Modern Approaches to the Treatment of Anal Fistulas
DOI:
https://doi.org/10.55791/2831-0098.1.2.209Keywords:
anal fistula, sphincter preserving techniques, fecal incontinenceAbstract
The treatment of anal fistulas presents a challenge for surgeons because of their high incidence and recurrence rate, prolonged healing time, because we still do not have a single standardized technique that fits all, and last but not least, possible problems with some types of postoperative continence disturbance that may occur in cases of inadequate treatment. The most common symptoms that patients have who suffer from this disease are constant anal pain and soiling from the fistula tract which undoubtedly decreases the patient’s quality of life. Most fistulas have cryptoglandular etiology, but also may be associated with Crohn’s disease, trauma, radiation etc. This text gives an overview of modern approaches in anal fistula treatment with the emphasis on sphincter preserving techniques.
References
Hamalainen KP, Sainio AP. Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum. 1998;41:1357-1361.
Mappes HJ, Farthmann EH. Anal abscess and fistula. Munich: Zuckschwardt; 2001.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1-12.
Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RKS. For many high anal fistulas, lay open is still a good option. Tech Coloproctol. 2011;15:143-150.
Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009;11:564-571.
Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2005;48:1337-42. Doi: 10.1007/s10350005-0055-3.PMID: 15933794)
Karlović D, Kršul D, Bačić Đ, Zelić M. Video-assisted anal fistula treatment in combination with ligation of the intersphincteric fistula tract in the treatment of complex transsphincteric fistulas—A video vignette. Colorectal Disease. 2020;22:1204-1201.
Zelić M, Karlović D, Kršul D, Bačić Đ, Warusavitarne J. Video-assisted anal fistula treatment (VAAFT) for treatment of complex cryptoglandular anal fistulas with 2 years follow up period Ourexperience. Journal of Laparoendoscopic Advanced Surgical Techniques. Part A. 2020;30:13
Kršul D, Karlović D, Bačić Đ, Zelić M. Sphincter Preserving Techniques in Anal Fistula Treatment. In: JCBe a, editor. Current Topics in Colorectal Surgery. Rijeka: IntechOpen; 2021.
Karlović D, Kršul D, Jerković A, Bačić Đ, Zelić M. Anal Fistula: Contemporary View of Complex Problem. In: Vannelli A, editor. Benign Anorectal Disorders - An Update [Working Title] [Internet]. London: IntechOpen; 2022 [cited 2022 Mar 30]. Available from:https://www.intechopen.com/online-first/80541doi:10.5772/intechopen. 102752
Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): A novel sphincter-saving procedure for treating complex anal fistulas. Techniques in Coloproctology. 2011;15:417-422.
Schwandner O. Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Tech Coloproctology. 2013;17:221-225.
García-Aguilar J, Davey CS, Le CT, Lowry AC, Rothenberger DA. Patient satisfaction after surgical treatment for fistula-in-ano. Dis Colon Rectum. 2000;43:1206-1212.
Emile SH, Elfeki H, Shalaby M, Sakr A. A Systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc. 2018;32:2084-2093.
Schwandner O. Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Techniques in Coloproctology. 2013;17:221-225.
Adegbola SO, Sahnan K, Tozer PJ, Strouhal R, Hart AL, Lung PFC, et al. Symptom amelioration in Crohn’s perianal fistulas using video-assisted anal fistula treatment (VAAFT). Journal of Crohn’s Colitis. 2018;12:1067-1072.
Elting AW. X. The Treatment of Fistula in Ano: With Especial Reference to the Whitehead Operation. Ann Surg. 1912;56:744-752.
Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, Garcia-Granero E. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis 2017; 32:599-609.
Dubsky PC, Stift A, Friedl J, Teleky B, Herbst F. Endorectal advancement flaps in the treatment of high anal fistula of cryptoglandular origin: fullthickness vs. mucosal-rectum flaps. Dis Colon Rectum 2008; 51:852-857.
Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M. Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. Int J Surg 2010; 8:321- 325
Mitalas LE, van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DD, Schouten WR. Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis 2010; 25:1499-1502.
Zimmerman DD, Delemarre JB, Gosselink MP, et al. Smoking affects the outcome of transanal mucosal advancement flap repair of transsphincteric fistulas. The British Journal of Surgery. 2003;90:351-354
Ellis CN, Clark S. Effect of tobacco smoking on advancement flap repair of complex anal fistulas. Diseases of the Colon and Rectum. 2007;50:459-463
Schwandner O. Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterology. 2011;11(61):1-5
Rojanasakul A. LIFT procedure: A simplified technique for fistula-in-ano. Techniques in Coloproctology. 2009;13(3):237-240
Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol. 2014 Aug;18(8):685-691.
Emile SH, Khan SM, Adejumo A, Koroye O. 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. Surgery. 2020 Feb;167(2):484-492.
Limura E, Giordano P. Modern management of anal fistula. World Journal of Gastroenterology. 2015;21(1):12-20
Garg P. A new understanding of the principles in the management of complex anal fistula. Medical Hypotheses. 2019;132:109329
Yao Y-B, Xiao C-F, Wang Q-T, Zhou H, Dong Q-J, Cao Y-Q, Wang C. VAAFT plus FiLaC™: a combined procedure for complex anal fistula. Tech Coloproctol. 2021 Jan 21. doi: 10.1007/s10151-021-02411-0.
Ellis CN. Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the intersphincteric fistula tract (BioLIFT procedure) for the management of complex anal fistulas. Dis Colon Rectum 2010 Oct;53(10):1361e4
Han JG, Yi BQ, Wang ZJ, Zheng Y, Cui JJ, Yu XQ, et al. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano. Colorectal Dis 2013 May;15(5):582e6.
Sileri P, Boehm G, Franceschilli L, Giorgi F, Perrone F, Stolfi C,et al. Collagen matrix injection combined with flap repair for complex anal fistula. Colorectal Dis. 2012 Dec;14(Suppl. 3):24e8.
Moreno-Serrano A, García-Díaz JJ, Ferrer-Márquez M, AlarcónRodríguez R, Álvarez-García A, Reina-Duarte Á (2016) Using autologous platelet-rich plasma for the treatment of complex fistulas. Rev Esp Enferm Dig (Madrid) 108:123-128
Göttgens KW, Vening W, van der Hagen SJ, van Gemert WG, Smeets RR, Stassen LP, Baeten CG, Breukink SO (2014) Longterm results of mucosal advancement flap combined with plateletrich plasma for high cryptoglandular perianal fistulas. Dis Colon Rectum 57:223-227
Göttgens KWA, Smeets RR, Stassen LPS, Beets GL, Pierik M, Breukink SO (2015) Treatment of Crohn’s disease-related high perianal fistulas combining the mucosa advancement flap with platelet-rich plasma: a pilot study. Tech Coloproctol 19:455-459
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