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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
  • 6,615 View
  • 566 Download
  • 1 Web of Science
  • 3 Citations
AbstractAbstract 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
  • 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
Original Article
Anorectal benign disease
Immediate sphincter repair following fistulotomy for anal fistula: does it impact the healing rate and septic complications?
Maher A. Abbas, Anna T. Tsay, Mohammad Abbass
Ann Coloproctol. 2024;40(3):217-224.   Published online June 28, 2024
DOI: https://doi.org/10.3393/ac.2022.01144.0163
  • 2,158 View
  • 219 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
Purpose
Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair.
Methods
This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications.
Results
In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42).
Conclusion
Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

Citations

Citations to this article as recorded by  
  • 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
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
  • 3,104 View
  • 254 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract 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 Articles
Anorectal benign disease
Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study
Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg
Ann Coloproctol. 2024;40(5):490-497.   Published online October 11, 2022
DOI: https://doi.org/10.3393/ac.2022.00346.0049
  • 2,637 View
  • 107 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by  
  • Recent Advances in the Understanding and Management of Anal Fistula from India
    Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
    Indian Journal of Surgery.2024; 86(6): 1105.     CrossRef
  • 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
  • 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
  • Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
    Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
    Health Science Reports.2023;[Epub]     CrossRef
  • Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
    David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
    Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16.     CrossRef
Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain
Zahra Abdulla Isa Yusuf Hasan, Bayan Mohamed, Rawaa AlSayegh, Raed AlMarzooq
Ann Coloproctol. 2023;39(1):27-31.   Published online August 9, 2021
DOI: https://doi.org/10.3393/ac.2020.00962.0137
  • 5,510 View
  • 180 Download
  • 3 Web of Science
  • 4 Citations
AbstractAbstract PDF
Purpose
Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice.
Methods
A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software.
Results
The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas.
Conclusion
The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

Citations

Citations to this article as recorded by  
  • Risk factors for perianal abscess recurrence after incision and drainage: a review of the literature
    Kheira Gabsi
    International Surgery Journal.2025; 12(2): 255.     CrossRef
  • Anal Cryptoglandular Suppuration
    Oladapo Akinmoladun, Quinton M. Hatch
    Surgical Clinics of North America.2024; 104(3): 491.     CrossRef
  • Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence
    Shan-Zhong Chen, Kui-Jun Sun, Yi-Fan Gu, Hong-Yuan Zhao, Dong Wang, Yun-Fang Shi, Ren-Jie Shi
    World Journal of Gastrointestinal Surgery.2024; 16(11): 3425.     CrossRef
  • Research Progress on Diagnosis and Surgical Treatment of Perianal Deep Space Abscess
    永罡 秦
    Advances in Clinical Medicine.2023; 13(01): 180.     CrossRef
Case Report
Benign proctology,Complication,Surgical technique
Rectal perforation and perirectal abscess following stapled hemorrhoidectomy for prolapsed hemorrhoids successfully managed with Endo-SPONGE endoluminal vacuum-assisted wound closure system
Emanuele Rosati, Manuel Valeri, Luigina Graziosi, Lavinia Amato, Stefano Avenia, Annibale Donini
Ann Coloproctol. 2022;38(5):387-390.   Published online June 9, 2021
DOI: https://doi.org/10.3393/ac.2021.02.07
  • 4,184 View
  • 178 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
Active drains, which work by negative pressure, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum-assisted wound closure dressings. Gastrointestinal leaks may be difficult to treat by surgical approach because of their association with high morbidity and mortality. Recently, endoscopic approaches have been applied with several degrees of success. Most recently, endoluminal vacuum-assisted wound closure (EVAC) has been employed with high success rates in decreasing both morbidity and mortality. In the present paper, the authors describe the successful use of Endo-SPONGE (B. Braun Medical B.V.) EVAC system therapy to drain an open rectal wound, following a perforation occurred during stapled hemorrhoidectomy.

