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M. D. Jafari - One of the best experts on this subject based on the ideXlab platform.

  • Assessing the effectiveness of laser Fistulectomy for anal fistula: a retrospective cohort study
    Techniques in Coloproctology, 2020
    Co-Authors: D. E. Brabender, K. L. Moran, M. Brady, J. C. Carmichael, S. Mills, A. Pigazzi, M. J. Stamos, M. D. Jafari
    Abstract:

    Background Laser Fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease. Methods A retrospective case analysis assessing the effectiveness of laser Fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated. Results Eighteen patients (10 males, mean age 41 ± 13 years) were analyzed. Transphincteric fistula was the most common type (67%, N  = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% ( N  = 4) success rate at an average postoperative follow-up period of 29 ± 8 months (range 18–46 months). Of those who failed, 64% ( N  = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment. Conclusions Our data showed a much higher failure rate of laser Fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

  • Assessing the effectiveness of laser Fistulectomy for anal fistula: a retrospective cohort study
    Techniques in coloproctology, 2020
    Co-Authors: D. E. Brabender, K. L. Moran, J. C. Carmichael, S. Mills, A. Pigazzi, M. J. Stamos, Matthew T. Brady, M. D. Jafari
    Abstract:

    Laser Fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease. A retrospective case analysis assessing the effectiveness of laser Fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated. Eighteen patients (10 males, mean age 41 ± 13 years) were analyzed. Transphincteric fistula was the most common type (67%, N = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% (N = 4) success rate at an average postoperative follow-up period of 29 ± 8 months (range 18–46 months). Of those who failed, 64% (N = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment. Our data showed a much higher failure rate of laser Fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

D. E. Brabender - One of the best experts on this subject based on the ideXlab platform.

  • Assessing the effectiveness of laser Fistulectomy for anal fistula: a retrospective cohort study
    Techniques in Coloproctology, 2020
    Co-Authors: D. E. Brabender, K. L. Moran, M. Brady, J. C. Carmichael, S. Mills, A. Pigazzi, M. J. Stamos, M. D. Jafari
    Abstract:

    Background Laser Fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease. Methods A retrospective case analysis assessing the effectiveness of laser Fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated. Results Eighteen patients (10 males, mean age 41 ± 13 years) were analyzed. Transphincteric fistula was the most common type (67%, N  = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% ( N  = 4) success rate at an average postoperative follow-up period of 29 ± 8 months (range 18–46 months). Of those who failed, 64% ( N  = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment. Conclusions Our data showed a much higher failure rate of laser Fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

  • Assessing the effectiveness of laser Fistulectomy for anal fistula: a retrospective cohort study
    Techniques in coloproctology, 2020
    Co-Authors: D. E. Brabender, K. L. Moran, J. C. Carmichael, S. Mills, A. Pigazzi, M. J. Stamos, Matthew T. Brady, M. D. Jafari
    Abstract:

    Laser Fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease. A retrospective case analysis assessing the effectiveness of laser Fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated. Eighteen patients (10 males, mean age 41 ± 13 years) were analyzed. Transphincteric fistula was the most common type (67%, N = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% (N = 4) success rate at an average postoperative follow-up period of 29 ± 8 months (range 18–46 months). Of those who failed, 64% (N = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment. Our data showed a much higher failure rate of laser Fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

Theo J. Van Vroonhoven - One of the best experts on this subject based on the ideXlab platform.

  • Treatment of anorectal abscess with or without primary Fistulectomy. Results of a prospective randomized trial.
    Diseases of the colon and rectum, 1991
    Co-Authors: W. R. Schouten, Theo J. Van Vroonhoven
    Abstract:

    To determine whether primary Fistulectomy should be performed or not at the time of incision and drainage, a prospective, randomized study in 70 patients with anorectal abscess was conducted. Thirty-six patients underwent incision, drainage and Fistulectomy with primary partial internal spincterectomy (group I), whereas in 34 patients anorectal abscess was treated by incision and drainage alone (group II). After a median follow-up of 42.5 months, the combined recurrence or persistence rate was 2.9 percent in group I and 40.6 percent in group II (P

