PDF(Pubmed)
Abstract：
BACKGROUND: Anal fistula and perianal abscess are commonly acquired anorectal pathologies in children. Surgical treatment options commonly adopted are fistulotomy, fistulectomy, cutting seton placement, and more recently video-assisted anal fistula treatment (VAAFT). Optimal postoperative wound dressing remains debated. This study aimed to report our series of pediatric patients, who received VAAFT and postoperative wound dressing using ozonide oil.
METHODS: All patients who underwent VAAFT between August 2018 and May 2023 were included in the study. Demographics, clinical features, pre-operative imaging, surgical details, outcome, and mid-term outcome data were retrospectively reviewed for each patient. All VAAFT procedures were performed under general anesthesia and using a 10-Ch fistuloscope.
RESULTS: Thirty-three VAAFT procedures were performed in 30 patients over the study period. The median patient age was 5.7 years (range 1.75-14). Anal fistula was idiopathic in 26/30 (86.6%), iatrogenic in 2/30 (6.7%), and secondary to Crohn\'s disease in 2/30 (6.7%). The median duration of surgery was 23 min (range 18-40). All patients received ozonide oil dressing twice a day for 5 weeks postoperatively. The median hospital stay was 24 h (range 9-36). The median healing time was 28 days (range 17-39). With a median follow-up of 2 years (range 0.5-5), disease recurrence occurred in 3/30 (10%) patients with idiopathic fistula, who were re-operated using the same technique, with no further recurrence. No fecal incontinence or soiling was observed.
CONCLUSIONS: Our series confirmed that VAAFT is a safe and effective technique to treat children with perianal fistula. The technique is versatile, allowing to treat fistulae of different etiologies. Postoperative course was painless and fast. Future comparative prospective studies are needed to better establish these conclusions.
METHODS: All patients who underwent VAAFT between August 2018 and May 2023 were included in the study. Demographics, clinical features, pre-operative imaging, surgical details, outcome, and mid-term outcome data were retrospectively reviewed for each patient. All VAAFT procedures were performed under general anesthesia and using a 10-Ch fistuloscope.
RESULTS: Thirty-three VAAFT procedures were performed in 30 patients over the study period. The median patient age was 5.7 years (range 1.75-14). Anal fistula was idiopathic in 26/30 (86.6%), iatrogenic in 2/30 (6.7%), and secondary to Crohn\'s disease in 2/30 (6.7%). The median duration of surgery was 23 min (range 18-40). All patients received ozonide oil dressing twice a day for 5 weeks postoperatively. The median hospital stay was 24 h (range 9-36). The median healing time was 28 days (range 17-39). With a median follow-up of 2 years (range 0.5-5), disease recurrence occurred in 3/30 (10%) patients with idiopathic fistula, who were re-operated using the same technique, with no further recurrence. No fecal incontinence or soiling was observed.
CONCLUSIONS: Our series confirmed that VAAFT is a safe and effective technique to treat children with perianal fistula. The technique is versatile, allowing to treat fistulae of different etiologies. Postoperative course was painless and fast. Future comparative prospective studies are needed to better establish these conclusions.
摘要：
背景：肛瘘和肛周脓肿是儿童常见的获得性肛门直肠病变。通常采用的手术治疗选择是瘘管切开术，瘘管切除术,切割挂线位置，以及最近的视频辅助肛瘘治疗（VAAFT）。最佳的术后伤口敷料仍存在争议。这项研究旨在报道我们的一系列儿科患者，谁接受了VAAFT和术后伤口敷料使用ozonide油。
方法：2018年8月至2023年5月期间接受VAAFT的所有患者均纳入研究。人口统计,临床特征,术前成像,手术细节,结果,对每位患者的中期结局数据进行回顾性分析.所有VAAFT程序均在全身麻醉下并使用10-Ch纤维镜进行。
结果：在研究期间对30名患者进行了33次VAAFT手术。患者年龄中位数为5.7岁（范围1.75-14）。肛瘘为特发性26/30(86.6%),医源性在2/30（6.7％），2/30（6.7%）继发克罗恩病。手术的中位持续时间为23分钟（范围18-40）。所有患者术后均接受了每日两次的ozonide油敷料，为期5周。中位住院时间为24小时（范围9-36）。中位愈合时间为28天(范围17-39)。中位随访时间为2年（范围0.5-5年），疾病复发发生在3/30（10％）特发性瘘患者中，他们使用相同的技术重新手术，没有进一步复发。没有观察到大便失禁或脏污。
结论：我们的系列研究证实VAAFT是治疗儿童肛周瘘的一种安全有效的技术。这项技术用途广泛，允许治疗不同病因的瘘管。术后过程无痛且快速。未来的比较前瞻性研究需要更好地建立这些结论。
方法：2018年8月至2023年5月期间接受VAAFT的所有患者均纳入研究。人口统计,临床特征,术前成像,手术细节,结果,对每位患者的中期结局数据进行回顾性分析.所有VAAFT程序均在全身麻醉下并使用10-Ch纤维镜进行。
结果：在研究期间对30名患者进行了33次VAAFT手术。患者年龄中位数为5.7岁（范围1.75-14）。肛瘘为特发性26/30(86.6%),医源性在2/30（6.7％），2/30（6.7%）继发克罗恩病。手术的中位持续时间为23分钟（范围18-40）。所有患者术后均接受了每日两次的ozonide油敷料，为期5周。中位住院时间为24小时（范围9-36）。中位愈合时间为28天(范围17-39)。中位随访时间为2年（范围0.5-5年），疾病复发发生在3/30（10％）特发性瘘患者中，他们使用相同的技术重新手术，没有进一步复发。没有观察到大便失禁或脏污。
结论：我们的系列研究证实VAAFT是治疗儿童肛周瘘的一种安全有效的技术。这项技术用途广泛，允许治疗不同病因的瘘管。术后过程无痛且快速。未来的比较前瞻性研究需要更好地建立这些结论。
