Fistura review by Dr Bouchard
Radiofrequency in the treatment of anal fistulas: a (good) alternative to fistulotomy?
My personal results in recent years with the Fistura procedure:
60% prolonged closure (at least 12 months follow-up), on clinical assessment for crypto-glandular fistulas and on clinical and MRI assessment for Crohn’s disease related anal fistulas. It is therefore a procedure of choice among sphincter-sparing techniques but at the price of a precise selection of patients…
Fistulas with a direct route, long (≥50 mm) and narrow (in practice, we just pass the 9 fr probe, i.e. about 3 mm) with an internal orifice that is not too wide, i.e. we can suture without too much tension without a connected diverticulum of more than 5 mm for Crohn’s fistulas.
Note that in case of Crohn’s disease, if the fistula is well dried out, and if all the clinical and MRI inflammatory signals are green, I don’t have the impression that the results are less good than for crypto-glandular fistulas. I therefore tend to propose RF before simple removal when the fistula has the above characteristics.
Dr. Dominique Bouchard, MD Procotologist, Head of the Proctology Unit, Maison de Santé Protestante Bagatelle, Talence, France