Citations

Citations to this article as recorded by  
  • Endoluminal Vacuum Therapy (EVT) for the Treatment of Rectal Perforation Following Cleansing Enema Application
    Alper Sozutek, Ekin Y Tas, Kemal Yener, Julia Ozcomert
    Cureus.2023;[Epub]     CrossRef
Original Article
Benign proctology
Long-term outcomes after anal fistula surgery: results from two university hospitals in Thailand
Weeraput Chadbunchachai, Varut Lohsiriwat, Krisada Paonariang
Ann Coloproctol. 2022;38(2):133-140.   Published online June 7, 2021
DOI: https://doi.org/10.3393/ac.2021.01.06
  • 7,516 View
  • 213 Download
  • 4 Web of Science
  • 3 Citations
AbstractAbstract PDF
Purpose
This study aimed to evaluate long-term outcomes after anal fistula surgery from university hospitals in Thailand.
Methods
A prospectively collected database of patients with cryptoglandular anal fistula undergoing surgery from 2011 to 2017 in 2 university hospitals was reviewed. Outcomes were treatment failure (persistent or recurrent fistula), fecal continence status, and chronic postsurgical pain.
Results
This study included 247 patients; 178 (72.1%) with new anal fistula and 69 (27.9%) with recurrent fistula. One hundred twenty-one patients (49.0%) had complex fistula; 53 semi-horseshoe (21.5%), 41 high transsphincteric (16.6%), 24 horseshoe (9.7%), and 3 suprasphincteric (1.2%). Ligation of intersphincteric fistula tract (LIFT) was the most common operation performed (n=88, 35.6%) followed by fistulotomy (n=79, 32.0%). With a median follow-up of 23 months (interquartile range, 12–45 months), there were 18 persistent fistulas (7.3%) and 33 recurrent fistulae (13.4%)—accounting for 20.6% overall failure. All recurrence occurred within 24 months postoperatively. Complex fistula was the only significant predictor for recurrent fistula with a hazard ratio of 4.81 (95% confidence interval, 1.82–12.71). There was no significant difference in healing rates of complex fistulas among seton staged fistulotomy (85.0%), endorectal advancement flap (72.7%), and LIFT (65.9%) (P=0.239). Four patients (1.6%) experienced chronic postsurgical pain. Seventeen patients (6.9%) reported worse fecal continence.
Conclusion
Overall failure for anal fistula surgery was 20.6%. Complex fistula was the only predictor for recurrent fistula. At least 2-year period of follow-up is suggested for detecting recurrent diseases and assessing patient-reported outcomes such as chronic pain and continence status.

Citations

Citations to this article as recorded by  
  • The Clinical Utility of Anorectal Manometry: A Review of Current Practices
    Eleanor Aubrey Belilos, Zoë Post, Sierra Anderson, Mark DeMeo
    Gastro Hep Advances.2025; 4(2): 100562.     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
  • Lower Fistula Recurrence with Pulling Seton: A Retrospective Cohort Study
    Ahmad Izadpanah, Ali Reza Safarpour, Mohammad Rezazadehkermani, Ali Zahedian, Reza Barati-Boldaji
    Shiraz E-Medical Journal.2022;[Epub]     CrossRef
Case Reports
Benign proctology,Rare disease & stoma
Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review
Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios
Ann Coloproctol. 2021;37(Suppl 1):S11-S14.   Published online January 31, 2020
DOI: https://doi.org/10.3393/ac.2020.01.20
  • 4,145 View
  • 132 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
Supralevator abscess is a rare form of anorectal disease responsible for very rare but morbid manifestations, one of which is superior spread through fascial planes. We present a rare case of a spreading anorectal abscess in a patient who presented with only diffuse abdominal pain, and we review similar cases in the literature according to anatomical considerations, presentation, diagnostic procedures, and treatment options. We identified 7 previously reported cases of spreading anorectal abscesses. Most abscesses had a horseshoe morphology, and all patients presented or developed abdominal pain. All patients had perianal swelling and pain. Five out of 7 patients were previously mistreated. Only 2 abscesses spread through both the pre- and retroperitoneal planes. Abdominal pain is a dominant feature of extraperitoneal inflammation originating from anorectal abscesses. The absence of perianal signs is rare, and proper inspection of the patient along with the medical history can lead to quicker diagnosis and decisive treatment.

