Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2020 Vol. 28 No 5

LECTURES, REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2020.5.565   |  

I.A. KRYVORUCHKO, T.M. FIRSYK

MODERN MINIMALLY INVASIVE SPHINCTER-SPARING TECHNIQUES OF SURGICAL TREATMENT OF ANAL FISTULAS

Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov,
Ukraine

Many surgical treatment techniques of anal fistulas are not effective enough, since many of them negatively affect the quality of life of operated patients due to the development of partial or complete disorders including functional urinary and fecal incontinence and accompanied by a significant percentage of recurrent fistulas. Therefore usually requires a repeat operation. There are a number of publications and recommendations for the treatment of rectal fistulas, but many of them are controversial, making practical treatment decisions extremely difficult. Trying to achieve three main aims of treatment (closing the fistula, preserving the sphincter function and minimizing the healing time), various minimally invasive methods of preserving the sphincter have been proposed over the past decades: such as endorectal flap advancement, intrafistular injection of fibrin glue, or the insertion of hermetic swabs, injection of autologous stem cells in the fistulous tract, ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment and other techniques. Despite such a large arsenal of the proposed minimally invasive technologies in the treatment of anal fistulas, many unclear questions still remain concerning adapting the existing surgical options to more complex clinical cases.

Keywords: anal fistulas, minimally invasive methods of treatment, recommendations, advantages, disadvantages
p. 565-576 of the original issue
References
  1. Musin AI, Antipova EV, Ulyanov AA, Kuznetsov DE. Ligature method for the treatment of anal fistula: a modern view on the old approach (literature review). Grekovs Bulletin of Surgery. 2019;178(2):79-84. doi: 10.24884/0042-4625-2019-178-2-79-84 (In Russ.)
  2. Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Quality of life with anal fistula. Ann R Coll Surg Engl. 2016 May;98(5):334-38. doi: 10.1308/rcsann.2016.0136
  3. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011 Mar;24(1):14-21. doi: 10.1055/s-0031-1272819
  4. Alasari S, Kim NK. Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol. 2014 Jan;18(1):13-22. doi: 10.1007/s10151-013-1050-7
  5. Lee MJ, Heywood N, Adegbola S, Tozer P, Sahnan K, Fearnhead NS, Brown SR. Systematic review of surgical interventions for Crohns anal fistula. BJS Open. 2017 Oct 17;1(3):55-66. doi: 10.1002/bjs5.13. eCollection 2017 Jun.
  6. Felt-Bersma RJ, Bartelsman JF. Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases. Best Pract Res Clin Gastroenterol. 2009;23(4):575-92. doi: 10.1016/j.bpg.2009.04.010
  7. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis. 2007 Dec;22(12):1459-62. doi: 10.1007/s00384-007-0334-7
  8. Hokkanen SR, Boxall N, Khalid JM, Bennett D, Patel H. Prevalence of anal fistula in the United Kingdom. World J Clin Cases. 2019 Jul 26;7(14):1795-804. Published online 2019 Jul 26. doi: 10.12998/wjcc.v7.i14.1795
  9. Jacob TJ, Perakath B, Keighley MR. Surgical intervention for anorectal fistula. Cochrane Database Syst Rev. 2010 May 12;(5):CD006319. doi: 10.1002/14651858.CD006319.pub2
  10. Bleier JIS, Moloo H. Current management of cryptoglandular fistula-in-ano. World J Gastroenterol. 2011 Jul 28;17(28):3286-91. Published online 2011 Jul 28. doi: 10.3748/wjg.v17.i28.3286
  11. Oh C. Management of high recurrent anal fistula. Surgery. 1983 Feb;93(2):330-32.
  12. Hjortrup A, Moesgaard F, Kjaergard J. Fibrin adhesive in the treatment of perineal fistulas. Dis Colon Rectum. 1991 Sep;34(9):752-54. doi: 10.1007/bf02051064
  13. Heydari A, Attinà GM, Merolla E, Piccoli M, Fazlalizadeh R, Melotti G. Bioabsorbable synthetic plug in the treatment of anal fistulas. Dis Colon Rectum. 2013 Jun;56(6):774-79. doi: 10.1097/DCR.0b013e3182839824
  14. Garcia-Olmo D, Garcia-Arranz M, Herreros D. Expanded adipose-derived stem cells for the treatment of complex perianal fistula including Crohns disease. Expert Opin Biol Ther. 2008 Sep;8(9):1417-23. doi: 10.1517/14712598.8.9.1417
