Response to: Comment on ‘Optimized fistulectomy using the novel FiXcision® device: a technical feasibility study and evaluation of short term healing rates’ Y. Zhang · Z. Fan
We thank Dr. Zhang and Dr. Fan for their interesting comments on our article. Our aim was to present our first experience with the novel FiXcision® device . We are well aware of the fact that there are certain limitations in using this technique. However, we also have to stress that the device has potential advantages, which may lead to better healing rates. Future studies need to prove this assumption.
Patient selection is crucial for using this device. We agree that fistula with a wide diameter can be difficult to excise completely. In addition, curved and multiple fistula tracts may also not be unsuitable and should therefore be avoided. In contrast, straight fistulas can be excised completely by FiXcision®. We found that the fistula tract was excised in toto in the vast majority of patients without evidence of attached sphincter muscle. Thus, by using the device a complete excision of the entire fistula tract can be achieved without causing damage to the sphincter muscle.
Whether video-assisted anal fistula treatment (VAAFT) helps to detect additional tracts is unclear. A careful preoperative diagnostic evaluation including magnetic resonance imaging or anal endosonography can be more helpful in choosing the appropriate patient. It is important to note that, as discussed in our article, with excision of the fistula tract by using FiXcision®, it is possible to accurately assess the complete tract. Therefore, further tracts may be found too.
Currently, there are few studies focusing on this technique. Further studies are required to define its role in anal fistula surgery.
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Conflict of interest
The authors declare that they have no conflict of interest.
This paper does not contain any studies with human participants performed by any of the authors.
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