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      Efficacy of video-assisted anal fistula treatment combined with closure of the internal opening using a stapler for Parks II anal fistula

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          Abstract

          Background

          To explore the efficacy of video-assisted anal fistula treatment (VAAFT) combined with an internal-opening closure technique using a stapler in the treatment of Parks II anal fistula.

          Methods

          From September 2017 to June 2019, 75 patients with Parks II anal fistulas in Beijing Erlonglu Hospital were enrolled and randomly allocated into two groups. The 37 patients in the treatment group received VAAFT combined with internal-opening closure techniques, and the 38 patients in the control group were treated with anal fistulotomy with seton placement. The primary outcomes included the healing rate and recurrence, the fecal incontinence severity index (FISI) score, and the Wexner incontinence score during the 6-month postoperative follow-up.

          Results

          Thirty-two cases were healed in the treatment group (86.5%) and thirty-six cases were cured in the control group (94.7%). There was no notable difference in the healing rate between the two groups (P=0.487). Significant differences between the groups were observed in the Wexner incontinence and FISI scores at 1, 3, and 6 months after the operation (P=0.001). Furthermore, the wound healing time in the treatment group was significantly shorter than in the control group (P<0.05), while the numerical rating scale (NRS) for postoperative pain on the first day and 1 week after the operation were significantly lower in the treatment group than in the control group (P<0.05).

          Conclusions

          VAAFT combined with closure of the internal opening using a stapler is effective and safe for Parks II anal fistula, and should be promoted as a promising treatment.

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          Most cited references24

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          STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery

          Riaz Agha, Ali Abdall-Razak, Eleanor Crossley … (2019)
          The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.
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            Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation.

            , M Quaglia, H. Guadalajara … (2012)
            Autologous adipose-derived stem cells may represent a novel approach for the management of complex fistula-in-ano. After successful phase I and II clinical trials, a phase III trial was performed to investigate the safety and efficacy. In this multicenter, randomized, single-blind, add-on clinical trial, 200 adult patients from 19 centers were randomly assigned to receive 20 million stem cells (group A, 64 patients), 20 million adipose-derived stem cells plus fibrin glue (group B, 60 patients), or fibrin glue (group C, 59 patients) after closure of the internal opening. Fistula healing was defined as reepithelization of the external opening and absence of collection >2 cm by MRI. If the fistula had not healed at 12 weeks, a second dose (40 million stem cells in groups A and B) was administered. Patients were evaluated at 24 to 26 weeks (primary end point) and at 1 year (long-term follow-up). All results are according to the "blinded evaluator" assessment. After 24 to 26 weeks, the healing rate was 39.1%, 43.3%, 37.3% in groups A, B, and C (p = 0.79). At 1 year, the healing rates were 57.1%, 52.4%, and 37.3 % (p = 0.13). On analysis of the subpopulation treated at the technique's pioneer center, healing rates were 54.55%, 83.33%, and 18.18%, at 24 to 26 weeks (p < 0.001). No SAEs were reported. In treatment of complex fistula-in-ano, a dose of 20 or 60 million adipose-derived stem cells alone or in combination with fibrin glue was considered a safe treatment, achieving healing rates of approximately 40% at 6 months and of more than 50% at 1-year follow-up. It was equivalent to fibrin glue alone. No statistically significant differences were found when the 3 groups where compared. www.clinicaltrials.gov, identifier NCT00475410; Sponsor, Cellerix SA.
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              Endorectal advancement flap for cryptoglandular or Crohn's fistula-in-ano.

              Ali Soltani, Andreas Kaiser (2010)
              Objectives of surgical treatment for transsphincteric and complex anorectal fistulas are the successful elimination of current/recurrent disease and the preservation of sphincter function. The concept of endorectal advancement flaps is to preserve the sphincter by closing off the primary opening by means of a mobilized flap. We performed a systematic review of the literature to assess the role of this technique.
              Article 0 comments Cited 57 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Transl Med
                Journal ID (iso-abbrev): Ann Transl Med
                Journal ID (publisher-id): ATM
                Title: Annals of Translational Medicine
                Publisher: AME Publishing Company
                ISSN (Print): 2305-5839
                ISSN (Electronic): 2305-5847
                Publication date (Print and electronic): November 2020
                Publication date (Print): November 2020
                Volume: 8
                Issue: 22
                Electronic Location Identifier: 1517
                Affiliations
                [1 ]Department of General Surgery, Xuanwu Hospital, Capital Medical University , Beijing, China;
                [2 ]Department of Colorectal Surgery, Beijing Erlonglu Hospital , Beijing, China
                Author notes

                Contributions: (I) Conception and design: Y Zhang, F Li (II) Administrative support: F Li; (III) Provision of study materials or patients: T Zhao, A Li; (IV) Collection and assembly of data: F Cao; (V) Data analysis and interpretation: Y Zheng; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Fei Li. Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing 100053, China. Email: feili36@ 123456ccmu.edu.cn .
                Article
                Publisher ID: atm-08-22-1517
                DOI: 10.21037/atm-20-7154
                PMC ID: 7729315
                PubMed ID: 33313262
                SO-VID: 1587b8c3-8b8f-4172-9d35-af0c107f2fc7
                Copyright © 2020 Annals of Translational Medicine. All rights reserved.
                License:

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                Date received : 23 September 2020
                Date accepted : 13 November 2020
                Categories
                Subject: Original Article

                Keywords: video-assisted anal fistula treatment (vaaft),stapler,internal opening,parks ii,anal function
                Data availability:
                Keywords: video-assisted anal fistula treatment (vaaft), stapler, internal opening, parks ii, anal function

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