  15. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007 Mar;90(3):581-86. http://www.jmatonline.com/index.php/jmat/article/view/8933
  16. Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011 Dec;15(4):417-22. doi: 10.1007/s10151-011-0769-2
  17. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011 Dec;15(4):445-49. doi: 10.1007/s10151-011-0726-0
  18. Boyko V, Kryvoruchko I, Parhomenko K, Firsyc T, Bozhko O, Yevtushenko D. Surgical Treatment of Rectal Fistulae Using Biowelding. Int J Sci Educ (IJES). 2019;2(3):1-6. doi: 10.26697/ijes.2019.3.5
  19. Prosst RL, Ehni W. The OTSCⓇ Proctology clip system for anorectal fistula closure: the anal fistula claw: case report. Minim Invasive Ther Allied Technol. 2012 Jul;21(4):307-12. doi: 10.3109/13645706.2012.692690
  20. Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015 Jan 7;21(1):12-20. doi: 10.3748/wjg.v21.i1.12
  21. Ommer A, Herold A, Berg E, Fürst A, Post S, Ruppert R, Schiedeck T, Schwandner O, Strittmatter B. German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg. 2017 Mar;402(2):191-201. doi: 10.1007/s00423-017-1563-z
  22. de Groof EJ, Cabral VN, Buskens CJ, Morton DG, Hahnloser D, Bemelman WA. Systematic review of evidence and consensus on perianal fistula: an analysis of national and international guidelines. Colorectal Dis. 2016 Apr;18(4):O119-34. doi: 10.1111/codi.13286
  23. Hilsabeck JR. Transanal advancement of the anterior rectal wall for vaginal fistulas involving the lower rectum. Dis Colon Rectum. 1980 May-Jun;23(4):236-41. doi: 10.1007/bf02587089
  24. Elting AW. X. The Treatment of fistula in ano: with especial reference to the whitehead operation. Ann Surg. 1912 Nov;56(5):744-52. doi: 10.1097/00000658-191211000-00010
  25. Göttgens KW, Vening W, van der Hagen SJ, van Gemert WG, Smeets RR, Stassen LP, Baeten CG, Breukink SO. Long-term results of mucosal advancement flap combined with platelet-rich plasma for high cryptoglandular perianal fistulas. Dis Colon Rectum. 2014 Feb;57(2):223-27. doi: 10.1097/DCR.0000000000000023
  26. van Onkelen RS, Gosselink MP, Thijsse S, Schouten WR. Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum. 2014 Aug;57(8):1007-11. doi: 10.1097/DCR.0000000000000154
  27. Perez F, Arroyo A, Serrano P, Sánchez A, Candela F, Perez MT, Calpena R. Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg. 2006 Jul;192(1):34-40. doi: 10.1016/j.amjsurg.2006.01.028
  28. Sungurtekin U, Sungurtekin H, Kabay B, Tekin K, Aytekin F, Erdem E, Ozden A. Anocutaneous V-Y advancement flap for the treatment of complex perianal fistula. Dis Colon Rectum. 2004 Dec;47(12):2178-83. doi: 10.1007/s10350-004-0744-3
  29. van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG. Autologous platelet-derived growth factors (platelet-rich plasma) as an adjunct to mucosal advancement flap in high cryptoglandular perianal fistulae: a pilot study. Colorectal Dis. 2011 Feb;13(2):215-18. doi: 10.1111/j.1463-1318.2009.01991.x
  30. Bleier JI, Moloo H. Current management of cryptoglandular fistula-in-ano. World J Gastroenterol. 2011 Jul 28;17(28):3286-91. doi: 10.3748/wjg.v17.i28.3286
  31. Hjortrup A, Moesgaard F, Kjaergard J. Fibrin adhesive in the treatment of perineal fistulas. Dis Colon Rectum. 1991 Sep;34(9):752-54. doi: 10.1007/bf02051064
  32. Swinscoe MT, Ventakasubramaniam AK, Jayne DG. Fibrin glue for fistula-in-ano: the evidence reviewed. Tech Coloproctol. 2005 Jul;9(2):89-94. doi: 10.1007/s10151-005-0204-7
  33. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006 Mar;49(3):371-76. doi: 10.1007/s10350-005-0288-1
  34. Amrani S, Zimmern A, OHara K, Corman ML. The Surgisis AFP anal fistula plug: a new and reasonable alternative for the treatment of anal fistula. Gastroenterol Clin Biol. 2008 Nov;32(11):946-48. doi: 10.1016/j.gcb.2008.09.003
  35. Ortiz H, Marzo J, Ciga MA, Oteiza F, Armendáriz P, de Miguel M. Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano. Br J Surg. 2009 Jun;96(6):608-12. doi: 10.1002/bjs.6613
