scholarly journals A comparative study in the management of fistula in ANO using various modalities

2018 ◽  
Vol 5 (6) ◽  
pp. 2223 ◽  
Author(s):  
Ramachandra M. L. ◽  
Mayank Garg
Keyword(s):  
Fistulous Tract ◽  
Selection Method ◽  
Fistula Tract ◽  
Internal Opening ◽  
Necrotic Tissue ◽  
Fistula In Ano ◽  
Sphincter Function ◽  
Medical College ◽  
Operative Complications ◽  
Comparative Prospective Study

Background: Fistula in ano is a track that connects deeply the anal canal or rectum to the skin around the anus. Fistula in ano most commonly follows an anorectal sepsis1. The main principles of management of anal fistula are closure of internal opening of fistula tract, drainage of infection or necrotic tissue, and eradication of fistulous tract with preservation of sphincter function. The objectives were to compare the various aspects like per operative complications, post-operative complications, mean hospital stay in the treatment of fistula in ano using various modalities like fistulotomy, fistulectomy, setons and lift procedure.Methods: This is a randomised, comparative, prospective study of 80 cases of fistula in ano, presenting at surgical opd of K.R. Hospital, Mysore attached to Mysore Medical College and research Institute. Out of which, 20 cases are treated by fistulectomy, 20 by seton, 20 by fistulotomy and the rest 20 cases by LIFT procedure by random selection method, during period of NOVEMBER 1, 2016 to 31st October 2017.Results: Most common age of presentation is 31-40 years and more common in males then females (M:F= 2.3:1 ). Per operative complications include bleeding seen more in patients undergoing fistulectomy. Per operative course of LIFT procedure patients was complication free. Postoperative pain seen more in patients undergoing setons procedure.Conclusions: we conclude that LIFT procedure and Fistulotomy were acceptable procedures for simple, uncomplicated low lying and high lying fistula.

COMPARATIVE STUDY BETWEEN LIFT PROCEDURE VERSUS SETON PLACEMENT IN THE MANAGEMENT OF FISTULA IN ANO

2021 ◽  
pp. 61-64
Author(s):  
S. Yashwanth ◽  
T. Praneeth
Keyword(s):  
Postoperative Pain ◽  
Fistula Tract ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Medical College ◽  
Group 12 ◽  
Group A ◽  
Intersphincteric Fistula ◽  
Group B ◽  
Seton Placement

INTRODUCTION: A stula-in-ano, is a chronic abnormal communication, usually lined by granulation tissue, which runs outwards from the anorectal lumen. The standards of anal stula surgery are to obliterate the stula, prevent recurrence and maintain sphincter work. Ligation of Intersphincteric Fistula Tract (LIFT) is the most promising surgical technique based on secure closure of the internal opening and removal of the infected crypto glandular tissue through intersphincteric approach. AIMS: To compare the effectiveness of LIFT over SETON procedure based on Postoperative pain on day 1 and2, Short term recurrence, Healing, Procedural visits PATIENTS AND METHODS: A prospective, single centered, interventional study in 60 patients with stula-in-ano admitted to general surgical wards in Narayana Medical College and Hospital, Nellore. From November 2018 to November 2020. Patients were divided into two groups, group A including patients undergoing LIFT procedure and group B, including patients undergoing SETON placement of Fistula-in- ano. RESULTS: Maximum patients were in 41-60 years in the LIFT Group 18(60%), 51-60 years in the SETON group 12(40%). Maximum patients were male 21 in each group (70%), and female were 9 in each group (30%). In the present study, Visual Analog Scale (0,1,2,3) in LIFT group on POD 1, were 2, 20, 6, 2 and in SETON group on POD 1 were 0, 9, 16, 5 respectively. Similarly, visual analogue scale (0,1,2,3) in LIFT group on POD 2, were 19.8.3.0 and in SETON group on POD 2 were 5, 20, 5, 0respectively. Patients who underwent LIFT procedure had a satisfactory postoperative period and the wound healed in all the cases. CONCLUSION: we conclude that LIFT gives good outcomes in terms of Postoperative pain on day 1 and 2, wound healing rate, single time procedure and recurrence during our short follow-up period of 6 months.

scholarly journals Anal incontinence in patients with fistula-in-ano: a comparative study between LIFT (ligation of inter-sphincteric fistulous tract) and fistulectomy

2018 ◽  
Vol 5 (7) ◽  
pp. 2533
Author(s):  
Vijayalakshmi Vidyanendh ◽  
Amilthan Karunakaran ◽  
Arun Damodharan ◽  
Venkatesh Balaiah Karuppiah ◽  
Vaitheeswaran Madhesan
Keyword(s):  
Anal Incontinence ◽  
Controlled Trial ◽  
Fistulous Tract ◽  
Fistula Tract ◽  
Fistula In Ano ◽  
Sphincter Function ◽  
Standard Procedures ◽  
Group A ◽  
General Surgeons ◽  
Group B

