Infections.2022; 23(4): 411. CrossRef
Fungal perianal abscess as the initial presentation of disseminated coccidioidomycosis
Christian Olivo-Freites, Oscar E. Gallardo-Huizar, Christopher J. Graber, Kevin Ikuta
IDCases.2022; 30: e01636. CrossRef

Benign GI diease, Inflammatory bowel disease,Benign diesease & IBD

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View: Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu; Ann Coloproctol. 2021;37(1):5-15. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2021.02.08

6,975 View
233 Download
10 Web of Science
13 Citations

Abstract PDF

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

Citations

Citations to this article as recorded by

Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Insights into treatment of complex Crohn's perianal fistulas
Gregor Norčič, Nataša Smrekar, Srđan Marković, Goran Barišić, Gediminas Kiudelis, Henrikas Paužas, Tamás Molnár, Attila Szijarto, Zuzana Šerclová, Tina Roblek, Viktor Uršič, Ian White
BMC Proceedings.2024;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Management of Perianal Fistulas Associated with Crohn Disease
Kay Greveson, Ola Haj, Ailsa Hart, Parnia Geransar, Oded Zmora
Gastroenterology Nursing.2024; 47(6): 428. CrossRef
Real-World Long-Term Persistence and Surgical Procedure-Free Period Among Bio-naïve Patients with Crohn’s Disease and Fistula Initiated on Ustekinumab
Maryia Zhdanava, Sumesh Kachroo, Porpong Boonmak, Sabree Burbage, Aditi Shah, Patrick Lefebvre, Caroline Kerner, Dominic Pilon
Advances in Therapy.2024; 41(10): 3922. CrossRef
Efficacy and Safety of Upadacitinib for Perianal Fistulizing Crohn’s Disease: A Post Hoc Analysis of 3 Phase 3 Trials
Jean-Frédéric Colombel, Ana P. Lacerda, Peter M. Irving, Remo Panaccione, Walter Reinisch, Florian Rieder, Adam Steinlauf, David Schwartz, Tian Feng, Elena Dubcenco, Samuel I. Anyanwu, F. Stephen Laroux, Colla Cunneen, Nick Powell
Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
Optimizing Treatment Outcomes in Crohn’s Disease: A Comprehensive Systematic Review and Meta-Analysis of Regenerative Therapies with Emphasis on Platelet-Rich Plasma
Marcia Carolina Mazzaro, Ana Emília Carvalho de Paula, Livia Bitencourt Pascoal, Livia Moreira Genaro, Isabela Machado Pereira, Bruno Lima Rodrigues, Priscilla de Sene Portel Oliveira, Raquel Franco Leal
Pharmaceuticals.2024; 17(11): 1519. CrossRef
Clinical Characteristics That Led to Diagnosis of Crohn’s Disease After Anal Fistula Surgery in Patients Aged 10–19 Years: A Single Center, Retrospective Study
Ah Young Kang, Ki-Yun Lim, Keehoon Hyun, Heecheol Chang
Advances in Pediatric Surgery.2024; 30(2): 64. CrossRef
Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease
Sebastián Jeri‐McFarlane, Álvaro García‐Granero, Aina Ochogavía‐Seguí, Gianluca Pellino, Anaí Oseira‐Reigosa, Alejandro Gil‐Catalan, Leandro Brogi, Daniel Ginard‐Vicens, Margarita Gamundi‐Cuesta, Francisco Xavier Gonzalez‐Argente
Colorectal Disease.2023; 25(6): 1279. CrossRef
Risk of anorectal cancer in patients with Crohn's disease and perianal fistula: a nationwide Danish cohort study
Alaa El‐Hussuna, Camilla Engel Lemser, Aske Thorn Iversen, Kristine Højgaard Allin, Tine Jess
Colorectal Disease.2023; 25(7): 1453. CrossRef
The Impact of Crohn’s Perianal Fistula on Quality of Life: Results of an International Patient Survey
Antonino Spinelli, Henit Yanai, Paolo Girardi, Slobodan Milicevic, Michele Carvello, Annalisa Maroli, Luisa Avedano
Crohn's & Colitis 360.2023;[Epub] CrossRef
A Prospective, Single-Arm Study to Evaluate the Safety and Efficacy of RD2-Ver.02, an Autologous Blood Clot, in the Treatment of Anal Fistula
Edward Ram, Yaniv Zager, Dan Carter, Olga Saukhat, Roi Anteby, Ido Nachmany, Nir Horesh
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Crohn disease
Elizabeth F. Snyder, Stephanie Davis, Kristina Aldrich, Manjakkollai Veerabagu, Tiziana Larussa, Ludovico Abenavoli, Luigi Boccuto
The Nurse Practitioner.2021; 46(12): 22. CrossRef

