Perianal fistulodesis - A pilot study of a novel minimally invasive surgical and medical approach for closure of perianal fistulae.
World J Gastrointest Surg
; 13(2): 187-197, 2021 Feb 27.
Article
em En
| MEDLINE
| ID: mdl-33643538
ABSTRACT
BACKGROUND:
Perianal fistulae strongly impact on quality of life of affected patients.AIM:
To challenge and novel minimally invasive treatment options are needed.METHODS:
Patients with Crohn's disease (CD) in remission and patients without inflammatory bowel disease (non-IBD patients) were treated with fistulodesis, a method including curettage of fistula tract, flushing with acetylcysteine and doxycycline, Z-suture of the inner fistula opening, fibrin glue instillation, and Z-suture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks. Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included. The primary end point was fistula healing, defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk.RESULTS:
Fistulodesis was performed in 17 non-IBD and 3 CD patients, with a total of 22 fistulae. After 24 wk, all fistulae were healed in 4 non-IBD and 2 CD patients (overall 30%) and fistula remained closed until the end of follow-up at 10-25 mo. In a secondary per-fistula analysis, 7 out of 22 fistulae (32%) were closed. Perianal disease activity index (PDAI) improved in patients with fistula healing. Low PDAI was associated with favorable outcome (P = 0.0013). No serious adverse events were observed.CONCLUSION:
Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low PDAI needs to be confirmed.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Aspecto:
Patient_preference
Idioma:
En
Revista:
World J Gastrointest Surg
Ano de publicação:
2021
Tipo de documento:
Article