The role of transient internal sphincter relaxation in faecal incontinence?

Twenty-five (18%) of 140 incontinent patients and 6 (17%) of 35 normal controls showed episodes of spontaneous internal sphincter relaxation during 30 min multiport manometric and electromyographic recording under resting conditions. The episodes lasted at least 15 s and reduced the pressure in the outermost anal channels by at least 20 cm of water. Patients exhibited more episodes of relaxation than controls (4.3±0.6 vs 2.3±0.2 per subject; mean±SEM; p<0.05) and the pressures fell to lower values (19±1 vs 42±5 cm water, p<0.01), but the duration of relaxation was not significantly different (53±4 vs 40±7 s). Episodes of spontaneous relaxation were associated with simultaneous rectal contractions in 33% of the normal subjects and 45% of incontinent patients. Unlike normal subjects, most of the episodes of transient relaxation recorded in the incontinent group were not associated with compensatory increases in the electrical activity of the external anal sphincter (77% vs 17%; p<0.05). Over 50% of the incontinent patients who showed spontaneous relaxation also showed post squeeze or post-strain IAS relaxations whereas these were seen in less than 6% of the normal subjects with spontaneous relaxation. The rectal volumes, required to elicit anal relaxation (10±0 vs 28±7 ml; p<0.05), to incude sustained relaxation (60±8 vs 82±5 ml; p<0.05), to elicit a sensation of wind (19±3 vs 27±8 ml; p<0.05) and to cause a desire to defaecate (36±4 vs 63±9 ml; p<0.05) were all lower in the incontinent patients who showed spontaneous relaxations than in the incontinent control group. In conclusion, spontaneous relaxation of the internal sphincter may be an important factor leading to faecal incontinence in patients with a sensitive rectum, especially as they tend to occur in these subjects in the absence of a compensatory increase in external sphincter activity.     

Treatment of Complex Anal Fistulas with the Collagen Fistula Plug

Purpose

Anal fistulas that involve a significant amount of sphincter may be difficult to treat without compromising continence function. In this study, we evaluated our experience with the Surgisis® anal fistula plug, which was recently reported to be successful in >80 percent of patients with complex fistulas.

Methods

We retrospectively collected patient and fistula characteristics, procedure details, and follow-up information for all patients treated with the anal fistula plug at our institution from January 2006 through April 2007. The outcome was considered successful if the external opening was closed and if the patient had no drainage at the last follow-up. Using multivariate statistics, we analyzed the relationship between anal fistula plug success and several key variables.

Results

From January 2006 through April 2007, 47 patients with 49 complex anal fistulas underwent 64 anal fistula plug procedures. The median follow-up time for patients who were considered healed was 6.5 (range, 3–11) months. The success rate was 31 percent per procedure and 43 percent per patient. An increased amount of external sphincter involvement was associated with a higher failure rate (P?

Conclusions

In our early experience with the anal fistula plug, 43 percent of patients with complex anal fistulas were successfully treated. Patients with less external sphincter involvement were more likely to heal.

     

Fistelspaltung und prim?re Sphinkterrekonstruktion zur Behandlung von Analfisteln

Background

There have been sporadic but enthusiastic reports in recent years about fistulotomy with primary sphincter repair as a radical but successful approach to dealing with complex anal fistula. Having had to overcome our own reservations we have found this method to be successful, prompting this case review.

Methods

Retrospective evaluation of patient records and subsequent telephone interview of all cases operated for fistulotomy with primary sphincter repair between January 2008 and May 2009.

Results

Of 38 patients, 34 (89%) had transsphincteric (20 ??high??, 14 ??low??), three (8%) suprasphincteric, one extrasphincteric fistula. Three (8%) had associated IBD. Seven (18%) had experienced recurrence following previously failed repairs. Postsurgical revision was necessary in four patients: three small wound revisions, one partial dehiscence of the sphincter reconstruction. The chart review showed??wounds completely healed?? in 37 patients (97%, persistent granulation tissue at wound edges in one patient); continence was noted as ??unchanged?? or??continent?? in 36 patients (95%; it was noted as ??diminished continence for gas?? in one patient, while changes were not documented for another patient). In all, 32 patients (84%) were available for telephone interview. Three (9%) reported occasional anal discomfort and slightly diminished gas continence (n, 1) and fluid stools (n, 2). One patient reported improved sphincter function.

