Our Summary

Complex anal fistulas, which are abnormal connections between the rectum and skin, can be difficult to treat while also maintaining the patient’s ability to control bowel movements. This study introduces a new method for treating these fistulas that involves several steps, including a video-assisted procedure (VAAFT), placing a string-like device (seton) to help healing, and other individualized procedures.

The researchers studied 18 patients and found that this new method helped simplify and heal the fistulas in about two-thirds of the cases. The time it took to perform the surgery decreased significantly with each additional procedure. After about 14 months, two patients were completely healed. However, one patient still had the fistula, and some patients (11%) experienced complications after surgery. Importantly, there was no worsening of the patients’ ability to control bowel movements after surgery.

This new approach, which combines VAAFT, seton placement, and other individualized procedures, could potentially be a solution for treating complex anal fistulas. It helps simplify the fistula, making it easier to place the seton, and allows for other procedures to be done based on the characteristics of each patient’s fistula.

FAQs

  1. What is the new method introduced for treating complex anal fistulas?
  2. What were the results of the study on this new method of treating anal fistulas?
  3. Did the patients experience any loss in their ability to control bowel movements after the surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions carefully to ensure proper healing and reduce the risk of complications. This may include keeping the surgical area clean and dry, taking prescribed medications as directed, and avoiding activities that could strain the surgical site. It is also important to attend follow-up appointments with your doctor to monitor progress and address any concerns. By following these recommendations, patients can improve their chances of successful healing and recovery after anal fistula surgery.

Suitable For

Patients who are typically recommended anal fistula surgery are those with complex anal fistulas that have not responded to other treatments such as medications or simple surgical procedures. These patients may experience symptoms such as recurrent abscesses, persistent discharge, pain, and difficulty controlling bowel movements. The new method described in the study may be particularly beneficial for these patients, as it offers a comprehensive approach to treating complex anal fistulas and has shown promising results in terms of healing and simplifying the fistula. It is important for patients to discuss their individual situation with their healthcare provider to determine if anal fistula surgery is the right treatment option for them.

Timeline

Timeline:

Before surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and difficulty controlling bowel movements.
  2. Patient undergoes diagnostic tests such as physical examination, imaging studies, and possibly an MRI to determine the extent of the fistula.
  3. Patient may have tried conservative treatments such as antibiotics or draining the abscess without success.

During surgery:

  1. Patient undergoes VAAFT procedure to visualize the fistula and determine its characteristics.
  2. Seton placement is done to help facilitate healing and prevent recurrence.
  3. Additional procedures may be performed based on the individual characteristics of the fistula.

After surgery:

  1. Patient may experience pain, swelling, and discomfort in the immediate post-operative period.
  2. Patient is monitored for healing and any signs of complications such as infection or recurrence.
  3. Follow-up appointments are scheduled to assess healing progress and adjust treatment as needed.
  4. In some cases, complete healing may take up to 14 months, with some patients experiencing complications or persistent fistula.

Overall, the new method for treating complex anal fistulas offers a potential solution for simplifying treatment and improving outcomes for patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery using this new method include:

  1. What is the success rate of this new approach in treating complex anal fistulas?
  2. How long does the surgery typically take, and how many procedures may be required?
  3. What are the potential complications or risks associated with this new method?
  4. Will I still be able to control my bowel movements after surgery?
  5. How long is the recovery process, and what can I expect in terms of pain and discomfort?
  6. Are there any specific post-operative care instructions or restrictions I should follow?
  7. What is the likelihood of the fistula recurring after this new method is performed?
  8. Are there any alternative treatment options available for my specific case?
  9. How experienced are you in performing this new method, and what is your success rate with it?
  10. Can you provide any references or success stories from other patients who have undergone this new method for anal fistula surgery?

Reference

Authors: La Torre M, La Greca G, Fiori E, D’Andrea V, Tierno SM, Tommasini F, Grossi U, Gallo G. Journal: Updates Surg. 2023 Oct;75(7):1867-1871. doi: 10.1007/s13304-023-01607-3. Epub 2023 Aug 3. PMID: 37535189