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Anal Fistula

Perspectives of Scientific Research Toward the Future

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Anal Fistula and Abscess

Part of the book series: Coloproctology ((COLOPROCT))

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Abstract

In this chapter I will address the key questions which face researchers in anal fistula, including those surrounding aetiology, imaging and assessment, communication of complexity, enhancing success rates with existing procedures, and improving research techniques in anal fistula, to include more patient-relevant outcomes and address the heterogeneity seen in fistula studies.

In general, fistula research tends to focus on demonstrating the efficacy in existing fistula treatments, or extolling the virtues of new techniques, in often poorly described and heterogeneous groups of patients. A more radical rethink is required in order to take the next step in the evolution of anal fistula management, and also to improve the research we do in existing techniques. A blueprint for this new approach is laid out in the following pages.

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References

  • Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R et al (2020a) Burden of disease and adaptation to life in patients with Crohn’s perianal fistula: a qualitative exploration. Health Qual Life Outcomes 18(1):370

    Article  Google Scholar 

  • Adegbola SO, Sarafian M, Sahnan K, Ding NS, Faiz OD, Warusavitarne J et al (2020b) Differences in amino acid and lipid metabolism distinguish Crohn’s from idiopathic/cryptoglandular perianal fistulas by tissue metabonomic profiling and may offer clues to underlying pathogenesis. Eur J Gastroenterol Hepatol. Publish Ahead of Print

    Google Scholar 

  • Adegbola SO, Dibley L, Sahnan K, Wade T, Verjee A, Sawyer R et al (2021) Development and initial psychometric validation of a patient-reported outcome measure for Crohn’s perianal fistula: the Crohn’s Anal Fistula Quality of Life (CAF-QoL) scale. Gut 70(9):1649–1656

    Article  CAS  Google Scholar 

  • Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RK (2011) For many high anal fistulas, lay open is still a good option. Tech Coloproctol 15(2):143–150

    Article  CAS  Google Scholar 

  • Christoforidis D (2010) Who benefits from the anal fistula plug? Dis Colon Rectum 53(8):1105–1106

    Article  Google Scholar 

  • Dige A, Hougaard HT, Agnholt J, Pedersen BG, Tencerova M, Kassem M et al (2019) Efficacy of injection of freshly collected autologous adipose tissue into perianal fistulas in patients with Crohn’s disease. Gastroenterology 156(8):2208–16 e1

    Article  Google Scholar 

  • Ellis CN (2007) Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 64(1):36–40

    Article  Google Scholar 

  • Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J et al (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79–86

    Article  Google Scholar 

  • Haddow JB, Musbahi O, MacDonald TT, Knowles CH (2019) Comparison of cytokine and phosphoprotein profiles in idiopathic and Crohn’s disease-related perianal fistula. World J Gastrointest Pathophysiol 10(4):42–53

    Article  Google Scholar 

  • Hindryckx P, Jairath V, Zou G, Feagan BG, Sandborn WJ, Stoker J et al (2019) Development and validation of a magnetic resonance index for assessing fistulas in patients with Crohn’s disease. Gastroenterology 157(5):1233–44 e5

    Article  CAS  Google Scholar 

  • Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F (1997) Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum 40(12):1435–1438

    Article  CAS  Google Scholar 

  • Jayne DG, Scholefield J, Tolan D, Gray R, Senapati A, Hulme CT et al (2021) A multicenter randomized controlled trial comparing safety, efficacy, and cost-effectiveness of the surgisis anal fistula plug versus surgeon’s preference for transsphincteric fistula-in-Ano: the FIAT trial. Ann Surg 273(3):433–441

    Article  Google Scholar 

  • Malik AI, Nelson RL, Tou S (2010) Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev (7):CD006827

    Google Scholar 

  • Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15(4):417–422

    Article  CAS  Google Scholar 

  • van Onkelen RS, Mitalas LE, Gosselink MP, van BA, Laman JD, Schouten WR. (2013) Assessment of microbiota and peptidoglycan in perianal fistulas. Diagn Microbiol Infect Dis 75(1):50–54

    Article  Google Scholar 

  • van Onkelen RS, Gosselink MP, van Meurs M, Melief MJ, Schouten WR, Laman JD (2016) Pro-inflammatory cytokines in cryptoglandular anal fistulas. Tech Coloproctol 20:619

    Article  Google Scholar 

  • Parks AG (1961) Pathogenesis and treatment of fistuila-in-ano. Br Med J 1(5224):463–469

    Article  CAS  Google Scholar 

  • Prosst RL, Ehni W (2012) The OTSC(R) proctology clip system for anorectal fistula closure: the ‘anal fistula claw’: case report. Minim Invasive Ther Allied Technol 21(4):307–312

    Article  Google Scholar 

  • Ratto C, Litta F, Donisi L, Parello A (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19(7):391–400