Conclusion

Fistulotomy with primary sphincter reconstruction is an important adjunct to the surgical armamentarium for the treatment of anal fistula. Fistulotomy enables full exposure of the fistulous tract and excision of all inflammatory remnants and bradytrophic granulation, which can be the cause of failure of other procedures if left in situ. We are able to confirm this method to be reliable and successful even with the more complex fistula varieties and with recurrences.     

Combined partial fistulectomy and electro-cauterization of the intersphincteric tract as a sphincter-sparing treatment of complex anal fistula: clinical and functional outcome

Background

The aim of this study was to report a simple, effective and safe procedure, associated with minimal risk of incontinence and recurrence, for treating complex anal fistulas.

Methods

This was a prospective study of 53 consecutive patients with complex anal fistulas. The technique used included excision of the distal part of the fistula tract down to the external anal sphincter and electro-cauterization of the intersphincteric part of the tract with simple closure of the internal opening. Data collected included patient characteristics, fistula type determined by magnetic resonance imaging, pre- and postoperative continence status evaluated using the Wexner incontinence score (0–10), previous operations, hospital stay, healing time, recurrence rate and complications.

Results

The patients had a mean age of 41.37 ± 7.82 years; the most frequent fistula type was the high transsphincteric fistula; the mean follow-up period was 19 months with a success rate of 92.5 %; the mean wound healing time was 3.6 weeks; the incontinence scores were the same as before the procedure. The recurrence rate was 7.5 %.

Conclusions

Partial fistulectomy combined with electrocauterization of the intersphincteric fistula tract is a simple, and effective procedure for the treatment of complex anal fistulas.     

Biofeedback improves functional outcome after sphincteroplasty

The primary treatment for obstetric sphincter injury is overlapping sphincteroplasty. However, despite restoration of the anatomy, only 65 percent of patients are fully continent. PURPOSE: This study was undertaken to determine if postoperative biofeedback improved continence in patients with poor functional outcomes after sphincteroplasty. METHOD: Outcomes of 28 patients who underwent electromyographic biofeedback training after sphincteroplasty for obstetric sphincter injury were reviewed. Nine patients had an accompanying levatorplasty. Average age was 34 (range, 23–57) years. Patients began biofeedback a mean of 32 (range, 2–192) months postoperatively. Before beginning biofeedback, patients completed an incontinence questionnaire, bowel diary, and scored their incontinence. At the end of treatment, they were again asked to score their incontinence and rate their improvement. Using an incontinence scale with a maximum score of 30, the average incontinence score before biofeedback was 20 (range, 13–30). Incontinent episodes per week ranged from one to nine. Sixteen patients were incontinent to solid stool. RESULTS: Overall, the average posttreatment incontinence score decreased from 20 to 3 (P < 0.0001). Average number of incontinent episodes per week decreased from 5.4 to 1.4 (P < 0.0001) Twenty-five patients (89 percent) reported improvement in their continence. All had a posttreatment incontinent score of less than three. Three patients noted no improvement. Of those, one subsequently had a colostomy, one is waiting the implant of an artificial anal sphincter, and one has sought no further treatment. There were no complications reported. CONCLUSION: Biofeedback improves functional outcome after sphincteroplasty and is a reasonable option for patients with less than optimum outcome after sphincteroplasty.     

Robotic approach mitigates perioperative morbidity in obese patients following pancreaticoduodenectomy

Introduction

The aim was to evaluate the impact of obesity on perioperative outcomes in patients undergoing robotic pancreaticoduodenectomy (RPD) compared to open pancreaticoduodenectomy (OPD).

Bronchoalveolar lavage fluid alteration in antioxidant and inflammatory status in lung cancer patients

Background

Increased oxidative and inflammatory markers have been reported in lung cancer patients, but relatively few studies have investigated the presence of antioxidants both in the local lung environment and in the systemic circulation. Furthermore, it is hypothesized that the immune system activation in vivo is regulated by the redox environment.

