scholarly journals A study on outcome of primary closure versus open fistulectomy in low level fistula in ano

2020 ◽  
Vol 7 (4) ◽  
pp. 1015 ◽  
Author(s):  
Maruti Basa ◽  
Karnati Prakash
Keyword(s):  
Primary Closure ◽  
Classical Method ◽  
Surgical Techniques ◽  
Healing Time ◽  
Fistula Tract ◽  
Fistula In Ano ◽  
Group I ◽  
Time Period ◽  
Surgical Units ◽  
Long Time

Background: Fistula-in-ano is one of the common ano-rectal disorder which causes appreciable morbidity and inconvenience to the patient. Different surgical techniques have been described in literature from time to time. Open fistulectomy though considered as the standard treatment for fistula in-ano, fistulectomy with primary closure has its merits of short hospital stay, early wound healing and lower costs. The objectives of this study was to compare the period of stay, period of healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique.Methods: Patients admitted in all surgical units of NIMRA Hospital, were included in the study without bias on a serial basis. This is a study comprising 50 patients over a period of 12 months from Febrauary 2019 to January 2020.Results: The patients were divided into two equal and comparable groups. Patients who underwent open fistulectomy were classified under Group I and those who underwent fistulectomy with primary closure were classified as Group II. The patient’s characteristics of the two groups were well matched.Conclusions: In patients treated by classical method because of long time taken to heal, number of hospital visits for dressings were more and more antibiotics were prescribed when compared to cases treated by excision of fistula tract and primary closure. From this study it can be concluded that fistulectomy with primary closure is ideal for low anal fistulaures.

scholarly journals A comparative study between fistulotomy and fistulectomy in management of low anal fistulae

2017 ◽  
Vol 4 (11) ◽  
pp. 3665 ◽  
Author(s):  
Ganesan R. ◽  
Karunakaran K. ◽  
Heber Anandan
Keyword(s):  
Wound Healing ◽  
Operating Time ◽  
Healing Time ◽  
Human Beings ◽  
Fistula In Ano ◽  
Post Surgery ◽  
Group I ◽  
Hospital Stays ◽  
Group Ii ◽  
Wound Healing Time

Background: Fistula in ano is a silent menace in human beings, the treatment is a challenging one even for experienced surgeons, fistula in ano forms a good majority of treatable benign lesions of rectum and anal canal. Aim was to study the efficacy of fistulotomy and fistulectomy in the treatment of low anal fistulae.Methods: A randomized control study was conducted to compare fistulotomy with fistulectomy in patients with low anal fistulae.Results: The operating time in fistulotomy group was 12.13minutes±2.11minutes and in fistulectomy group was 22.23±3.36minutes. The post-surgery hospital stays in Group I was 1.80±0.66days and in Group II was 2.60±0.563 days. The wound healing time in Group I was 24.20±2.95 days which was considerably less when compared to patients in Group II where it was 31.50±4.34 days.Conclusions: Fistulotomy has a slight edge over fistulectomy in the treatment of low anal fistulas since it has shorter operating time, less post-operative pain, less complications, quicker wound healing time, less incontinence and a comparable recurrence rate.

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 Ligation of the Intersphincteric Fistula Tract (LIFT) Technique in the Treatment of Complex Perianal Fistula: Experience of First 50 Cases

2020 ◽  
Vol 15 (1) ◽  
pp. 3-7
Author(s):  
Swapan Kumar Biswas ◽  
ASM Tanjilur Rahman ◽  
Muhammad Mofazzal Hossain ◽  
Saiful Islam Khan
Keyword(s):  
Tissue Injury ◽  
Surgical Techniques ◽  
Perianal Fistula ◽  
Healing Time ◽  
Good Choice ◽  
Fistula Tract ◽  
Common Disease ◽  
College Hospital ◽  
Recurrent Fistula ◽  
Intersphincteric Fistula

Perianal fistula is a common disease and surgery is the only treatment option. Many surgical techniques have been described. Ligation of intersphincteric fistula tract (LIFT) is a sphincter saving surgical technique in which fistula tract is ligated and excised through intersphincteric approach. The aim of study is to present our experience of first 50 LIFT procedures particularly healing rate, recurrence rate and complications from the procedure. This is a prospective observational study started from March 2018 on whom underwent LIFT procedure for primary complex perianal fistula of infective origin at Faridpur Central Hospital and Faridpur Medical College Hospital. In this study, 50 patients (42 male and 8 female) of average age of 39±7.6 years with complex fistula were included. The mean operative time was 34.7±5.67 minutes and most of the fistulas were transsphincteric variety (90%). Median wound healing time was 21.45±6.34 days for intersphincteric wound and 26.78±6.93 days for the external opening of the fistula. Mean follow up period was 10.5 months. Seven patients of our series developed recurrent fistula, making the overall success of 86%. None of the patient in our series developed incontinence. LIFT procedure has the advantage of preservation of anal sphincter, minimal tissue injury, shorter healing time, relatively easy to perform, and high success rate. It's a good choice for treatment of complex perianal fistula. Faridpur Med. Coll. J. Jan 2020;15(1): 3-7

