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C. Ratto - One of the best experts on this subject based on the ideXlab platform.
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Simple Fistula-in-ano: is it all simple? A systematic review
Techniques in Coloproctology, 2021Co-Authors: F. Litta, A. Parello, L. Ferri, N. O. Torrecilla, A. A. Marra, R. Orefice, V. Simone, P. Campennì, M. Goglia, C. RattoAbstract:Background Simple Anal Fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple Anal Fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple Anal Fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple Anal Fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple Anal Fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple Anal Fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.
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fistulotomy and primary sphincteroplasty for Anal Fistula long term data on continence and patient satisfaction
Techniques in Coloproctology, 2019Co-Authors: F. Litta, C. Ratto, A. Parello, R. Orefice, V. Simone, Ugo GrossiAbstract:The aim of this study was to evaluate the safety and long-term efficacy of fistulotomy and primary sphincteroplasty (FIPS). Secondary endpoints were its impact on postoperative continence status and patients’ satisfaction. A retrospective study was conducted on patients with cryptoglandular Anal Fistula (AF) who had FIPS between June 2006 and May 2017. Patients were evaluated with standardized telephone interviews and clinical/instrumental assessment. Main outcome measures included Fistula healing rate, continence status, and patient satisfaction. Incontinence was defined as an inability to hold either gas, liquid, or solid stools, as well as postdefecation soiling, and was measured by the Cleveland Clinic fecal incontinence score. Patient satisfaction was evaluated by an 11-point numeric rating scale. There were 203 patients (139 males; mean age: 48.7 years) who had FIPS. The overall healing rate was 93% (188 patients) with a mean follow-up period of 56 ± 31 months. Half of the total cohort (51%) had a complex Fistula. Preoperatively, 8 (4%) patients complained of postdefecation soiling and 2 (1%) of gas incontinence. Postoperatively, 26 (13%) patients had continence impairment (de novo n = 24), mainly consisting of postdefecation soiling (10%). In univariate Analysis, patients with recurrent (RR 6.153 95% CI 2.097–18.048; p = 0.002) or complex (RR 3.005 95% CI 1.203–7.506; p = 0.012) AF and those with secondary tracts (RR 8.190 95% CI 2.188–30.654; p = 0.004) or previous set on drainage (RR 5.286 95% CI 2.235–12.503; p = 0.0001) were at higher risk of incontinence. In multivariate Analysis, no significant predictors were found, although Fistula complexity approached statistical significance (RR 5.464 95% CI 0.944–31.623; p = 0.050). The mean patient satisfaction numeric rating scale was 9.3 ± 1.6. Lower satisfaction rates were found in patients with transphincteric (p = 0.011) or complex (p = 0.0001) AF, with secondary tracts (p = 0.041) or previous seton drainage (p = 0.008), and in those with postoperative continence impairment (p = 0.0001). Postoperative onset of incontinence was the only significant factor in multivariate Analysis (p = 0.0001). FIPS should be considered a valid therapeutic option for selected AF. However, the risk of postoperative minor fecal incontinence exists, and should be discussed during preoperative patient counselling.
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Contemporary surgical practice in the management of Anal Fistula: results from an international survey
Techniques in Coloproctology, 2019Co-Authors: C. Ratto, F. Litta, A. Parello, V. Simone, U. Grossi, G. L. Di Tanna, P. Tozer, D. Zimmerman, Y. MaedaAbstract:Background Management of Anal Fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons. Methods An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques. Results In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple Fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric Fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons’ experience. Only 1–4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn’s disease. Conclusions Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.
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Fistulotomy or fistulectomy and primary sphincteroplasty for Anal Fistula (FIPS): a systematic review
Techniques in Coloproctology, 2015Co-Authors: C. Ratto, F. Litta, L. Donisi, A. ParelloAbstract:There is still no clear consensus about surgical treatment of Anal Fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex Anal Fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex Anal Fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex Anal Fistulas.
L Mori - One of the best experts on this subject based on the ideXlab platform.
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video assisted Anal Fistula treatment vaaft a novel sphincter saving procedure for treating complex Anal Fistulas
Techniques in Coloproctology, 2012Co-Authors: P Meinero, L MoriAbstract:Background Video-assisted Anal Fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex Fistulas. The aim of this report is to describe the procedural steps and preliminary results of VAAFT.