  • treatment of anorectal abscess with or without primary Fistulectomy results of a prospective randomized trial
    Diseases of The Colon & Rectum, 1991
    Co-Authors: W. R. Schouten, Theo J. Van Vroonhoven
    Abstract:

    To determine whether primary Fistulectomy should be performed or not at the time of incision and drainage, a prospective, randomized study in 70 patients with anorectal abscess was conducted. Thirty-six patients underwent incision, drainage and Fistulectomy with primary partial internal spincterectomy (group I), whereas in 34 patients anorectal abscess was treated by incision and drainage alone (group II). After a median follow-up of 42.5 months, the combined recurrence or persistence rate was 2.9 percent in group I and 40.6 percent in group II (P<0.0003, log-rank test). Recurrent abscesses or persistent fistulas were treated by secondary partial internal sphincterectomy. Comparing anal continence before and 1 year after definite treatment, we found increased anal function disturbances in 39.4 percent of the patients in group I and in 21.4 percent of the patients in group II (P<0.106, Fisher-exact test). The combined recurrence or persistence rate of 40.6 percent indicates that more than half of the patients with anorectal abscess will have no further problems after simple incision and drainage. This finding, as well as the increased anal function disturbances after partial internal sphincterectomy (either primary or secondary) are the main reasons to reserve Fistulectomy as a second stage procedure if necessary.

Aly Saber - One of the best experts on this subject based on the ideXlab platform.

  • Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula
    Journal of Surgery, 2016
    Co-Authors: Aly Saber
    Abstract:

    Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally, Fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula while others reported that fistulotomy continues to have excellent results. Patients and Methods: This study represented parallel prospective randomized clinical trial where 200 patients were divided randomly into two main groups; A and B. Group A patients were subjected to fistulotomy and those of group B were subjected to Fistulectomy for low anal fistulae. The study included all patients having low anal fistulae complicating perianal abscesses. Patients with high fistulae and patients with multiple external openings were excluded. The primary end point was anal incontinence and the secondary end points were time off from work, postoperative pain, wound discharge, wound healing and patients’ satisfaction. Results: The mean operative time, time taken for wound discharge to cease and time taken for complete healing was significantly less in patients of group A. Regarding the occurrence of fecal incontinence, no permanent cases were reported in our series but temporary incontinence was observed in 2 patients in fistulotomy group while in Fistulectomy group there were 4 patients. Therefore, the overall patient satisfaction mean values were 90.6 ± 8.87and 85.6 ± 13.2 for patients in group A and B respectively with statistically insignificant distribution. Conclusion: Fistulotomy could be used as a primary treatment of low anal fistula as being safe and simple to perform with good patient’s satisfaction as regard postoperative pain and outcome.

J. Marzo - One of the best experts on this subject based on the ideXlab platform.

  • Endorectal flap advancement repair and Fistulectomy for high trans-sphincteric and suprasphincteric fistulas.
    The British journal of surgery, 2000
    Co-Authors: Héctor Ortiz, J. Marzo
    Abstract:

    Background Low-lying trans-sphincteric anal fistulas respond well to simple Fistulectomy or fistulotomy. However, management of high fistulas has long been a serious problem because of the necessity of preserving at least some of the sphincter mechanism. The clinical results of endorectal flap advancement and Fistulectomy for complex anal fistulas were assessed. Methods A total of 103 consecutive patients with high trans-sphincteric (n = 91) and suprasphincteric (n = 12) fistulas undergoing endorectal advancement flap repair together with core Fistulectomy were included in a prospective study. Clinical outcome was assessed in terms of continence and recurrence by an independent observer for a period of 1 year after operation. Results Successful healing was achieved in 96 patients (93 per cent). Recurrent fistula occurred in six (7 per cent) of the 91 patients in the trans-sphincteric group and in one of the 12 patients in the suprasphincteric group. Continence disturbance was noted in eight patients (8 per cent). Previous repair and the level of the fistula did not adversely affect the results obtained. Conclusion Core Fistulectomy associated with endorectal advancement flap repair is a safe and effective technique for any high trans-sphincteric and suprasphincteric fistula, with good results in terms of recurrence and anal continence. © 2000 British Journal of Surgery Society Ltd