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high anal fistula

Antoni Zawadzki, Louis Banka Johnson, Måns Bohe, Claes Johansson, Mats Ekelund, Ole Haagen Nielsen
PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal fistulas without any concomitant medication...
November 23, 2016: International Journal of Colorectal Disease
M Martí-Gallostra, P Myrelid, N Mortensen, S Keshav, S P L Travis, B George
OBJECTIVE: A defunctioning stoma is a therapeutic option for colonic or perianal Crohn's disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11-20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals. MATERIAL AND METHODS: All patients undergoing a defunctioning stoma for colonic/perianal Crohn's disease since 2003-2011 were identified from a prospective database...
November 18, 2016: Scandinavian Journal of Gastroenterology
Pankaj Garg
OBJECTIVE/BACKGROUND: Nontuberculous mycobacteria (NTM) are not known to be associated with fistula-in-ano. NTM was detected in three fistula-in-ano patients in our series. In this study, related data was reviewed to find the mycobacterial disease in patients in our database. METHODS: In this study, 311 consecutive fistula-in-ano patients operated over 2years were analyzed. The histopathology of anal fistula tract epithelial lining of every operated patient was analyzed and other tests (real-time-polymerase chain reaction [RT-PCR], GeneXpert, and mycobacterial culture) were conducted in patients with high index of suspicion of having mycobacterial disease...
September 2016: International Journal of Mycobacteriology
Mikio Kawamura, Toshimitsu Araki, Yoshiki Okita, Satoru Kondo, Takashi Ichikawa, Hiroyuki Fujikawa, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki
BACKGROUND: Spinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death. Although patients with spinal epidural abscess have systemic predisposing immunocompromised conditions, spinal intervention, or trauma, this condition has been reported as a result of perforation or fistulization arising from inflammatory bowel disease. We describe herein a rare case of spinal epidural abscess as a complication of ileal pouch anal anastomosis...
December 2016: Surgical Case Reports
E Zittan, Grace W Ma, N Wong-Chong, R Milgrom, R S McLeod, M Silverberg, Z Cohen
BACKGROUND: We aimed to summarize the outcomes of ulcerative colitis (UC) patients receiving an ileal pouch-anal anastamosis (IPAA) over an 11-year period at a high-volume Canadian inflammatory bowel disease (IBD) center. METHODS: A retrospective chart review was performed for subjects with UC who underwent IPAA between 2002 and 2013. Patient charts were reviewed for demographic data, clinical characteristics, preoperative medical treatment, and surgical outcomes...
October 4, 2016: International Journal of Colorectal Disease
Shilpa Sharma, Devendra K Gupta
Congenital H-type fistula is a rare congenital rectourogenital connection with an external anal opening in a normal or ectopic position. A systematic review was done to study the anatomical types of congenital H-type fistula, embryology, clinical presentation, relative gender distribution, associated anomalies, investigative modalities, and recent advances in treatment of these lesions. A PubMed search included H-type anorectal malformation; H-type anorectal malformations; H-type anorectal; and H-type congenital anorectal that gave 9;43;76;26 abstracts, respectively...
October 1, 2016: Pediatric Surgery International
Gentilini Lorenzo, Coscia Maurizio, Lombardi Pietro Maria, Marta Tanzanu, Laureti Silvio, Podda Mariangela, Poggioli Gilberto
PURPOSE: Short-term results after ileo-pouch anal anastomosis (IPAA) are well established; data are conflicting in long-standing patients. We retrospectively evaluated long-term complications and functional results after follow-up longer than 20 years. METHODS: Two hundred five patients with follow-up longer than 20 years have been identified out of 1112 IPAA performed in our institution; of these, 20 cases were lost at follow-up or decline to take part at the study...
September 28, 2016: International Journal of Colorectal Disease
Xi Chen, Xiaosheng He, Yifeng Zou, Ping Lan
OBJECTIVE: To determine the indications of colonoscopic screening for Crohn's disease in patients with fistula-in-ano. METHODS: Clinical data of 302 patients with perianal fistula who received colonoscopy examination from January 2010 to December 2013 in the Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University were analyzed retrospectively. Parameters for differentiating perianal Crohn's disease from nonspecific fistulae were screened by logistic regression analysis...
September 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Adam Lundqvist, Ida Ahlberg, Frida Hjalte, Mats Ekelund
INTRODUCTION: Anal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden. METHODS: The study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden...
September 24, 2016: International Journal of Surgery
Stella R Smith, Katy Newton, Jennifer A Smith, Jo C Dumville, Zipporah Iheozor-Ejiofor, Lyndsay E Pearce, Paul J Barrow, Laura Hancock, James Hill
BACKGROUND: A perianal abscess is a collection of pus under the skin, around the anus. It usually occurs due to an infection of an anal gland. In the UK, the annual incidence is 40 per 100,000 of the adult population, and the standard treatment is admission to hospital for incision and drainage under general anaesthetic. Following drainage of the pus, an internal dressing (pack) is placed into the cavity to stop bleeding. Common practice is for community nursing teams to change the pack regularly until the cavity heals...
