scholarly journals Surgical management of chronic fourth degree perineal tear: a single center experience

2018 ◽  
Vol 7 (12) ◽  
pp. 4919
Author(s):  
Ramesh Kumar R ◽  
Seema Chigateri ◽  
Leena Kamat ◽  
Divya Divya
Keyword(s):  
Success Rate ◽  
Anal Sphincter ◽  
Significant Finding ◽  
Perineal Tear ◽  
Duration Of Symptoms ◽  
Fourth Degree ◽  
Single Center Experience ◽  
Satisfactory Outcome ◽  
Duration Of Surgery

Background: The aim of this article is to present the ridge about the recognition, preoperative management, surgical technique and long term follow up of patients with chronic fourth degree perineal tear.Methods: Authors conducted a prospective study in the department of obstetrics and gynecology in SDM hospital of medical sciences from 2008 January to 2016 December. Data on age, parity, incontinence to flatus, solid or liquids stools, duration of symptoms, history of previous repair, duration of repair, post-operative stay, complications and recovery were collected and analyzed. A total of thirty cases of chronic perineal tear were studied.Results: A total of 30 patients underwent CPT repair. Average duration of surgery was 90 minutes. 27 out of 30 patients were discharged on post-operative day 10. Three patients were non-compliant to treatment. Of the total 30 patients, two patients were lost for follow up. Overall success rate was 93% including patients who underwent re-surgery for failed repair.Conclusions: The significant finding of the present study was that a secondary repair of an anal sphincter injury was not associated with an unfavorable subjective outcome in relation to symptoms of anal incontinence. A good insight of perineal and anal sphincter anatomy and adherence to the sound principles is essential. The success rate in this study is 93.3% highlighting that a diligently performed operation by a surgeon of adequate expertise likely results in satisfactory outcome.

scholarly journals Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mahad Ali ◽  
Richard Migisha ◽  
Joseph Ngonzi ◽  
Joy Muhumuza ◽  
Ronald Mayanja ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Tertiary Hospital ◽  
Monthly Income ◽  
Obstetric Anal Sphincter Injuries ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Anal Sphincter Injury ◽  
Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

scholarly journals THE EXPERIENCE OF LIGATION OF INTERSPHINCTERICFISTULA TRACT IN THE TREATMENT OF PATIENTS WITH TRANS- AND SUPRASPHINCTERIC ANAL FISTULAE

2016 ◽  
pp. 47-53
Author(s):  
A. Yu. Titov ◽  
I. V. Kostarev ◽  
I. S. Anosov ◽  
O. Yu. Fomenko
Keyword(s):  
Success Rate ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Anorectal Manometry ◽  
Healing Rate ◽  
Fistula Tract ◽  
Anal Continence ◽  
Wexner Score ◽  
Is Evaluation

AIM. Ligation of intersphinctericfistllа tract (LIFT) is a new sphincter-preserving technique avoiding development of anal incontinence. The aim of the study is evaluation of effectiveness of this procedure. METHOD. From Jan 2013 to Dec 2015 40 patients with anal fistulae, exciting more than 30% of anal sphincter was included in the study. Male: 28 (70%), Female: 12 (30%). 29 (72,5%) cases were middle transsphincteric, 16 (22,5%) - deep transsphincteric and 2 (5%) was suprasphincteric. RESULTS. The median follow up was 16 months ((3-36) months). The healing rate was (72,5%). Recurrents developed in 5 (17,3%) patients with middle transsphincteric fistulae, 5 (55,6%) - with deep transsphincteric fistulae, and 1 (50%) with suprasphincteric fistulae. 4 patients developed an intersphincteric abscess. After excision of this fistulae healing occurred in all four cases. A second operation did not affect the function of anal continence. At follow-up there was no change in continence evaluated by Wexner score and anorectal manometry. CONCLUSION. LIFT has a high success rate in middle transsphinteric anal fistulae. Recurrence is related to deep portion fistulae or suprasphinteric fistula tract.

A Long-Term Follow-Up of the Effect of Repeated Corticosteroid Injections for Stenosing Tenovaginitis

1989 ◽  
Vol 14 (2) ◽  
pp. 242-243
Author(s):  
P. FAUNØ ◽  
H. J. ANDERSEN ◽  
O. SIMONSEN
Keyword(s):  
Success Rate ◽  
Single Injection ◽  
Adult Patients ◽  
Complete Relief ◽  
Duration Of Symptoms ◽  
Associated Diseases ◽  
Long Term Follow Up ◽  
Corticosteroid Injections

Ninety-three consecutive adult patients with stenosing tenovaginitis of 104 digits have been treated by corticosteroid injections repeated at three week intervals up to thrice in partial responders. At follow-up after 3–15 years, partial relapse had occurred in two patients, who now and then experienced triggering but without pain or locking. Complete relief of symptoms was obtained in 76%. There were no complications and the success rate was independent of sex, age, duration of symptoms, the digit involved, or associated diseases. These results are superior to those previously reported following a single injection.