Objectives

To investigate local and systemically circulating antioxidant and inflammatory mediators in lung cancer patients and potential correlations between them.

Methods

Forty two male patients (mean age 65 ± 8 years) with primary lung cancer were studied. Sixteen age and smoking history matched male subjects without any evidence of malignancy served as controls. Total antioxidant status (TAS) and glutathione (GSH), as well as interleukin-1a (IL-1a), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were measured in bronchoalveolar lavage fluid (BALF) and serum samples.

Results

A statistically significant increase of TAS and GSH in BALF was observed in lung cancer patients compared to healthy subjects (0.27 ± 0.24 vs. 0.12 ± 0.02 mmol/L, p = 0.02 and 7.56 ± 4.29 vs. 4.62 ± 2.23 μmol/L, p = 0.01 respectively). Statistically significant correlations in cancer patients were observed in BALF between TAS and a. IL-1α (r = 0.87, p < 0.001), b. IL-6 (r = 0.52, p = 0.001) and c. TNF-α (r = 0.67, p < 0.001).

Conclusions

Alteration in antioxidant and inflammatory mediator status was found in lung cancer patients both in serum and in BALF compared to healthy subjects matched for smoking history. Moreover, a positive correlation was observed between antioxidants and pro-inflammatory cytokines, but only locally and not systematically.     

Die Fistulotomie

Purpose

The optimal treatment for high/complex anal fistulas remains unclear. We studied one surgeon??s results over a 10-year period, concentrating on high fistulas.

Methods

Demographic, fistula anatomy and treatment data were recorded for all patients undergoing surgery for anal fistula. Outcome data were recorded for patients who had been followed-up for a minimum of 4?weeks.

Results

In all, 180?patients were studied. Outcome data were available for 52 low and 84 high fistulas. Fistulotomy was performed for 50 low and 48 high fistulas, with closure rates of 98% and 96%, respectively. Fistula recurrence was seen in two patients with high fistulas. Symptoms of sphincter disturbance were similar after lay open of both low and high fistulas. The treatment of high fistulas by drainage seton had a lower rate of inadvertent passage of flatus but a similar rate of minor soiling compared with fistulotomy.

Conclusions

Lay open of low and high anal fistulas is effective and associated with a similar, predictable rate of minor sphincter disturbance, affecting a third to a quarter of patients with mild leakage of flatus and mucus. Patients with high fistulas can be cured; however, in case of doubt, a second opinion should be sought from an expert centre before definitive intervention.     

Plasma levels of stromal cell-derived factor-1 in patients with coronary artery disease: effect of clinical presentation and cardiovascular risk factors

Objective

To investigate the possible association of plasma levels of stromal cell-derived factor-1 (SDF-1; CXCL12) with clinical presentation of symptomatic coronary artery disease (CAD) and with cardiovascular risk factors.

Methods

A cath lab cohort of 492 consecutive patients with symptomatic CAD were recruited. Blood for plasma-SDF-1 determination was taken at the time of heart catheterization before percutaneous coronary intervention.

Results

Plasma-SDF-1 was significantly decreased in ST-elevation myocardial infarction (STEMI) compared to stable angina pectoris (SAP) or to non-ST-elevation myocardial infarction (NSTEMI) (SAP vs. NSTEMI vs. STEMI: [pg/ml]: mean ± SD: 2110 ± 562 vs. 2127 ± 467 vs. 1834 ± 377; P < 0.001) independent of cardiovascular therapy. A weak correlation was observed between cholesterol levels and plasma SDF-1 in the whole study population. Left ventricular function and diabetes mellitus associated with plasma SDF-1 levels in patients with NSTEMI, while among STEMI patients, those with hyperlipidemia presented with even further decreased SDF-1 levels.

Conclusion

Plasma SDF-1 is significantly decreased in patients with STEMI, a fact which may reflect the importance of SDF-1 regulation in patients with acute myocardial infarction.     

Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review

Background

The surgical treatment of complex anal fistulae, particularly those involving a significant portion of the anal sphincter in which fistulotomy would compromise continence, is challenging. Video-assisted anal fistula treatment (VAAFT), fistula tract laser closure (FiLaC?) and over-the-scope clip (OTSC^®) proctology system are all novel sphincter-sparing techniques targeted at healing anal fistulae. In this study, all published articles on these techniques were reviewed to determine efficacy, feasibility and safety.

