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Tan IJW, Siew BE, Lau J, Yap CPL, Soon SMME, Tan KK. Is the ligation of the intersphincteric fistula tract (LIFT) procedure truly a sphincter preserving procedure for anal fistula? A scoping review of the literature. Eur J Med Res 2025; 30:243. [PMID: 40186276 PMCID: PMC11971777 DOI: 10.1186/s40001-025-02380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/12/2025] [Indexed: 04/07/2025] Open
Abstract
INTRODUCTION The ligation of the intersphincteric fistula tract (LIFT) procedure has garnered popularity with its success rates and purported sphincter-continence preservation. However, there remains a paucity in the literature on the objective evaluation of sphincter integrity and fecal continence after the LIFT procedure. OBJECTIVES The present study undertakes a scoping review to systematically explore and map the published literature, to evaluate the sufficiency of data on the impact on continence in patients after the LIFT procedure. DESIGN A systematic search of MEDLINE, PubMed, EMBASe, CINAHL was performed from January 2007 to April 2020 and 597 publications were identified. Forty-two satisfied the inclusion and exclusion criteria. We performed a scoping review in accordance to the PRISMA-ScR guidelines. RESULTS Only 3 (7.1%) of publications were randomized controlled trials, of which just 1 (2.4%) measured incontinence as a primary outcome. Continence was measured both pre- and post-LIFT in 30 (71.4%), of which 19 (45.2%) had a fixed protocol for continence assessment, which was heterogeneous between the studies. Continence was assessed using subjective scoring systems in 27 (64.3%) and objective measurement was performed in just 6 (14.3%). No studies performed post-operative anatomical assessment of the anal sphincter complex. CONCLUSIONS Long-term continence in post-LIFT patients is not supported with adequately powered prospective longitudinal trials using rigorously protocoled pre- and post-operative assessment of continence. Future research that focuses on a combination of objective assessment using anal manometry as well as anatomical assessment of the sphincter complex on top of subjective evaluation is needed before we can be certain if LIFT is indeed a sphincter and continence preserving technique.
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Affiliation(s)
- Ian Jse-Wei Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
| | - Bei En Siew
- Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Jerrald Lau
- Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Carol Pei Ling Yap
- Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Stephanie Marie May Ee Soon
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Gemma N, McMahon K, Clapp M, Ma T, Laipply E. The Use of Biologic Mesh for Repair of Perianal Fistulas. Cureus 2024; 16:e64675. [PMID: 39149662 PMCID: PMC11326804 DOI: 10.7759/cureus.64675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 08/17/2024] Open
Abstract
This is a case series of three patients who presented with complex anorectal fistulas. Each patient underwent repair of complex anorectal fistulas with biologic mesh. We will discuss each case and our institution's experience with this relatively new technique. This case series demonstrates the use of biologic mesh for the repair of complex anorectal fistulas. Three patients are discussed who underwent repair of perianal fistulas using ACell mesh by two separate surgeons. We will discuss the rationale for offering this treatment, as well as the advantages and disadvantages. The use of biologic mesh in perianal fistulas is a relatively new topic that needs further investigation. Perianal fistulas can be difficult to manage for both patients and surgeons. There are many options for repair, ranging from simple to complex. Biologic mesh for complex fistulas may be a useful option to avoid the morbidity of more complex repairs, such as flaps.
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Ahn HS, Hu R, Gilbert R, Zwiep T, Moloo H, Williams L, Raiche I, Boushey RP, Friedlich M, Musselman RP. Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e065876. [PMID: 37612106 PMCID: PMC10450130 DOI: 10.1136/bmjopen-2022-065876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Identifying the optimal treatment for anal fistula has been challenging. Since first reported in 2007, the ligation of the intersphincteric fistula tract (LIFT) procedure has reported healing rates between 40% and 95% and is being increasingly adopted. The BioLIFT is an augmentation of the LIFT with an intersphincteric bioprosthetic mesh and has reported healing rates between 69% and 94%. Despite increased costs and potential complications associated with mesh, the evidence comparing healing rates between BioLIFT and LIFT is unknown. This study details the protocol for a systematic review and meta-analysis of BioLIFT and LIFT to compare outcomes associated with each procedure. METHODS AND ANALYSIS MEDLINE, EMBASE and the Cochrane Database will be searched from inception using a search strategy designed by an information specialist. Randomised controlled trials, prospective and retrospective cohort studies, consecutive series, cross-sectional studies and case series with more than five patients will be included. Both comparative and single group studies will be included. The eligible population will be adult patients undergoing BioLIFT or LIFT for trans-sphincteric anal fistula. The primary outcome will be primary healing rate. Secondary outcomes will capture secondary healing rate and complications. Abstract, full text and data extraction will be completed independently and in duplicate by two reviewers. Study risk of bias will be assessed using Risk of Bias In Non-randomized Studies - of Interventions and the Risk of Bias (RoB 2.0) tool. Quality of evidence for outcomes will be evaluated using Grading of Recommendations, Assessment, Development and Evaluations criteria. A meta-analysis will be performed using a random-effects inverse variance model. Subgroup and sensitivity analyses will be explored in relation to complex fistula characteristics and patients who have undergone previous LIFT. Heterogeneity will be assessed using the I2 statistic. ETHICS AND DISSEMINATION This review does not require research ethics board approval. This study will be completed in September 2022. The findings of this study will be disseminated through peer-reviewed international conferences and journals. PROSPERO REGISTRATION NUMBER CRD42020127996.