David Armstrong - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Anal Fistula plug in closure of cryptoglandular Fistulas long term follow up
Diseases of The Colon & Rectum, 2006Co-Authors: Bradley J. Champagne, Marion E Schertzer, Guy R Orangio, Martha A. Ferguson, Lynn Oconnor, David ArmstrongAbstract:Purpose The long-term efficacy of Surgisis® Anal Fistula plug in closure of cryptoglandular anorectal Fistulas was studied.
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efficacy of Anal Fistula plug in closure of crohn s anorectal Fistulas
Diseases of The Colon & Rectum, 2006Co-Authors: Lynn Oconnor, Marion E Schertzer, Guy R Orangio, Bradley J. Champagne, Martha A. Ferguson, David ArmstrongAbstract:The efficacy of Surgisis® Anal Fistula plug in closure of Crohn’s anorectal Fistula was studied. Patients with Crohn’s anorectal Fistulas were prospectively studied. Diagnosis was made by histologic, radiographic, or endoscopic criteria. Variables recorded were: number of Fistula tracts (primary openings), presence of setons, and current antitumor necrosis factor therapy. Under general anesthesia and in prone jackknife position, patients underwent irrigation of the Fistula tract by using hydrogen peroxide. Each primary opening was occluded by using a Surgisis® Anal Fistula plug. Superficial tracts amenable to fistulotomy were excluded. Twenty consecutive patients were prospectively enrolled, comprising a total of 36 Fistula tracts. At final follow-up, all Fistula tracts had been successfully closed in 16 of 20 patients, for an overall success rate of 80 percent. Thirty of 36 individual Fistula tracts (83 percent) were closed at final follow-up. Patients with single Fistulas (with 1 primary opening) were most likely to have successful closure using the Anal Fistula plug. Successful closure was not correlated with the presence of setons or antitumor necrosis factor therapy. Closure of Crohn’s anorectal Fistula tracts using Surgisis® Anal Fistula plug is safe and successful in 80 percent of patients and 83 percent of Fistula tracts. Closure rates were higher with single tracts than complex Fistulas with multiple primary openings.
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Efficacy of Anal Fistula plug vs. fibrin glue in closure of anorectal Fistulas
Diseases of the Colon & Rectum, 2006Co-Authors: Eric K Johnson, Janette U. Gaw, David ArmstrongAbstract:PURPOSE: Long-term closure rates of anorectal Fistulas using fibrin glue have been disappointing, possibly because of the liquid consistency of the glue. A suturable bioprosthetic plug (Surgisis®, Cook Surgical, Inc.) was fashioned to close the primary opening of Fistula tracts. A prospective cohort study was performed to compare fibrin glue vs. the Anal Fistula plug. METHODS: Patients with high transsphincteric Fistulas, or deeper, were prospectively enrolled. Patients with Crohn's disease or superficial Fistulas were excluded. Age, gender, number and type of Fistula tracts, and previous Fistula surgeries were compared between groups. Under general anesthesia and in prone jackknife position, the tract was irrigated with hydrogen peroxide. Fistula tracts were occluded by fibrin glue vs. closure of the primary opening using a Surgisis Anal Fistula plug. RESULTS: Twenty-five patients were prospectively enrolled. Ten patients underwent fibrin glue closure, and 15 used a Fistula plug. Patient's age, gender, Fistula tract characteristics, and number of previous closure attempts was similar in both groups. In the fibrin glue group, six patients (60 percent) had persistence of one or more Fistulas at three months, compared with two patients (13 percent) in the plug group (P < 0.05, Fisher exact test). CONCLUSIONS: Closure of the primary opening of a Fistula tract using a suturable biologic Anal Fistula plug is an effective method of treating anorectal Fistulas. The method seems to be more reliable than fibrin glue closure. The greater efficacy of the Fistula plug may be the result of the ability to suture the plug in the primary opening, therefore, closing the primary opening more effectively. Further prospective, long-term studies are warranted.
F. Litta - One of the best experts on this subject based on the ideXlab platform.
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Simple Fistula-in-ano: is it all simple? A systematic review
Techniques in Coloproctology, 2021Co-Authors: F. Litta, A. Parello, L. Ferri, N. O. Torrecilla, A. A. Marra, R. Orefice, V. Simone, P. Campennì, M. Goglia, C. RattoAbstract:Background Simple Anal Fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple Anal Fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple Anal Fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple Anal Fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple Anal Fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple Anal Fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.