Efficacy of Lift (Ligation of Intersphincteric Fistula Tract) for Complex and Recurrent Anal Fistulas - A Single-Center Experience and A Review of the Literature

2015 ◽  
Vol 86 (11) ◽  
Author(s):  
Michał Romaniszyn ◽  
Piotr Julian Walega ◽  
Wojciech Nowak
Keyword(s):  
Success Rate ◽  
Current Literature ◽  
Operating Time ◽  
Late Complications ◽  
Fistula Tract ◽  
Single Center ◽  
Anal Fistulas ◽  
Single Center Experience ◽  
Intersphincteric Fistula

AbstractLigation of intersphincteric fistula tract in treatment of anal fistulas (LIFT) is being said to have satisfactory results in short and long follow up, with low risk of complications. This study was designed to evaluate the results in patients with complex and recurrent fistulas in comparison with simple transsphincteric anal fistulas.was to present a single-center experience in LIFT procedure in treatment of both simple and complex anal fistulas, including recurrent fistulas, in comparison with a review of current literature.A series of 17 patients were qualified to LIFT procedure. 5 patients were treated for simple transsphincteric, 6 for complex fistulas, 6 with fistulas recurrent after fistulotomy. Median age was 47, most of the patients were male (16/17). Mean follow up was 11 months.Mean operating time was 55 minutes counting from surgical site disinfection to final dressing of the wound. Of the 17 patients the overall success rate was 53%. As expected, best results were achieved in patients with simple fistulas (80% success rate), then complex (50%), and recurrent fistulas (only 33%). There were no early nor late complications of the surgery.As expected, in simple transsphincteric fistulas the results were satisfactory, taking into account low complication rate. Complex and recurrent fistulas seem to be risk factors of LIFT failure. The results are consistent with data published by other authors, based on the review of the current literature, and it seems there is still room for improvement, so further research is required.

Penetrating deep sclerectomy in primary open-angle and pseudoexfoliative glaucoma

2019 ◽  
Vol 30 (2) ◽  
pp. 264-268
Author(s):  
Vassilios Kozobolis ◽  
Eleni Kalogianni ◽  
Haris Sideroudi
Keyword(s):  
Intraocular Pressure ◽  
Success Rate ◽  
Open Angle Glaucoma ◽  
Positive Outcome ◽  
Deep Sclerectomy ◽  
Open Angle ◽  
Pseudoexfoliative Glaucoma ◽  
Satisfactory Outcome ◽  
Department Of Ophthalmology

Purpose: To evaluate the outcomes of a new antiglaucoma surgical method, a modification of the standard deep sclerectomy, the penetrating deep sclerectomy. Participants: Patients with medically uncontrolled primary open-angle glaucoma or pseudoexfoliative glaucoma were prospectively, in a consecutive way, enrolled in this study. Methods: The study was conducted in Glaucoma Unit, Department of Ophthalmology, University of Hospital of Alexandroupolis, Greece, in 29 eyes of 29 patients. In a fornix-based surgical procedure, all eyes underwent the proposed penetrating deep sclerectomy (deep sclerectomy plus trabeculectomy) with the use of mitomycin C applied intraoperatively (0.2 mg/mL for 2 min). The follow-up period was 3 years. Ocular examination was conducted before the operation and at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. Results: The average reduction in intraocular pressure at the end of follow-up was 11.24 (57.88%). The complete success rate (intraocular pressure ⩽21 mm Hg without medication) after 3 years was 58.6%. The qualified success rate (intraocular pressure ⩽21 mm Hg without or with medication) was 75.86%. Postoperatively, the mean number of medication dropped from 3.75 ± 0.89 to 0.89 ± 0.98. Low postoperative complications were recorded. Conclusion: During the 3-year follow-up period, penetrating deep sclerectomy presented very positive outcome. The addition of a controlled perforation of the trabeculo-Descemet’s membrane in deep sclerectomy, playing the role of an early goniopuncture, seems to ensure a satisfactory outcome and is not associated with additional complications.

