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Easy clip to treat anal fistula tracts: a word of caution

Abstract : Background and aims: Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. Materials and methods Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. Results Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29–54]) who had an anal fistula: 12 (71 %) high fistulas (including 4 rectovaginal fistulas), 5 (29 %) lower fistulas (with 3 rectovaginal fistulas), and 6 (35 %) Crohn’s fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47 %) patients and the median operative time was 27.5 min (20–36.5). Postoperative period was painful for 11 (65 %) patients. A clip migration was noted in 11 patients (65 %) after a median follow-up of 10 days (5.5–49.8). Eleven patients (65 %) who failed had reoperation including 10 new drainages within the first month (0.5–5). After a mean follow-up of 4 months (2–7),, closing the tract was observed in 2 patients (12 %) following the first insertion of the clip and in another one after a second insertion. Conclusion: Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.
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Submitted on : Monday, September 14, 2015 - 4:53:39 PM
Last modification on : Wednesday, August 19, 2020 - 10:00:25 AM
Long-term archiving on: : Tuesday, December 29, 2015 - 6:49:46 AM

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M. Gautier, P. Godeberge, R. Ganansia, G. Bozio, B. Godart, et al.. Easy clip to treat anal fistula tracts: a word of caution. International Journal of Colorectal Disease, Springer Verlag, 2015, 30 (5), pp.621--624. ⟨10.1007/s00384-015-2146-5⟩. ⟨hal-01154233⟩

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