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

• Published in: International journal of colorectal disease 2015-05, Vol.30 (5), p.621-624
• Main Authors: Gautier, M., Godeberge, P., Ganansia, R., Bozio, G., Godart, B., Bigard, M.A., Barthet, M., Siproudhis, L.
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Surgical Procedures - methods; Analysis; Anorectal fistula; Cohort Studies; Female; Follow-Up Studies; Gastroenterology; Hepatology; Humans; Internal Medicine; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Operative Time; Original Article; Patient Safety; Pilot Projects; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Proctology; Rectal Fistula - diagnosis; Rectal Fistula - surgery; Rectovaginal Fistula - diagnosis; Rectovaginal Fistula - surgery; Recurrence; Retrospective Studies; Risk Assessment; Surgery; Surgical Instruments - adverse effects; Time Factors; Treatment Outcome; Wound Healing - physiology
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-015-2146-5

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.