Methods

A systematic search of major databases was performed using defined terms. All studies reporting on experience of these techniques were included and outcomes (fistula healing and safety) evaluated.

Results

Eighteen studies (VAAFT—12, FiLaC?—3, OTSC^®—3) including 1245 patients were analysed. All were case series, and outcomes were heterogeneous with follow-up ranging from 6 to 69 months and short-term (< 1 year) healing rates of 64–100%. Morbidity was low with only minor complications reported. There was one report of minor incontinence following the first reported study of FiLaC?, and this was treated successfully at 6 months with rubber band ligation of hypertrophied prolapsed mucosa. There are inconsistencies in the technique in studies of VAAFT and FiLaC?.

Conclusions

All three techniques appear to be safe and feasible options in the management of anal fistulae, and short-term healing rates are acceptable with no sustained effect on continence. There is, however, a paucity of robust data with long-term outcomes. These techniques are thus welcome additions; however, their long-term place in the colorectal surgeon’s armamentarium, whether diagnostic or therapeutic, remains uncertain.

     

Long-term effects of intermittent Iloprost infusion on pulmonary arterial pressure in connective tissue disease

Background

Intravenous periodic Iloprost is proven effective in the treatment of Raynaud phenomenon (RP) related to connective tissue disorder (CTD). It's well known that synthetic prostaglandins are effective drugs for the treatment of pulmonary arterial hypertension (PAH), and that PAH is frequently associated with CTD.

Objective

The aim of the study is to evaluate in the chronic effect of cyclic intravenous Iloprost on pulmonary arterial pressure.

Methods

We studied 17 consecutive patients with CTD (14 systemic sclerosis, 3 mixed CTD) and RP, at the entry and after at least 6 months of treatment of RP with cyclic Iloprost. On both occasions, in all patients we performed transthoracic Doppler echocardiography and we determined NT-proBNP plasma levels, NYHA functional class, 6 Minute-Walk Distance (6MWD).

Results

At follow-up (8.2 ± 1.9 months; range 6–12) mean values of pulmonary arterial systolic pressure (PASP) significantly decreased (from 32.2 ± 9.2 to 29.2 ± 7.6 mmHg, p < 0.04) and mean values of 6MWD significantly increased (from 407.5 ± 101.5 to 448.3 ± 89.9 m, p < 0.01). Moreover, we observed a significant direct correlation between PASP and NT-proBNP values and a significant inverse correlation both between NT-proBNP and 6MWD values and between PASP and 6MWD values.

Conclusion

Our results suggest that cyclic intravenous Iloprost may protect against the development or worsening of PAH in patients with CTD and RP.     

Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn’s disease: a single-center experience

Purpose

To determine risk factors for early postoperative complications and longer hospital stay after ileocecal resection and right hemicolectomy in a single-center cohort of patients with Crohn’s disease (CD).

Methods

A retrospective analysis of the prospectively maintained surgical database for patients with CD at our institution was performed. All consecutive patients operated on between January 2010 and December 2016 were included.

Results

A total of 305 patients were included. Median length of hospital stay was 7 days (interquartile range, IQR 6–10). Major postoperative complications were observed in 9.5% of patients (n?=?29). Anastomotic leak was observed in five patients (1.8% of all patients with anastomosis). The rate of local septic complications was 4.3% (n?=?13, anastomotic leak, postoperative abscess, and/or postoperative fistula). In multivariable analysis, independent risk factors for major postoperative complications were bowel perforation (odds ratio (OR)?=?12.796, 95% CI?=?1.144–143.178); elevated preoperative leucocyte levels (OR?=?1.115, 95% CI?=?1.013–1.228); and low levels of preoperative albumin (OR?=?0.885, 95% CI?=?0.827–0.948). The cutoff value for albumin was 32.5 g/L (sensitivity 75.9%, specificity 62.6%).

Conclusions

In this large cohort of patients surgically treated for CD in a tertiary referral center, 9.5% of the patients developed major postoperative complications. Preoperative albumin levels >?32.5 g/L significantly reduce the risk for postoperative complications and shorten the length of hospital stay. In a multidisciplinary concept with adequate preoperative management, surgery can be performed with a low rate of major complications and a very low rate of anastomotic leakage.

