Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term
| Autor: | Jordi Escoll-Rufino, Jacques Mégevand, Eloy Espin-Basany, Andrea Rusconi, Leonardo Lenisa, Roberto Lozoya-Trujillo, Luigi Mascheroni, Francesc Vallribera-Valls |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Anal fistula medicine.medical_specialty Adolescent Fistula Fistulotomy Young Adult Recurrence Internal medicine medicine Humans Rectal Fistula Postoperative Period Major complication Young adult Child Digestive System Surgical Procedures Aged Aged 80 and over business.industry Gastroenterology Middle Aged Hepatology Surgical Instruments medicine.disease Surgery Clinical trial Treatment Outcome Operative time Female Collagen business Fecal Incontinence |
| Zdroj: | International Journal of Colorectal Disease. 25:1487-1493 |
| ISSN: | 1432-1262 0179-1958 |
| DOI: | 10.1007/s00384-010-0957-y |
| Popis: | This prospective, two-centre study was designed to evaluate long-term outcomes when using a collagen plug to treat cryptoglandular anal fistulae. Over 3 years, 60 consecutive patients with cryptoglandular fistulae were treated using an anal fistula plug by experienced surgeons. Preoperative, postoperative and follow-up data were collected in a dedicated database. Success was defined as the closure of all fistula openings and the absence of discharge. Faecal incontinence scores were administered at baseline and at 6 months follow-up. Eleven patients had multiple fistula tracts. All fistulae treated in this series were classified as complex. Seventeen fistulae were anterior tracts in females, and the remaining tracts were trans-sphincteric in nature. Thirty-eight tracts were recurrent. Mean operative time was 26 ± 10 min. No major complications, active sepsis or mortality were observed. Success rate with a mean follow-up of 13 months was 60% of patients and 70% of tracts. Mean time for recurrence was 5.7 months. Two recurrent patients were successfully treated with a redo plug procedure, and five were successfully closed with a post-plug fistulotomy, leading to a global 72% success rate without continence impairment. Of the patients with a minimum follow-up of 6 months (mean, 18.5 months; range, 6–34 months), 29 in 32 (90.6%) were healed at final evaluation. In these patients, the mean preoperative CCF incontinence score was 0.73. This was reduced to 0.14 at 6-month follow-up. The mean reduction of CCF incontinence score was −0.6 (95% CI, 1.3 to −0.1; p = 0.01). Fistula tract treatment with the anal fistula plug is a safe and viable surgical option that should be offered to complex fistula patients. The reasons and risk factors for recurrence remain to be explored. |
| Databáze: | OpenAIRE |
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