Perianal fistulodesis–A pilot study of a novel minimally invasive surgical and medical approach for closure of perianal fistulae  

作　　者：Roxanne Villiger Daniela Cabalzar-Wondberg Daniela Zeller Pascal Frei Luc Biedermann Christian Schneider Michael Scharl Gerhard Rogler Matthias Turina Andreas Rickenbacher Benjamin Misselwitz 

机构地区：[1]Department of Gastroenterology and Hepatology,University Hospital of Zurich,Zurich 8091,Switzerland [2]Visceral-and Transplant Surgery,University Hospital of Zurich,Zurich 8091,Switzerland [3]Department of Surgery,Zeller Surgery,Zurich 8008,Switzerland [4]Department of Gastroenterology,University Hospital of Zurich,Zurich 8091,Switzerland [5]Visceral Surgery and Medicine,University Hospital of Bern,Bern 3010,Switzerland

出　　处：《World Journal of Gastrointestinal Surgery》2021年第2期187-197,共11页世界胃肠外科杂志（英文版）（电子版）

摘　　要：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 Zsuture 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.

关 键 词：FISTULA Fibrin glue Crohn's disease Perianal disease activity index Inflammatory bowel disease Fistula closure 

分 类 号：R657.1[医药卫生—外科学]