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Affiliation(s)
| | - Richard Hu
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Gilbert
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry Zwiep
- General Surgery, University of Western Ontario, London, Ontario, Canada
| | - Husein Moloo
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Lara Williams
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Raiche
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin P Boushey
- General Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Tsang JS, Chan TY, Cheung HH, Wei R, Foo CC, Lo OSH. Porcine dermal collagen mesh (Permacol™) as a bioprosthesis in the ligation of intersphincteric tract (BioLIFT) procedure. Tech Coloproctol 2020; 24:1277-1283. [PMID: 32813119 DOI: 10.1007/s10151-020-02325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ligation of intersphincteric tract (LIFT) is a sphincter-saving technique used to treat anal fistulas. Incorporation of a bioprosthesis in LIFT (BioLIFT) aims to improve healing. The use of cross-linked porcine dermal collagen mesh Permacol™ in BioLIFT has never been investigated. The aim of this study was to compare the healing rates and outcome of LIFT and BioLIFT for complex anal fistulas using the Permacol™ biological mesh. METHODS A retrospective analysis of all patients having LIFT or BioLIFT for complex fistulas from January 2010 to November 2019 was performed in a tertiary referral centre. Patient data from a prospectively collected database of all patients having LIFT or BioLIFT were analyzed. RESULTS LIFT and BioLIFT were performed in 48 (82.8%) and 10 (17.2%) patients, respectively. All BioLIFT patients had previous interventions for their fistulas compared to 30 (62.5%) of patients who had LIFT, p = 0.023. The primary healing rate for LIFT was 87.5% (42/48) compared to 80% (8/10) in BioLIFT, (p = 0.42). Eight (13.8%) patients developed complications, 6 (12.5%) in the LIFT group vs 2 (20%) in the BioLIFT group (p = 0.62). On univariate analysis, the number of previous operations was predictive of complications (p = 0.03). BioLIFT was not associated with complication (OR = 1.75, 95% CI: 0.30-10.3, p = 0.54) or primary healing (OR = 0.57, 95% CI: 0.97-3.36, p = 0.54). There was no significant difference in recurrence (LIFT 12.5% vs BioLIFT 0%, p = 0.58). Kaplan-Meier analysis found no difference in time to recurrence between the two groups (p = 0.65). CONCLUSION Permacol™ mesh in BioLIFT is feasible and achieves a high primary healing rate of 80%. Prospective evidence is needed to establish the benefits of BioLIFT and determine whether Permacol™ is superior to the non-cross-linked porcine submucosal mesh.
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Affiliation(s)
- J S Tsang
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR.