How effective is cyanoacrylate closure in small saphenous vein insufficiency? A single center experience

Vascular ◽  
2021 ◽  
pp. 170853812110514
Author(s):  
Görkem Yiğit
Keyword(s):  
Success Rate ◽  
Saphenous Vein ◽  
Treatment Method ◽  
Technical Failure ◽  
Single Center ◽  
Single Center Experience ◽  
Kaplan Meier ◽  
The Mean ◽  
Anatomic Success

Objectives The present study was aimed to evaluate the efficacy and early outcomes of n-butyl cyanoacrylate (NBCA) ablation in small saphenous vein (SSV) insufficiency. Methods In this single-center, retrospective, single-arm study, NBCA ablation was performed in 80 patients with SSV insufficiency between September 2018 and May 2020. Primary outcomes (anatomic success rate and occlusion rate) and secondary outcomes (VCSS and AVVQ scores) of the patients were analyzed. Results No technical failure and device-related complications were encountered. Anatomic success rate was 100% after procedures. Each treated SSV was occluded on colored Doppler ultrasonography immediately after the procedure, and all veins remained occluded at 2 weeks after the procedure. Partial recanalization was observed in five patients at 12-month follow-up. Kaplan–Meier analysis revealed an occlusion rates at 6 months and 12 months follow-up were 97.5% and 93.75%, respectively. The mean pretreatment VCSS (4.72 ± 2.04) decreased to 1.61 ± 0.93, 0.87 ± 0.58, and 0.73 ± 0.52 at 2 weeks, 6 months, and 12 months after treatment, respectively ( p < .001). The mean pretreatment AVVQ score (11.92 ± 2.23) decreased to 8.2 ± 1.89, 4.2 ± 1.16, and 3.32 ± 1.19 at 2 weeks, 6 months, and 12 months after treatment, respectively ( p < .001). The Clinical, Etiologic, Anatomic, and Pathophysiology clinical classification at 12 months demonstrated a significant reduction in disease severity compared with preoperative values ( p < .001). There was no mortality and major adverse events including anaphylaxis and pulmonary thromboembolism (PTE) related to procedure after follow-ups. Moreover, there were no symptoms or signs of any sural nerve injury and no cases of skin necrosis, infection, or hyperpigmentation. In addition, no hematoma, deep venous thrombosis, and hypersensitivity reactions were observed. Phlebitis-like abnormal reaction was observed in three patients (3.8%). Conclusions In conclusion, in patients with SSV insufficiency, NBCA ablation with VenaBlock® system appears to be an effective and reliable treatment method. At the 12-month follow-up, the NBCA of SSVs showed a low recanalization rate and had a satisfactory improvement on the VCSS and AVVQ scores.

A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears

2021 ◽  
pp. 1-11
Author(s):  
Saida Abrar ◽  
Raheela Mohsin Rizvi ◽  
Urooj Kashif ◽  
Admin
Keyword(s):  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Suture Material ◽  
Clinical Audit ◽  
University Hospital ◽  
Absorbable Suture ◽  
Fourth Degree ◽  
Absorbable Suture Material ◽  
Vaginal Deliveries

Abstract Objective: To perform a clinical audit of the practices of third and fourth degree preineal tears management in our institution. Methods: A review of  medical records was performed, of women having singleton term vaginal delivery sustaining obstetric anal sphincter injuries (OASIS) at Aga Khan University Hospital (AKUH), Karachi from January 2008 to December 2018. We compared the change in practices regarding management of OASIS with the results of our previous study done at AKUH in 2008. Results: The frequency of  OASIS in our department is 0.56% (142/25370). The documentation of OASIS improved compared to previous study ( 20.7% to 87%). There was also a significant increase in documentation of the method of repair, use of delayed absorbable suture material for the repair of external anal sphincter and follow-up at 06 weeks to see the success of repair and plan next delivery. The use of vaccum vaginal delivery increased to 27(19%) from 5(4%) but there was decrease in the OASIS complicated by instrumental vaginal deliveries, which may be due to the decrease in the use of forceps from 64% to 26%. Conclusions: Despite of increase in the  number of deliveries , frequency of OASIS remained similar to the previous study. There was a significant increase in the vaccum vaginal delivery, documentation of degree of tears, use of delayed absorbable suture material and long-term follow-up and decrease in the use of forceps. The compliance to international guideline increased as compared to our previous paper. Continuous...

scholarly journals Management of fourth degree obstetric perineal tear without colostomy using non - stimulated gracilis - our experience over eleven years

2016 ◽  
Vol 49 (01) ◽  
pp. 26-34
Author(s):  
Jiten Kulkarni ◽  
Anuradha J. Patil ◽  
Bhaskar Musande ◽  
Abhishek B. Bhamare
Keyword(s):  
Faecal Incontinence ◽  
Digital Rectal Examination ◽  
Gracilis Muscle ◽  
Vaginal Fistula ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Grade Ii ◽  
Manometric Studies

