RESUMO
BACKGROUND: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. AIM: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. METHODS: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with "U" stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. RESULTS: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). CONCLUSIONS: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Fabaceae/química , Extratos Vegetais/uso terapêutico , Fístula Retal , Canal Anal/cirurgia , Animais , Ratos , Ratos Wistar , Fístula Retal/cirurgia , Resultado do TratamentoRESUMO
ABSTRACT Background: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. Aim: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. Methods: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with "U" stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. Results: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). Conclusions: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.
RESUMO Racional: Há ainda necessidade de avanço no tratamento das fístulas transesfincterianas e o uso de fitoterápicos parece promissor. Objetivo: Avaliar a eficácia da Stryphnodendron adstringens associada à fistulotomia e esfincteroplastia primária no tratamento de fístulas transesfincterianas em ratos. Métodos: Utilizou-se 30 ratos Wistar submetidos à confecção de fístulas transesfincterianas com fio de aço 0; após 30 dias realizou-se tratamento de acordo com o grupo. O grupo A (n=10) foi submetido à fistulotomia; o grupo B (n=10) fistulotomia seguida de esfincteroplastia primária com ponto em "U" com poliglactina 911 4-0; o grupo C (n=10), semelhante ao grupo B, porém com a interposição entre os cotos musculares de esponja hemostática embebida em extrato de Stryphnodendron adstringens. Realizou-se eutanásia após 14 dias, ressecando-se segmento do canal anal para análise histológica, que objetivou avaliar o fechamento da fístula, a área de afastamento dos cabos musculares, o processo inflamatório e o grau de fibrose. Resultados: Nenhum animal apresentou trajeto fistuloso remanescente. Quanto ao afastamento entre os cabos musculares observou-se média 106,3 µm2 no grupo A, 82,8 µm2 no grupo B e 51,8 µm2 no grupo C (p<0,05). Não houve diferença entre os grupos quanto ao processo inflamatório e, em relação à fibrose; no grupo A observou-se média 0,6, no grupo B 0,7 e no grupo C 0,2 (p<0,05). Conclusões: O extrato de Stryphnodendron adstringens foi capaz de permitir menor afastamento entre os cabos musculares em ratos submetidos à fistulotomia seguida por esfincteroplastia primária, além de proporcionar menor fibrose local.
