Medical Interventional Treatment of Adult Fistula-in-ano. A Pilot Study for Curative Response of Intra-tract Injections of Ceftazidine and Metronidazol
Seyed Mansour Alamshah*, Nozar Dorestan and Alireza KabiriDepartment of surgery, Golestan Hospital. Ahwaz Jundishapou University of Medical Science. Ahwaz-Iran. *Corresponding Author E-mail: mansourseyedalam@gmail.com
Abstract: The standard treatment of fistula in-ano is surgical; however, considering recurrence and incontinence, non-surgical approach might be justified. The study was aimed to investigate application of combined antimicrobial drugs for cure the fistula as a primary treatment. 30 referral cases of perianal fistulas in three groups were enrolled during 15 months. Intermittent multiple intra-tract injections of combined Sodium Tetra Decyl Sulphate (STDS 1%), Metronidazol and Ceftazidine were performed and followed for ten months. 25 cases co-operated until the end of follow up. 16 cases (64%) were completely cured after 10 months of fallow up. 9 cases (36%) were recurred and referred for surgery. Metronidazol + Ceftazidine was shown 71.42% success; STDS + Metronidazol 70% success and STDS + Ceftazidine group 50% success. There were no significant differences between cured and recurrent fistulas considering demographic features, involvement duration, number of injections, length of tracts and distance of orifices from the anal verge. There was significant relation between recurrence and short tract length in anterior type of fistulas (P = 0.023). Conclusively, we suggest that direct injection of selective combined antibiotics, as premier Metronidazol, may cure perianal fistulas as the first step. Short tract anterior and cavitated active fistulas should not be considered.
Keywords: Perianal fistula; Non-surgical treatment; Combined antibiotic therapy; Sodium Tetra Decyl Sulphate; Ceftazidine; Metronidazol Back to TOC