Use of the OVESCO OTSC® Proctology Clip for closure of fistula-in-ano at Wits Donald Gordon Medical Centre - a single centre experience

Background: Definitive closure of fistula-in-ano poses an ongoing surgical challenge.The OVESCO OTSC ® Proctology Clip (proctology clip) purports to offer improved preservation of the anal sphincter whilst at the same time curing the fistula by closure.Methods: A retrospective record review was conducted for patients who received the proctology clip as part of the management of fistula-in-ano in the Colorectal Unit at Wits Donald Gordon Medical Centre (WDGMC).Results: There were 19 cases of fistula-in-ano treated with the proctology clip.All were cryptoglandular in origin.The median age was 50 years (IQR 44-56 years) and post-procedure, the median follow-up duration was 145 days (IQR 63-298 days).Overall, 9 procedures were successful (47%).Success rates were higher for simple (66.7%) as opposed to complex (38.5%) fistula-in-ano.For patients who underwent placement of the proctology clip as a primary procedure, the success rate (50%) was slightly better than those who received the clip as a secondary procedure (44.4%). Conclusion:This preliminary data presents our initial experience using the proctology clip.While these data may serve as a "proof of concept", a multi-centre controlled trial comparing this method to the rectal mucosal advancement flap (RMAF) is needed to determine the role of the proctology clip in the management of fistula-in-ano.