Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review

作     者：Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon 

作者机构：Department of Colorectal SurgeryGarg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal SurgeryIndus International HospitalMohali 140201PunjabIndia Department of RadiologySSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of PathologyGian Sagar Medical College and HospitalPatiala 140601PunjabIndia Department of Surgical GastroenterologyNishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of SurgerySSR Medical CollegeBelle Rive 744101Mauritius Department of StatisticsIndian Council of Medical ResearchNew Delhi 110029New DelhiIndia 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第4期

页      面：340-354页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Anal fistula Fistulotomy Incontinence Surgery Recurrence 

摘      要：BACKGROUND A complex anal fistula is a challenging disease to *** To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula *** Anal fistulas operated on by a single surgeon over 14 years were *** magnetic resonance imaging was done in all *** procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula *** was initiated before *** per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex *** with associated abscesses were treated by definitive *** was evaluated objectively by Vaizey incontinence *** A total of 1351 anal fistula operations were performed in 1250 *** overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)*** did not change significantly after surgery in any *** per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS *** overall success rate was 93.5%in those *** a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,*** 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done *** sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex *** is the largest anal fistula series to date.