2016: Cochrane Database of Systematic Reviews
Verónica Giubergia, Florencia Alessandrini, Carolina Barrias, Carlos Giuseppucci, Aixa Reusmann, Marcelo Barrenechea, Claudio Castaños
BACKGROUND AND OBJECTIVE: Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS: In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities...
August 10, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Ahmet Rencuzogullari, Luca Stocchi, Meagan Costedio, Emre Gorgun, Hermann Kessler, Feza H Remzi
BACKGROUND: Previous work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA. METHODS: Perioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs. 10 low-volume surgeons) during 2002-2013, included in a prospectively maintained database, were assessed. Predicted outcome models were constructed using perioperative variables selected by stepwise logistic regression, using Akaike's information criterion...
July 12, 2016: Surgical Endoscopy
Reza Bagherzadeh Saba, Adnan Tizmaghz, Somar Ajeka, Mehdi Karami
INTRODUCTION: Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. METHODS: Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped collagen plug was pulled through the fistula tract...
April 2016: Electronic Physician
Salah M Raslan, Mohammed Aladwani, Nasser Alsanea
BACKGROUND: Perianal fistulas are distressing for the patient and sometimes a challenge for the surgeon. Different methods for the treatment of perianal fistulas have a range of success rates and use of the cutting seton is still debatable. OBJECTIVES: We evaluated the recurrence, success rate and incontinence with the cutting seton method for treating perianal fistula. DESIGN: Prospective, descriptive study. SETTING: Al-Hada Armed Forces Hospital, Department of General Surgery, Taif, Saudi Arabia...
May 2016: Annals of Saudi Medicine
Anuradha Shenoy-Bhangle, Michael S Gee
Perianal penetrating complications of Crohn disease are among the most important causes of symptoms in the pediatric population. High-quality diagnostic imaging of the perianal region is crucial for treatment planning and therapeutic response assessment. MRI, with its absence of ionizing radiation and high soft-tissue resolution, provides an excellent noninvasive tool for evaluation of perianal fistulae and associated abscesses, as well as their anatomical relationship to the anal sphincter complex. In this review we discuss the role of MRI in initial diagnosis and follow-up of perianal fistulizing Crohn disease in the pediatric population...
May 2016: Pediatric Radiology
Melinda E Stack, Konstantin Umanskiy
BACKGROUND: Various methods exist for the treatment of rectovaginal fistulas, with the choice of repair largely dependent on the fistula location. Options include local repair with mucosal advancement flaps, the use of agents like fibrin glue, and an abdominal approach with resection and colo-anal reconstruction. Traditionally, local repair with mucosal advancement flaps is reserved for simple, low rectovaginal fistulas, while high rectal fistulas require a transabdominal approach.1,2 METHODS: Here, we demonstrate an innovative approach for the treatment of a complex, high rectovaginal fistula in a patient with a hostile pelvis via a transanal approach with robotic assistance...
May 24, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ahmad Izadpanah, Mohammad Rezazadehkermani, Seyed Mohammad Hosseiniasl, Afrouz Farghadin, Leila Ghahramani, Alimohammad Bananzadeh, Reza Roshanravan, Ahad Izadpanah
BACKGROUND: Seton-based techniques are among popular methods for treating high type anal fistula. These techniques are categorized to cutting and noncutting regarding their mechanism of action. In this report we are about to describe a new technique, which is a combination of both mechanisms; we call it Pulling Seton. MATERIALS AND METHODS: In this technique after determining internal and external orifice of fistula, fistulectomy is done from both ends to the level of external sphincteric muscle...
2016: Advanced Biomedical Research
Philipp-Alexander Neumann, Emile Rijcken
Patients with inflammatory bowel disease (IBD) comprise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions. Therefore surgical procedures need to aim at minimizing operative trauma with best postoperative recovery. Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease. However due to special disease related characteristics such as bowel stenosis, interenteric fistula, abscesses, malnutrition, repetitive surgeries, or immunosuppressive medications, patients with IBD represent a special cohort with specific needs for surgery...
May 6, 2016: World Journal of Gastrointestinal Pharmacology and Therapeutics
Pedro J Prada, Juan Cardenal, Ana García Blanco, Javier Anchuelo, María Ferri, Gema Fernández, Elisabeth Arrojo, Andrés Vázquez, Maite Pacheco, José Fernández
BACKGROUND: To evaluate acute and late genitourinary, the gastrointestinal toxicity and the long-term biochemical control after HDR monotherapy in one fraction (19Gy). PATIENTS AND METHODS: Between April 2008 and October 2010, 60 consecutive patients were treated with favorable clinically localized prostate cancer; the median follow-up was 72months (range 32-91). All patients received one implant and one fraction of HDR. Fraction dose was 19Gy. Toxicity was reported according to the Common Toxicity Criteria for Adverse Event, Version 4...
June 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
I Seow-En, F Seow-Choen, P K Koh
BACKGROUND: The aim of this retrospective study was to assess our experience of 41 patients with anal fistulae treated with video-assisted anal fistula treatment (VAAFT). METHODS: Forty-one consecutive patients with cryptoglandular anal fistulae were included. Patients with low intersphincteric anal fistulae or those with gross perineal abscess were excluded. Eleven (27 %) patients had undergone prior fistula surgery with 5 (12 %) having had three or more previous operations...
June 2016: Techniques in Coloproctology
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