  36. The Surgisis AFP anal fistula plug: report of a consensus conference. Colorectal Dis. 2008 Jan;10(1):17-20. doi: 10.1111/j.1463-1318.2007.01423.x
  37. Buchberg B, Masoomi H, Choi J, Bergman H, Mills S, Stamos MJ. A tale of two (anal fistula) plugs: is there a difference in short-term outcomes? Am Surg. 2010 Oct;76(10):1150-53.
  38. Ratto C, Litta F, Donisi L, Parello A. Prospective evaluation of a new device for the treatment of anal fistulas. World J Gastroenterol. 2016 Aug 14;22(30):6936-43. doi: 10.3748/wjg.v22.i30.6936
  39. Cetinkaya E, Bulut B, Ersoz S, Guldogan CE, Akgul O, Yuksel BC, Aslar AK. Clinical Experience with Lift Technique For Complex Anal Fistulas. J Gastrointest Dig Syst. 2016;6:425. doi: 10.4172/2161-069X.1000425
  40. Ellis CN. Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the intersphincteric fistula tract (BioLIFT procedure) for the management of complex anal fistulas. Dis Colon Rectum. 2010 Oct;53(10):1361-64. doi: 10.1007/DCR.0b013e3181ec4470
  41. Tan KK, Lee PJ. Early experience of reinforcing the ligation of the intersphincteric fistula tract procedure with a bioprosthetic graft (BioLIFT) for anal fistula. ANZ J Surg. 2014 Apr;84(4):280-83. doi: 10.1111/ans.12242
  42. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011 Dec;15(4):445-49. doi: 10.1007/s10151-011-0726-0
  43. Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula-in-ano with laser--FiLaC: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis. 2014 Feb;16(2):110-15. doi: 10.1111/codi.12440
  44. Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011 Dec;15(4):417-22. doi: 10.1007/s10151-011-0769-2
  45. Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J, De-La-Quintana P, Garcia-Arranz M, Pascual M. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum. 2009 Jan;52(1):79-86. doi: 10.1007/DCR.0b013e3181973487
  46. Herreros MD, Garcia-Arranz M, Guadalajara H, De-La-Quintana P, Garcia-Olmo D. 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. Dis Colon Rectum. 2012 Jul;55(7):762-72. doi: 10.1097/DCR.0b013e318255364a
  47. Mizushima T, Takahashi H, Takeyama H, Naito A, Haraguchi N, Uemura M, Nishimura J, Hata T, Takemasa I, Yamamoto H, Doki Y, Mori M. A clinical trial of autologous adipose-derived regenerative cell transplantation for a postoperative enterocutaneous fistula. Surg Today. 2016 Jul;46(7):835-42. doi: 10.1007/s00595-015-1246-8
  48. Raslan MM, Ayoub MA. Autologous bone marrow derived stem cells in the treatment of complex anal fistula. Int Surg J. 2018;5(6):2049-53. doi: 10.18203/2349-2902.isj20181840
  49. Xu Y, Liang S, Tang W. Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula. Springerplus. 2016 Oct 6;5(1):1722. eCollection 2016. doi: 10.1186/s40064-016-3406-8
  50. Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum. 2005 Jul;48(7):1337-42. doi: 10.1007/s10350-005-0055-3
  51. Subhas G, Singh Bhullar J, Al-Omari A, Unawane A, Mittal VK, Pearlman R. Setons in the treatment of anal fistula: review of variations in materials and techniques. Dig Surg. 2012;29(4):292-300. doi: 10.1159/000342398
  52. Patton V, Chen CM, Lubowski D. Long-term results of the cutting seton for high anal fistula. ANZ J Surg. 2015 Oct;85(10):720-27. doi: 10.1111/ans.13156
  53. Shelygin JuA. Koloproktologija. Klinicheskie rekomendacii. Moscow, RF: GJeOTAR-Media; 2015. 528 p. https://www.rosmedlib.ru/book/ISBN9785970434239.html
  54. Bakhtawar N, Usman M. Factors increasing the risk of recurrence in fistula-in-ano. Cureus. 2019 Mar 7;11(3):e4200. doi: 10.7759/cureus.4200
Address for correspondence:
61022, Ukraine, Kharkov,
Nauki av., 4
Kharkov National Medical University
of the Ministry of Health of Ukraine,
the Surgery Department No2,
tel.: +38-050-301-90-90,
e-mail:ikryvoruchko60@gmail.com
Kryvoruchko Igor A.
Information about the authors:
Kryvoruchko IgorA., MD, Professor, Head of the Surgery Department No2, Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-5525-701
Firsyk Tetiana M., Post-Graduate Student of the Surgery Departmet No2, Kharkov National Medical University of the Ministry of Health of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-6823-7416
Contacts | ©Vitebsk State Medical University, 2007