Original Article

Benign proctology,Surgical technique

Two-Stage Complete Deroofing Fistulotomy Approach for Horseshoe Fistula: Successful Surgery Leaving Continence Intact: Asami Usui, Gentaro Ishiyama, Akihiko Nishio, Maiko Kawamura, Yukiko Kono, Yuji Ishiyama; Ann Coloproctol. 2021;37(3):153-158. Published online January 12, 2021; DOI: https://doi.org/10.3393/ac.2020.06.08

6,005 View
139 Download
3 Web of Science
3 Citations

Abstract PDF

Purpose
Surgery of the horseshoe fistula is challenging due to its complex configuration and sphincter muscle involvement. Complete deroofing fistulotomy for horseshoe fistula is highly curative with the eradication of all fistulous lesions but has been discredited for its high incontinence rate. It was replaced with the more conservative Hanley’s procedure leaving the lateral tracts intact, despite its issue of recurrence. Our study aimed to report the outcomes of a procedure dividing complete deroofing fistulotomy for horseshoe fistula into 2 stages to avoid impairment of sphincter function.
Methods
We retrospectively reviewed 139 patients who underwent surgery for horseshoe fistula using the 2-stage complete deroofing fistulotomy method between 2014 and 2017. The first surgery deroofed the lateral tracts with an arch-like incision severing the anococcygeal ligament. The primary lesion was also drained and curetted. A seton was placed in the primary tract which was laid open in the second surgery after the lateral wound had partially healed.
Results
Recurrence was observed in 12 patients. All were superficial recurrences except for 1, in which recurrence was confirmed in the primary lesion. Those with blind intersphincteric upward extensions had a significantly higher recurrence rate. Furthermore, patients who resided far from the hospital and could not make visits for frequent wound inspections also had a significantly higher recurrence rate. No patient had any continence issues at the end of the follow-up period.
Conclusion
Managing horseshoe fistula with the 2-stage deroofing fistulotomy approach allows for eradication of the fistula tract without compromising anal sphincter function.

Citations

Citations to this article as recorded by

Clinical efficacy of the bared external anal sphincter (BEAS) in high horseshoe-shaped anal fistulas: Protocol for a real-world, prospective cohort study
Qianqian Ye, Ye Han, Peixin Du, Min Yang, De Zheng, Zubing Mei, Qingming Wang
Heliyon.2024; 10(15): e35024. CrossRef
Evaluating the efficacy of multi-incision and tube-dragging therapy combined with laser closure for high horseshoe-shaped anal fistula: Protocol of a prospective, randomized, controlled trial
Min Yang, Zubing Mei, Qingming Wang, Ye Han, De Zheng, James Mockridge
PLOS ONE.2024; 19(9): e0307653. CrossRef
A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son
Annals of Coloproctology.2022; 38(3): 183. CrossRef

Case Report

Benign proctology

Combined Fistulotomy and Contralateral Anal Internal Sphincterotomy for Recurrent and Complex Anal Fistula to Prevent Recurrence: Adeodatus Yuda Handaya, Aditya Rifqi Fauzi; Ann Coloproctol. 2020;36(2):122-127. Published online March 17, 2020; DOI: https://doi.org/10.3393/ac.2018.11.19

5,264 View
155 Download
5 Web of Science
3 Citations

Abstract PDF

The ideal intervention in the treatment of perianal fistula prevents the onset of infection to speed healing and prevent fistula recurrence while maintaining the function of the anal sphincter. Currently, there is no consensus on the best recommended surgical technique for perianal fistula management. Several studies have shown that fistulotomy was an easy and safe procedure for treatment of perianal fistula. Lateral internal sphincterotomy is the usual procedure performed on an anal fissure to decrease the anal sphincter tone. This study reports a combination of fistulotomy and contralateral internal sphincterotomy procedures for recurrent and complex perianal fistula to prevent recurrence. Here, we report 5 cases of recurrent and complex perianal fistula. The combination of fistulotomy and contralateral internal sphincterotomy is a relatively easy and safe procedure for complex perianal fistulae. In our cases, we found neither recurrence nor postoperative anal incontinence.