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fistulotomy and primary sphincteroplasty for Anal Fistula long term data on continence and patient satisfaction
Techniques in Coloproctology, 2019Co-Authors: F. Litta, C. Ratto, A. Parello, R. Orefice, V. Simone, Ugo GrossiAbstract:The aim of this study was to evaluate the safety and long-term efficacy of fistulotomy and primary sphincteroplasty (FIPS). Secondary endpoints were its impact on postoperative continence status and patients’ satisfaction. A retrospective study was conducted on patients with cryptoglandular Anal Fistula (AF) who had FIPS between June 2006 and May 2017. Patients were evaluated with standardized telephone interviews and clinical/instrumental assessment. Main outcome measures included Fistula healing rate, continence status, and patient satisfaction. Incontinence was defined as an inability to hold either gas, liquid, or solid stools, as well as postdefecation soiling, and was measured by the Cleveland Clinic fecal incontinence score. Patient satisfaction was evaluated by an 11-point numeric rating scale. There were 203 patients (139 males; mean age: 48.7 years) who had FIPS. The overall healing rate was 93% (188 patients) with a mean follow-up period of 56 ± 31 months. Half of the total cohort (51%) had a complex Fistula. Preoperatively, 8 (4%) patients complained of postdefecation soiling and 2 (1%) of gas incontinence. Postoperatively, 26 (13%) patients had continence impairment (de novo n = 24), mainly consisting of postdefecation soiling (10%). In univariate Analysis, patients with recurrent (RR 6.153 95% CI 2.097–18.048; p = 0.002) or complex (RR 3.005 95% CI 1.203–7.506; p = 0.012) AF and those with secondary tracts (RR 8.190 95% CI 2.188–30.654; p = 0.004) or previous set on drainage (RR 5.286 95% CI 2.235–12.503; p = 0.0001) were at higher risk of incontinence. In multivariate Analysis, no significant predictors were found, although Fistula complexity approached statistical significance (RR 5.464 95% CI 0.944–31.623; p = 0.050). The mean patient satisfaction numeric rating scale was 9.3 ± 1.6. Lower satisfaction rates were found in patients with transphincteric (p = 0.011) or complex (p = 0.0001) AF, with secondary tracts (p = 0.041) or previous seton drainage (p = 0.008), and in those with postoperative continence impairment (p = 0.0001). Postoperative onset of incontinence was the only significant factor in multivariate Analysis (p = 0.0001). FIPS should be considered a valid therapeutic option for selected AF. However, the risk of postoperative minor fecal incontinence exists, and should be discussed during preoperative patient counselling.
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Contemporary surgical practice in the management of Anal Fistula: results from an international survey
Techniques in Coloproctology, 2019Co-Authors: C. Ratto, F. Litta, A. Parello, V. Simone, U. Grossi, G. L. Di Tanna, P. Tozer, D. Zimmerman, Y. MaedaAbstract:Background Management of Anal Fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons. Methods An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques. Results In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple Fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric Fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons’ experience. Only 1–4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn’s disease. Conclusions Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.
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Fistulotomy or fistulectomy and primary sphincteroplasty for Anal Fistula (FIPS): a systematic review
Techniques in Coloproctology, 2015Co-Authors: C. Ratto, F. Litta, L. Donisi, A. ParelloAbstract:There is still no clear consensus about surgical treatment of Anal Fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex Anal Fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex Anal Fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex Anal Fistulas.
A. Parello - One of the best experts on this subject based on the ideXlab platform.
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Simple Fistula-in-ano: is it all simple? A systematic review
Techniques in Coloproctology, 2021Co-Authors: F. Litta, A. Parello, L. Ferri, N. O. Torrecilla, A. A. Marra, R. Orefice, V. Simone, P. Campennì, M. Goglia, C. RattoAbstract:Background Simple Anal Fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple Anal Fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple Anal Fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple Anal Fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple Anal Fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple Anal Fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.
