Aim: Adequate drainage of high horseshoe and supra-levator (complex) collections remains one of the main challenges in treating complex anal fistulae with the only effective approach being wide drainage of the cavity. This requires an extended perianal incision and a long period of regular dressings postoperatively. Negative pressure wound therapy (NPWT) is successful in treating complex wounds, promoting and accelerating wound healing, this was applied to the treatment of complex anal sepsis. Method: Between 2009 and 2013, selected patients with complex perianal sepsis had NPWT with a gauze dressing (Renasys-G System, Smith and Nephew, FL, USA). The NPWT was changed in theatre until thecavity reduced in size or the patient tolerated changes without GA. Success was defined as the patient not requiring any further surgery for the secondary extension. Results: Eleven male patients, (median age 37 years, range 24–70), with median duration of symptoms of 18 months (range 1–120) (7 having surgery in the previous year) were included in the study. Nine had a high trans-sphincteric fistula, treated with lay open in 1 and seton in 8. They required a median of 5 (range 2–7) changes of dressing (median hospital stay 12 days, range 5–26). Six patients required outpatient dressing changes. All patients but one tolerated the NPWT. At follow-up (median 12 months, range 2–48) seven patients (64%) did not require further treatment for the secondary extension. Conclusion: NPWT is feasible and effective in the treatment of complex anal sepsis. Further studies are required to assess the long-term outcomes.
Rottoli, M., Campbell-Smith, T., Schizas, A., Williams, A. (2014). SP108 Negative pressure wound therapy helps resolve high complex anal sepsis with anal fistulae (Tripartite Colorectal Meeting of the American Society of Colon & Rectal Surgeons (ASCRS); Association of Coloproctology of GB & Ireland; the Section of Coloproctology, Royal Societyof Medicine; the Colon and Rectal Surgery Section, Royal Australasian College of Surgeons and the Colorectal Surgical Society of Australia and New Zealand, in association with the European Society of Coloproctology (ESCP), 30 June – 3 July 2014, Birmingham, UK). COLORECTAL DISEASE, 16, 30-30 [10.1111/codi.12640].
SP108 Negative pressure wound therapy helps resolve high complex anal sepsis with anal fistulae (Tripartite Colorectal Meeting of the American Society of Colon & Rectal Surgeons (ASCRS); Association of Coloproctology of GB & Ireland; the Section of Coloproctology, Royal Societyof Medicine; the Colon and Rectal Surgery Section, Royal Australasian College of Surgeons and the Colorectal Surgical Society of Australia and New Zealand, in association with the European Society of Coloproctology (ESCP), 30 June – 3 July 2014, Birmingham, UK)
Rottoli M;
2014
Abstract
Aim: Adequate drainage of high horseshoe and supra-levator (complex) collections remains one of the main challenges in treating complex anal fistulae with the only effective approach being wide drainage of the cavity. This requires an extended perianal incision and a long period of regular dressings postoperatively. Negative pressure wound therapy (NPWT) is successful in treating complex wounds, promoting and accelerating wound healing, this was applied to the treatment of complex anal sepsis. Method: Between 2009 and 2013, selected patients with complex perianal sepsis had NPWT with a gauze dressing (Renasys-G System, Smith and Nephew, FL, USA). The NPWT was changed in theatre until thecavity reduced in size or the patient tolerated changes without GA. Success was defined as the patient not requiring any further surgery for the secondary extension. Results: Eleven male patients, (median age 37 years, range 24–70), with median duration of symptoms of 18 months (range 1–120) (7 having surgery in the previous year) were included in the study. Nine had a high trans-sphincteric fistula, treated with lay open in 1 and seton in 8. They required a median of 5 (range 2–7) changes of dressing (median hospital stay 12 days, range 5–26). Six patients required outpatient dressing changes. All patients but one tolerated the NPWT. At follow-up (median 12 months, range 2–48) seven patients (64%) did not require further treatment for the secondary extension. Conclusion: NPWT is feasible and effective in the treatment of complex anal sepsis. Further studies are required to assess the long-term outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
