The proposed use of radiofrequency ablation for the treatment of fistula-in-ano.

2.50
Hdl Handle:
http://hdl.handle.net/11287/595867
Title:
The proposed use of radiofrequency ablation for the treatment of fistula-in-ano.
Authors:
Keogh, Kenneth M; Smart, Neil J. ( 0000-0002-3043-8324 )
Abstract:
Fistula in ano is a very common presentation to colorectal clinic. Embarrassment due to the symptoms makes accurate estimations of incidence difficult. It is estimated that up to 40% of peri-anal abscess will be accompanied by or preceded by a fistula. Fistulae can be classified into simple fistulae that involve no or minimal sphincter muscle and complex, which involve significant amounts of the anal sphincter muscle, possibly with multiple tracts. For complex fistulae a seton suture is usually placed through the tract and out through the anus to form a loop allowing pockets of sepsis to drain internally and externally and a mature tract of fibrous tissue to develop. Following this period definitive fistula treatment is considered. This can involve a number of procedures that have tremendously varied success rates in the literature. The first stage of surgical treatment is often a core fistulectomy, which entails surgical removal of the tract. This may be followed by insertion of fibrin glue, a collagen plug or formation of a rotation skin flap from surrounding tissue in order to close the resultant tissue defect. All current treatments have a significant failure rate. If this wound breaks down the surgery can leave a large painful peri-anal wound that can lead to ongoing fistulation. Should this occur resiting of the seton will be required with the patient only getting back to square one after months of healing around the seton. In addition removing cores of fibrous tissue passing through the sphincter can threaten the sphincter function resulting in impaired continence. Having seen radiofrequency ablation used to close varicose veins the authors propose that one could use similar techniques to close a fibrous tract matured with a seton in order to close a fistula. The authors propose that a short length radiofrequency catheter could be used to treat fistula in ano. This would in theory be less painful with less tissue destruction. In addition there would be no necessity for extensive incisions. As the energy penetration can be controlled the procedure will be safe even if it fails, without causing a large wound or tissue necrosis. All other treatment options will still be available.
Citation:
The proposed use of radiofrequency ablation for the treatment of fistula-in-ano. 2016, 86:39-42 Med. Hypotheses
Publisher:
Elsevier
Journal:
Medical hypotheses
Issue Date:
Jan-2016
URI:
http://hdl.handle.net/11287/595867
DOI:
10.1016/j.mehy.2015.11.019
PubMed ID:
26804594
Additional Links:
http://www.sciencedirect.com/science/article/pii/S0306987715004429
Type:
Journal Article
Language:
en
ISSN:
1532-2777
Appears in Collections:
Colorectal Surgery; HeSRU publications; 2016 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorKeogh, Kenneth Men
dc.contributor.authorSmart, Neil J.en
dc.date.accessioned2016-02-08T15:06:39Zen
dc.date.available2016-02-08T15:06:39Zen
dc.date.issued2016-01en
dc.identifier.citationThe proposed use of radiofrequency ablation for the treatment of fistula-in-ano. 2016, 86:39-42 Med. Hypothesesen
dc.identifier.issn1532-2777en
dc.identifier.pmid26804594en
dc.identifier.doi10.1016/j.mehy.2015.11.019en
dc.identifier.urihttp://hdl.handle.net/11287/595867en
dc.description.abstractFistula in ano is a very common presentation to colorectal clinic. Embarrassment due to the symptoms makes accurate estimations of incidence difficult. It is estimated that up to 40% of peri-anal abscess will be accompanied by or preceded by a fistula. Fistulae can be classified into simple fistulae that involve no or minimal sphincter muscle and complex, which involve significant amounts of the anal sphincter muscle, possibly with multiple tracts. For complex fistulae a seton suture is usually placed through the tract and out through the anus to form a loop allowing pockets of sepsis to drain internally and externally and a mature tract of fibrous tissue to develop. Following this period definitive fistula treatment is considered. This can involve a number of procedures that have tremendously varied success rates in the literature. The first stage of surgical treatment is often a core fistulectomy, which entails surgical removal of the tract. This may be followed by insertion of fibrin glue, a collagen plug or formation of a rotation skin flap from surrounding tissue in order to close the resultant tissue defect. All current treatments have a significant failure rate. If this wound breaks down the surgery can leave a large painful peri-anal wound that can lead to ongoing fistulation. Should this occur resiting of the seton will be required with the patient only getting back to square one after months of healing around the seton. In addition removing cores of fibrous tissue passing through the sphincter can threaten the sphincter function resulting in impaired continence. Having seen radiofrequency ablation used to close varicose veins the authors propose that one could use similar techniques to close a fibrous tract matured with a seton in order to close a fistula. The authors propose that a short length radiofrequency catheter could be used to treat fistula in ano. This would in theory be less painful with less tissue destruction. In addition there would be no necessity for extensive incisions. As the energy penetration can be controlled the procedure will be safe even if it fails, without causing a large wound or tissue necrosis. All other treatment options will still be available.en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0306987715004429en
dc.rightsArchived with thanks to Medical hypothesesen
dc.subjectWessex Classification Subject Headings::Gastroenterologyen
dc.titleThe proposed use of radiofrequency ablation for the treatment of fistula-in-ano.en
dc.typeJournal Articleen
dc.identifier.journalMedical hypothesesen
dc.type.versionIn press (epub ahead of print)en

Related articles on PubMed

All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.