PMID- 34599414
OWN - NLM
STAT- MEDLINE
DCOM- 20211213
LR  - 20211214
IS  - 1128-045X (Electronic)
IS  - 1123-6337 (Linking)
VI  - 25
IP  - 12
DP  - 2021 Dec
TI  - External sphincter-sparing anal fistulotomy (ESSAF): a simplified technique for 
      the treatment of fistula-in-ano.
PG  - 1311-1318
LID - 10.1007/s10151-021-02525-5 [doi]
AB  - BACKGROUND: Fistula-in-ano due to cryptoglandular disease is a common condition. 
      While a simple anal fistula can be treated successfully by a fistulotomy, the 
      risk of potential damage to the anal sphincters and subsequent poor functional 
      outcomes persist in a large portion of patients with complex fistulae. Several 
      sphincter-preserving treatment procedures have been described for complex 
      fistulae over the past 3 decades, with variable results and complication rates, 
      and no procedure is proven to be superior to the others. We developed external 
      sphincter-sparing anal fistulotomy (ESSAF), a reproducible simple modification of 
      the ligation of intersphincteric fistula tract (LIFT) technique for the treatment 
      of complex fistula-in-ano.. The aim of the present study was to describe the 
      technique and our outcomes. METHODS: This was a retrospective review of all 
      patients who underwent ESSAF for a complex anal fistula at our institution from 
      January 2014 to December 2019. The primary outcome measure of this study was the 
      primary fistula healing rate. Secondary outcome measures included fecal and/or 
      gas incontinence and postoperative complications. During the ESSAF procedure, the 
      mucosa and skin overlying the fistula tract are incised to allow complete 
      exposure of the sphincter complex. Then the internal sphincter muscle fibers 
      overlying the tract are divided and the tract is meticulously curetted and 
      debrided. Next, the internal opening of the tract traversing the external 
      sphincter muscle is suture-ligated with absorbable sutures. Then, a minimal 
      amount of mucosa is advanced and the incision is partially closed with absorbable 
      sutures, while its external portion is left open for drainage. RESULTS: 
      Fifty-nine patients [43 males, median age was 50 years (range 36-63 years)] 
      underwent ESSAF for complex anal fistula during the study period. Mean follow-up 
      was 12 +/- 14.7 months. Of the 59 patients, 42 (71.2%) experienced fistula closure, 
      with a median healing time of 8 weeks (IQR 4-16 weeks). None of the patients 
      developed significant anal incontinence following the procedure. One patient 
      (1.7%) suffered from soiling and another patient (1.7%) developed postoperative 
      bleeding. There were no infectious complications. Of the 17 patients (28.8%) who 
      failed to heal successfully, 9 (15.2%) did not heal primarily and 8 (16%) 
      experienced recurrence after complete healing. Thirteen (76%) of these patients 
      underwent reoperation with complete recovery after ESSAF (n = 4), fistulotomy 
      (n = 8) or endorectal advancement flap (ERAF) (n = 1). Overall ESSAF initiated 
      recovery in 93.2% of the patients. CONCLUSIONS: ESSAF is a feasible, safe, 
      reproducible and effective sphincter-sparing procedure for the treatment of 
      complex anal fistulae.
CI  - (c) 2021. Springer Nature Switzerland AG.
FAU - Parnasa, S Y
AU  - Parnasa SY
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Helou, B
AU  - Helou B
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Mizrahi, I
AU  - Mizrahi I
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Gefen, R
AU  - Gefen R
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Abu-Gazala, M
AU  - Abu-Gazala M
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Pikarsky, A J
AU  - Pikarsky AJ
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel.
FAU - Shussman, N
AU  - Shussman N
AUID- ORCID: 0000-0002-6167-109X
AD  - Department of General Surgery, Hadassah Medical Organization and Faculty of 
      Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem, 91120, Israel. 
      noams@hadassah.org.il.
LA  - eng
PT  - Journal Article
DEP - 20211001
PL  - Italy
TA  - Tech Coloproctol
JT  - Techniques in coloproctology
JID - 9613614
SB  - IM
MH  - Adult
MH  - Anal Canal/surgery
MH  - *Fecal Incontinence/etiology
MH  - Humans
MH  - Ligation
MH  - Male
MH  - Middle Aged
MH  - Organ Sparing Treatments
MH  - *Rectal Fistula/etiology/surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anal continence
OT  - ESSAF
OT  - Fistula-in-ano
OT  - Sphincter preservation
EDAT- 2021/10/03 06:00
MHDA- 2021/12/15 06:00
CRDT- 2021/10/02 06:21
PHST- 2021/04/17 00:00 [received]
PHST- 2021/09/07 00:00 [accepted]
PHST- 2021/10/03 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/10/02 06:21 [entrez]
AID - 10.1007/s10151-021-02525-5 [pii]
AID - 10.1007/s10151-021-02525-5 [doi]
PST - ppublish
SO  - Tech Coloproctol. 2021 Dec;25(12):1311-1318. doi: 10.1007/s10151-021-02525-5. 
      Epub 2021 Oct 1.