Citations

Citations to this article as recorded by  
  • Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
    Hsiang Teng, Po-Hsien Wu
    Medicina.2024; 60(2): 293.     CrossRef
  • A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series
    Giridhar Ashwath, Eshwar Kathiresan Manasijan, Logeshbalaji Seelampatti Palanisamy, Anthony P Rozario, Nachiket Shankar
    Cureus.2024;[Epub]     CrossRef
  • Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
    Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
    Cureus.2024;[Epub]     CrossRef
Malignant disease,Rare disease & stoma
Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano
Jordan Au, Francis M. Hulme-Moir, Andrew Herd, Mathew A. Kozman
Ann Coloproctol. 2021;37(Suppl 1):S7-S10.   Published online November 26, 2019
DOI: https://doi.org/10.3393/ac.2019.11.19
  • 3,416 View
  • 97 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

Citations

Citations to this article as recorded by  
  • Perianal Mucinous Adenocarcinoma: A Case Report and a Systematic Review of the Literature
    Ioannis D. Gkegkes, Vassilis Milionis, Nikolaos Goutas, Ioannis Mantzoros, Antonia A. Bourtzinakou, Apostolos P. Stamatiadis
    Journal of Gastrointestinal Cancer.2025;[Epub]     CrossRef
  • Perianal Mucinous Adenocarcinoma Found Incidentally From Perianal Mass
    Seyed Khalafi, Malini Riddle, Brittany Harper, Vid Fikfak
    Cureus.2023;[Epub]     CrossRef
  • Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
    Youngbae Jeon, Eun Jung Park
    The Ewha Medical Journal.2023;[Epub]     CrossRef
Original Articles
Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results
Melina Svraka Hansen, Monica Linda Kjær, Jens Andersen
Ann Coloproctol. 2019;35(3):123-128.   Published online March 20, 2019
DOI: https://doi.org/10.3393/ac.2018.07.14
  • 6,891 View
  • 157 Download
  • 8 Web of Science
  • 9 Citations
AbstractAbstract PDF
Purpose
Bioprosthetic plugs are appealing, allow simple, repeatable applications, preserve sphincter integrity, minimize patient discomfort, and allow subsequent surgical options when needed. However, success rates vary widely. This study assessed the healing rate in our department when both the Cook-Surgisis and the Gore fistula plugs were used and the long-term effectiveness of using anal plugs for managing anal fistulae.
Methods
A chart review was performed for patients who had undergone plug insertion between January 2008 and December 2015 at Copenhagen University Hospital, Hvidovre. Data were collected through a prospectively collected database. Plugs were inserted according to guidance provided by 2 experienced surgeons. Long-term results were determined by clinical visits 3, 6, and 12 months after surgery and once yearly thereafter.
Results
From 2008 to 2015, 36 fistula plugs were inserted. During the follow-up period with a median duration of 18 months (range, 7–60 months), the fistulae of 52.8% of the patients healed. The plug failure rate was 44.4%, and the fistula recurrence rate was 26.3%. The median time to recurrence was 12 months. The overall success rate for plug treatment in our department was 39% when adjusted for recurrence.
Conclusion
The use of bioprosthetic plugs to treat patients with complex anal fistulae seems to be a safe, viable option for complex fistula repair when other surgical attempts have failed. However, it should not be the treatment of choice. Further prospective randomized studies with a sufficient sample-size and standardized measurements are necessary to evaluate the efficacy of fistula plugs fully.