     

Fistula tract curettage and the use of biological dermal plugs improve high transsphincteric fistula healing in an animal model

Purpose

The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula.

Methods

Sixteen female New Zealand rabbits, weighing 2.8–4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination.

Results

According to the MRI findings, all groups showed significant healing after the treatment (p?<?0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29 % in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p?<?0.05).

Conclusion

According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.

     

Rehabilitation of fecal incontinence: What is the influence of anal sphincter lesions?

Background

The aim of this study was to evaluate the results of rehabilitative treatment of incontinent patients with anal sphincter lesions in order to verify whether these lesions influence the outcome of rehabilitation.

Methods

Between January 2008 and June 2011, 48 patients [36 women, age range 51–77 years; 12 men, age range 57–70 years] affected by fecal incontinence were included in the study. After a preliminary clinical evaluation, including the Fecal Incontinence Severity Index (FISI) score, all patients were studied by means of endoanal ultrasound and anorectal manometry. Two patients groups were identified: Group 1 comprised 27 patients with sphincter lesions and Group 2 had 21 patients without sphincter lesions. All 48 underwent a multimodal rehabilitation program. At the end of the rehabilitation program, all patients were reassessed by means of clinical evaluation and anorectal manometry and their data were analyzed.

Results

Although we obtained an overall significantly lower FISI score in all patients after rehabilitation (p < 0.001) when compared with pre-treatment values, our study revealed that patients with sphincter lesions had a significantly worse post-rehabilitative FISI score (p < 0.003) when compared with those patients with intact anal sphincters and that there is a linear relationship between post-rehabilitative FISI scores and severity of sphincter lesions (ρ _s 0.69).

Conclusions

These data suggest that rehabilitation may be less effective in patients affected by sphincter defects.     

Photodynamic therapy for the treatment of complex anal fistula

Background

Photodynamic therapy (PDT) is a new procedure for the treatment of anal fistula. This preliminary study was designed to investigate the safety and effectiveness of this new technique in the treatment of anal fistula.

Methods

Ten patients were treated with PDT. Intralesional 5-aminolevulinic acid (ALA) 2% was directly injected into the fistula. The internal and external orifices were closed. After an incubation period of 2 h, the fistula was irradiated using an optical fibre connected to a red laser (MULTIDIODE 630 PDT, INTERmedic, Spain) operating at 1 W/cm for 3 min (180 Joules). Patient demographics, operation notes and complications were recorded.

Results

There were no complications. The average length of patient follow-up was 14.9 months (range 12–20 months). We could observe primary healing in eight patients (80%). Two patients (20%) showed persistence of suppuration after the operation. No patient reported incontinence postoperatively.

Conclusions

PDT is a potential sphincter-saving procedure that is safe, simple and minimally invasive and has a high success rate.

     

Autologous Fibrin Glue in Treatment of Fistula in Ano

Aim: This study was done to assess the efficacy and advantage of fibrin glue therapy in anal fistulae in comparison to conventional treatment. Patients and Method: The results of treatment of anal fistula by autologous fibrin tissue adhesive in 30 patients were compared with those obtained by conventional surgery in another 30 patients. All patients in both procedures had preoperative mechanical bowel preparations and preoperative intravenous antibiotic. The two groups were matched for age, sex, fistula type and follow-up duration. Results: The non-invasive fibrin glue application was extremely satisfactory in 24 patients out of 30 patients (80%), two healed after another attempt, three showed no postoperative improvement and one patient developed intersphincteric abscess (morbidity 3.3%) Median hospital stay was 1.5 days, while patients' discomfort was minimal. There was no postoperative impairment of anal sphincter function and there was no recurrence. In the group undergoing laying open operations, recurrence occurred in five patients, median hospital stay was 3.1 days, and strong analgesia was needed. Continence disorder occurred in four patients, one patient remained incontinent only for flatus, in two patients minimal soiling persists for more than three months follow-up. Conclusion In conclusion, the above data showed that fibrin glue application in anal fistula is a simple, easy, safe, and effective procedure, although longer follow-up and bigger series are needed.     

