OUTCOME OF USE OF 1% SILVER NITRATE IN PATIENTS WITH LOW LYING PERIANAL FISTULA
AbstractBackground: Anorectal fistula is a common illness which is seen among the middle-aged male patients. Various surgical procedures have been proposed and are associated with the recurrence of the fistula, repeated surgery and in some cases incontinence which may reach up to 43% in complicated fistulas. The purpose of this study was to assess and formulate a non-surgical procedure for fistula in ano through irrigation of the fistula tract with 1% of silver nitrate solution in healing the low perianal fistula. Methods: Seventy-nine patients presenting to the outpatient department of Ward 3, Surgical unit 1 in Jinnah Postgraduate Medical Centre during a period of 8 months from April to November 2017 with complain of perianal pain and pussy discharge were included in the study. Three patients of the total 79 patients lost to follow up. Outcome measure were cessation of the symptoms for consecutive 10 weeks. Results: Seventy-six patients were assessed and underwent irrigation using this 1% of silver nitrate solution. Out of 76 patients, 58 (76.3%) patients showed complete clinical healing while 18 (23.68%) of patients showed failure to clinical healing. Patients with continuous discharge had a significantly higher rate of complete clinical healing than those with intermittent discharge. Conclusion: From this study it can be concluded that cauterizing and corrosive properties of silver nitrate are effective in treating the patients with low lying perianal fistula. We suggest that this method should be used as a first line treatment option for all the patients presenting with low lying anal fistula since it is simple, can be easily performed on an OPD basis is minimally invasive and avoids any complication.Keywords: silver nitrate; perianal fistula; low lying perianal fistula; nonoperative management
Zubaidi AM. Anal fistula. Past and present. Saudi Med J 2014;35(9):937–44.
Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg 2011;24(1):14–21.
Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H. Evolution of treatment of fistula in ano. World J Surg 2012;36(5):1162–7.
Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Quality of life with anal fistula. Ann R Coll Surg Engl 2016;98(5):334–8.
Damon H, Guye O, Seigneurin A, Long F, Sonko A, Faucheron JL, et al. Prevalence of anal incontinence in adults and impact on quality-of-life. Gastroenterol Clin Biol 2006;30(1):37–43.
de Miguel Criado J, del Salto LG, Rivas PF, del Hoyo LF, Velasco LG, de las Vacas MI, et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 2011;32(1):175–94.
Sugrue J, Nordenstam J, Abcarian H, Bartholomew A, Schwartz JL, Mellgren A, et al. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctol 2017;21(6):425–32.
Attaallah W, Tuney D, Gulluoglu BM, Ugurlu MU, Gunal O, Yegen C. Should we consider topical silver nitrate irrigation as a definitive nonsurgical treatment for perianal fistula? Dis Colon Rectum 2014;57(7):882–7.
Kumar Pandian SR, Deepak V, Kalishwaralal K, Viswanathan P, Gurunathan S. Mechanism of bactericidal activity of Silver Nitrate-a concentration dependent bi-functional molecule. Braz J Microbiol 2010;41(3):805–9.
van Koperen PJ, D’Hoore A, Wolthuis AM, Bemelman WA, Slors JF. Anal fistula plug for closure of difficult anorectal fistula: a prospective study. Dis Colon Rectum 2007;50(12):2168–72.
Vyas AK, Katlana A, Rathi A, Porwal P, Jain R, Etta P. Comparison and Evaluation of the Outcome of Fistulotomy Vs Fistulectomy Technique in Treatment of Low Fistula in Ano. J Med Sci Clin Res 2016;4(12):14999–5006.
Doll D, Vassiliu P. Silver nitrate for anal fistulas: a word of caution. Dis Colon Rectum 2015;58(12):e459.
Garcia-Olmo D, Herreros D, Pascual M, Pascual I, De-La-Quintana P, Trebol J, et al. Treatment of enterocutaneous fistula in Crohn’s disease with adipose-derived stem cells: a comparison of protocols with and without cell expansion. Int J Colorectal Dis 2009;24(1):27–30.
Ahmed T, Khan I, Iqbal MM, Khan MI, Shah SH, Parveen S. Comparison of Fistulectomy with Fistulotomy in Low Fistula in Ano. J Surg Pak 2016;21(3):102–5.