title: Should we consider topical silver nitrate irrigation as a definitive nonsurgical treatment for perianal fistula?
abstract: BACKGROUND
  Surgery is currently the sole treatment modality for anal fistulas. However, surgery is associated with complications such as permanent incontinence, which reduces quality of life.
  
  
  OBJECTIVE
  To determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment.
  
  
  METHODS
  Prospective single arm study.
  
  
  METHODS
  Tertiary university hospital
  
  
  METHODS
  : Adult patients with symptomatic perianal fistula presenting between June 2012 and January 2013.
  
  
  METHODS
  Irrigation of the fistula tract with 1% silver nitrate solution. Irrigation was repeated every 2 weeks when necessary.
  
  
  METHODS
  The primary outcome measure was the rate of complete clinical healing.
  
  
  RESULTS
  Fifty-six consecutive patients with anal fistula were analyzed. Of those, 29 (52%) had complete clinical healing without recurrence for a median of 10 months. The median number of irrigations needed for complete clinical healing was 4 (1-10). The level of satisfaction was excellent in patients with complete clinical healing. The frequency of complaints was the only independent factor that had an impact on healing; patients with intermittent discharge had a significantly higher rate of complete clinical healing (67%) than those with continuous discharge (40%). There were no notable complications.
  
  
  CONCLUSIONS
  Short follow-up, small sample size, and no comparisons.
  
  
  CONCLUSIONS
  This study demonstrates that the application of silver nitrate solution often produces a favorable outcome in the treatment of anal fistula. This method may be considered as a first-line treatment for the disease because it is simple, performed on an outpatient basis, minimally invasive, and lacks the complications encountered with current conventional surgical modalities.
authors.affiliation: 1Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey 2Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Wafi
authors.initials: W
authors.lastname: Attaallah
authors.forename: Davut
authors.initials: D
authors.lastname: Tuney
authors.forename: Bahadir M
authors.initials: BM
authors.lastname: Gulluoglu
authors.forename: M Umit
authors.initials: MU
authors.lastname: Ugurlu
authors.forename: Omer
authors.initials: O
authors.lastname: Gunal
authors.forename: Cumhur
authors.initials: C
authors.lastname: Yegen
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D012003:Rectal Fistula / Q000188:drug therapy*; D012835:Silver Nitrate / Q000627:therapeutic use*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D012835:Silver Nitrate