Garg P, Yagnik VD, Dawka S. Fecal diversion in complex anal fistulas: Is there a way to avoid it? World J Clin Cases 2021; 9(25): 7306-7310 [PMID: 34616796 DOI: 10.12998/wjcc.v9.i25.7306]
Corresponding Author of This Article
Pankaj Garg, MBBS, MS, Associate Professor, Surgeon, Colorectal Surgery, Garg Fistula Research Institute, House No. 1042, Sector-15 Near Amartex Chowk, Panchkula 134113, Haryana, India. drgargpankaj@yahoo.com
Research Domain of This Article
Surgery
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Clin Cases. Sep 6, 2021; 9(25): 7306-7310 Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7306
Fecal diversion in complex anal fistulas: Is there a way to avoid it?
Pankaj Garg, Vipul D Yagnik, Sushil Dawka
Pankaj Garg, Colorectal Surgery,Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Pankaj Garg, Colorectal Surgery, Indus International Hospital, Mohali 140201, Punjab, India
Vipul D Yagnik, Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
Sushil Dawka, Surgery, SSR Medical College, Belle Rive 744101, Mauritius
Author contributions: Garg P conceived and designed the study; Garg P and Yagnik VD collected and revised the data; Dawka S reviewed and edited the manuscript; All authors critically analyzed the data, finally approved and submitted the manuscript.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
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: Pankaj Garg, MBBS, MS, Associate Professor, Surgeon, Colorectal Surgery, Garg Fistula Research Institute, House No. 1042, Sector-15 Near Amartex Chowk, Panchkula 134113, Haryana, India. drgargpankaj@yahoo.com
Received: May 11, 2021 Peer-review started: May 11, 2021 First decision: June 23, 2021 Revised: June 23, 2021 Accepted: July 16, 2021 Article in press: July 16, 2021 Published online: September 6, 2021
Core Tip
Core Tip: Fecal diversion is performed for severe and uncontrolled anal fistula disease. Though usually done as a last resort, it significantly increases morbidity and cost. We speculated on whether fecal diversion is actually the last resort, is it effective and can it be avoided? A novel non-surgical protocol [LOOP: L: Liquid diet with no fiber; O: Oral rehydration salt; O: Oral vitamins and protein powder/supplements; P: Phosphate (sodium phosphate) enema] prevents contact of fecal matter with the anorectum and has been successfully utilized to treat several acute anorectal conditions. LOOP can potentially avoid the need to divert the fecal stream in many fistula cases where it would be deemed necessary. This would markedly decrease the morbidity and cost incurred due to fecal diversion.
