Management of anal fistula

Division of Digestive Diseases, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham NG7 2UH, UK.
BMJ (online) (Impact Factor: 16.38). 10/2012; 345:e6705. DOI: 10.1136/bmj.e6705
Source: PubMed
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. The treatment of complex fistulae-in-ano is challenging and often includes a number of operations due to high rates of recurrence. Recently, techniques using in vitro expanded adipose tissue-derived stem cells have been described. We describe a novel treatment for cryptoglandular fistulae used in 7 patients, using a combination of surgical closure of the internal opening and real-time autologous adipose tissue-derived regenerative cells (ADRC)-enhanced lipofilling, without need for in vitro expansion. Methods. Following exclusion of active perianal sepsis, patients underwent a standard tumescent liposuction procedure, harvesting ~300 to 400 mL of raw lipoaspirate. The lipoaspirate was prepared in real time, using the Celution 800/CRS system to obtain the stromal vascular fraction containing ADRCs. After excision of the fistula tract and closure of the internal orifice, fresh ADRC-enhanced lipoaspirate was injected into and around the fistula tract. Results. At 6-months' follow-up, 5 of 7 (71.4%) patients showed clinical signs of fistula closure; one of these patients had a recurrence at 10 months due to sepsis. The remaining 4 patients (57.1%) all had complete fistula closure at a median of 46 months' follow-up. There were no adverse events associated with the technique, and no new incontinence. Conclusion. Treatment of cryptoglandular fistulae-in-ano with ADRC-enhanced lipofilling appears feasible and safe, and may add to the range of procedures that can be used to treat this difficult problem. © The Author(s) 2015.
    Surgical Innovation 02/2015; DOI:10.1177/1553350615572656 · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.
    Gastroenterology clinics of North America 12/2013; 42(4):773-84. DOI:10.1016/j.gtc.2013.08.003 · 1.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess agreement between different forms of T2 weighted imaging (T2WI), and post-contrast T1WI in the depiction of fistula tracts, inflammation, and internal openings with that of a reference test.