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fistulotomy and primary sphincteroplasty for Anal Fistula long term data on continence and patient satisfaction
Techniques in Coloproctology, 2019Co-Authors: F. Litta, C. Ratto, A. Parello, R. Orefice, V. Simone, Ugo GrossiAbstract:The aim of this study was to evaluate the safety and long-term efficacy of fistulotomy and primary sphincteroplasty (FIPS). Secondary endpoints were its impact on postoperative continence status and patients’ satisfaction. A retrospective study was conducted on patients with cryptoglandular Anal Fistula (AF) who had FIPS between June 2006 and May 2017. Patients were evaluated with standardized telephone interviews and clinical/instrumental assessment. Main outcome measures included Fistula healing rate, continence status, and patient satisfaction. Incontinence was defined as an inability to hold either gas, liquid, or solid stools, as well as postdefecation soiling, and was measured by the Cleveland Clinic fecal incontinence score. Patient satisfaction was evaluated by an 11-point numeric rating scale. There were 203 patients (139 males; mean age: 48.7 years) who had FIPS. The overall healing rate was 93% (188 patients) with a mean follow-up period of 56 ± 31 months. Half of the total cohort (51%) had a complex Fistula. Preoperatively, 8 (4%) patients complained of postdefecation soiling and 2 (1%) of gas incontinence. Postoperatively, 26 (13%) patients had continence impairment (de novo n = 24), mainly consisting of postdefecation soiling (10%). In univariate Analysis, patients with recurrent (RR 6.153 95% CI 2.097–18.048; p = 0.002) or complex (RR 3.005 95% CI 1.203–7.506; p = 0.012) AF and those with secondary tracts (RR 8.190 95% CI 2.188–30.654; p = 0.004) or previous set on drainage (RR 5.286 95% CI 2.235–12.503; p = 0.0001) were at higher risk of incontinence. In multivariate Analysis, no significant predictors were found, although Fistula complexity approached statistical significance (RR 5.464 95% CI 0.944–31.623; p = 0.050). The mean patient satisfaction numeric rating scale was 9.3 ± 1.6. Lower satisfaction rates were found in patients with transphincteric (p = 0.011) or complex (p = 0.0001) AF, with secondary tracts (p = 0.041) or previous seton drainage (p = 0.008), and in those with postoperative continence impairment (p = 0.0001). Postoperative onset of incontinence was the only significant factor in multivariate Analysis (p = 0.0001). FIPS should be considered a valid therapeutic option for selected AF. However, the risk of postoperative minor fecal incontinence exists, and should be discussed during preoperative patient counselling.
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Contemporary surgical practice in the management of Anal Fistula: results from an international survey
Techniques in Coloproctology, 2019Co-Authors: C. Ratto, F. Litta, A. Parello, V. Simone, U. Grossi, G. L. Di Tanna, P. Tozer, D. Zimmerman, Y. MaedaAbstract:Background Management of Anal Fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons. Methods An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques. Results In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple Fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric Fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons’ experience. Only 1–4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn’s disease. Conclusions Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.
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Fistulotomy or fistulectomy and primary sphincteroplasty for Anal Fistula (FIPS): a systematic review
Techniques in Coloproctology, 2015Co-Authors: C. Ratto, F. Litta, L. Donisi, A. ParelloAbstract:There is still no clear consensus about surgical treatment of Anal Fistulas. Fistulotomy or fistulectomy and primary sphincter reconstruction is still regarded with skepticism. The aim of this systematic review was to evaluate the evidence in the literature supporting the use of this technique in the treatment of complex Anal Fistulas. MEDLINE, EMBASE and Cochrane Library databases were searched for the period between 1985 and 2015. The studies selected were peer-reviewed articles, with no limitations concerning the study cohort size, length of the follow-up or language. Technical notes, commentaries, letters and meeting abstracts were excluded. The major endpoints were the technique adopted, clinical efficacy, changes at anorectal manometry and assessment of quality of life after the procedure. Fourteen reports (666 patients) satisfied the inclusion criteria. The quality of the studies was low. Some differences about the surgical technique emerged; however, after a weighted average duration of follow-up of 28.9 months, the overall success rate was 93.2 %, with a low morbidity rate. The overall postoperative worsening continence rate was 12.4 % (mainly post-defecation soiling). In almost all cases, the anorectal manometry parameters remained unchanged. The quality of life, when evaluated, improved significantly. Fistulotomy or fistulectomy and primary sphincteroplasty could be a therapeutic option for complex Anal Fistula. Success rates were very high and the risk of postoperative fecal incontinence was lower than after simple fistulotomy. Well-designed trials are needed to support the inclusion of this technique in a treatment algorithm for the management of complex Anal Fistulas.