Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study
| Autor: | Matthew T. Brady, Steven Mills, Mehraneh D. Jafari, D E Brabender, Joseph C. Carmichael, Alessio Pigazzi, K L Moran, Michael J. Stamos |
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| Rok vydání: | 2020 |
| Předmět: |
Anal fistula
Adult Male medicine.medical_specialty Fistula Clinical Sciences Fistulectomy Anal Canal Laser Oral and gastrointestinal Cohort Studies 03 medical and health sciences 0302 clinical medicine Clinical Research medicine Fecal incontinence Humans Rectal Fistula Minimally invasive Retrospective Studies business.industry Lasers Pain Research Gastroenterology Fistula-in-ano Retrospective cohort study Middle Aged medicine.disease Sphincter-saving Colorectal surgery Surgery Treatment Outcome 030220 oncology & carcinogenesis Cohort FiLaC™ procedure FiLaC (TM) procedure 030211 gastroenterology & hepatology medicine.symptom business Organ Sparing Treatments Fecal Incontinence Abdominal surgery |
| Zdroj: | Techniques in coloproctology, vol 24, iss 10 |
| Popis: | BackgroundLaser 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.MethodsA 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.ResultsEighteen patients (10 males, mean age 41 ± 13years) 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 ± 8months (range 18-46months). 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.ConclusionsOur 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. |
| Databáze: | OpenAIRE |
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