Background: General surgeons perform surgeries for Fistula in ano day in and day out as elective procedures. Fistula in ano is more common nowadays because of improper hygiene. 3 major basic aims of Fistula in ano surgeries are control of sepsis closure of fistula and maintenance of continence. Post operatively some patients developed anal incontinence due to sphincter injury which affects patients’ day to day activity. The present study compared the utility and effectiveness of two standard procedures LIFT (Ligation of Intersphincteric Fistula Tract) and Fistulectomy in terms of anal incontinence.Methods: This study included 100 patients with fistula in ano during the 6 months period from January 2017 to June 2017. Randomized controlled trial was done to divide the patients into two groups. Group A underwent fistulectomy and Group B underwent LIFT (Ligaton of intersphincteric fistulous tract). Post-operative anal incontinence between the two groups were observed for 6 months.Results: In our study it was observed that four patients of group A (fistulectomy) had anal incontinence whereas no patients in group B (LIFT) developed anal incontinence.Conclusions: LIFT (Ligation of intersphincteric fistulous tract) is a better procedure when compared to fistulectomy in preserving sphincter function and preventing anal incontinence offering better quality of life.

scholarly journals Management of Complex Fistula in Ana with Fistulotomy and Stage Procedure

2018 ◽  
Vol 27 (1) ◽  
pp. 83-87
Author(s):  
MNH Masum ◽  
A Yazdani ◽  
M Masum ◽  
MS Biswas ◽  
MA Bhuiyan ◽  
...  
Keyword(s):  
Anal Verge ◽  
Advancement Flap ◽  
Single Stage ◽  
Fistula Tract ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Medical College ◽  
Stool Incontinence ◽  
Complex Fistula

Background: Complex fistula in ano is a troublesome disease and is difficult to treat. Complex fistula in ano occurs in various forms like multiple external and/or internal openings, internal opening above the dentate line, external opening far away from anal verge, anterior tract etc. They are almost invariably recurrent and frequently associated with other systemic diseases like tuberculosis, inflammatory bowel disease, malignancy etc.A complex fistula in ano has various modalities of treatments like application of setons, fistulotomy or fistulectomy, endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser and ligation of intersphincteric fistula tract (LIFT). Objective: The purpose of the study is to evaluate the outcome of complex fistula in ano by fistulotomy and staged procedure. Methods: The study was held in Dhaka medical college Hospital and various private hospitals located in Dhaka and Brahmonbaria within duration of 8 years (from January, 2011 to January, 2018). Among 256 patients (221 male, 35 female) with median age 48 years (30 to 72 years) with the diagnosis of complex fistula in ano, 135 underwent fistulotomy with application of Seton with stage procedure. 121 patients underwent single stage fistulotomy. 158 patients had history of previous operations. After stage procedure, regular follow up was done every week until wound healing occurred. Result: Among 256 patients 121 patients (47%) underwent single stage, 133 (52%) patients underwent two stage and 2 patients underwent three stage procedure during the trial period. Majority of the patients had minor incontinence; that is flatus and/or loose stool incontinence. But they only persisted for an average of 10 to 16 days and subsided spontaneously. None of the patient had any major (solid stool) incontinence. 4 patients (2%) had recurrence of fistula on an average of 3-6 months after complete healing. Recurrence occurred in the form of abscess, automatically burst internally, recurrent fistula.2 patients developed bleeding after single stage procedure and was managed by cauterization. Conclusion: With adequate postoperative care and regular follow up, application of Seton with ‘staged procedure’ in cases of complex fistula in ano is very effective and has very minimal complications. Chance of major incontinence and recurrence is also less. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 83-87

scholarly journals Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

2020 ◽  
Vol 7 (3) ◽  
pp. 721
Author(s):  
Davinder Koli ◽  
Pravin Kumar ◽  
Viraj Panda ◽  
Manu Vats
Keyword(s):  
Anal Fistula ◽  
Fistulous Tract ◽  
Significant Risk ◽  
Digital Rectal Examination ◽  
Fistula Tract ◽  
Internal Opening ◽  
Cyanoacrylate Glue ◽  
Fistula In Ano ◽  
Infant Feeding Tube

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

scholarly journals Outcome of Seton in the Management of Complex Fistula in Ano in a Tertiary Care Center in Bangladesh

