title: Easy clip to treat anal fistula tracts: a word of caution.
abstract: OBJECTIVE
  Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience.
  
  
  METHODS
  Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected.
  
  
  RESULTS
  Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion.
  
  
  CONCLUSIONS
  Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.
authors: CHU Pontchaillou, Rennes, France.
authors: M
authors: M
authors: Gautier
authors: P
authors: P
authors: Godeberge
authors: R
authors: R
authors: Ganansia
authors: G
authors: G
authors: Bozio
authors: B
authors: B
authors: Godart
authors: M A
authors: MA
authors: Bigard
authors: M
authors: M
authors: Barthet
authors: L
authors: L
authors: Siproudhis
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D061646:Operative Time; D061214:Patient Safety; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D012003:Rectal Fistula / Q000175:diagnosis* / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013525:Surgical Instruments / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology