Miguel Cunha interviews Professor Bruno Roche who teaches proctology and perineal pathology at Geneva University, University College London Hospital, Raschid Hospital in Dubai, as well as at several other universities in Italy (Verona, Bologna, Bari).

Former President of the Swiss Coloproctology Group, he is the author of more than 150 proctology publications and book chapters. His international expertise has led him to present his experience at more than 500 congresses around the world, as a guest speaker.

Bruno will speak on ‘Anal Fistula: Options’ at ESCP Virtually Vilnius 2020. We asked him about what delegates can expect this September at #ESCP2020.

Anal fistula is known as non-physiological tract-like connection from the anal canal or the distal rectum to the perianal skin. Anal fistula was first described in 380BC by Hippocrates; at this time he also mentioned a drainage seton.

It is assumed that about 2% of all people suffer from perianal abscesses or fistulas throughout the course of their lives. Anal fistulas are an indication for surgery. Surgery aims to heal the fistula without disturbing continence. Operative measures must be based on the location and the course of the fistula, and therefore on its relation to the sphincter muscle.

Treatment planning poses a problem: the operation should remove the fistula as completely as possible yet without compromising continence. During his presentation, Bruno will discuss the best options for this pathology towards current knowledge.

Miguel Cunha: Firstly, we would like to thank you for sharing with us the inside view on the options that we have for anal fistula. What would you want to add to this challenging subject in your presentation at ESCP 2020?

Bruno Roche: We have known of anal fistulas since the ancient times. Egyptians already knew of this pathology. One of the most famous surgeons of Great Britain in the middle ages who described and treated anal fistulas is John Ardene. He is considered as the father of surgery in England. I invite people who have the chance to go to Oslo or Glasgow to have a look to John Ardene papyrus on fistulas with classification treatments and instruments to treat.

MC: In your opinion, what are the key things to know about anal fistulas?

BR: Everything begins with an abscess in the majority of the cases. So, it is important to know the etiology of the fistula - the majority (90%) tend to be from cryptoglandular origin. We know where the fistula finishes at the secondary orifice - but we must know where the fistula begins at the primary orifice.

We need to find which noble tissue is crossing by the tract:

  1. Clinic digital examination air instillation
  2. Ultrasound
  3. Draw the fistula, plan the type of surgery, save the sphincter

MC: With your vast experience on the subject, can you tell us why no one should miss your talk about the anal fistula options?

BR: Fistulas are a pathology of kings. So, if one day you hope to treat a king, do fistula surgery. This talk is important because fistula surgery is more complex than hepatectomy because fistula tract anatomy is always different and always a challenge.

MC: From a surgical point of view, what developments do you think we can expect in the future for anal fistula treatment?

BR: I believe in internal approach and closure of the fistula. The problem is the persistence of glands’ secretion which keeps the fistula open. The day we find the way to destroy the gland in association with an endoluminal closure is the day we’ll be able to get better results.

MC: Once again, thank you so much for sharing your knowledge with us. We have great expectations for your talk at the upcoming ESCP meeting and I personally will make sure to be online on the 23rd of September at 14:00! Thank you.

Bruno's talk on 'Anal Fistuals: Options' at ESCP Virtually Vilnius 2020 will take place at 14:00 on Wednesday 23 September.

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