    Article  CAS  Google Scholar 

  • Sahnan K, Askari A, Adegbola SO, Tozer PJ, Phillips RKS, Hart A et al (2017) Natural history of anorectal sepsis. Br J Surg 104(13):1857–1865

    Article  CAS  Google Scholar 

  • Sahnan K, Adegbola SO, Tozer PJ, Patel U, Ilangovan R, Warusavitarne J et al (2018) Innovation in the imaging perianal fistula: a step towards personalised medicine. Ther Adv Gastroenterol 11:1756284818775060

    Article  Google Scholar 

  • Sahnan K, Tozer PJ, Adegbola SO, Lee MJ, Heywood N, McNair AGK et al (2019) Developing a core outcome set for fistulising perianal Crohn’s disease. Gut 68(2):226–238

    Article  Google Scholar 

  • Schizas AM, Ahmad AN, Emmanuel AV, Williams AB (2016) Synchronized functional anal sphincter assessment: maximizing the potential of anal vector manometry and 3-D anal endosonography. Neurogastroenterol Motil 28(7):1075–1082

    Article  CAS  Google Scholar 

  • Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ (2019) Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas. BJS Open 3(3):231–241

    Article  CAS  Google Scholar 

  • Sugrue J, Nordenstam J, Abcarian H, Bartholomew A, Schwartz JL, Mellgren A et al (2017) Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctol 21(6):425–432

    Article  Google Scholar 

  • Tang CL, Chew SP, Seow-Choen F (1996) Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum 39(12):1415–1417

    Article  CAS  Google Scholar 

  • Tozer PJ, Whelan K, Phillips RK, Hart AL (2009) Etiology of perianal Crohn’s disease: role of genetic, microbiological, and immunological factors. Inflamm Bowel Dis 15(10):1591–1598

    Article  Google Scholar 

  • Tozer P, Al-Hassi OH, Rayment N, Bernardo Ordiz D, Murguranathan A, Daulatzai N, Ansari T, Whelan K, Phillips RK, Knight S, Hart AL (ed) (2011) Dendritic cell homing, cytokines and tract inflammation In: Crohn’s anal fistulae. UEGW, Stockholm

    Google Scholar 

  • Tozer P, Sala S, Cianci V, Kalmar K, Atkin GK, Rahbour G et al (2013) Fistulotomy in the tertiary setting can achieve high rates of fistula cure with an acceptable risk of deterioration in continence. J Gastrointest Surg 17(11):1960–1965

    Article  CAS  Google Scholar 

  • Tozer PJ, Rayment N, Hart AL, Daulatzai N, Murugananthan AU, Whelan K et al (2015) What role do bacteria play in persisting fistula formation in idiopathic and Crohn’s anal fistula? Color Dis 17(3):235–241

    Article  CAS  Google Scholar 

  • Tozer PJ, Lung P, Lobo AJ, Sebastian S, Brown SR, Hart AL et al (2018) Review article: pathogenesis of Crohn’s perianal fistula-understanding factors impacting on success and failure of treatment strategies. Aliment Pharmacol Ther 48(3):260–269

    Article  CAS  Google Scholar 

  • Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44(1):77–80

    Article  CAS  Google Scholar 

  • Van AG, Vanbeckevoort D, Bielen D, Coremans G, Aerden I, Noman M et al (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98(2):332–339

    Article  Google Scholar 

  • Wilhelm A (2011) A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol 15(4):445–449

    Article  CAS  Google Scholar 

  • Yassin NA, Lung PFC, Askari A, Edwards P et al (2014) Crohn’s perianal fistulae - assessing response to biological therapy using novel imaging techniques. Gastroenterology 146(5 suppl 1):S-153

    Article  Google Scholar 

  • Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR (2003) Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg 90(3):351–354

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Robin Phillips Fistula Research Unit, St Mark’s Hospital and Academic Institute, Harrow, UK

    Phil Tozer

Authors
  1. Phil Tozer
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Corresponding author

Correspondence to Phil Tozer .

Editor information

Editors and Affiliations

  1. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Catholic University, Rome, Italy

    Carlo Ratto

  2. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Angelo Parello

  3. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Francesco Litta

  4. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Rome, Italy

    Veronica De Simone

  5. Proctology Unit Dept. of Medical and Surgical Sciences, Foundation University Hospital “A. Gemelli”, IRCCS, Roma, Italy

    Paola Campennì

Section Editor information

  1. University Hospital “A. Gemelli”, Proctology Unit, Catholic University, Rome, Italy

    Carlo Ratto MD, FASCRS

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Tozer, P. (2022). Anal Fistula. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-76670-2_34

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  • DOI: https://doi.org/10.1007/978-3-030-76670-2_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-76669-6

  • Online ISBN: 978-3-030-76670-2

  • eBook Packages: MedicineReference Module Medicine

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