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Randomized clinical trial of local gentamicin-collagen treatment in advancement flap repair for anal fistula
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
2006 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 93, no 10, 1202-1207 p.Article in journal (Refereed) Published
Abstract [en]

Background: Endoanal advancement flap repair is widely used in sphincter-preserving surgery for anal fistula, but the high recurrence rate is a major problem. A possible cause of non-healing is local infection of the flap. The aim of this study was to evaluate whether local antibiotic treatment with gentamicin-collagen improves healing after endoanal advancement flap repair for anal fistula.

Methods: Eighty-three patients (52 men and 31 women; mean age 47 (range 17-71) years) who had endoanal advancement flap repair for anal fistula between September 1998 and January 2004 were randomized to surgery with (42 patients) or without (41 patients) application of gentamicin-collagen beneath the flap. Patients were evaluated at 1-3 and 12 months after surgery for healing and/or recurrence.

Results: The overall healing rate with no recurrence at 1 year after surgery was 57 per cent (47 of 83). Twenty-six of 42 patients randomized to gentamicin-collagen healed primarily compared with 21 of 41 patients randomized to surgery only. There were no overall differences in healing rate according to sex, previous fistula surgery, complexity of fistula, smoking habit or body mass index.

Conclusion: Endoanal advancement flap repair for anal fistula has a fairly high primary recurrence rate. Healing was not significantly improved by local application of gentamicin-collagen.

Place, publisher, year, edition, pages
2006. Vol. 93, no 10, 1202-1207 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95799DOI: 10.1002/bjs.5398ISI: 000241584900005PubMedID: 16952209OAI: oai:DiVA.org:uu-95799DiVA: diva2:170142
Available from: 2007-04-13 Created: 2007-04-13 Last updated: 2011-05-18Bibliographically approved
In thesis
1. Anal Fistula: Aspects of Aetiology, Diagnosis and Prognosis After Surgical Treatment
Open this publication in new window or tab >>Anal Fistula: Aspects of Aetiology, Diagnosis and Prognosis After Surgical Treatment
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients with idiopathic anal fistula (n=85) were compared with 215 control subjects, matched for age and sex, through a 180-item questionnaire. Obesity, smoking, constipation and bowel symptoms associated with IBS were more common in the patients.

Endoanal ultrasound (EUS) and magnetic resonance imaging (MRI) were compared in the preoperative evaluation of anal fistula in 23 patients. For classifying the primary tract, EUS and surgical findings agreed in 14 cases, and MRI and surgery for 11: for identifying an internal opening, the corresponding figures were 17 and 10.

Healing and sphincter function were studied in 42 patients operated with fistula excision and closure of the internal opening. Twenty-three patients healed primarily and another 10 after one re-operation, whereas nine required further surgery until healed. Anal resting pressure was reduced after three and 12 months, and squeeze pressure after 12 months.

Eighty-three patients were randomised to surgery with or without application of gentamicin-collagen underneath the flap: 26/42 of patients randomised to gentamicin-collagen healed primarily compared with 21/41 of patients randomised to surgery only (n.s).

Micro perfusion in the flap was studied by laser Doppler flowmetry during surgery in 16 patients. No correlation was seen between change in blood flow during surgery and non-healing/recurrence of the fistula.

In conclusion, obesity, functional bowel symptoms and possibly smoking are more common in patients with idiopathic anal fistula than in the general population. Endoanal ultrasound is a useful tool in the preoperative evaluation of anal fistula. Advancement flap repair has a reasonably high primary recurrence rate and healing is not significantly improved by local application of gentamicin-collagen: impaired intraoperative blood perfusion of the flap is an unlikely reason for non-healing. A decrease in continence occurs also after this kind of surgery, probably due to an impaired internal anal sphincter function.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 60 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 253
Keyword
Surgery, anal fistula, risk factors, endoanal advancement flap, anal incontinence, endoanal ultrasound, magnetic resonance imaging, gentamicin-collagen, micro perfusion, laser Doppler flowmetry, Kirurgi
Identifiers
urn:nbn:se:uu:diva-7831 (URN)978-91-554-6873-6 (ISBN)
Public defence
2007-05-05, Grönwallsalen, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2007-04-13 Created: 2007-04-13Bibliographically approved

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Gustafsson, Ulla MariaGraf, Wilhelm

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