• Anal fistula
• Complications
• Endoanal flap
• FILAC
• LIFT
• Recurrence
• VAAFT

• Humans
• Rectal Fistula/surgery
• Anal Canal/surgery
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Network Meta-Analysis as Topic
• Treatment Failure
• Organ Sparing Treatments/methods
• Organ Sparing Treatments/adverse effects
• Female
• Ligation/methods
• Ligation/adverse effects
• Male
• Fecal Incontinence/etiology
• Laser Therapy/adverse effects
• Laser Therapy/methods
• Surgical Flaps
• Adult
• Middle Aged

• biological plug
• fascia lata
• high anal fistula
• incontinence
• recurrence

• Magnetic resonance fistulogram
• St. Mark’s incontinence score
• Transanal opening of the intersphincteric space

• abscess
• anal fistula
• elective surgical procedures
• emergency treatment
• ligation

• Colorectal cancer
• anastomotic leak
• endoscopic clips

• 3-dimensional
• fistula
• imaging
• magnetic resonance imaging

• Male
• Humans
• Adult
• Anal Canal/surgery
• Rectal Fistula/diagnostic imaging
• Rectal Fistula/surgery
• Magnetic Resonance Imaging
• Treatment Outcome

• cohort
• fistula
• fistula plug

Cutting seton is still one of the main methods for the treatment of high complex anal fistula at present. During the treatment, the thread should be tightened many times until it falls off. The traditional thread tightening method is not only complicated in operation and painful for patients, but also requires specialized equipment and doctors to operate, which is very inconvenient. The above problems can be solved by self-adjusting seton.

To explore the clinical feasibility of self-adjustable seton in the treatment of high complex anal fistula.

Sixty-one patients with anal fistula who met the inclusion criteria at the Department of Anorectal Surgery of Yuyao People's Hospital from July 2019 to June 2022 were selected and randomly divided into an experimental group (n = 29) with self-adjustable seton and a control group (n = 32) with traditional cutting seton (tightening the seton by stages). There was no significant difference between the two groups in terms of age, gender, body mass index, educational level, or the nature of disease (P > 0.05). The main pipe of the anal fistula was all treated with cutting and seton, but the postoperative tightening methods were different: A self-adjustable seton was used in the experimental group, while a traditional cutting seton in the control group. Tightening-falling off time, total tightening times, outpatient tightening times, the degree of tightening-related pain, wound healing time, and efficacy were compared between the two groups.

One patient in the experimental group and two in the control group were intraoperatively treated with drainage and seton, which was removed after surgery. There was no significant difference between the experimental group and the control group in terms of the time of thread tightening off, total thread tightening times, wound healing time, or efficacy (P > 0.05). Outpatient tightening times were less, and the average degree of tightening-related pain was lower in the experimental group than in the control group (P < 0.001).

Self-adjustable seton can achieve the effect of traditional cutting seton in tightening-falling off time, wound healing time, and efficacy. However, it is more convenient than traditional seton tightening, and can be adjusted at home to reduce outpatient tightening times, with less cutting pain and lower medical costs. Therefore, it is a relatively suitable tightening method at present and can be popularized and applied in the medical service community and other grass-roots hospitals as a suitable technology in the future.

• Anal fistula
• High complex anal fistula
• Cutting seton
• Self-adjustable seton
• Tightening
• Pain

• Anal fistulae
• Anal incontinence
• Fistulectomy
• Fistulotomy
• Innovations

• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Bariatric Surgery/adverse effects
• Gastrectomy/adverse effects
• Humans
• Laparoscopy
• Obesity, Morbid/surgery
• Reoperation
• Retrospective Studies
• Stents
• Treatment Outcome

• Abdominal resection
• Endorectal advancement flap
• Primary closure
• RVF etiology
• Rectovaginal fistula

Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects.

We retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications.

The surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function.

Although randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.

• VAAFT-Plug
• Video-assisted anal fistula treatment
• anal fistula plug
• fecal incontinence
• horseshoe anal fistula
• sphincter function

• Anal fistula
• Fistulotomy
• Incontinence
• Recurrence
• Surgery

• Complex anal fistula
• Crohn's disease
• anal fistula plug

One of the most challenging phenotypes of Crohn’s disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn’s disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.

