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Photodynamic Therapy for the Treatment of Complex Anal Fistula


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Title:
Photodynamic Therapy for the Treatment of Complex Anal Fistula
Authors:
Arroyo, Antonio  
Sánchez-Guillén, Luis  
Antonio Parra, Pedro
García‐Catalá, Luís
Peña‐Ros, Emilio
Ferrer‐Márquez, Manuel
nofuentes, carmen  
Barber‐Valles, Xavier
ROMERO SIMÓ, MANUEL  
Editor:
Springer
Department:
Departamentos de la UMH::Patología y Cirugía
Issue Date:
2020
URI:
https://hdl.handle.net/11000/31120
Abstract:
Background and objectives: To validate and analyze the results of intralesional photodynamic therapy in the treatment of complex anal fistula. Study design/materials and methods: This prospective multicentric observational study enrolled patients treated for complex anal fistula who underwent intralesional photodynamic therapy (i-PDT). The included patients were treated from January 2016 to December 2018 with a minimum follow-up of 1 year to evaluate recurrence, continence and postoperative morbidity. Intralesional 5-aminolevulinic acid (ALA) gel (2%) was injected directly into the fistula. The internal and external orifices were closed. After an incubation period of 2 hours, the fistula was irradiated using an optical fiber connected to a red laser (Multidiode 630 PDT) operating at 1 W/cm for 3 minutes (180 J). Results: In total, 49 patients were included (61.2% male). The mean age was 48 years, and the mean duration of fistula was 13 months. Of the fistulas included, 75.5% were medium transphincteric, and 24.5% were high transphincteric. The median fistula length was 4 ± 1,14 cm (range: 3-5). A total of 41 patients (83.7%) had a previous history of fistula surgery. Preoperatively, some degree of anal incontinence was found in 5 patients (10.2%). No center reported any other procedure-related complications intraoperatively. Phototoxicity was found in one patient. In the first 48 hours after the procedure, fever was reported in 2 patients (4%). At the end of follow-up, total healing was observed in 32/49 patients (65.3%). No patient reported new incontinence postoperatively. Conclusion: i-PDT could be considered a good choice in patients with complex anal fistulas to avoid surgery and its complications. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
Keywords/Subjects:
complex anal fistula
incontinence
photodynamic therapy
proctology
surgery
Knowledge area:
CDU: Ciencias aplicadas: Medicina: Patología. Medicina clínica. Oncología
Type of document:
application/pdf
Access rights:
info:eu-repo/semantics/closedAccess
DOI:
https://doi.org/10.1002/lsm.23162
Appears in Collections:
Artículos Patología y Cirugía



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