dr.aljuraisy
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عدد الرسائل : 4046
العمل/الترفيه : طبيب أختصاصي طب الأطفال وحديثي الولادة
المزاج : الحمد لله جيد
تاريخ التسجيل : 15/09/2008
 | موضوع: Anorectal fistula update treatment  الجمعة نوفمبر 21, 2008 6:45 pm | |
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Anorectal fistula
The Surgisis AFP plug is revolutionizing the treatment of anal fistulas.
A minimally invasive, natural solution for anal fistula repair, the Surgisis AFP plug provides an innovative yet simple treatment for a notoriously difficult condition.
Traditionally, surgical intervention is required for anal fistula repair and may lead to post-operative incontinence. With the Surgisis AFP plug, the fistula tract is repaired without cutting the sphincter muscle.
Anal Fistula: Causes
What is an anal fistula?
Generally speaking, a fistula is a small tunnel or tract that connects one surface in the body to another. When such a tunnel occurs between the internal anal canal and the exterior skin of the body near the anus, it is called an anal fistula.
What causes an anal fistula?
An anal fistula is usually caused by an anal abscess, an infection-filled cavity occurring in the underlying tissues of the anal canal. When an abscess bursts or is opened, and the pus or fluid drains from it, an anal fistula is often formed. It then remains open, even after the abscess has healed.
If you have an inflammatory bowel disease (IBD)—such as diverticulitis, colitis, or Crohn’s disease—you are more likely to develop an anal abscess and fistula. Individuals with diseases that reduce the body’s immunity—such as AIDS or cancer—are also at a higher risk.
Does an abscess always result in a fistula?
Many anal abscesses do not result in anal fistulas. In fact, a fistula develops in only about half of all anal abscess cases.
Anal Fistula: Symptoms
What are the symptoms of an anal fistula?
Ongoing pain, swelling, and tenderness are symptoms of both anal abscesses and fistulas. You may also experience drainage of pus and fluid from the abscess, which can cause irritation and itching on the skin around the anus. Other symptoms include fever, chills, fatigue or weakness.
How is it diagnosed?
A physician may be able to diagnose an anal fistula by physically examining the area surrounding the anus. However, if external signs, such as an opening in the skin, are missing, then an internal exam will be necessary. An instrument called an anoscope is used to inspect the anal canal and rectum for indications of an abscess or other inflammation.
Anal Fistula: Treatment Options
How is an anal fistula treated?
An anal fistula will not heal on its own. Although antibiotics may occasionally be effective, most persistent anal fistulas require a more aggressive approach.
Surgery
The most common treatment for an anal fistula is a surgical procedure called a fistulotomy.
In a fistulotomy, the surgeon makes an incision in the fistula tract, opening it up and merging it with the anal canal. This allows the tissues to heal from the inside out.
For very small fistulas, a fistulotomy may be performed in a doctor’s office, using only local anesthesia. Larger fistulas, however, require surgery under spinal or general anesthesia, and are typically performed in a hospital or surgery center. Patients typically experience mild or moderate discomfort or pain following this procedure, with a recovery time of one to four weeks.
Seton
Fistulotomies work well for fistulas that are relatively close to the skin. For deeper fistulas, however, the physician may choose to use a seton. A seton is a piece of suture material that is passed from the external skin opening, along the fistula tract, through the internal opening in the anal canal, exiting through the anus. The suture material is then tied in a loop, which is gradually tightened over a period of weeks. This ultimately has the same effect as a fistulotomy—to open the fistula tract and allow it to heal.
Fibrin Glue
In some cases, an anal fistula is closed by the injection of fibrin glue—a solution of the clotting factors fibrinogen and thrombin. This glue results in the formation of a clot within the fistula, which helps promote healing of the tract.
Endorectal Advancement Flap
Endorectal advancement flaps are a surgical procedure typically reserved for more complex fistulas. This surgery is often more involved and invasive than the other procedures described above. In the operating room the doctor first identifies the internal opening of the fistula. After identifying the internal opening, the doctor uses surgical instruments to dissect and lift a portion, or flap, of the rectal wall adjacent to the internanl opening. He pulls the flap down over thet internal opening and sutures it into place to close the opening, allowing the fistula to heal.
Surgisis AFP Plug
The Surgisis AFP plug is a unique alternative to traditional fistula surgery. It is a conical device made of a biomaterial that supports tissue healing. The plug is placed by drawing it through the fistula tract and suturing it in place.
Surgisis AFP Plug: Technology
What is the Surgisis AFP plug made of?
The Surgisis AFP plug is made from a complex collagen (protein) scaffold obtained from pigs—which have a collagen structure almost identical to that of human tissue.
How is the Surgisis AFP plug made?
Several steps in the manufacturing of the Surgisis AFP plug ensure its safety as an implant. All Surgisis material undergoes thorough cleaning and disinfection using certified medical device manufacturing procedures. A patented process removes living cells to help ensure that no transmittable diseases are present in the tissue; special testing confirms the manufacturing process inactivates any viruses.
NOTE: Since the Surgisis AFP plug is derived from a porcine source, it should not be used for patients with a known sensitivity to porcine material.
How does the Surgisis AFP plug facilitate closure of the fistula?
Porcine collagen is so similar to human collagen, the plug, once implanted, incorporates naturally over time into your own tissue.