• Crohn’s disease
• Inflammatory bowel disease
• Surgical treatment
• Perianal fistulas
• Anorectal fistula

• Crohn Disease/diagnosis
• Crohn Disease/surgery
• Fecal Incontinence
• Humans
• Quality of Life
• Rectal Fistula/etiology
• Rectal Fistula/surgery
• Surgical Stomas

With the improvement in flexible endoscopic technology and the availability of new endoscopic devices, current endoscopic therapies spare many patients who would otherwise undergo surgical repair of gastrointestinal fistulas. These endoscopic techniques include gastrointestinal stents, endoscopic suturing, cardiac septal occluders, endo-sponge, vacuum therapy and others. This review elaborates on the indications, evidence, procedural details, efficacy, and complications of various endoscopic techniques for the management of gastrointestinal fistulas.

• Gastrointestinal fistula
• endoscopy
• leak
• stent
• suturing
• technique

•

Falandry and Martius’ techniques were used firstly for vesico-vaginal fistulas with satisfying long-term functional results.

Rectovaginal fistula (RVF) is defined as an abnormal communication between the anterior wall of the rectum and the posterior wall of the vagina. Many surgical techniques have been described in the treatment of RVF. However, none has proved its superiority. The aim of the study was to evaluate the functional results of surgical treatment of RVF using Martius and Falandry techniques in order to assess the feasibility and the efficacy of these techniques which were first described for vesico-vaginal fistulas.

The study was a retrospective case series conducted in a single centre: Department of general surgery at Ibn Sina University Hospital in Rabat. We included patients with rectovaginal fistula consecutively recruited from 2011 to 2014. 10 patients developed RVF after surgery for rectal cancer (9 cases), uterine cancer (1 case). One patient had RVF for ano-rectal malformation. Colostomy was performed before the treatment of fistula in 9 cases (82 %). They underwent surgical treatment using Falandry (8 patients) and Martius techniques (3 patients) performed by an experienced urologist surgeon.

No postoperative complications were recorded. Time to discharge was postoperative day 3–4. There was a complete disappearance of RVF in 8 patients (72.7 % of cases), relapse in 2 cases (18 %), and failure in one case (9%). The average follow-up was 12.6 +/-10 months. Functionally, no long-term cases of fecal incontinence or dyspareunia were noted.

The choice of surgical technique in the treatment of RVF remains difficult because of poor literature data and absence of consensus. RVF repair results either by Martius or Falandry techniques are encouraging with low morbidity.

• Falandry
• Incontinence
• Martius
• Rectovaginal fistula

• bibliometric analysis
• citations
• hot topics
• perianal fistula
• surgery

• Bibliometrics
• Humans
• Periodicals as Topic
• Rectal Fistula/epidemiology
• Rectal Fistula/surgery

• Fistula
• Inflammatory bowel disease
• Sphincter reconstruction
• Stem cell
• TNF-α

• Anal fistula
• Meta-Analysis
• Recurrence
• Risk factor
• Surgical treatment

• Adult
• Female
• Humans
• Male
• Postoperative Complications/etiology
• Rectal Fistula/etiology
• Rectal Fistula/surgery
• Recurrence
• Risk Factors

• Colorectal surgery
• Reconstructive surgical procedures
• Rectovaginal fistula

• Anal fistula
• Non-surgical treatment

• Adult
• Aged
• Ambulatory Care/methods
• Curettage
• Female
• Humans
• Male
• Middle Aged
• Platelet-Rich Fibrin
• Rectal Fistula/therapy
• Retrospective Studies
• Treatment Outcome

• Anorectal fistula
• Bioprosthetic plugs
• Fistula plugs
• Gore plug
• Plug efficacy, Cook-Surgisis plug

The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch–vaginal fistulas in patients with inflammatory bowel disease (IBD).

A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected.

A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients).

GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.

• Crohn disease
• Fecal incontinence
• Surgical flaps
• Surgical stomas

Bronchopleural fistula (BPF) is a feared complication of pulmonary resection. Fistula plugs (FP) have been described as an adequate treatment in anorectal disease. We describe our early experience placing an FP in the treatment of BPF.

We retrospectively reviewed 5 patients for whom a FP was placed for BPF at our institution. Demographic data, initial perioperative information, method and technique of FP placement, and success is reported.

Five patients (4 male, 1 female) with a median age of 63 years (range, 57–76 years) underwent 6 FP placements for BPF. Two patients were post-pneumonectomy and 3 patients post-lobectomy. The median time to presentation following surgery was 118 days (range 22–218). Upon bronchoscopic or operative re-evaluation, 3 patients had successful cessation of their air leak at 0, 1 and 4 days. Two of three patients subsequently underwent a thoracic muscle flap placement to augment healing. One patient had a persistent air leak despite 2 separate FP placements. The air leak stopped with endobronchial valves (EBV) which were deployed proximal to the FP, 9 days after placement of the FP. Another patient had a successful muscle flap placed 80 days after FP placement. There were no complications associated with the FP. Three of five patients were deemed successfully treated with FP placement alone.

