Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely chal...Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.展开更多
Background and aim:High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients.Although the sphincter-sparing approach seems an ideal surgical intervention,there remains room for i...Background and aim:High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients.Although the sphincter-sparing approach seems an ideal surgical intervention,there remains room for improvement in treatment efficacy.Herein,we introduce an enhanced sphincter-sparing approach,namely the fistula occlusion with the internal sphincter flap(FOISF),for treating high complex anal fistulas.Methods:This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital,Sun Yat-sen University(Guangzhou,P.R.China).Data on success rates,anal function,and various surgical characteristics were subjected to rigorous analysis.Results:All patients underwent the FOISF procedure,with a median operation time of 53 min.Fourteen patients achieved primary intention healing,while one patient healed by second intention.No recurrence was observed over a follow-up period of 14-30 months.All patients exhibited satisfactory anal continence,with no statistically significant difference observed between preoperative and postoperative Wexner scores(P=0.331).A significant improvement in the quality of life was observed when compared with the preoperative assessment(P<0.001).Conclusion:The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.展开更多
文摘Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.
基金supported by the Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research-“1010”Program[grant number 1010PY(2022)-40]the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases[grant number 2020B111117004].
文摘Background and aim:High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients.Although the sphincter-sparing approach seems an ideal surgical intervention,there remains room for improvement in treatment efficacy.Herein,we introduce an enhanced sphincter-sparing approach,namely the fistula occlusion with the internal sphincter flap(FOISF),for treating high complex anal fistulas.Methods:This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital,Sun Yat-sen University(Guangzhou,P.R.China).Data on success rates,anal function,and various surgical characteristics were subjected to rigorous analysis.Results:All patients underwent the FOISF procedure,with a median operation time of 53 min.Fourteen patients achieved primary intention healing,while one patient healed by second intention.No recurrence was observed over a follow-up period of 14-30 months.All patients exhibited satisfactory anal continence,with no statistically significant difference observed between preoperative and postoperative Wexner scores(P=0.331).A significant improvement in the quality of life was observed when compared with the preoperative assessment(P<0.001).Conclusion:The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.
