Clinical effect of anal fistula clip in treatment of anal fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yong , ZHANG Zhengguo ,  YANG Guang

Department of Anorectal, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;

Corresponding author：

YANG Guang, Email: 362939833@qq.com

Keywords：

anal fistula; anal fistula clip; endorectal advancement flap; therapeutic effect

DOI：

10.7507/1007-9424.202208031

Video：

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Objective To analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. Methods A historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. Results The operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ²=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.

Citation： YANG Yong, ZHANG Zhengguo, YANG Guang. Clinical effect of anal fistula clip in treatment of anal fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 175-178. doi: 10.7507/1007-9424.202208031 Copy

1.	Blumetti J, Abcarian A, Quinteros F, et al. Evolution of treatment of fistula in ano. World J Surg, 2012, 36(5): 1162-1167.
2.	Wang Q, He Y, Shen J. The best surgical strategy for anal fistula based on a network meta-analysis. Oncotarget, 2017, 8(58): 99075-99084.
3.	Narang SK, Keogh K, Alam NN, et al. A systematic review of new treatments for cryptoglandular fistula in ano. Surgeon, 2017, 15(1): 30-39.
4.	Prosst RL, Herold A, Joos AK, et al. The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis, 2012, 14(9): 1112-1117.
5.	Emile SH. Recurrent anal fistulas: when, why, and how to manage? World J Clin Cases, 2020, 8(9): 1586-1591.
6.	de Groof EJ, Cabral VN, Buskens CJ, et al. Systematic review of evidence and consensus on perianal fistula: an analysis of national and international guidelines. Colorectal Dis, 2016, 18(4): O119-O134. doi: 10.1111/codi.13286.
7.	Williams G, Williams A, Tozer P, et al. The treatment of anal fistula: second ACPGBI position statement—2018. Colorectal Dis, 2018, 20 Suppl 3: 5-31.
8.	Amato A, Bottini C, De Nardi P, et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol, 2020, 24(2): 127-143.
9.	中国医师协会肛肠医师分会临床指南工作委员会. 肛瘘诊治中国专家共识(2020版). 中华胃肠外科杂志, 2020, 23(12): 1123-1130.
10.	Ratto C, Litta F, Donisi L, et al. Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol, 2015, 19(7): 391-400.
11.	Pommaret E, Benfredj P, Soudan D, et al. Sphincter-sparing techniques for fistulas-in-ano. J Visc Surg, 2015, 152(2 Suppl): S31-S36. doi: 10.1016/j.jviscsurg.2014.08.002.
12.	Stellingwerf ME, van Praag EM, Tozer PJ, et al. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas. BJS Open, 2019, 3(3): 231-241.
13.	Balciscueta Z, Uribe N, Balciscueta I, et al. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis, 2017, 32(5): 599-609.
14.	Uribe N, Balciscueta Z, Cuneo B, et al. Long-term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence? Colorectal Dis, 2020, 22(11): 1649-1657.
15.	Mennigen R, Laukötter M, Senninger N, et al. The OTSC^® proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol, 2015, 19(4): 241-246.
16.	Prosst RL, Joos AK. Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas. Tech Coloproctol, 2016, 20(11): 753-758.
17.	Mascagni D, Pironi D, Grimaldi G, et al. OTSC^® proctology vs. fistulectomy and primary sphincter reconstruction as a treatment for low trans-sphincteric anal fistula in a randomized controlled pilot trial. Minerva Chir, 2019, 74(1): 1-6.
18.	Grossberg SJ, Harran N, Bebington B, et al. Use of the OVESCO OTSC^® Proctology Clip for closure of fistula-in-ano at Wits Donald Gordon Medical Centre—a single centre experience. S Afr J Surg, 2020, 58: 74-77.
19.	Prosst R. Minimally invasive surgical clip closure of anorectal fistulas: current status of OTSC Proctology. Minim Invasive Ther Allied Technol, 2019, 28(5): 261-267.
20.	Chaveli Diaz C, Esquiroz Lizaur I, Marzo Virto J, et al. Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up. Int J Colorectal Dis, 2021, 36(4): 841-846.

1. Blumetti J, Abcarian A, Quinteros F, et al. Evolution of treatment of fistula in ano. World J Surg, 2012, 36(5): 1162-1167.
2. Wang Q, He Y, Shen J. The best surgical strategy for anal fistula based on a network meta-analysis. Oncotarget, 2017, 8(58): 99075-99084.
3. Narang SK, Keogh K, Alam NN, et al. A systematic review of new treatments for cryptoglandular fistula in ano. Surgeon, 2017, 15(1): 30-39.
4. Prosst RL, Herold A, Joos AK, et al. The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis, 2012, 14(9): 1112-1117.
5. Emile SH. Recurrent anal fistulas: when, why, and how to manage? World J Clin Cases, 2020, 8(9): 1586-1591.
6. de Groof EJ, Cabral VN, Buskens CJ, et al. Systematic review of evidence and consensus on perianal fistula: an analysis of national and international guidelines. Colorectal Dis, 2016, 18(4): O119-O134. doi: 10.1111/codi.13286.
7. Williams G, Williams A, Tozer P, et al. The treatment of anal fistula: second ACPGBI position statement—2018. Colorectal Dis, 2018, 20 Suppl 3: 5-31.
8. Amato A, Bottini C, De Nardi P, et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol, 2020, 24(2): 127-143.
9. 中国医师协会肛肠医师分会临床指南工作委员会. 肛瘘诊治中国专家共识(2020版). 中华胃肠外科杂志, 2020, 23(12): 1123-1130.
10. Ratto C, Litta F, Donisi L, et al. Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol, 2015, 19(7): 391-400.
11. Pommaret E, Benfredj P, Soudan D, et al. Sphincter-sparing techniques for fistulas-in-ano. J Visc Surg, 2015, 152(2 Suppl): S31-S36. doi: 10.1016/j.jviscsurg.2014.08.002.
12. Stellingwerf ME, van Praag EM, Tozer PJ, et al. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas. BJS Open, 2019, 3(3): 231-241.
13. Balciscueta Z, Uribe N, Balciscueta I, et al. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis, 2017, 32(5): 599-609.
14. Uribe N, Balciscueta Z, Cuneo B, et al. Long-term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence? Colorectal Dis, 2020, 22(11): 1649-1657.
15. Mennigen R, Laukötter M, Senninger N, et al. The OTSC^® proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol, 2015, 19(4): 241-246.
16. Prosst RL, Joos AK. Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas. Tech Coloproctol, 2016, 20(11): 753-758.
17. Mascagni D, Pironi D, Grimaldi G, et al. OTSC^® proctology vs. fistulectomy and primary sphincter reconstruction as a treatment for low trans-sphincteric anal fistula in a randomized controlled pilot trial. Minerva Chir, 2019, 74(1): 1-6.
18. Grossberg SJ, Harran N, Bebington B, et al. Use of the OVESCO OTSC^® Proctology Clip for closure of fistula-in-ano at Wits Donald Gordon Medical Centre—a single centre experience. S Afr J Surg, 2020, 58: 74-77.
19. Prosst R. Minimally invasive surgical clip closure of anorectal fistulas: current status of OTSC Proctology. Minim Invasive Ther Allied Technol, 2019, 28(5): 261-267.
20. Chaveli Diaz C, Esquiroz Lizaur I, Marzo Virto J, et al. Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up. Int J Colorectal Dis, 2021, 36(4): 841-846.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical effect of anal fistula clip in treatment of anal fistula

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