Evaluation of a New Synthetic Plug in the Treatment of Anal Fistulas: Results of a Pilot Study
| Autor: | Ricardo Rada, José Manuel Sánchez-Gil, José Manuel Díaz-Pavón, R. M. Jimenez-Rodriguez, Fernando de la Portilla |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Fistula Pilot Projects Physical examination Bioabsorbable polymer Cohort Studies Dioxanes Recurrence medicine Humans Rectal Fistula Tampons Surgical Aged medicine.diagnostic_test business.industry Perianal Abscess Gastroenterology General Medicine Middle Aged medicine.disease Colorectal surgery Surgery Treatment Outcome Ambulatory Female Observational study business Polyglycolic Acid Cohort study |
| Zdroj: | Diseases of the Colon & Rectum. 54:1419-1422 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0b013e31822c4d59 |
| Popis: | Background The treatment of anal fistulas using plugs is a very promising method because of its simplicity and ability to be carried out on an ambulatory basis. If unsuccessful, it does not compromise subsequent alternative surgical techniques and/or products. However, success rates are variable. Objective This pilot study was designed to investigate the safety and effectiveness of a new synthetic plug in the treatment of transsphincteric anal fistulas. Design This was a prospective observational study. Setting Patients were treated at 2 colorectal surgery centers in Spain (Seville and Huelva). Interventions Anal fistulas were treated with a fistula plug made of bioabsorbable polymers (67% polyglycolide, 33% trimethylene carbonate). Patients Starting in January 2009, consecutive adult patients with transsphincteric anal fistulas were evaluated. Main outcome measures Outcome measures included rates of successful fistula closure, complications, and continence (Jorge-Wexner incontinence score), assessed postoperatively at 1 week and again at 1, 3, 6, and 12 months. Healing was determined by clinical examination by a surgeon blinded for the intervention. Results A total of 19 patients (18 men, 1 woman) with transsphincteric anal fistulas were included in the study. The median age was 49 (range, 33-65) years. Of these patients, 12 presented with fistula relapse. The median time from onset of symptoms to surgery was 12 (range, 6-120) months. Three patients had previously placed setons. The follow-up duration was 12 months. Relapse occurred in 16 patients (with a perianal abscess in 1), and successful closure was observed in 3 patients (15.8%). Limitations The number of patients was small, and time was needed for the learning curve of the technique. Conclusions This study indicates that the new synthetic plug is safe, but the fistula closure rate was low. Randomized studies are needed to further determine the role of the bioabsorbable synthetic plug in the management of anal fistulas. |
| Databáze: | OpenAIRE |
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