Ozone Treatment for Chronic Anal Fistula: It Is Not Promising
Received: 15 December 2015 /Accepted: 14 March 2016 /Published online: 21 March 2016
Association of Surgeons of India 2016
Abstract The aim of this study is to assess the effect of ozone
gas in the treatment of anorectal fistulae. The tip of a 20 G
intravenous cannula was inserted from the fistula orifice.
Medical ozone was introduced into the fistula. A total of 10
sessions of ozone gas insufflation was performed on alternate
days. Treatment was considered to be successful if fistula
discharge ceased and the outer fistula orifice closed; however,
if discharge was continued or outer fistula orifice was open,
the treatment considered to be failed. A total of 12 adult pa-
tients were included in the study. The fistula was closed in
three patients (25 %), in nine patients (75 %) without closure.
In one patient who had fistula closure, the fistula recurred after
2 months. Patients did not express any discomfort during
ozone insufflation. There were no side effects or complica-
tions due to ozone insufflation. The success rate of ozone
insufflation in anorectal fistulae closure is low.
Keywords Anorectal fistula
Anorectal fistula is an enterocutaneous fistula that develops
after spontaneous or surgical drainage of an anorectal abscess.
It causes discharge, moisture, and a recurrent abscess in
the perianal region. Spontaneous recovery cannot be ex-
pected. The main treatment for anorectal fistula is sur-
gery. The aim of treatment is to eliminate the fistula,
prevent recurrence, and maintain anal continence.
Postoperative recurrence and development of inconti-
nence are serious problems for these patients. Hence,
various treatments are being investigated for anorectal
Ozone is a natural gas composed of three oxygen
atoms. It is a powerful disinfectant, inactivating a large
number of pathogenic bacteria. It also offers recovery-
enhancing effects by stimulating cell proliferation [1,
2]. It has been demonstrated to be an effective, practical
antibacterial agent . Medical ozone is composed of
5 % ozone and 95 % oxygen. When dissolved in circu-
lating blood, it has antioxidant effects on many organs
and tissues through oxygen radicals and lipid oxidation
products. The mechanism of action of ozone in the body
has been described in detail in the literature [2, 4].
Ozone has been used to treat various diseases, includ-
ing infectious, ischemic, and neurodegenerative diseases;
cancers; autoimmune diseases; dental diseases; and de-
generative lumbar diseases . For treating those various
entities, ozone is supplied to the body in various ways:
intravenously, intramuscularly, subcutaneously, intraperi-
toneally, intrapleurally, intraarticularly, intralesionally, na-
sally, urethrally, and rectally [1, 2, 4].
Ozone gas has been used to treat some chronic in-
flammatory diseases similar to anorectal fistula disease
because of its healing effects [1, 2]. It has not, however,
been used to treat anorectal fistulas. In this prospective,
single-arm study, we aimed to assess the healing rate of
chronic anal fistulas in adult patients after ozone gas
insufflation to the fistula tract.
* Alaattin Ozturk
Department of General Surgery, Fatih University Medical Faculty,
Yal ı Mh. Sahilyolu Sk No: 16 Maltepe, 34844 Istanbul, Turkey
Department of Algology, Fatih University Medical Faculty, Yalı Mh.
Sahilyolu Sk No: 16 Maltepe, 34844 Istanbul, Turkey
Indian J Surg (August 2017) 79(4):308–311