Citations

Citations to this article as recorded by

Modified anal sphincter suspension improves anal function in patients with anal fistula
Peng Chen
American Journal of Translational Research.2024; 16(9): 4858. CrossRef
Ligation of Intersphincteric Fistulous Tract vs Endorectal Advancement Flap for High-Type Fistula in Ano: A Randomized Controlled Trial
Pankaj Kumar, Siddhant Sarthak, Pradeep K Singh, Tushar S Mishra, Prakash K Sasmal
Journal of the American College of Surgeons.2023; 236(1): 27. CrossRef
Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef

Original Articles

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

4,197 View
161 Download
3 Web of Science
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

Citations to this article as recorded by

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

Evaluation of a Seton Procedure Combined With Infliximab Therapy (Early vs. Late) in Perianal Fistula With Crohn Disease: Myunghoon Jeon, Kihwan Song, Jail Koo, Sohyun Kim; Ann Coloproctol. 2019;35(5):249-253. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.11.23.1

4,359 View
126 Download
11 Web of Science
12 Citations

Abstract PDF

Purpose
We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy.
Methods
This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy.
Results
There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract.
Conclusion
Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.

Citations

Citations to this article as recorded by

Management of Anal Fistula with Crohn's Disease
Shota Takano, Yasushi Nakamura, Kohei Tamaoka, Takafumi Yoshimoto, Yasue Irei, Yoriyuki Tsuji
Journal of the Anus, Rectum and Colon.2025; 9(1): 10. CrossRef
Management of Perianal Fistulizing Crohn’s Disease
Arshdeep Singh, Vandana Midha, Gursimran Singh Kochhar, Bo Shen, Ajit Sood
Inflammatory Bowel Diseases.2024; 30(9): 1579. CrossRef
The use of core descriptors from the ENiGMA code study in recent literature: a systematic review
Saher‐Zahra Khan, Andrea Arline, Kate M. Williams, Matthew J. Lee, Emily Steinhagen, Sharon L. Stein
Colorectal Disease.2024; 26(3): 428. CrossRef
Impact of Seton Use on Clinical, Patient-Reported, and Healthcare Resource Utilization Outcomes in Complex Crohn’s Perianal Fistulas: A Systematic Literature Review
Ian White, Chitra Karki, Parnia Geransar, Lilia Leisle, Sophia Junker, Phillip Fleshner
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials
Panu Wetwittayakhlang, Alex Al Khoury, Gustavo Drügg Hahn, Peter Laszlo Lakatos
Journal of Clinical Medicine.2022; 11(11): 3045. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula
Wolfgang B. Gaertner, Pamela L. Burgess, Jennifer S. Davids, Amy L. Lightner, Benjamin D. Shogan, Mark Y. Sun, Scott R. Steele, Ian M. Paquette, Daniel L. Feingold
Diseases of the Colon & Rectum.2022; 65(8): 964. CrossRef
Management of perianal fistula in inflammatory bowel disease: identification of prognostic factors associated with surgery
Sara Gortázar de Las Casas, Mario Alvarez-Gallego, Jose Antonio Gazo Martínez, Natalia González Alcolea, Cristina Barragán Serrano, Aitor Urbieta Jiménez, María Dolores Martín Arranz, Jose Luis Marijuan Martín, Isabel Pascual Migueláñez
Langenbeck's Archives of Surgery.2021; 406(4): 1181. CrossRef
Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View
Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu
Annals of Coloproctology.2021; 37(1): 5. CrossRef
Multidisciplinary management of perianal Crohn's disease
Suha Abushamma, David H. Ballard, Radhika K. Smith, Parakkal Deepak
Current Opinion in Gastroenterology.2021; 37(4): 295. CrossRef
Approach to medical therapy in perianal Crohn’s disease
Abhinav Vasudevan, David H Bruining, Edward V Loftus, William Faubion, Eric C Ehman, Laura Raffals
World Journal of Gastroenterology.2021; 27(25): 3693. CrossRef
Infliximab

