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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2021; 13(2): 187-197
Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.187
Perianal fistulodesis – A pilot study of a novel minimally invasive surgical and medical approach for closure of perianal fistulae
Roxanne Villiger, Daniela Cabalzar-Wondberg, Daniela Zeller, Pascal Frei, Luc Biedermann, Christian Schneider, Michael Scharl, Gerhard Rogler, Matthias Turina, Andreas Rickenbacher, Benjamin Misselwitz
Roxanne Villiger, Pascal Frei, Luc Biedermann, Christian Schneider, Gerhard Rogler, Benjamin Misselwitz, Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
Daniela Cabalzar-Wondberg, Matthias Turina, Andreas Rickenbacher, Visceral- and Transplant Surgery, University Hospital of Zurich, Zurich 8091, Switzerland
Daniela Zeller, Department of Surgery, Zeller Surgery, Zurich 8008, Switzerland
Michael Scharl, Department of Gastroenterology, University Hospital of Zurich, Zurich 8091, Switzerland
Benjamin Misselwitz, Visceral Surgery and Medicine, University Hospital of Bern, Bern 3010, Switzerland
Author contributions: Misselwitz B, Rogler G, Turina M, Zeller D, Frei P, and Schneider C contributed to concept and design of the study; Misselwitz B, Rickenbacher A, Cabalzar-Wondberg D, Zeller D, and Biedermann L contributed to recruitment and clinical care of patients; Misselwitz B, Rickenbacher A, Cabalzar-Wondberg D, Zeller D, Biedermann L, Scharl M, Burk S, and Villiger R contributed to data acquisition; Villiger R and Misselwitz B contributed to statistical analysis; Misselwitz B, Villiger R, Rickenbacher A, and Cabalzar-Wondberg D contributed to interpretation of data; Villiger R, Misselwitz B, Cabalzar-Wondberg D, Rickenbacher A, Rogler G, and Zeller D contributed to drafting of the article and critical revisions to the manuscript; Cabalzar-Wondberg D and Villiger R contributed equally to this work and share the first authorship; Rickenbacher A and Misselwitz B contributed equally to this work and share the last authorship; all authors final approval of version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the kantonalen Ethikkomission Zürich (Approval No. 2019-00208).
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benjamin Misselwitz, MD, Professor, Clinique for Visceral Surgery and Medicine, Inselspital Bern, University Hospital of Bern, Freiburgstrasse 4, Bern 3010, Switzerland. benjamin.misselwitz@insel.ch
Received: September 1, 2020
Peer-review started: September 1, 2020
First decision: October 23, 2020
Revised: November 20, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 27, 2021
BACKGROUND
Perianal fistulae strongly impact on quality of life of affected patients.
AIM
To challenge and novel minimally invasive treatment options are needed.
METHODS
Patients with Crohn’s disease (CD) in remission and patients without inflammatory bowel disease (non-IBD patients) were treated with fistulodesis, a method including curettage of fistula tract, flushing with acetylcysteine and doxycycline, Z-suture of the inner fistula opening, fibrin glue instillation, and Z-suture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks. Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included. The primary end point was fistula healing, defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk.
RESULTS
Fistulodesis was performed in 17 non-IBD and 3 CD patients, with a total of 22 fistulae. After 24 wk, all fistulae were healed in 4 non-IBD and 2 CD patients (overall 30%) and fistula remained closed until the end of follow-up at 10-25 mo. In a secondary per-fistula analysis, 7 out of 22 fistulae (32%) were closed. Perianal disease activity index (PDAI) improved in patients with fistula healing. Low PDAI was associated with favorable outcome (P = 0.0013). No serious adverse events were observed.
CONCLUSION
Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low PDAI needs to be confirmed.
Core Tip: Perianal fistulae strongly impact on quality of life of affected patients. Despite various treatment options clinical care of fistula patients remains a challenge and novel minimally invasive treatment options are needed. Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low perianal disease activity index needs to be confirmed.
