PMID- 33875192
OWN - NLM
STAT- Publisher
LR  - 20240222
IS  - 2173-5077 (Electronic)
IS  - 2173-5077 (Linking)
DP  - 2021 Apr 16
TI  - Comparison of different methods to manage supralevator rectal opening in anal 
      fistulas: A retrospective cohort study.
LID - S0009-739X(21)00114-7 [pii]
LID - 10.1016/j.ciresp.2021.03.011 [doi]
AB  - INTRODUCTION: Supralevator fistula-in-ano are difficult to manage. If these 
      fistulas have an additional supralevator internal-opening in rectum apart from 
      the primary internal-opening at the dentate line, then the management becomes 
      even more difficult. There is no literature/guidelines available on the 
      management of supralevator rectal opening (SRO). METHODS: All consecutive 
      supralevator fistula-in-ano patients having a SRO were retrospectively analyzed. 
      The operative management of SRO in these fistulas was reviewed. All the fistulas 
      were managed by the same procedure, transanal opening of intersphincteric space 
      (TROPIS). The latter was a modification of LIFT (ligation of intersphincteric 
      tract) procedure in which the intersphincteric tract was opened-up in the rectum 
      rather than ligated (as is done in LIFT). The SRO was managed in three ways, 
      group-1:SRO was laid-open into the rectum in continuity with the primary opening 
      at dentate line, group-2:the mucosa around SRO was cauterized, group-3:nothing 
      could be done to SRO. RESULTS: Out of 836 patients operated between 2015 and 
      2020, 138 patients (16.5%) had supralevator extension. Amongst these, 23/138 
      (16.6%) patients had a SRO. 2 patients were excluded (short follow-up) and 21 
      patients were included in the analysis. 12/13(92%) patients in group-1, 4/5 (80%) 
      patients in group-2 and 2/3(67%) patients in group-3 got healed (p=0.47, 
      Chi-square test). The overall healing rate was 18/21(86%). CONCLUSIONS: The 
      supralevator rectal opening (SRO) heals well irrespective of the method utilized. 
      Thus, proper management of the primary opening at the dentate line holds the key 
      to fistula healing and SRO is perhaps not much responsible for persistence of the 
      fistula. However, more studies are needed to corroborate these findings.
CI  - Copyright (c) 2021 AEC. Publicado por Elsevier Espana, S.L.U. All rights reserved.
FAU - Garg, Pankaj
AU  - Garg P
AD  - Indus International Hospital, Mohali, Punjab, India; Garg Fistula Research 
      Institute, Panchkula, Haryana, India. Electronic address: drgargpankaj@yahoo.com.
FAU - R Menon, Geetha
AU  - R Menon G
AD  - Chief Statistician, Indian Council of Medical Research, New Delhi, India.
FAU - Kaur, Baljit
AU  - Kaur B
AD  - SSRD MRI Centre, Chandigarh, India.
LA  - eng
LA  - spa
PT  - Journal Article
DEP - 20210416
PL  - Spain
TA  - Cir Esp (Engl Ed)
JT  - Cirugia espanola
JID - 101771152
SB  - IM
OTO - NOTNLM
OT  - Anal fistula
OT  - Apertura interna
OT  - Fistula anal
OT  - Internal opening
OT  - Supraelevador
OT  - Supralevator
EDAT- 2021/04/21 06:00
MHDA- 2021/04/21 06:00
CRDT- 2021/04/20 05:44
PHST- 2021/01/06 00:00 [received]
PHST- 2021/03/17 00:00 [revised]
PHST- 2021/03/17 00:00 [accepted]
PHST- 2021/04/20 05:44 [entrez]
PHST- 2021/04/21 06:00 [pubmed]
PHST- 2021/04/21 06:00 [medline]
AID - S0009-739X(21)00114-7 [pii]
AID - 10.1016/j.ciresp.2021.03.011 [doi]
PST - aheadofprint
SO  - Cir Esp (Engl Ed). 2021 Apr 16:S0009-739X(21)00114-7. doi: 
      10.1016/j.ciresp.2021.03.011.