PMID- 35392057
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2296-875X (Print)
IS  - 2296-875X (Electronic)
IS  - 2296-875X (Linking)
VI  - 9
DP  - 2022
TI  - Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique 
      for Complex Anal Fistulas.
PG  - 832397
LID - 10.3389/fsurg.2022.832397 [doi]
LID - 832397
AB  - BACKGROUND: The optimal treatment of complex anal fistulas remains unclear, 
      though many different sphincter-preserving procedures have been described. A 
      minimally invasive technique with a better outcome is desired. The purpose of 
      this study was to present a new technique-sphincter-preserving fistulectomy (SPF) 
      and its clinical outcomes. MATERIALS AND METHODS: A retrospective study was 
      performed to compare the efficacy and outcomes of SPF with ligation of the 
      intersphincteric fistula tract (LIFT) in the management of complex anal fistulas 
      in regards to postoperative pain, complications, wound healing time, recurrence, 
      overall success rate, fecal continence function, and quality of life. Continence 
      function was evaluated using the Wexner incontinence scale and anal manometry. 
      The fecal incontinence quality of life (FIQL) scale was used to assess patients' 
      quality of life. RESULTS: From June 2020 to July 2021, 41 patients with 43 SPF 
      procedures and 35 patients with 35 LIFT procedures were included. Postoperative 
      pain was comparable between two groups. The morbidity rate and the mean wound 
      healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 
      48.6%, p < 0.001; 1.4 +/- 0.3 vs. 1.7 +/- 0.4 months, p = 0.001). At a mean follow-up 
      duration of 11.4 +/- 3.5 months in the SPF group and 10.7 +/- 4.3 months in the LIFT 
      group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, p = 
      0.014). Three patients in the SPF group and 4 patients in the LIFT group who all 
      underwent a simultaneous fistulotomy procedure complained new incontinence of 
      flatus. There was no statistical difference between the two groups in regards to 
      the Wexner scores (p = 0.790), the maximum resting anal canal pressure (p = 
      0.641), the maximum squeeze pressure (p = 0.289), and the FIQL scores including 
      lifestyle (p = 0.188), coping (p = 0.188), depression (p = 0.850), and 
      embarrassment (p = 0.910). CONCLUSIONS: SPF is a novel, safe, and effective 
      minimally invasive technique for the management of complex anal fistulas, with a 
      promising success rate and negligible impairment on continence. Future 
      prospective studies are needed to evaluate the long-term outcomes of SPF.
CI  - Copyright (c) 2022 Hong, Xu, Gao, Sun, Chen, Wen, Wang and Sun.
FAU - Hong, Yinwen
AU  - Hong Y
AD  - Department of Obstetrics and Gynecology, Suzhou Hospital of Integrated 
      Traditional Chinese and Western Medicine, Suzhou, China.
FAU - Xu, Zhizhong
AU  - Xu Z
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Gao, Ying
AU  - Gao Y
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Sun, Mingming
AU  - Sun M
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Chen, Yinghui
AU  - Chen Y
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Wen, Ke
AU  - Wen K
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Wang, Xiaopeng
AU  - Wang X
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
FAU - Sun, Xueliang
AU  - Sun X
AD  - Department of Colorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing 
      University of Chinese Medicine, Suzhou, China.
LA  - eng
PT  - Journal Article
DEP - 20220322
PL  - Switzerland
TA  - Front Surg
JT  - Frontiers in surgery
JID - 101645127
PMC - PMC8980274
OTO - NOTNLM
OT  - anal fistula
OT  - fistulectomy
OT  - lift
OT  - ligation of the intersphincteric fistula tract
OT  - sphincter-preserving technique
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/04/09 06:00
MHDA- 2022/04/09 06:01
PMCR- 2022/03/22
CRDT- 2022/04/08 05:14
PHST- 2021/12/09 00:00 [received]
PHST- 2022/02/03 00:00 [accepted]
PHST- 2022/04/08 05:14 [entrez]
PHST- 2022/04/09 06:00 [pubmed]
PHST- 2022/04/09 06:01 [medline]
PHST- 2022/03/22 00:00 [pmc-release]
AID - 10.3389/fsurg.2022.832397 [doi]
PST - epublish
SO  - Front Surg. 2022 Mar 22;9:832397. doi: 10.3389/fsurg.2022.832397. eCollection 
      2022.