Epidemiological study of the idiopathic dilated cardiomyopathy in Tunisia

Aims of the study

Idiopathic dilated cardiomyopathy (IDC) is a complex disease. The interest of this study were to investigate the epidemiology characteristics of the disease and to evaluate the prognostic echocardiographic markers by region in order to highlight the existence of genetic risk factors and/or environmental and to identify those patients who could benefit from early treatment and better care to avoid further complications of the disease.

Patients and methods

This is a retrospective study based on the Fischer exact and bilateral Mann-Whitney test.

Results

We included 526 patients with dilated cardiomyopathies of them we detected 50 cases of IDC including 12 families: The average age was 39,3 ± 15.2 years. The sex ratio was 2.6. Mean left ventricular end-diastolic diameter (DIVGd) was higher in patients from the North East region (44.3 ± 6.2 mm/m²). Using Receiver Operating Characteristics (ROC) curve, we found a threshold value of 40 mm/m². The odds ratio associated with this cutoff was 9.2.

Conclusion

Our results suggest that the prevalence and severity of IDC were higher in the North East region of Tunisia. Furthermore, large-scale prospective studies are needed to confirm these findings. In confirmation of a higher prevalence, a genetic study should be undertaken in this region.     

Anal sphincter reconstruction in the elderly: Does advancing age affect outcome?

PURPOSE: This study was designed to determine whether advancing age affects outcome after anal sphincter reconstruction. METHOD: Anal sphincter reconstruction, performed on patients 55 years of age and older, was reviewed to determine if functional outcome was adversely affected by advancing age. A subgroup of patients was studied with anal manometry before and after repair and with pudendal nerve terminal motor latency (PNTML) before surgery. Results were compared with a younger group of patients. RESULTS: Between July 1986 and July 1991, 14 patients, ages ranging from 55 to 81, underwent anal sphincter reconstruction using an overlapping muscle repair. Ten patients were incontinent of solid stool and four of liquid stool. Improvement was seen in 13 of 14 patients: 7 (50 percent) complete control, 3 (21 percent) incontinent to flatus, and 4 (29 percent) incontinent to liquid stools (including the patient who failed to improve). Ten patients were studied with a continuous pull-out manometric technique and PNTML: one was not improved. There was minimum change in mean maximum resting pressure (35.0–37.9 mmHg). Mean maximum squeezing pressure increased from 66 to 75 mmHg overall. Patients with complete control had a mean maximum squeezing pressure of 81 mmHg compared with 60 mmHg in patients with residual incontinence. Mean anterior anal sphincter length increased from 2.92 cm to 331 cm. PNTML was normal (2.0±0.2) on one or both sides in all nine patients who improved (average, 2.1). The patient who failed to improve had abnormal nerve function bilaterally (2.4, 2.7). CONCLUSION: Anal sphincter reconstruction can be performed in elderly patients with improvements in the majority of patients. Total control can be achieved by restoring maximum squeezing pressure in a patient with normal pudendal nerve function.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.     

Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up

Background

Optimal surgical treatment for anal fistula should result in healing of the fistula track and preserve anal continence. The aim of this study was to evaluate Permacol? collagen paste (Covidien plc, Gosport, Hampshire, UK) injection for the treatment of complex anal fistulas, reporting feasibility, safety, outcome and functional results.

Methods

Between May 2013 and December 2014, 21 consecutive patients underwent Permacol paste injection for complex anal fistula at our institutions. All patients underwent fistulectomy and seton placement 6–8 weeks before Permacol? paste injection. Follow-up duration was 12 months.

Results

Eighteen patients (85.7%) had a high transsphincteric anal fistula, and three female patients (14.3%) had an anterior transsphincteric fistula. Fistulas were recurrent in three patients (14.3%). Seven patients (33%) had a fistula with multiple tracts. After a follow-up of 12 months, ten patients were considered healed (overall success rate 47.6%). The mean preoperative FISI score was 0.33 ± 0.57 and 0.61 ± 1.02 after 12 months.

Conclusions

Permacol? paste injection was safe and effective in some patients with complex anal fistula without compromising continence.