2021 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Md Armanul Islam ◽  
Md Mahfuzur Rahman Khan ◽  
Md Mustafizur Rahman ◽  
SM Quamrul Akther ◽  
Md Mozammel Hoque ◽  
...  
Keyword(s):  
Anal Fistula ◽  
Care Center ◽  
Fistulous Tract ◽  
Tertiary Care ◽  
Fistula Tract ◽  
Internal Opening ◽  
Narcotic Analgesics ◽  
Cross Sectional ◽  
Fistula In Ano ◽  
Complex Fistula

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

scholarly journals A prospective interventional study of postoperative pain, healing rates and incontinence rates following ligation of intersphincter fistula tract procedure

2018 ◽  
Vol 5 (12) ◽  
pp. 3976
Author(s):  
Arunraj P. ◽  
Viswanathan M. S. ◽  
Anbazhagan R. ◽  
Kulwant Singh
Keyword(s):  
Wound Healing ◽  
Postoperative Pain ◽  
Anal Fistula ◽  
Fistula Tract ◽  
Fistula In Ano ◽  
Sphincter Function ◽  
Incontinence Score ◽  
Group A ◽  
Complete Wound Healing ◽  
Group B

Background: Fistula in ano is one of the oldest ailments known to us, troublesome both to the patient and also challenging to the treating surgeon. The treatment of fistula in ano has evolved so much, to reduce complications and to improve patient’s compliance. This study was conducted to compare the age old method of open fistulectomy to that of recently developed technique of ligation of intersphincter fistula tract (LIFT), in patients suffering from low fistula in ano.Methods: A totally of 80 patients, suffering from low anal fistula was divided randomly into two groups. Group A: undergoing LIFT procedure and Group B: undergoing open fistulectomy procedure .The two groups were compared in the postoperative period for wound healing, postoperative pain (by visual analog scale) and fecal incontinence (by Wexner incontinence score).Results: Group A patients who underwent LIFT at the end of 3rd postoperative week had a pain score of 0.43 when compared to group B patients (1.33) who underwent fistulectomy. Group A patients had 100% continence preservation, whereas a 17.5% of moderate incontinence was documented in Group B patients. About 97.5% of patients under Group A had complete wound healing by the 3rd postoperative week, as compared to group B patients, where100% complete wound healing was noted at 6 weeks, postoperatively.Conclusions: It was found that LIFT was a promising procedure in reducing the postoperative pain significantly, with better wound healing rates. It was effective in maintaining good sphincter function, thereby providing better faecal continence following surgery, in low anal fistula.

scholarly journals A prospective interventional study on ligation of intersphincteric fistula tract in patients with fistula-in-ano-as a tertiary care centre

2021 ◽  
Vol 8 (3) ◽  
pp. 968
Author(s):  
Pradeep Panwar ◽  
Richa Jain ◽  
Mohit Jain ◽  
Rajendra Bagree ◽  
Hetish M. Reddy ◽  
...  
Keyword(s):  
Anal Incontinence ◽  
Single Case ◽  
Fistulous Tract ◽  
Tertiary Care ◽  
Healing Time ◽  
Sphincter Preservation ◽  
Fistula Tract ◽  
Tertiary Care Centre ◽  
Fistula In Ano ◽  
Wound Healing Time

Background: Fistula-in-ano is a very common condition encountered in proctology OPD. The treatment of fistula-in-ano is difficult due to potential risk of recurrence and fecal incontinence. Ligation of Intersphincteric Fistulous Tract is new modality of treatment for the condition. LIFT is a sphincter preserving surgery, aim of our study to evaluate the effectiveness of LIFT surgery.Methods: We did LIFT surgery in 35 cases of intersphincteric and transsphincteric types of fistula-in-ano during the period of December 2019 to July 2020. Standard investigation protocol was followed in all cases. Evaluation of effectiveness of procedure done in terms of anal incontinence, wound healing time, recurrence rate and wound infection rate.Results: 35 patients (23 men, 12 women) were included with mean age of 40 SD 10.38 years. Most of study population have Inter sphincteric fistula (62.9%), and 37.1% participants have trans sphincteric fistula. Healing time was 10-15 days (42.9%) and mean healing time is 17 SD 4.25 days. We didn’t see a single case of anal incontinence with LIFT in our study. 6 cases of recurrence were seen.Conclusions: Result from our study showed that LIFT surgery is effective modality and fulfilling the outcome of sphincter preservation.

scholarly journals ROLE OF ASPHOTA (HEMIDESMUS INDICUS R.BR.) KSHARASUTRA IN THE MANAGEMENT OF LOW-ANAL FISTULA

2021 ◽  
Vol 9 (12) ◽  
pp. 2920-2932
Author(s):  
Rechana V. P. ◽  
Soumya V.V.
Keyword(s):  
Anal Fistula ◽  
Fistulous Tract ◽  
Burning Sensation ◽  
Dietary Habit ◽  
Fistula In Ano ◽  
Medical College ◽  
Hemidesmus Indicus ◽  
Digestive Disorder ◽  
Signed Rank ◽  
Modern Era

