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[Anal fistulas: Sparing the sphincter].

Vincent De Parades1, Mohamed Amine Haouari2, Nadia Fathallah1

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Fistulotomy is effective for anal fistulas but risks incontinence. Sphincter-sparing techniques are being developed to improve outcomes while preserving continence.

Keywords:
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Area of Science:

  • Colorectal surgery
  • Gastroenterology
  • Surgical innovation

Context:

  • Anal fistulas are common and typically treated with fistulotomy.
  • Fistulotomy offers high cure rates (>95%) but risks anal sphincter damage and incontinence.
  • This necessitates the exploration of alternative sphincter-sparing treatments.

Purpose:

  • To review current and emerging sphincter-sparing techniques for anal fistula treatment.
  • To evaluate the efficacy and limitations of various surgical and non-surgical approaches.
  • To highlight advancements in anal fistula management.

Summary:

  • Fistulotomy, while effective, poses a risk of incontinence, driving the development of sphincter-sparing methods.
  • Techniques like biologic glue injection and plug insertion have shown limited success.
  • Rectal advancement flaps offer moderate success (75%) with potential incontinence.
  • Intersphincteric ligation and laser treatment are common in France (60-70% cure rates).
  • Emerging techniques include video-assisted anal fistula treatment and cell-based therapies (adipose tissue, SVF, PRP, MSCs) with promising future results.

Impact:

  • Provides a comprehensive overview of anal fistula treatment options.
  • Informs clinicians about the efficacy and risks associated with different surgical techniques.
  • Highlights the potential of novel regenerative medicine approaches for anal fistula management.