Newer procedures need to demonstrate efficacy in high complex anal fistulas.

IF 3 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Coloproctology Pub Date : 2023-08-01 DOI:10.3393/ac.2022.01109.0158
Pankaj Garg
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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
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更新的手术需要证明对高度复杂肛瘘的疗效。
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来源期刊
CiteScore
3.30
自引率
3.20%
发文量
73
期刊最新文献
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