In this modern era, due to a sedentary lifestyle and improper dietary habit digestive disorder shows greater inci- dence. Among them, fistula-in-ano is troubleshooting one, which is a communicating tract between two epithelial surfaces lined by granulation tissues. Due to the higher recurrence rate and postoperative complication fistula-in- ano is a headache in the present era. In Ayurvedic classics, Ksharasutra prayoga is mentioned for the treatment of Nadi Vrana, which can be adopted in the management of anal fistula. The objective of the present study was to be evaluated the efficacy of Asphota Kshara sutra in the management of low anal fistula. The clinical trial was con- ducted in OPD and IPD of Shalyatantra department at Pankajakasthuri Ayurveda Medical College. The intervention was ligation of the fistulous tract with Asphota Ksharasutra. 25 subjects were selected satisfying inclusion and exclusion criteria. The clinical assessment was done before treatment, after treatment and follow up on the 30th day after cutting through of the tract. The assessment was done based on parameters prepared for anal fistula by Paul O Madson and Peter. Pain, burning sensation, inflammation, itching, discharge and unit cutting time was statistically analysed in different periods. Outcome variables were analysed statistically by using the Friedman test and Wilcox- son signed-rank rest, and a conclusion was drawn. Pain, burning sensation, inflammation, discharge, itching was effectively managed using Asphota Ksharasutra. The unit cutting time of Aspota ksharasutra was found to be more than standard Ksharasutra. The result showed that Aspota Ksharasutra is effective in the management of low anal fistula. Keywords: Fistula-in-ano; Asphota ksharasutra.

scholarly journals A comparative study of laying open of wound vs primary closure in low fistula in ano

2019 ◽  
Vol 6 (7) ◽  
pp. 2561
Author(s):  
Sushila Garag ◽  
Basavaraj Nagur
Keyword(s):  
Primary Closure ◽  
Postoperative Wound Infection ◽  
Recurrence Rates ◽  
Postoperative Wound ◽  
Feasible Method ◽  
Perianal Fistulas ◽  
Fistula In Ano ◽  
Medical College ◽  
Closure Method ◽  
Comparative Prospective Study

Background: Perianal fistulas remain a surgical treatment challenge in colorectal practice due to high recurrence rates and the risk of postoperative wound infection and incontinence. Anal fistula represents one of the most frequent anorectal diseases.Methods: This is a randomized comparative prospective study of 30 cases of fistula-in-ano presenting at the surgical OPD of Almeen Medical College and Research Institute from 1 September 2017 to 31 june 2018.Results: In our study the age of the patient varied from 25-60 years, patient’s wound healed in 3-4 weeks in those who underwent open fistulectomy, whereas in the primary closure method the wounds healed in 1-2 weeks. Recurrence of fistula occurred in 5 patients.Conclusions: The primary closure method of fistulectomy is a safe and feasible method and more effective in the management of fistula-in-ano.

scholarly journals Comparative study of MRI fistulogram and X-ray fistulography with operative findings: in fistula in ano

2019 ◽  
Vol 6 (5) ◽  
pp. 1704 ◽  
Author(s):  
Nishant Tripathi ◽  
Shahaji Chavan ◽  
Mahendra Bendre ◽  
Vishal Sharma
Keyword(s):  
Prospective Study ◽  
Fistulous Tract ◽  
Research Centre ◽  
College Hospital ◽  
Fistula In Ano ◽  
X Ray ◽  
Medical College ◽  
Group A ◽  
Group B ◽  
Operative Findings

Background: The current study has attempted to evaluate the effectiveness and diagnostic accuracy of MRI fistulogram over X-ray fistulography by comparing their findings with intraoperative findings.Methods: A hospital based prospective study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune with 60 patients to compare the findings of MRI fistulogram and X-ray fistulography with operative finding in fistula in ano. The study was carried out with following two groups of 30 patients each. Group A -30 cases underwent MRI fistulogram. Group B: 30 cases had done X-ray fistulography. Its findings were compared with the final findings of the operation.Results: On evaluation of the intra-operative findings with MRI fistulogram, we found that inter-sphincteric fistulous tract were noted in 23 patients as compared to 22 patients detected by MRI. In the rest of the findings the sensitivity of MRI with intraoperative findings was nearly 100% with a significant correlation. Sensitivity and specificity of X-ray fistulogram for fistula in ano was very low.Conclusions: The results have been statistically significant in providing data in favour of MRI fistulogram as diagnostically superior to X-ray fistulography.

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