In patients with a postoperative BPF and pleural window, placement of a FP had a modest success rate and can be considered as a treatment modality option for BPF.

• Bronchopleural fistula
• Fistula plug
• Persistent air leak
• Prolong air leak

Surgery for fistula in ano is associated with anal incontinence. The biologic anal fistula plug (AFP) can minimize this. This is a retrospective analysis of patients with cryptoglandular anorectal fistulae, who underwent a surgical procedure using AFP. Patient’s demographics and characteristics of the fistulae were obtained from a prospective database. Each primary opening was occluded by using an AFP. Success was defined by the closure of the external opening and absent drainage.

Fifty-one patients were treated with AFP (male:female: 37:14), mean age 42 years (SD ± 14.86, range 26–70). Ten patients defaulted follow-up. Forty-seven procedures were analysed. Twenty-three (56.1%) patients had complete healing while 18 (43.9%) patients failed the fistula plug procedure during the follow up period of 12 months. Logistical regression failed to identify any statistical significant association with demographic or disease factors and healing. Healing was 1.5 times less likely for every failed procedure prior to AFP insertion. Contrary to other published studies, placement of fistula plug was associated with much lower overall rates of fistula healing. Highest success rates were seen in simple fistulae when compared to the complex type. Repeat plug placement may be successful in selected patients.

• Fistula plug
• Fistula-in-ano
• South Asia

• biologics
• colorectal surgery
• crohn’s disease
• perianal fistula
• therapeutic endoscopy

• Biological Therapy/methods
• Combined Modality Therapy
• Crohn Disease/complications
• Endoscopy/methods
• Humans
• Mesenchymal Stem Cell Transplantation/methods
• Rectal Fistula/complications
• Rectal Fistula/therapy

• Crohn’s disease
• medical therapy
• perianal
• surgery

• anal fistula
• network meta-analysis
• surgical strategy

• anal fistula
• biomaterial plug
• plug implantation

• Children
• Cryptoglandular fistulas
• Perianal abscess

Fistulas still represent one of the most important complications in patients with Crohn’s disease (CD). At least one third of CD patients suffer from fistulas during their disease course and amongst them longstanding remission of complex fistulas occurs only in about one third. So far, fistula pathogenesis is only partially understood. From a histopathological view, a fistula is a tube covered by flat epithelial cells. Current research suggests that the driving force for fistula development is epithelial-to-mesenchymal transition (EMT). Around the fistula, high levels of tumor necrosis factor (TNF), IL-13, and TGFβ can be detected and recent studies indicated an involvement of the intestinal microbiota. Fistula diagnosis requires clinical and surgical assessment, radiologic investigations, e.g., magnet resonance imaging and endoscopy. Routine medical treatment of fistulas includes antibiotics, immunosuppressives, and anti-TNF antibodies. There is no well-established role for calcineurin inhibitors in fistula treatment, corticosteroids appear to be even contra-productive. A promising novel approach might be the application of adipose tissue-derived or bone marrow-derived mesenchymal stem cells that have been studied recently. Due to insufficient efficacy of medical treatment and recurrence of fistulas, surgical interventions are frequently necessary. Further research is needed to better understand fistula pathogenesis aiming to develop novel treatment option for our patients.

• Anal fistula
• faecal incontinence
• quality of life

• Adipose tissue-derived
• Autologous
• Complex
• Perianal fistula
• Stem cells

• Adipocytes/transplantation
• Adipose Tissue/cytology
• Adult
• Humans
• Male
• Middle Aged
• Rectal Fistula/etiology
• Rectal Fistula/therapy
• Stem Cell Transplantation/methods
• Treatment Outcome
• Young Adult

Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

• Bariatric surgery
• Bariatric complications
• Endoscopic treatment
• Leaks
• Stenosis
• Sleeve gastrectomy
• Gastric Roux-en-Y bypass

Perianal Crohn’s disease affects a significant number of patients with Crohn’s disease and is associated with poor quality of life. The nature of the disease, compounded by presentation of various disease severities, has made the treatment of perianal Crohn’s disease difficult. The field continues to evolve with the use of both historical and contemporary solutions to address the challenges associated with it. The goal of this article is to review current literature regarding medical and surgical treatment, as well as the future directions of therapy.

• Crohn’s disease
• fistula
• perirectal
• surgery

• Nitinol
• anal fistula
• anorectal disease
• bear-claw clip
• long-term follow up
• minimally invasive surgery
• outcome