Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas.
BACKGROUND
One hundred consecutive applications of a new clipping device, the OTSC®Proctology (Ovesco Endoscopy AG), were analyzed to assess its efficacy for the treatment of complex anorectal fistulas.


METHODS
In patients with anorectal fistulas, minimally invasive surgery with the OTSC®Proctology system was performed according to a standardized technique: the fistula tract was debrided using a special fistula brush, and the clip was applied on the internal fistula opening. In some of the patients, postoperative pain was evaluated using a visual analog scale. After 6 months, the postoperative clinical course and the fistula healing were assessed.


RESULTS
A total of 100 OTSC®Proctology procedures were performed in 96 patients with 55 transsphincteric, 38 suprasphincteric, 2 extrasphincteric, and 5 rectovaginal fistulas. In all but 11 fistulas (8 Crohn's disease, 3 ulcerative colitis), the fistulas were of cryptoglandular origin. The median operation time was 32 min (range 17-66 min). There were no major intraoperative technical problems. All patients found the postoperative pain to be tolerable with standard pain medication. The short-term results of 99 clip applications were analyzed: the healing rate for first-line fistula therapy was 79 %, whereas in recurrent fistulas, the success rate was 26 %. OTSC®Proctology was successful in 45 % of fistulas associated with inflammatory bowel disease and in 20 % of rectovaginal fistulas.


CONCLUSIONS
OTSC®Proctology provides convincing results as first-line treatment for complex cryptoglandular fistulas. It is a safe, effective, minimally invasive, and sphincter-sparing procedure with postoperative pain comparable to other types of fistula surgery.
Proctological Institute Stuttgart, Esslinger Str. 40, 70182, Stuttgart, Germany. ruediger@prosst.de.
R L
RL
Prosst
End- und Dickdarm-Zentrum Mannheim, Bismarckplatz 1, 68165, Mannheim, Germany.
A K
AK
Joos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
Anorectal; Clip; Fistula; Nitinol; OTSC® Proctology
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