Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, South Africa.
Colorectal Unit, Wits Donald Gordon Medical Centre, South Africa and Department of Surgery, University of the Witwatersrand, South Africa.
S Afr J Surg. 2020 Jun;58:74-77.
Definitive closure of fistula-in-ano poses an ongoing surgical challenge. The OVESCO OTSC Proctology Clip (proctology clip) purports to offer improved preservation of the anal sphincter whilst at the same time curing the fistula by closure.
A retrospective record review was conducted for patients who received the proctology clip as part of the management of fistula-in-ano in the Colorectal Unit at Wits Donald Gordon Medical Centre (WDGMC).
There were 19 cases of fistula-in-ano treated with the proctology clip. All were cryptoglandular in origin. The median age was 50 years (IQR 44-56 years) and post-procedure, the median follow-up duration was 145 days (IQR 63-298 days). Overall, 9 procedures were successful (47%). Success rates were higher for simple (66.7%) as opposed to complex (38.5%) fistula-in-ano. For patients who underwent placement of the proctology clip as a primary procedure, the success rate (50%) was slightly better than those who received the clip as a secondary procedure (44.4%).
This preliminary data presents our initial experience using the proctology clip. While these data may serve as a "proof of concept", a multi-centre controlled trial comparing this method to the rectal mucosal advancement flap (RMAF) is needed to determine the role of the proctology clip in the management of fistula-in-ano.
肛门瘘的确定性闭合仍然是一个持续存在的手术挑战。OVESCO OTSC 肛肠夹（肛肠夹）据称在保留肛门括约肌的同时通过闭合来治愈瘘管。
对在威特沃特斯兰德大学唐纳德·戈登医学中心（WDGMC）的肛肠科接受肛肠夹治疗肛门瘘的患者进行回顾性病历审查。
有 19 例肛门瘘采用肛肠夹治疗。所有病例均起源于隐窝腺。中位年龄为 50 岁（IQR 44-56 岁），术后中位随访时间为 145 天（IQR 63-298 天）。总体而言，有 9 例手术成功（47%）。单纯性（66.7%）肛门瘘的成功率高于复杂性（38.5%）肛门瘘。对于作为主要手术接受肛肠夹放置的患者，成功率（50%）略高于作为次要手术接受肛肠夹的患者（44.4%）。
这些初步数据展示了我们使用肛肠夹的初步经验。虽然这些数据可以作为“概念验证”，但需要进行多中心对照试验，将这种方法与直肠黏膜推进瓣（RMAF）进行比较，以确定肛肠夹在肛门瘘管理中的作用。