Reactions Weekly.2020; 1785(1): 284. CrossRef
Mesenchymal stem cells in perianal Crohn’s disease
H. Guadalajara, M. García-Arranz, M. Dolores Herreros, K. Borycka-Kiciak, A. L. Lightner, D. García-Olmo
Techniques in Coloproctology.2020; 24(8): 883. CrossRef

Case Report

Anal Adenocarcinoma Can Masquerade as Chronic Anal Fistula in Asians: Faith Qi-Hui Leong, Dedrick Kok Hong Chan, Ker-Kan Tan; Ann Coloproctol. 2019;35(1):47-49. Published online December 3, 2018; DOI: https://doi.org/10.3393/ac.2018.03.15

12,707 View
127 Download
6 Web of Science
6 Citations

Abstract PDF

Purpose
Perianal adenocarcinoma arising from a chronic anorectal fistula is a rare condition for which the natural history and optimal management are not well established. For that reason, we conducted a retrospective analysis of 5 consecutive patients with a perianal adenocarcinoma arising from a chronic anorectal fistula managed at our institution from January 2014 to December 2015.
Methods
The patients were identified from a prospectively collected colorectal cancer database that included all patients managed for colorectal cancer at our institution.
Results
The median age at diagnosis was 64 years (range, 55–72 years). Magnetic resonance imaging (MRI) was the initial investigation for all patients and showed a hyperintense T2-weighted image. One patient underwent an abdominoperineal resection following neoadjuvant chemoradiotherapy and remained disease free during the 12-month follow-up. Three patients received neoadjuvant therapy with intent for surgery, but did not undergo surgery due to either worsening health or metastatic spread. One patient declined intervention. The median overall survival was 10.5 months (range, 2–19 months).
Conclusion
A high index of suspicion is required to make a clinical diagnosis of an anal adenocarcinoma arising from a chronic fistula. Histologic diagnosis must be achieved to confirm the diagnosis. Multimodal therapy with neoadjuvant chemoradiotherapy followed by abdominoperineal resection is the treatment of choice.

Citations

Citations to this article as recorded by

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature
Nalini Kanta Ghosh, Ashok Kumar
Annals of Coloproctology.2024; 40(Suppl 1): S1. CrossRef
Value of apparent diffusion coefficient on MRI for prediction of histopathological type in anal fistula cancer
Shinji Yamamoto, Keiji Yonezawa, Naoki Fukata, Koji Takeshita, Makoto Kodama, Tetsuro Yamana, Shigeru Kiryu, Yukinori Okada
Medicine.2023; 102(14): e33281. CrossRef
Synchronous anal mucinous adenocarcinoma and anal tuberculosis presenting as chronic anal fistula: Challenging management
Sarah Benammi, Youness Bakali, Mouna Alaoui
Archive of Clinical Cases.2023; 10(2): 74. CrossRef
Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature
Aysun Tekbaş, Henning Mothes, Utz Settmacher, Silke Schuele
Journal of Cancer Research and Clinical Oncology.2022; 148(6): 1509. CrossRef
Management and Outcomes in Anal Canal Adenocarcinomas—A Systematic Review
Vasilis Taliadoros, Henna Rafique, Shahnawaz Rasheed, Paris Tekkis, Christos Kontovounisios
Cancers.2022; 14(15): 3738. CrossRef
Adjuvant chemoradiotherapy does not improve outcomes in patients with fistula-associated anal adenocarcinoma undergoing abdominoperineal resection
Min Wang, Yu Xiang, Yunshan Wang, Jiayi Zhang, Haoran Zhao, Can Wang, Lichao Qiao, Bolin Yang
Frontiers in Oncology.2022;[Epub] CrossRef

Original Articles

The Impact of the Outcome of Treating a High Anal Fistula by Using a Cutting Seton and Staged Fistulotomy on Saudi Arabian Patients: Bader Hamza Shirah, Hamza Asaad Shirah; Ann Coloproctol. 2018;34(5):234-240. Published online October 10, 2018; DOI: https://doi.org/10.3393/ac.2018.03.23

10,527 View
169 Download
16 Web of Science
14 Citations

Abstract PDF

Purpose
A cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians.
Methods
Between January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics.
Results
Two hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3–21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred.
Conclusion
The utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.

