Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000143
Original Contributions: Anorectal Disease

Should We Consider Topical Silver Nitrate Irrigation as a Definitive Nonsurgical Treatment for Perianal Fistula?

Attaallah, Wafi M.D.; Tuney, Davut M.D.2; Gulluoglu, Bahadir M. M.D.1; Ugurlu, M. Umit M.D.1; Gunal, Omer M.D.1; Yegen, Cumhur M.D.1

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BACKGROUND: Surgery is currently the sole treatment modality for anal fistulas. However, surgery is associated with complications such as permanent incontinence, which reduces quality of life.

OBJECTIVE: To determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment.

DESIGN: Prospective single arm study.

SETTING: Tertiary university hospital

PATIENTS: Adult patients with symptomatic perianal fistula presenting between June 2012 and January 2013.

INTERVENTION: Irrigation of the fistula tract with 1% silver nitrate solution. Irrigation was repeated every 2 weeks when necessary.

MAIN OUTCOME MEASURES: The primary outcome measure was the rate of complete clinical healing.

RESULTS: Fifty-six consecutive patients with anal fistula were analyzed. Of those, 29 (52%) had complete clinical healing without recurrence for a median of 10 months. The median number of irrigations needed for complete clinical healing was 4 (1–10). The level of satisfaction was excellent in patients with complete clinical healing. The frequency of complaints was the only independent factor that had an impact on healing; patients with intermittent discharge had a significantly higher rate of complete clinical healing (67%) than those with continuous discharge (40%). There were no notable complications.

LIMITATIONS: Short follow-up, small sample size, and no comparisons.

CONCLUSION: This study demonstrates that the application of silver nitrate solution often produces a favorable outcome in the treatment of anal fistula. This method may be considered as a first-line treatment for the disease because it is simple, performed on an outpatient basis, minimally invasive, and lacks the complications encountered with current conventional surgical modalities.

© 2014 The American Society of Colon and Rectal Surgeons


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