ArticleClinical and experimental gastroenterology2022
Non-Locatable Internal Opening in Anal Fistula Associated with Acute Abscess and Its Definitive Management by Garg Protocol.
Article in Clinical and experimental gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Intraoperative Flexible Rectoscopy for Internal Opening Identification in Transsphincteric Perianal Fistula: A Feasible and Accessible Adjunct to Seton Placement.Medicina (Kaunas, Lithuania) · 2026Article
- Transperineal ultrasonography with a high-frequency probe and a three-dimensional end-fire probe for imaging perianal abscesses and locating the internal openings of anal fistulas.Diagnostic and interventional radiology (Ankara, Turkey) · 2026Article
- Comparison of the proposed new classification of anal fistulas with the Garg classification.Annals of coloproctology · 2026Article
- The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results.Annals of coloproctology · 2024Article
- Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: A meta‑analysis.Experimental and therapeutic medicine · 2024Article
- Recent advances in the diagnosis and treatment of complex anal fistula.Annals of coloproctology · 2024Review
- Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review.Health science reports · 2023Article
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6 authors.
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Abstract
Background: Definitive management of acute fistula-abscess (anal fistulas associated with acute abscess) is gaining popularity against the two-staged approach (early abscess drainage with deferred fistula management). However, locating an internal opening (IO) in acute fistula-abscess can be difficult. A recent protocol (Garg protocol) has been shown to be effective in managing anal fistulas with non-locatable IO. Purpose: To test the efficacy of the Garg protocol in managing acute fistula-abscess with non-locatable IO. Methods: Patients with acute fistula-abscess operated by a definitive procedure were included. A preoperative MRI was done in all patients. Patients in whom the IO was non-locatable after clinical, MRI, and intraoperative examination were managed by the three-step Garg protocol. Garg protocol: 1) Reassessment of MRI; 2) In non-horseshoe fistulas, the IO was assumed to be at the point where the fistula tract reached closest to the sphincter-complex; 3) In horseshoe fistulas, the IO was assumed to be located in the midline (anterior or posterior as per the horseshoe location). Low fistulas were treated by fistulotomy and high fistulas by a sphincter-sparing procedure. The long-term healing rate and change in continence (Vaizey scores) were evaluated. Results: A total of 201 patients with acute fistula-abscess were operated over six years, and 19 were lost to follow-up. A total of 182 patients (154-males) were followed up (median-37 months). The IO was locatable in 133/182 (73.1%) (control group) and was non-locatable in 49/182 (26.9%) (study group). The study group was managed as per the Garg protocol. The age, sex-ratio, and fistula parameters were comparable in both groups. The long-term healing rate was 112/133(84.2%) in the IO-locatable group and 43/49 (87.8%) in the IO-non-locatable group (p=0.64, not-significant). The objective continence scores did not change significantly after surgery in both groups. Conclusion: Acute fistula-abscess with non-locatable IO can be managed successfully by the Garg protocol without any risk of incontinence.
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