The Experts below are selected from a list of 609 Experts worldwide ranked by ideXlab platform
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 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 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.
Yun Zhang - One of the best experts on this subject based on the ideXlab platform.
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needle knife precut papillotomy and Fistulotomy for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography
Digestion, 2013Co-Authors: Qisheng S Zhang, Bing Han, Wenmin M Bao, Jieli L Tao, Yun ZhangAbstract:Background: Although needle knife precut papillotomy and needle knife Fistulotomy have been considered useful alternatives for achieving selective biliary cannula
Russell K Pearl - One of the best experts on this subject based on the ideXlab platform.
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island flap anoplasty for treatment of transsphincteric fistula in ano
Diseases of The Colon & Rectum, 1996Co-Authors: Alberto Del Pino, Richard L. Nelson, Russell K PearlAbstract:BACKGROUND: Treatment of fistula-in-ano often replaces one problem, risk of persistent anal sepsis, with another, either incontinence after Fistulotomy or mucosal ectropion after rectal flap advancement. A new technique for treatment of transsphincteric fistulas is described that could eliminate risk of both complications. TECHNIQUE: Island flap anoplasty, previously used in management of anal strictures or ectropion, is modified to treat transsphincteric fistulas. RESULTS: The operation has been performed in 11 patients, 3 of whom had Crohn's disease. Follow-up varied from one to ten months. Early recurrences have occurred in three patients, two with Crohn's disease and one without. Remaining patients have done well. CONCLUSION: This procedure is technically easy to perform and appears to cure transsphincteric fistulas while preserving anal sphincter. In the event of persistence of fistula, other operative options are not eliminated by this procedure. We feel that further experience and longer follow-up is needed to define precise indications for this procedure and to determine if continence is improved more so than with standard Fistulotomy.
Carla Rolanda - One of the best experts on this subject based on the ideXlab platform.
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early precut Fistulotomy for biliary access time to change the paradigm of the later the better
Gastrointestinal Endoscopy, 2014Co-Authors: Luis Lopes, Mario Dinisribeiro, Carla RolandaAbstract:Background The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed. Objective To assess the success, safety, and procedure duration of an early precut Fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B). Design Single-center, prospective cohort study. Setting University-affiliated hospital. Patients A total of 350 patients with a naive papilla. Interventions Standard biliary cannulation followed by needle-knife Fistulotomy (NKF). Main Outcome Measurements Biliary cannulation rate, NKF success, adverse events, and ERCP duration. Results The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P P Limitations Single-center study design, referral center. Conclusions If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late Fistulotomy approach and substantially reduces ERCP duration.