New Techniques for Treating an Anal Fistula

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae

Polymorphism Thr241Met of the XRCC3 Gene and Lack of Association with Colorectal Cancer Susceptibility Risk among Malaysian Population: A Preliminary Report

The genesis of colorectal cancer (CRC) involves a series of steps in which environmental and/or endogenous carcinogens interact with genetic factors and induce or promote cancer development. Genetic polymorphisms in DNA repair genes may influence individual variation in DNA repair capacity and may be associated with a high risk of developing cancer. Studies on the association between DNA repair gene polymorphisms and CRC appear to be limited and nil from Malaysia. Objective: To examine the polymorphism at codon 241 of the X-Ray Cross Complementing group 3 (XRCC3) in 118 CRC cases and 118 normal controls and to investigate the associated risk of this polymorphism for CRC susceptibility. Material and Method: Peripheral blood from the study subjects were collected in EDTA tubes, genomic DNA extracted and XRCC3 Thr241Met genotyped by using PCR-RFLP technique using Nla III restriction enzyme. The resulting genotypes were categorized into wildtype homozygous (Thr/Thr), heterozygous (Thr/Met) and homozygous variant (Met/Met). Results and conclusion: The distribution of genotypes (Thr/Thr, Thr/Met and Met/Met) among CRC cases (83%, 16%, 1% respectively) was not significantly different from those among controls (79%, 21%, 0% respectively). On examining the association between the variant genotypes and CRC risk, the variant genotype either single or in combination did not show significant association with CRC susceptibility risk suggesting that the XRCC3 codon 241 polymorphism does not convey moderate increase in susceptibility to CRC in Malaysian population. Lack of association could be attributed to the small sample size, interaction of other polymorphic DNA repair genes and also low frequency of variant allele for the polymorphism studied in this population

Risk factors associated with low anterior resection syndrome: a cross-sectional study

Purpose Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS. Methods This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery. Results Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13). Conclusion Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery

Polymorphism in the Tumor Necrosis Factor alpha promoter region and its Influence on Colorectal Cancer Predispositiom risk in Malaysian Population

Objective: A case control study was designed to investigate the TNF-,1 -308 G>A polymorphism allele frequencies and to determine the influence of the polymorphic gcnot.ype on sporadic CRC susceptibility risk in Malaysian population. Material. and Method!: Peripheral blood samples of 164 normal controls and 161 clinically and histopathologically con­firmed CRC patients were genotyped for TNF-u -308 G>A polymorphism employing allele specific PCR. The relative associa­tions of various genotypes with CRC susceptibility risk was determined by calculating Odds Ratios. Corresponding chi-square tests on the CRC patients and controls were carried out and 95% confidence interval (95% CI) were determined using Fisher e,acts tests. Results: On comparing the frequencies of genotypes of patients and controls, the homozygous ,·ariant AA was significantly higher in CRC patients (p = 0.030) compared to controls. On investigating the association of the polymorphic genotypes with CRC susceptibility risk, the homozygous variant TNF-a -308 AA showed significantly increased risk with OR 2.5842. Conclusion: Our results suggest that, pol) morphic genotJpe of inflammation response gene TNF-a is significantly associat­ed with CRC susceptibility risk and could be considered as a high risk variant for CRC predisposition

Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano

PURPOSE: This study was designed to assess the total anal sphincter–saving technique of ligating the intersphincteric fistula tract for the treatment of fistulain-ano. METHODS: We performed a prospective observational study of patients with fistula-in-ano treated with the ligation of the intersphincteric fistula tract technique from May 2007 through September 2008. All patients had fistulas arising from cryptoglandular infections. Recurrence rate, healing time, and morbidities related to the procedure were determined with a standard followup protocol. RESULTS: Forty-five patients with transsphincteric (n � 33) or complex (n � 12) fistulas were included in the study. Five patients (11.1%) had recurrent fistula-in-ano after prior surgery using other recognized treatment procedures. The median age was 41.5 (range, 27–56) years; median follow-up, 9 (range, 2–16) months. Primary healing was achieved in 37 patients (82.2%), with a median healing time of 7 (range, 4–10) weeks. Eight patients (17.7%) had recurrence of fistula between 3 and 8 months after the operation. No clinically significant morbidity was noted in any of the 45 patients. CONCLUSIONS: The ligation of the intersphincteric fistula tract technique for fistula-in-ano surgery, which aims at total anal sphincter preservation, appears to be both safe and easy to perform, with encouraging early outcomes