| | - T Y Chan
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - H H Cheung
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - R Wei
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - C C Foo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - O S H Lo
- Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
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Comparison of Ligation of the Intersphincteric Fistula Tract and BioLIFT for the Treatment of Transsphincteric Anal Fistula: A Retrospective Analysis. Dis Colon Rectum 2020; 63:365-370. [PMID: 32032144 DOI: 10.1097/dcr.0000000000001573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ligation of the intersphincteric fistula tract is a sphincter-preserving technique for the treatment of anal fistulas. The BioLIFT modification involves the placement of a biologic mesh in the intersphincteric plane. Advocates of this modification state improved healing rates, however evidence for this is lacking, and this approach costs significantly more. OBJECTIVE The purpose of this study was to compare the healing rates of the ligation of the intersphincteric fistula tract with the BioLIFT. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at a tertiary care hospital from April 2008 to April 2018. PATIENTS All adult patients with transsphincteric anal fistulas were included. Patients were excluded if they had IBD, more than 1 fistula tract operated on simultaneously, or a previous attempt at repair. MAIN OUTCOME MEASURES The primary outcome was primary healing of the fistula tract, and secondary outcomes included overall success, complications, and time to recurrence. RESULTS There were 119 cases (75 ligation of the intersphincteric fistula tract and 44 BioLIFTs). One surgeon performed 84% of the BioLIFT cases. The primary healing rate was 75.0% versus 58.7% (p = 0.08), and the complication rate was 22.7% versus 17.3% (p = 0.48; BioLIFT vs ligation of intersphincteric fistula tract). After multivariate logistic regression, the BioLIFT had a significantly better healing rate (OR = 2.38 (95% CI, 1.01-5.62); p = 0.048). Median follow-up was 9 versus 29 weeks (BioLIFT vs ligation of intersphincteric fistula tract). Kaplan-Meier analysis demonstrated no difference in the time to recurrence (p = 0.48). LIMITATIONS This study was limited by the retrospective nature, different lengths of follow-up, and varying case numbers between the surgeons. CONCLUSIONS The BioLIFT modification is safe and effective for the treatment of anal fistulas but has a higher cost. This modification warrants additional prospective studies to establish its benefits over the ligation of the intersphincteric fistula tract procedure. See Video Abstract at http://links.lww.com/DCR/B139. COMPARACIÓN DE LIFT VERSUS BIOLIFT PARA EL TRATAMIENTO DE LA FÍSTULA ANAL TRANSFINTERÉRICA: UN ANÁLISIS RETROSPECTIVO: Ligadura del tracto de la fístula interesfintérica es una técnica para preservación del esfínter en el tratamiento de las fístulas anales. La modificación BioLIFT implica la colocación de una malla biológica en el plano interesfintérico. Protagonistas de la modificación mejoraron las tasas de curación, sin embargo, carecen evidencias definitivas y la técnica eleva costos significativamente.Comparar las tasas de curación de ligadura del tracto de la fístula interesfintérica con el BioLIFT.Estudio de cohorte retrospectivo.Hospital de atención de tercer nivel desde abril de 2008 hasta abril de 2018.Se incluyeron todos los pacientes adultos con fístulas anales transfinteréricas. Los pacientes fueron excluidos si tenían enfermedad inflamatoria intestinal, más de un tracto fistuloso operado simultáneamente o con un intento previo de reparación.El resultado principal fue la curación primaria del tracto fistuloso y los resultados secundarios incluyeron el éxito en general, las complicaciones y tiempo hasta recurrencia.Se registraron 119 casos (75 ligaduras del tracto de la fístula interesfintérica y 44 BioLIFT). Un cirujano realizó el 84% de los casos de BioLIFT. La tasa de curación primaria fue del 75.0% vs 58.7%, p = 0.08, y la tasa de complicaciones fue del 22.7% vs 17.3%, p = 0.48 comparando BioLIFT vs ligadura del tracto de la fístula interesfintérica. Después de la regresión logística multivariada, el BioLIFT tuvo una tasa de curación significativamente mejor (OR 2.38 [IC 95% 1.01-5.62], p = 0.048). La mediana de seguimiento fue de 9 vs 29 semanas (BioLIFT vs ligadura del tracto de la fístula interesfintérica). El análisis de Kaplan-Meier no demostró diferencias en el tiempo hasta la recurrencia (p = 0,48).Este estudio estuvo limitado por ser retrospectivo, las diferentes duraciones de seguimiento y el número variable de casos entre los cirujanos.La modificación BioLIFT es segura y efectiva para el tratamiento de las fístulas anales pero tiene un costo más alto. Esta modificación amerita más estudios prospectivos para establecer los beneficios sobre ligadura del tracto de la fístula interesfintérica. Consulte Video Resumen en hhttp://links.lww.com/DCR/B139.
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Lau YC, Brown KGM, Cheong J, Byrne C, Lee PJ. LIFT and BioLIFT: a 10-Year Single-Centre Experience of Treating Complex Fistula-In-Ano With Ligation of Intersphincteric Fistula Tract Procedure With or Without Bio-prosthetic Reinforcement (BioLIFT). J Gastrointest Surg 2020; 24:671-676. [PMID: 31240556 DOI: 10.1007/s11605-019-04305-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/10/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the outcome of ligation of intersphincteric fistula tract (LIFT) and bioprosthetic graft (BioLIFT) in the management of transsphincteric perianal fistula. METHODS A single-institution retrospective analysis of all patients undergoing LIFT and BioLIFT from January 2009 to June 2018 was performed. Only patients who had LIFTs and BioLIFT performed as their primary sphincter-preserving procedure was included. Primary outcome measured was primary healing. Secondary outcomes measured were secondary healing, morbidity, time to recurrence, and pre- and post-operative anorectal manometry. Chi-square analysis was used to determine predictive factors. RESULTS A total of 116 patients were identified. One hundred five had LIFT and 11 had BioLIFT. The total primary healing rate was 60.3% (62.9% and 34.9% for LIFT and BioLIFT respectively). The overall secondary healing rate was 80.2% (80.0% and 81.9% for LIFT and BioLIFT respectively). There was no inpatient morbidity or post-procedural faecal incontinence reported. There was no significant change in the pre- and post-operative manometries in either group (P = 0.417 and P = 0.834 for LIFT and BioLIFT respectively). The only predictor for primary failure identified was anteriorly located fistula. CONCLUSION LIFT and BioLIFT compare favourably with other sphincter-preserving procedures. LIFT and BioLIFT can be performed safely, with minimal morbidity and with no reported loss of sphincteric function.