Citations

Citations to this article as recorded by

Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis
J. Khamar, A. Sachdeva, T. McKechnie, Y. Lee, L. Tessier, D. Hong, C. Eskicioglu
Techniques in Coloproctology.2024;[Epub] CrossRef
Evaluation surgical strategies in perianal fistulas treatment: Efficacy draining seton compared to other surgical approaches; a case‐control study
Amir Ghasemlouei, Amirhosein Naseri, Ali Ashjaei, Shahryar Sadeghi, Amir Keshvari
Health Science Reports.2024;[Epub] CrossRef
Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating
Xiao-Li Tang, Zi-Yang Xu, Jun Yang, Zhe Yang, Zhi-Gang Wang, Zheng-Yun Zhang, Jing Yao
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Comparative Evaluation Between Cutting of the Intersphincteric Space vs Cutting Seton in High Anal Fistula: A Randomized Controlled Trial
Jiawei Qin, Yanlan Wu, Xueping Zheng, Kunlan Wu, Gongjian Dai, Yanyan Tan, Xu Yang, Yuqing Sun
Journal of the American College of Surgeons.2024; 239(6): 563. CrossRef
Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study
Fakhrosadat Anaraki, Mohammad Reza Nikshoar, Arsh Haj Mohamad Ebrahim Ketabforoush, Rojin Chegini, Nasrin Borumandnia, Mehdi Tavallaei
Techniques in Coloproctology.2023; 27(2): 145. CrossRef
Exploring Health-Related Quality of Life in Patients with Anal Fistulas: A Comprehensive Study
Tudor Mateescu, Lazar Fulger, Durganjali Tummala, Aditya Nelluri, Manaswini Kakarla, Lavinia Stelea, Catalin Dumitru, George Noditi, Amadeus Dobrescu, Cristian Paleru, Ana-Olivia Toma
Life.2023; 13(10): 2008. CrossRef
Surgical treatment of anal fistula
A. Ya. Ilkanich, V. V. Darwin, E. A. Krasnov, F. Sh. Aliyev, K. Z. Zubailov
Сибирский научный медицинский журнал.2023; 43(5): 74. CrossRef
Evaluation of the Cutting Seton Technique in Treating High Anal Fistula
Asim M Almughamsi, Mohamed Khaled S Zaky, Abdullatif M Alshanqiti, Ibrahim S Alsaedi, Hamed I Hamed, Tariq E Alharbi, Ali A Elian
Cureus.2023;[Epub] CrossRef
Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef
Evaluating the Efficacy of Cutting Setons for the Treatment of Anal Fistulas
Miguel E. Gomez, Koianka Trencheva, Matthew Symer, Kelly Garrett, Jeffrey W. Milsom, Parul J. Shukla
Indian Journal of Surgery.2022; 84(5): 961. CrossRef
Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton
Hojjatollah Nazari, Zahra Ebrahim Soltani, Reza Akbari Asbagh, Amirsina Sharifi, Abolfazl Badripour, Asieh Heirani Tabasi, Majid Ebrahimi Warkiani, Mohammad Reza Keramati, Behnam Behboodi, Mohammad Sadegh Fazeli, Amir Keshvari, Mojgan Rahimi, Seyed Mohsen
Health Sciences Review.2022; 3: 100026. CrossRef
Treatment of the fistula tract with laser ablation in high anal fistula
Erkan Karacan, Eyüp Murat Yılmaz
Journal of Clinical Medicine of Kazakhstan.2022; 19(6): 43. CrossRef
Influence of the cotton and silastic seton on the distance of the anal sphincter cables after fistulotomy in rats
Ana Laura Sanches Lima, Beatriz Schorro Gianini, Bruna Miranda Santana, Carlos Henrique Marques dos Santos, Doroty Mesquita Dourado, Juliano Seger Falcão, Lucas Bannwart, Sara Jéssica Falcão Câmara
Journal of Coloproctology.2020; 40(01): 056. CrossRef
A Commentary on the article: “Risk factors for recurrence after anal fistula surgery: A meta-analysis”, Int J Surg 2019;69:153–164
F. Karimian
International Journal of Surgery.2019; 71: 79. CrossRef

Application of Advancement Flap After Loose Seton Placement: A Modified Two-Stage Surgical Repair of a Transsphincteric Anal Fistula: Metin Ertem, Hakan Gok, Emel Ozveri, Volkan Ozben; Ann Coloproctol. 2014;30(4):192-196. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.192

11,200 View
72 Download
7 Web of Science
11 Citations

Abstract PDF

Purpose

A number of techniques have been described for the treatment of a transsphincteric anal fistula. In this report, we aimed to introduce a relatively new two-stage technique, application of advancement flap after loose seton placement, to present its technical aspects and to document our results.

