Non-Locatable Internal Opening in Anal Fistula Associated with Acute Abscess and Its Definitive Management by Garg
Vipul D Yagnik1, Baljit Kaur2, Sushil Dawka3
1Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan, Gujarat, India.
Clinical and Experimental Gastroenterology
|October 3, 2022
Summary
The Garg protocol successfully manages acute fistula-abscess with non-locatable internal openings (IO), achieving high healing rates without impacting patient continence. This definitive approach offers a safe alternative to traditional two-staged treatments.
Area of Science:
- Proctology and Colorectal Surgery
- Surgical Management of Anal Fistulas
- Advanced Imaging in Surgical Planning
Background:
- Definitive management of acute fistula-abscess is increasingly preferred over staged approaches.
- Identifying the internal opening (IO) in acute fistula-abscess cases presents a significant challenge.
- The Garg protocol has demonstrated efficacy in treating anal fistulas with non-locatable IOs.
Purpose of the Study:
- To evaluate the effectiveness of the Garg protocol for managing acute fistula-abscess cases where the internal opening (IO) is not locatable.
- To assess the long-term healing rates and impact on continence following the Garg protocol.
Main Methods:
- A prospective study included patients with acute fistula-abscess undergoing definitive surgery.
- Preoperative MRI was utilized, and the Garg protocol was applied to patients with non-locatable IOs after comprehensive assessment.
- The protocol involved MRI reassessment, assumed IO location based on fistula tract proximity to the sphincter complex or midline, and tailored surgical procedures (fistulotomy or sphincter-sparing).
Main Results:
- Out of 182 patients followed, 49 (26.9%) had non-locatable IOs and were managed by the Garg protocol.
- The Garg protocol group achieved a high long-term healing rate of 87.8%, comparable to the 84.2% in the IO-locatable group (p=0.64).
- No significant changes in objective continence scores (Vaizey scores) were observed in either group post-surgery.
Conclusions:
- The Garg protocol provides a successful management strategy for acute fistula-abscess with non-locatable internal openings.
- This approach achieves favorable healing outcomes without compromising patient continence.
- The Garg protocol represents a safe and effective definitive treatment option for complex anal fistula cases.
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