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Affiliation(s)
- Yee Chen Lau
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.
| | - Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia
| | - Juyong Cheong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia
| | - Christopher Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia
| | - Peter J Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, Sydney, NSW, 2050, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia
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Koh SZ, Tsang CB. Reprint of: The LIFT procedure. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ommer A, Herold A, Berg E, Farke S, Fürst A, Hetzer F, Köhler A, Post S, Ruppert R, Sailer M, Schiedeck T, Schwandner O, Strittmatter B, Lenhard BH, Bader W, Krege S, Krammer H, Stange E. S3-Leitlinie: Kryptoglanduläre Analfisteln. COLOPROCTOLOGY 2016. [DOI: 10.1007/s00053-016-0110-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Narang SK, Keogh K, Alam NN, Pathak S, Daniels IR, Smart NJ. A systematic review of new treatments for cryptoglandular fistula in ano. Surgeon 2016; 15:30-39. [PMID: 26993759 DOI: 10.1016/j.surge.2016.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/18/2016] [Accepted: 02/09/2016] [Indexed: 12/11/2022]
Abstract
AIM In 2007 the ACPGBI published a position statement on the management of cryptoglandular fistula in ano. Over the last seven years a number of new treatments have been developed and the aim of this systematic review was to assess their effectiveness. METHOD A systematic review of all English language literature relevant to novel treatment strategies for cryptoglandular fistula in ano, published between 1 January 2007 and 31 Dec 2014 was carried out using MEDLINE (PubMed and Ovid), EMBASE (Ovid) and the Cochrane Library of Systematic Reviews/Controlled Trials for relevant literature. Technical notes, commentaries, letters and meeting abstracts were excluded. The different treatments were assessed with regards to fistula closure rate in relation to length of follow up and reported complications. RESULTS Seventy potential articles published between 1 January 2007 and 31 December 2014 were identified from the initial literature search. Twenty-one articles were included for final analysis although only two were randomized controlled trials, the remainder being retrospective or prospective series. CONCLUSION This systematic review has demonstrated that whilst there have been technological advances to treat complex cryptoglandular fistula in ano, these are in an early stage of evolution and although early results were promising they are difficult to reproduce. Longer follow up data is not currently available and these treatments should not be introduced without further evidence.
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Affiliation(s)
- Sunil K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Kenneth Keogh
- North Bristol NHS Foundation Trust, Frenchay Hospital, Frenchay Park Road, Frenchay, Bristol, BS16 1LE, UK
| | - Nasra N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Samir Pathak
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Ian R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK.
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Ye F, Tang C, Wang D, Zheng S. Early Experience with the Modificated Approach of Ligation of the Intersphincteric Fistula Tract for High Transsphincteric Fistula. World J Surg 2014; 39:1059-65. [DOI: 10.1007/s00268-014-2888-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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DeBarros M, Sohn VY, Steele SR. Future directions in the management of anal fistula. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Scoglio D, Walker AS, Fichera A. Biomaterials in the treatment of anal fistula: hope or hype? Clin Colon Rectal Surg 2014; 27:172-81. [PMID: 25435826 DOI: 10.1055/s-0034-1394156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence. New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches.
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Affiliation(s)
- Daniele Scoglio
- Department of Surgery, University of Washington Medical Center, Seattle, Washington
| | - Avery S Walker
- Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington
| | - Alessandro Fichera
- Department of Surgery, University of Washington Medical Center, Seattle, Washington
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Abstract
Symptoms thought related to hemorrhoids must be carefully considered before intervention. The first line of therapy for any hemorrhoidal complaint remains conservative management with increased fluid and fiber intake and appropriate modification of toileting behavior. Bleeding in grades 1 and 2 hemorrhoids that does not respond to this can be satisfactorily and safely managed with office-based therapies; some grade 3 hemorrhoids would also respond to this, though more treatment sessions would likely be required. Operative therapy is the best choice for management of persistently symptomatic grade 2 disease and for grades 3 and 4 symptomatic hemorrhoids as well. With proper patient selection and preparation, along with a familiarity with instrumentation and techniques, good results can be obtained with newer operative interventions for internal hemorrhoids. Outcomes must always be compared with those obtained with classic excisional hemorrhoidectomy.
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