{"title":"Newer procedures need to demonstrate efficacy in high complex anal fistulas.","authors":"Pankaj Garg","doi":"10.3393/ac.2022.01109.0158","DOIUrl":null,"url":null,"abstract":"I read with great interest the article by Lalhruaizela [1] highlighting his experience with endofistula laser ablation (EFLA) in anal fistulas. The author reported a primary success rate of 67.7% and a secondary (overall) success rate of 80% in a cohort of 31 anal fistula patients. However, there are a couple of questions and pertinent points that merit discussion according to our experiences. The author included only primary, simple low uncomplicated fistulas in the study and excluded high complex fistulas [1]. However, it was not precisely defined which fistulas were categorized as simple and which ones as complex. One patient with a suprasphincteric fistula was also included in the study. Suprasphincteric fistulas are high complex fistulas and are categorized as grade III by Garg [2] and grade V by the St. James’s University Hospital [2] and Garg classifications [2, 3]. Low fistulas are defined as those involving less than one-third of the external anal sphincter [2]. It is an established fact that fistulotomy is the gold standard for managing low simple fistulas [3]. A success rate of 98% to 100% can be achieved in low fistulas with minimal risk to continence [3]. Therefore, the management of low simple fistulas is almost a settled issue. However, fistulotomy is contraindicated in high fistulas (fistulas involving more than onethird of the external anal sphincter) due to the high risk of incontinence [3]. Therefore, what is urgently needed is to find a sphincter-saving procedure in high fistulas that would not cause a significant deterioration in continence. Several new sphincter-saving procedures have been advocated Newer procedures need to demonstrate efficacy in high complex anal fistulas","PeriodicalId":8267,"journal":{"name":"Annals of Coloproctology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/c0/ac-2022-01109-0158.PMC10475806.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Coloproctology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3393/ac.2022.01109.0158","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
I read with great interest the article by Lalhruaizela [1] highlighting his experience with endofistula laser ablation (EFLA) in anal fistulas. The author reported a primary success rate of 67.7% and a secondary (overall) success rate of 80% in a cohort of 31 anal fistula patients. However, there are a couple of questions and pertinent points that merit discussion according to our experiences. The author included only primary, simple low uncomplicated fistulas in the study and excluded high complex fistulas [1]. However, it was not precisely defined which fistulas were categorized as simple and which ones as complex. One patient with a suprasphincteric fistula was also included in the study. Suprasphincteric fistulas are high complex fistulas and are categorized as grade III by Garg [2] and grade V by the St. James’s University Hospital [2] and Garg classifications [2, 3]. Low fistulas are defined as those involving less than one-third of the external anal sphincter [2]. It is an established fact that fistulotomy is the gold standard for managing low simple fistulas [3]. A success rate of 98% to 100% can be achieved in low fistulas with minimal risk to continence [3]. Therefore, the management of low simple fistulas is almost a settled issue. However, fistulotomy is contraindicated in high fistulas (fistulas involving more than onethird of the external anal sphincter) due to the high risk of incontinence [3]. Therefore, what is urgently needed is to find a sphincter-saving procedure in high fistulas that would not cause a significant deterioration in continence. Several new sphincter-saving procedures have been advocated Newer procedures need to demonstrate efficacy in high complex anal fistulas