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Fistulotomy: Still a Gold Standard!

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Lasers in Proctology

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Abstract

The expertise and preference of the surgeon are deciding elements in fistula management. The options available are fistulotomy, fistulectomy, or seton placement. Minimally invasive procedures have become popular recently, including fistula plugs, fibrin glue, LIFT, VAAFT, stem cells, and lasers.

“Too aggressive fistulotomy results in incontinence, too timid fistulotomy renders fistula to persist.”

Herand Abcarian

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References

  1. Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis. 2008;10(5):420–30. https://doi.org/10.1111/j.1463-1318.2008.01483.x. PMID: 18479308

    Article  CAS  PubMed  Google Scholar 

  2. Arderne J. Treatises of fistula in ano: hemorrhoids, and clysters. Routledge; 2019.

    Book  Google Scholar 

  3. Dudukgian H, Abcarian H. Why do we have so much trouble treating anal fistula? World J Gastroenterol. 2011;17(28):3292–6. https://doi.org/10.3748/wjg.v17.i28.3292. PMID: 21876616; PMCID: PMC3160532

    Article  PubMed  PubMed Central  Google Scholar 

  4. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;1(5224):463–9. https://doi.org/10.1136/bmj.1.5224.463. PMID: 13732880; PMCID: PMC1953161

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Eisenhammer S. The final evaluation and classification of the surgical treatment of the primary anorectal cryptoglandular intermuscular (inter-sphincteric) fistulous abscess and fistula. Dis Colon Rectum. 1978;21(4):237–54. https://doi.org/10.1007/BF02586698. PMID: 657933

    Article  CAS  PubMed  Google Scholar 

  6. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeon. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465–74.

    Article  PubMed  Google Scholar 

  7. Garcés-Albir M, García-Botello SA, Esclapez-Valero P, Sanahuja-Santafé A, Raga-Vázquez J, Espi-Macías A, Ortega-Serrano J. Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study. Int J Colorectal Dis. 2012;27(8):1109–16.

    Article  PubMed  Google Scholar 

  8. Van Onkelen RS, Gosselink MP, van Rosmalen J, Thijsse S, Schouten WR. Different characteristics of high and low trans-sphincteric fistulae. Colorectal Dis. 2014;16(6):471–5. https://doi.org/10.1111/codi.12578. PMID: 24471695

    Article  PubMed  Google Scholar 

  9. Pescatori M, Ayabaca SM, Cafaro D, Iannello A, Magrini S. Marsupialization of fistulotomy and fistulectomy wounds improves healing and decreases bleeding: a randomized controlled trial. Colorectal Dis. 2006;8(1):11–4. https://doi.org/10.1111/j.1463-1318.2005.00835.x. PMID: 16519632

    Article  CAS  PubMed  Google Scholar 

  10. Ho YH, Tan M, Leong AF, Seow-Choen F. Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial. Br J Surg. 1998;85(1):105–7. https://doi.org/10.1046/j.1365-2168.1998.00529.x. PMID: 9462396

    Article  CAS  PubMed  Google Scholar 

  11. Lockhart-Mummery JP. Discussion on fistula-in-ano. Proc R Soc Med. 1929;22:1331–41.

    Google Scholar 

  12. Hill MR, Sheryock EH, ReBell FG. Role of anal glands in the pathogenesis of the anorectal disease. JAMA. 1943;121:742.

    Article  Google Scholar 

  13. Jimenez M, Mandava N. Anorectal fistula. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022. PMID: 32809492.

    Google Scholar 

  14. Abcarian H. Classification and management strategies. In: Abcarian H, editor. Anal fistula. New York: Springer; 2014. p. 39–44.

    Chapter  Google Scholar 

  15. Hyman N, O’Brien S, Osler T. Outcomes after fistulotomy: results of a prospective, multicenter regional study. Dis Colon Rectum. 2009;52(12):2022–7. https://doi.org/10.1007/DCR.0b013e3181b72378. PMID: 19934925

    Article  PubMed  Google Scholar 

  16. Hall JF, Bordeianou L, Hyman N, Read T, Bartus C, Schoetz D, Marcello PW. Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 2014;57(11):1304–8.

    Article  PubMed  Google Scholar 

  17. Garg P. Is fistulotomy still the gold standard in the present era, and is it highly underutilized? An audit of 675 operated cases. Int J Surg. 2018;56:26–30. https://doi.org/10.1016/j.ijsu.2018.06.009. Epub 2018 Jun 8. PMID: 29886281

    Article  PubMed  Google Scholar 

  18. Al Sebai OI, Ammar MS, Mohamed SH, El Balshy MA. Comparative study between inter sphincteric ligation of perianal fistula versus conventional fistulotomy with or without seton in the treatment of perianal fistula: a prospective randomized controlled trial. Ann Med Surg. 2021;61:180–4.