Citations

Citations to this article as recorded by  
  • Application of biomaterials for complex anal fistulae
    Daniel P. Fitzpatrick, Carmel Kealey, Damien Brady, Noel Gately
    International Journal of Polymeric Materials and Polymeric Biomaterials.2023; 72(3): 204.     CrossRef
  • Improved fistula plug outcome depends on the type of plug: a single‐centre retrospective study
    Adele E Sayers, Matthew J Lee, Steve R Brown
    Colorectal Disease.2023; 25(5): 995.     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
  • 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
  • Impact du nombre de chirurgies antérieures sur la continence anale et la cicatrisation des fistules anales récidivantes
    S.H. Emile, W. Khafagy, S.A. Elbaz
    Journal de Chirurgie Viscérale.2022; 159(3): 219.     CrossRef
  • Impact of number of previous surgeries on the continence state and healing after repeat surgery for recurrent anal fistula
    S.H. Emile, W. Khafagy, S.A. Elbaz
    Journal of Visceral Surgery.2022; 159(3): 206.     CrossRef
  • Plug, Laser, videogestützte Behandlung von Analfisteln, Over-The-Scope-Clip, Stammzellen
    Johannes Jongen, Jessica Scheider, Tilman Laubert, Volker Kahlke
    coloproctology.2022; 44(1): 23.     CrossRef
  • Comprehensive literature review of the applications of surgical laser in benign anal conditions
    Ahmed Hossam Elfallal, Mohammad Fathy, Samy Abbas Elbaz, Sameh Hany Emile
    Lasers in Medical Science.2022; 37(7): 2775.     CrossRef
  • Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: An updated systematic review, meta-analysis, and meta-regression of the predictors of failure
    Sameh Hany Emile, Sualeh Muslim Khan, Adeyinka Adejumo, Oyintonbra Koroye
    Surgery.2020; 167(2): 484.     CrossRef
Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods
Ji Hye Choi, Byeong Geon Jeon, Sang-Gi Choi, Eon Chul Han, Heon-Kyun Ha, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park
Ann Coloproctol. 2014;30(1):35-41.   Published online February 28, 2014
DOI: https://doi.org/10.3393/ac.2014.30.1.35
  • 6,229 View
  • 115 Download
  • 47 Web of Science
  • 46 Citations
AbstractAbstract PDF
Purpose

A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF.

Methods

The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed.

Results

The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion.

Conclusion

Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.

Citations

Citations to this article as recorded by  
  • Complex case of granulomatosis with polyangiitis involving the urethra and prostate causing outflow obstruction and ano-urethral fistula
    Mustafa Rashid, Adam Cox
    Journal of Clinical Urology.2024; 17(1): 89.     CrossRef
  • A rare case of fatal rectal perforation and sepsis following traumatic urinary catheterization
    Darshan Sitharthan, Paul Sved
    Urology Case Reports.2024; 54: 102706.     CrossRef
  • Gracilis muscle interposition for complex perineal fistulas: A systematic review and meta‐analysis of the literature
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Review
New Techniques for Treating an Anal Fistula
Kee Ho Song
J Korean Soc Coloproctol. 2012;28(1):7-12.   Published online February 29, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.1.7
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AbstractAbstract PDF

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

Citations

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Case Report
Levator Ani Muscle Posterior Midline Incision Method for Diffrentiation of Anal Fistulas Involving Ischioretal and Pelvirectal Spaces.
Lim, Seok Won
J Korean Soc Coloproctol. 2008;24(1):72-74.
DOI: https://doi.org/10.3393/jksc.2008.24.1.72
  • 1,589 View
  • 18 Download
AbstractAbstract PDF
The difference between anal fistulas involving the ischioretal space and pelvirectal space is that in the former the involvement of the anal fistula is low the levator ani muscle whereas in the latter it is above the levator ani muscle. The levator ani muscle posterior midline incision method, which is introduced here, is thought not to injure the anal sphincter; thus, it does not affect the anal function. The method also allow the surgeon to assess readily and accurately whether or not the fistula has invaded the pelvirectal space.
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