Methods

Included in this retrospective study were 13 patients (10 males, 3 females) with a mean age of 42 years who underwent a two-stage seton and advancement flap surgery for transsphincteric anal fistula between June 2008 and June 2013. In the first stage, a loose seton was placed in the fistula tract, and in the second stage, which was performed three months later, the internal and external orifices were closed with advancement flaps.

Results

All the patients were discharged on the first postoperative day. The mean follow-up period was 34 months. Only one patient reported anal rigidity and intermittent pain, which was eventually resolved with conservative measures. The mean postoperative Wexner incontinence score was 1. No recurrence or complications were observed, and no further surgical intervention was required during follow-up.

Conclusion

The two-stage seton and advancement flap technique is very efficient and seems to be a good alternative for the treatment of a transsphincteric anal fistula.

Citations

Citations to this article as recorded by

Loss of seton in patients with complex anal fistula: a retrospective comparison of conventional knotted loose seton and knot-free seton
C. Verkade, D. D. E. Zimmerman, D. K. Wasowicz, S. W. Polle, H. S. de Vries
Techniques in Coloproctology.2020; 24(10): 1043. CrossRef
Relocation and silastic tension only (RASTO) procedure for very long anal fistula tracts: Initial case series with results of a new surgical technique
John Alfred Carr
International Journal of Surgery Open.2020; 26: 1. CrossRef
Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta‐analysis of studies with long‐term follow‐up
H. Lin, Z. Jin, Y. Zhu, M. Diao, W. Hu
Colorectal Disease.2019; 21(5): 502. CrossRef
A comparative study on the effectiveness of rectal advancement flap and seton placement surgeries in patients with anal fistula on the rate of recurrence, incontinence and infection
Jafar Jafarzadeh, Neda Najibpoor, Amirahmad Salmasi
Journal of Family Medicine and Primary Care.2019; 8(11): 3591. CrossRef
Análisis y descripción de la calidad de vida específica en pacientes con fístula anal
Manuel Ferrer-Márquez, Natalia Espínola-Cortés, Ángel Reina-Duarte, José Granero-Molina, Cayetano Fernández-Sola, José Manuel Hernández-Padilla
Cirugía Española.2018; 96(4): 213. CrossRef
Analysis and Description of Disease-Specific Quality of Life in Patients With Anal Fistula
Manuel Ferrer-Márquez, Natalia Espínola-Cortés, Ángel Reina-Duarte, José Granero-Molina, Cayetano Fernández-Sola, José Manuel Hernández-Padilla
Cirugía Española (English Edition).2018; 96(4): 213. CrossRef
Seton drainage in sphincter-sparing treatment of rectal fistulas
A. I. Musin, I. V. Kostarev
Khirurgiya. Zhurnal im. N.I. Pirogova.2018; (8): 65. CrossRef
Adoption and success rates of perineal procedures for fistula‐in‐ano: a systematic review
C. Kontovounisios, P. Tekkis, E. Tan, S. Rasheed, A. Darzi, S. D. Wexner
Colorectal Disease.2016; 18(5): 441. CrossRef
Evaluation of the inflammatory response induced by different materials in the treatment of perianal fistulas: experimental study in rats
Mariana Ocampos Galvão, Carlos Henrique Marques dos Santos, Gustavo Ribeiro Falcão
Journal of Coloproctology.2016; 36(01): 016. CrossRef
TREATMENT OF FISTULA IN ANO BY ADVANCEMENT FLAP. IS IT OUTDATED OR STILL MODERN APPROACH?
I. V. Kostarev, Y. A. Shelygin, A. Y. Titov
Koloproktologia.2016; (1): 6. CrossRef
Advancement Flap for the Treatment of a Complex Anal Fistula
Do Sun Kim
Annals of Coloproctology.2014; 30(4): 161. CrossRef

First
Prev
Page of 2
Next
Last

Search