How does it work?
When the Surgisis AFP plug is implanted, your cells, tissues and blood vessels readily move into the plug. When viewed through a microscope, the implanted Surgisis material resembles a mat of fibers, with your own living cells and tissue growing into it. This tissue ingrowth allows your body’s immune system to protect the plug from potential infection.
More importantly, the plug provides sufficient mechanical strength for tissue support while acting as a scaffold for rapid, guided tissue incorporation. Gradually, the Surgisis scaffold is replaced and rebuilt with your own tissue for a long-lasting effect. This process is called “tissue remodeling.”
Tissue Remodeling
Following implantation, tissues adjacent to the Surgisis AFP plug begin to deliver cells and nutrients.
Cells rapidly invade the Surgisis AFP plug. Capillary growth follows and more nutrients enter the matrix.
The Surgisis AFP plug is gradually replaced as the patient's system reinforces and rebuilds the weakened site.
The patient's body tissue grows completely into the surgical site while the Surgisis AFP plug maintains the needed tissue support.
Surgisis AFP Plug: Procedure
What happens during the procedure?
1. The doctor locates the inside opening of the fistula in the anal canal using a fistula probe and irrigates the tract.
2. The Surgisis AFP plug is pulled into the inside opening. The doctor notes where the plug enters the primary opening and cuts the plug to size.
3. The inside opening is closed by suturing the top tissue layers of the anal canal over the Surgisis AFP plug's head.
4. Finally, the doctor sutures the tip of the plug to the edge of the exterior opening at skin level (optional). The exterior opening is not closed to allow for drainage. The tip of the plug is trimmed at skin level.
Surgisis AFP Plug (0:41)
What care is needed before and after the procedure?
It is important for you and your doctor to discuss the appropriate care needed before and after your procedure. Your doctor will have specific recommendations for you to follow.
Some of your doctor’s recommendations for care before your procedure may or may not include those listed below.
- No solid foods the day before the procedure
- Drink clear liquids 24 hours before the procedure
- Clear soda (i.e., ginger ale)
- Clear fruit juices (i.e., apple, grape or white grape)
- Tea
- Ice
- Popsicles
- Jell-O
- Soup, broth/bouillon
Bowel prep the evening before the procedure
Oral antibiotic the evening before the procedure
After your procedure, your doctor’s recommendations may or may not include those listed below. Please discuss specific questions or concerns with your doctor.
Maintain a liquid diet for two days after the procedure (i.e., soup, Jell-O, etc.) Eat a high fiber diet after two days Use the bathroom once a day Avoid heavy lifting, straining and strenuous exercise for two weeks at a minimum (i.e., weightlifting, jogging, swimming, etc.) Take over-the-counter pain medicine as needed Shower standing up and bathe the area with water to soothe and keep it clean Do not sit in the bathtub Do not use topical steroids or topical agents such as Preparation H Expect some drainage for two to four weeks after the procedure as the Surgisis AFP plug is incorporated and the fistula tract is closed Schedule a follow-up appointment and call your doctor if you develop significant pain, swelling around the area, fever or chills
Surgisis AFP Plug: FAQs
What happens to the Surgisis AFP plug after my procedure?
Once the Surgisis AFP is implanted, your body’s cells, tissues, and blood vessels will grow into it. Eventually, the plug will be incorporated into your body and completely replaced by your own tissue.
Is there a risk for incontinence after my procedure?
Incontinence typically is caused by surgeries that damage the sphincter muscles. Since the placement of the Surgisis AFP plug does not require cutting the sphincters, incontinence would be unlikely.
What happens if the plug falls out?
If the Surgisis AFP plug falls out, it simply means that the suture holding it in place has broken or dissolved. You will need to return to your physician and discuss the situation. He or she may decide to put another Surgisis AFP plug in place.
How long will drainage continue after my procedure?
It is not uncommon to have some drainage for two to four weeks after the Surgisis AFP has been placed. This is a natural part of the healing process.
Will the anal fistula heal on its own?
An anal fistula typically will not heal on its own. Getting it to close will require some form of treatment.
Will the Surgisis AFP plug work if I have Crohn's, colitis or other IBD-related diseases?
There is no 100% guarantee that the Surgisis AFP plug will work in any patient. However, clinical experience to date indicates the plug can be an effective option for patients with Crohn's, colitis or an IBD-related disease.
Are there physicians in my area that provide the Surgisis AFP plug as a treatment option?
The Surgisis AFP plug is cleared for use in North and South America, and Europe. To search for physicians in your area, visit click here.
Additional Resources: Helpful Links
Below is a list of helpful links to resources for information about anal fistulas.
Crohn’s & Colitis Foundation of America
www.ccfa.org
www.ucandcrohns.org
Crohn’s & Colitis Foundation of Canada
www.ccfc.ca
National Association for Colitis and Crohn’s Disease
www.nacc.org.uk
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free sun
عضو ماسي
عدد الرسائل : 396
تاريخ التسجيل : 01/10/2008
| | موضوع: رد: Anorectal fistula update treatment الثلاثاء ديسمبر 09, 2008 10:46 pm | |
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شكرا لك أيها الأستاذ الدكتور نورتنا بهذه المواضيع المميزة والمفيدة جدا بالنسبة لنا
Thanks sir for your nice sub.
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