    Article  Google Scholar 

  19. Pescatori M. Surgery for anal fistulae: state of the art. Int J Colorectal Dis. 2021;36(10):2071–9.

    Article  PubMed  Google Scholar 

  20. Kurihara H, Kanai T, Ishikawa T, Ozawa K, Kanatake Y, Kanai S, Hashiguchi Y. A new concept for the surgical anatomy of posterior deep complex fistulas: the posterior deep space and the septum of the ischiorectal fossa. Dis Colon Rectum. 2006;49(10 Suppl):S37–44. https://doi.org/10.1007/s10350-006-0736-6. PMID: 17106814

    Article  PubMed  Google Scholar 

  21. Zhang H, Zhou ZY, Hu B, Liu DC, Peng H, Xie SK, Su D, Ren DL. Clinical significance of 2 deep posterior perianal spaces to complex cryptoglandular fistulas. Dis Colon Rectum. 2016;59(8):766–74. https://doi.org/10.1097/DCR.0000000000000628. PMID: 27384095

    Article  PubMed  Google Scholar 

  22. Burney RE. Long-term results of surgical treatment of anal fistula in a case series of 483 patients. Int J Surg Open. 2021;33:100350.

    Article  Google Scholar 

  23. Kronborg O. To lay open or excise a fistula-in ano: a randomized trial. Br J Surg. 1985;72(12):970.

    Article  CAS  PubMed  Google Scholar 

  24. Xu Y, Liang S, Tang W. Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula. Springerplus. 2016;5(1):1722. https://doi.org/10.1186/s40064-016-3406-8. PMID: 27777858; PMCID: PMC5052239

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lunniss PJ, Phillips RKS. Anal fistula, fistulectomy. In: Colorectal surgery. 5th ed. 2014. https://www.sciencedirect.com/topics/medicine-anddentistry/fistulectomy.

  26. Belmonte Montes C, Ruiz Galindo GH, Montes Villalobos JL, Decanini Terán C. Fistulotomía vs fistulectomía. Valoración ultrasonográfica de lesión al mecanismo de esfínter anal [Fistulotomy vs fistulectomy. Ultrasonographic evaluation of lesion of the anal sphincter function]. Rev Gastroenterol Mex. 1999;64(4):167–70. Spanish. PMID: 10851578

    CAS  PubMed  Google Scholar 

  27. Tozer P, Sala S, Cianci V, Kalmar K, Atkin GK, Rahbour G, Ranchod P, Hart A, Phillips RK. Fistulotomy in the tertiary setting can achieve high rates of fistula cure with an acceptable risk of deterioration incontinence. J Gastrointestinal Surg. 2013;17(11):1960–5. https://doi.org/10.1007/s11605-013-2198-1. Epub 2013 Sep 4. PMID: 24002754

    Article  CAS  Google Scholar 

  28. Sheikh P, Baakza A. Management of fistula-in-ano-the current evidence. Indian J Surg. 2014;76(6):482–6. https://doi.org/10.1007/s12262-014-1150-2. Epub 2014 Aug 15. PMID: 25614724; PMCID: PMC4297991

    Article  PubMed  PubMed Central  Google Scholar 

  29. Irfan Ali S, Irfan S, Muhammad Shoaib H, Muhammad Misbah R, Noman K, Saad A. Fistulotomy vs. fistulectomy in treating simple low anal fistula of male patients. Pak Armed Forces Med J. 2015;65(6):798–802.

    Google Scholar 

  30. Farag AFA, Elbarmelgi MY, Mostafa M, Mashhour AN. One stage fistulectomy for high anal fistula with the reconstruction of anal sphincter without fecal diversion. Asian J Surg. 2019;42(8):792–6.

    Article  PubMed  Google Scholar 

  31. Hirschburger M, Schwandner T, Hecker A, Kierer W, Weinel R, Padberg W. Fistulectomy with primary sphincter reconstruction in treating high trans-sphincteric anal fistulas. Int J Colorectal Dis. 2014;29(2):247–52. https://doi.org/10.1007/s00384-013-1788-4. Epub 2013 Dec 15. PMID: 24337835

    Article  PubMed  Google Scholar 

  32. Jivapaisarnpong P. Core out fistulectomy, anal sphincter reconstruction, and primary repair of internal opening in treating complex anal fistula. J Med Assoc Thai. 2009;92(5):638–42. PMID: 19459524

    PubMed  Google Scholar 

  33. Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A. Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis. 2018;33(7):911–8. https://doi.org/10.1007/s00384-018-3042-6. Epub 2018 Apr 12. PMID: 29651553

    Article  PubMed  Google Scholar 

  34. Mascagni D, Pironi D, Pontone S, Tonda M, Eberspacher C, Panarese A, Miscusi G, Grimaldi G, Catania A, Santoro A, Filippini A, Sorrenti S. Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient. Aging Clin Exp Res. 2017;29(Suppl 1):101–8. https://doi.org/10.1007/s40520-016-0652-0. Epub 2016 Nov 9. PMID: 27830517

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Karan Hospital, Jalandhar, India

    Kamal Gupta

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Gupta, K. (2022). Fistulotomy: Still a Gold Standard!. In: Lasers in Proctology. Springer, Singapore. https://doi.org/10.1007/978-981-19-5825-0_13

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  • DOI: https://doi.org/10.1007/978-981-19-5825-0_13

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-5824-3

  • Online ISBN: 978-981-19-5825-0

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