Does the perianal abscess have an Ayurvedic treatment

LIFT technique against Seton in the treatment of the anal fistula

Short Summary

Abscesses and anal fistulas account for about 70% of perianal suppuration, with an estimated incidence of 1 / 10,000 inhabitants per year and 5% of inquiries in coloproctology. Anal fistula is the chronic phase of anorectal infection that is characterized by chronic purulent drainage or cyclical pain associated with an acute relapse of the abscess followed by intermittent spontaneous decompression. Perianal fistulas have a problematic pathology. The most popular theory is the anal abscess is caused by infection of an anal crypt. The suppuration moves from the anal gland into the inter-sphincteric space, which forms an abscess that leads to the development of a fistula. The incidence of fistulas after an abscess is almost 33%. A fistula can cause pain, perianal swelling, discharge, bleeding, and other non-specific symptoms. Diagnosing a fistula-in-ano may include a digital rectal endoanal exam, ultrasound, fistulography, and MRI. Management of the disease is difficult and sometimes a challenge for the surgeon. The ideal treatment is based on three central principles: control of the sepsis, closure of the fistula, and maintenance of continence. The management of complex fistulas must balance the results of healing and continence. Success is usually determined by identifying the primary opening and splitting the least amount of muscle as possible. During the fistulotomy there is a risk of damage to the sphincter, leading to an unacceptable risk of anal incontinence to varying degrees. The surgical techniques described for treating fistula-in-ano are fistulotomy, core-out fistulectomy, seton placement, endorectal advancement flap, injection of fibrin glue, insertion of a fistula plug, video-assisted anal fistula treatment (VAAFT), and ligation Fistula tracts (LIFT) are composed of 2 broad categories of techniques, including procedures for sphincter sacrifice, such as fistulotomy, fistulectomy, and incision seton. and sphincter-conserving procedures such as fibrin glue injection, fistula plugs, rectal advancement flaps, VAAFT and LIFT. In general, sphincter sacrifice procedures have high rates of success, but are associated with high rates of fecal incontinence. In contrast, sphincter maintenance procedures have more modest success rates but are associated with a relatively low risk of continence changes. While low level transspincteric fistulas are well addressed by fistulotomy (i.e., open technique) with minimal change in long-term bowel habits, fistulas that involve more than 30% of the internal sphincter pose a significant risk of fecal incontinence approach. The endorectal advancing flap is technically difficult and associated with a high recurrence rate of up to 50% and the risk of incontinence up to 35%. Fibrin glue and anal fistula plugs have little effect on incontinence, but are linked to each other with a high recurrence rate of up to 60% and are costly. VAAFT is an effective method, but it is very costly. Setons can be used as cutting and non-cutting types as dividers or markers. Some types of the setons used are the Ayurvedic thread, braided sewing thread, elastic band, penrose drains, and zip ties. Seton material should be non-absorbable, non-slip material, comfortable and the least irritating to the patient and equally expectorant, resulting in a focal reaction in the track that leads to fibrosis. Setons, however, can cause patient discomfort, both due to irritation and due to persistent drainage discomfort. In addition, the incontinence rate can reach 67%. The ligation of the intersphincteric fistula tract (LIFT) was first described by Rojanasakul and colleagues in 2007. Since then, this technique has become popular with providers due to its simple technical elements, especially compared to anorectal advancing valves, and favorable success rate. Among the many studies published in the literature, the success rate after LIFT ranges from 40 to 95%, with a recurrence rate of 6-28% .3,5-28 In comparison, the success rate after the ascent is between 60 and 94%.