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A New Rigid Fistulectomy Set for Minimally Invasive “Core-Out“ Excision of High Anal Fistulas

Authors: Siamak Najarian, Meysam Esmaeili, Mohsen Towliat Kashani


In this article, we propose a new surgical device for circumferentially excision of high anal fistulas in a minimally invasive manner. The new apparatus works on the basis of axially rotating and moving a tubular blade along a fistulous tract straightened using a rigid straight guidewire. As the blade moves along the tract, its sharp circular cutting edge circumferentially separates approximately 2.25 mm thickness of tract encircling the rigid guidewire. We used the new set to excise two anal fistulas in a 62-year-old male patient, an extrasphincteric type and a long tract with no internal opening. With regard to the results of this test, the new device can be considered as a sphincter preserving mechanism for treatment of high anal fistulas. Consequently, a major reduction in the risk of fecal incontinence, recurrence rate, convalescence period and patient morbidity may be achieved using the new device for treatment of fistula-in-ano.

Keywords: Minimally Invasive, fistulectomy, Fecal Incontinence, High Anal Fistula

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[1] M. H. Whiteford, J. Kilkenny III, N. Hyman, W. Donald Buie, J. Dohen, C. Orsay, et al. "Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised)," Dis. Colon Rectum, vol. 48, pp. 1337-1342, 2005.
[2] A. E. Lasheen, "Partial fistulectomy and fistular wall flap for the treatment of high perianal fistulas," Surg. Today, vol. 34, pp. 977-980, 2004.
[3] J. Garcia-Aguilar, C. Belmonte, D. W. Wong, S. M. Goldberg, R. D. Madoff, "Anal fistula surgery: factors associated with recurrence and incontinence," Dis. Colon Rectum, vol. 39, pp. 723-729, 1996.
[4] T. Toyonaga, M. Matsushima, Y. Tanaka, K. Suzuki, N. Sogawa, H. Kanyama, et al. "Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study," Int. J. Colorectal Dis., vol. 22, pp. 1097-1102, 2007.
[5] I. Tasci, "The fistulectome: a new device for treatment of complex anal fistulas by "core-out" fistulectomy," Dis. Colon Rectum, vol. 46, pp. 1566-1571, 2003.
[6] T. Sonoda, T. Hull T, M. R. Piedmonte, V. W. Fazio, "Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap," Dis. Colon Rectum, vol. 45, pp. 1622-1628, 2002.
[7] H. Ortiz, J. Marzo, "Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas," Br. J. Surg., vol. 87, pp. 1680-1683, 2000.
[8] S. Najarian, J. Dargahi, A. Abouei Mehrizi, Artificial tactile sensing in biomedical engineering. USA: McGraw-Hill, 2009, pp. 182-192.
[9] J. Dargahi, S. Najarian, B. Liu, "Sensitivity analysis of a novel tactile probe for measurement of tissue softness with applications in biomedical robotics," J. Mater. Process. Technol., vol. 183, pp. 176-182, 2007.
[10] Al-Tameem, Moshin. "Device for excision of a fistula." Patent 5,643,305. 1 July 1997.
[11] Al-Tameem, Moshin. "Method of using a device for excision of a fistula." Patent 5,628,762. 13 May 1997.
[12] S. H. Jun, G. S. Choi, "Anocutaneous advancement flap closure of high anal fistulas," Br. J. Surg., vol. 86, pp. 490-492, 1998.
[13] N. Uribe, M. Millán, M. Minguez, C. Ballester, F. Asencio, V. Sanchiz, et al. "Clinical and manometric results of endorectal advancement flaps for complex anal fistula," Int. J. Colorectal Dis., vol. 22, pp. 259-264, 2007.
[14] C. Vatansev, Ö. Alabaz, A. Tekin, F. Aksoy, H. Yilmaz, T. Kücükkartallar, et al. "A new seton type for the treatment of anal fistula," Dig. Dis. Sci., vol. 52, pp. 1920-1923, 2007.
[15] A. P. Zbar, J. Ramesh, M. Beer-Gabel, R. Salazar, M. Pescatori, "Conventional cutting vs. internal anal sphincter-preserving seton for high trans-sphincteric fistula: a prospective randomized manometric and clinical trial," Tech. Coloproctol., vol. 7, pp. 89-94, 2003.
[16] R. Loungnarath, D. W. Dietz, M. G. Mutch, E. H. Birnbaum, I. J. Kodner, J. W. Fleshman, "Fibrin glue treatment of complex anal fistulas has low success rate," Dis. Colon Rectum, vol. 47, pp. 432-436, 2004.
[17] S. M. Sentovich, "Fibrin glue for anal fistulas: long-term results," Dis. Colon Rectum, vol. 46, pp. 498-502, 2003.
[18] G. N. Buchanan, C. I. Bartram, R. K. S. Phillips, S. W. T. Gould, S. Halligan, T. A. Rockall, et al. "Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial," Dis. Colon Rectum, vol. 46, pp. 1167-1174, 2003.
[19] E. K. Johnson EK, J. U. Gaw, D. N. Armstrong, "Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas," Dis. Colon Rectum, vol. 49, pp. 371-376, 2006.
[20] B. J. Champagne, L. M. O-Connor, M. Ferguson, G. R. Orangio, M. E. Schertzer, D. N. Armstrong, "Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up," Dis. Colon Rectum, vol. 49, pp. 1817-1821, 2006.
[21] S. Najarian, J. Dargahi, X. Z. Zheng, "A novel method in measuring the stiffness of sensed objects with applications for biomedical robotic systems," Int. J. Med. Robotics Comput. Assist. Surg., vol. 2, pp. 84-90, 2006.