ABSTRACTBackground: Although gracilis muscle transposition for faecal incontinence has been well-described method, its literature for use in obstetric perineal tear without colostomy is sparse. In this study, we have tried to analyse its use in fourth-degree obstetric perineal tears. Patients and Methods: A total of 30 patients with recto-vaginal fistula with faecal incontinence secondary to obstetric perineal tear were retrospectively studied between February 2003 and May 2014. The recto-vaginal fistula was explored, dissected and identification of sphincters was done using muscle stimulator. Fistula closure was done followed by sphincter repair, vaginal tightening procedure and single gracilis transposition. None of the patients had covering colostomy. Faecal incontinence was assessed pre- and post-operatively by digital rectal examination (single examiner), Park's score and Corman's score in all cases and using barium hold and transperineal ultrasonography, manometric studies in a few cases. The outcome was measured at an average follow-up of 8.8 months (7–24 months). Results: As per Park's score 26 patients had Grade I continence, two had Grade II and two patients had Grade III continence. Corman's score improved from fair to excellent in 26 patients. The patients in whom manometry was performed showed a remarkable rise in both resting and squeeze pressures. Two patients developed post-operative infections in upper 1/3 thigh incision site and three patients at gluteal region scar site. Conclusion: Satisfactory continence following gracilis muscle could be achieved.

scholarly journals Surgery for Renal Hyperparathyroidism in the Era of Cinacalcet: A Single-Center Experience

2020 ◽  
pp. 145749691989700
Author(s):  
M. T. Mogl ◽  
T. Skachko ◽  
E. M. Dobrindt ◽  
P. Reinke ◽  
C. Bures ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Cardiovascular Complications ◽  
Kidney Graft ◽  
Renal Hyperparathyroidism ◽  
Single Center Experience ◽  
Duration Of Surgery ◽  
Few Data ◽  
Demographical Data

Background and Aims: There are only few data on the influence of cinacalcet on the outcome of parathyroidectomy in patients with renal hyperparathyroidism. Indication and timing of surgery have changed since its introduction, especially with regard to kidney transplantation. Therefore, we retrospectively analyzed patients undergoing parathyroidectomy for renal hyperparathyroidism in our institution. Material and methods: Between 2008 and 2015, 196 consecutive operations in 191 patients were analyzed. About 80 operations (41%) were performed in patients receiving cinacalcet compared with 116 operations (59%) in patients without cinacalcet. Clinical data, preoperative medication, pre- and postoperative laboratory values, type and details of surgery including complications, as well as cardiovascular complications and kidney transplantation with graft function were recorded. Results: Demographical data were similar in patients with or without cinacalcet treatment. A total of 54% of patients received a kidney graft before or after parathyroidectomy. Pre- and postoperative parathormone levels were similar in both groups (preoperatively 755 vs 742 ng/L, postoperatively 50 vs 46 ng/L, p > 0.10), whereas patients with cinacalcet showed significantly lower calcium levels preoperatively (2.28 vs 2.41 mmol/L, p = 0.0002). There was no difference in recurrence or persistence of hyperparathyroidism, duration of surgery, hospital stay, or complication rate. Creatinine levels in patients with tertiary hyperparathyroidism were similar after 1-year follow-up. Conclusion: Cinacalcet did not influence outcome of patients with parathyroidectomy for renal hyperparathyroidism and can be safely offered to patients not responding to medical treatment.

scholarly journals A Friendly Approach to Repair Fourth Degree Perineal Tears

2014 ◽  
Vol 41 (2) ◽  
pp. 31-33
Author(s):  
RA Khanam ◽  
N Sultana ◽  
A Rubaiat ◽  
B Ahmed ◽  
N Sayeeda ◽  
...  
Keyword(s):  
Faecal Incontinence ◽  
Traditional Approach ◽  
Rectal Mucosa ◽  
Perineal Tear ◽  
College Hospital ◽  
Fourth Degree ◽  
Medical College ◽  
Perineal Tears ◽  
Group B

To make the gynaecologists familiar with the procedure of continuous repair of rectal mucosa and repair the anal sphincter by other than figure of 8 suture and to compare the effectiveness of these procedures with the traditional procedures this study was planned. This was a observational comparative study. This study was carried out in one public medical college hospital and two private hospitals in Dhaka city and out side. Total 18 (Eighteen) patients were included in this study . Age, parity, residence were different but all had fourth degree perineal tear. Tears were repaired by traditional approach in half of the patients who were grouped under A and with the new approach in another half, grouped under B. Follow up was carried out at an interval of 6 weeks, 12 weeks, 24 weeks in both groups and the findings were compared. Among 18 patients a large number of women were mother of one child and were of 21 -25 years age group. At post operative period - wound infection was nil. Perineums were well established in all cases. On follow up at 24th week-pain in perineum and dyspareunia was nil in all cases, though this was present at early weeks in few cases. Faecal incontinence was absent in any patient by 24 weeks postoperatively. In early follow up periods there were some faecal incontinence, pain and dyspareunia in group A but les with group B. So, continuous repair of anal mucosa and repair anal sphincters other than figure of eight seems better regarding technical easiness, better compliance for the surgeon and less traumatic to the rectal mucosa and ultimately better results. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18803 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 31-33

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