scholarly journals Efficacy of cyanoacrylate glue in anal fistulas

2019 ◽  
Vol 6 (4) ◽  
pp. 1352 ◽  
Author(s):  
Santhosh Chikkanayakanahalli Shivashanka ◽  
Aruna Nayaka Nagaraja Nayaka ◽  
Mallikarjuna Manangi ◽  
Seshagiri Rao ◽  
Srinivas Nanjangud Masanashetty
Keyword(s):  
Surgical Techniques ◽  
Primary Treatment ◽  
Purulent Discharge ◽  
Anal Fistulas ◽  
Cyanoacrylate Glue ◽  
Excessive Bleeding ◽  
Fistula In Ano ◽  
Medical College ◽  
Surgical Units ◽  
Infection Recurrence

Background: Fistula in ano is a common problem. Surgical techniques such as fistulectomy, fistulotomy were associated with complications like excessive bleeding, infection, recurrence etc. The employment of cyano acrylate glue is one of the newer promising techniques. The aim of this study was to evaluate the efficacy of cyanoacrylate glue in the treatment of anal fistulas.Methods: Study was conducted on patients with fistula-in-ano admitted to various surgical units in hospitals attached to Bangalore Medical College and Research Institute from November 2016 to May 2018. A total of 30 patients fulfilling the criteria were included in the study. Under spinal anesthesia, patients were posted for the procedure. Post operatively the patients were examined every 2 weeks for the first 2 months, and then once every 3 months. If the fistula failed to heal with primary treatment at a 4-week interval, a second glue treatment was performed. Post-treatment the success of the procedure was assessed by the incidence of infection and recurrence.Results: Twenty two patients got healed with primary application with stoppage of any discharge from the fistulous track. Two patients required one more application, and one patient required fistulotomy. One patient developed complex fistulas and had to be treated with colostomy and fistulectomy. 4 patients developed purulent discharge after application of glue and were treated with IV antibiotics and healed completely.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to fistulectomy in patients with anal fistulas.

scholarly journals Comparative study on efficacy of fistulotomy and Ligation of intersphincteric fistula tract (LIFT) procedure in management of fistula-in-ano

2017 ◽  
Vol 4 (10) ◽  
pp. 3406
Author(s):  
Vinay G. ◽  
Balasubrahmanya K. S.
Keyword(s):  
Comparative Study ◽  
Anal Incontinence ◽  
Healing Time ◽  
Fistula Tract ◽  
Chi Square ◽  
Fistula In Ano ◽  
Chi Square Test ◽  
Average Operative Time ◽  
Rectal Cancers ◽  
Intersphincteric Fistula

Background: Fistula-in-ano is one of the most common benign anal conditions in daily surgical practice. Present study aims at comparing the efficacy of open fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure based on its post-operative outcomes.Methods: A comparative study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex diagnosed with anal fistula were included in the study. Patients with recurrent fistulas, Crohn’s disease, anal or distal rectal cancers were excluded from the study. Descriptive statistics, unpaired t-test, Fischer exact chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 44.6±8.34 and 41.3±9.71 years among fistulotomy and LIFT procedure group respectively. The gender distribution showed a higher number of males (38) as compared to females (12). There was 23 inter-sphincteric, 2 trans-sphincteric fistula in fistulotomy group and 22 inter-sphincteric, 3 trans-sphincteric fistula in LIFT group. The average operative time for fistulotomy was significantly shorter at 19.6 minutes, compared with 28.4 minutes for LIFT procedure. Wound infection detected in 1 (4%) and 2 (8%) subjects in fistulotomy and LIFT groups, respectively. 1 (4%) subject among fistulotomy group developed anal incontinence. The average healing time for fistulotomy was 8 weeks compared to 3 weeks for LIFT procedure. Total 3 (12%) subjects developed recurrence in LIFT procedure, but no recurrence was observed in fistulotomy group.Conclusions: LIFT procedure is effective and sphincter saving technique for fistula in ano with shorter healing time and lower incidence of postoperative anal incontinence, as compared to open fistulotomy. 

scholarly journals Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands

2021 ◽  
Author(s):  
L. Dekker ◽  
D. D. E. Zimmerman ◽  
R. M. Smeenk ◽  
R. Schouten ◽  
I. J. M. Han-Geurts
Keyword(s):  
The Netherlands ◽  
Outcome Measurement ◽  
Imaging Modality ◽  
Surgical Techniques ◽  
Advancement Flap ◽  
Patient Choice ◽  
Fistula Tract ◽  
Fistula In Ano ◽  
Internal Fistula ◽  
Anal Ultrasound

Abstract Background Management of cryptoglandular fistula-in-ano (FIA) can be challenging. Despite Dutch and international guidelines determining optimal therapy is still quite difficult. The aim of this study was to report current practices in the management of cryptoglandular FIA among gastrointestinal surgeons in the Netherlands. Methods Dutch surgeons and residents who are treating FIA regularly were sent a survey invitation by email. The survey was available online from September 19 to December 1 2019. The questionnaire consisted of 28 questions concerning diagnostic and surgical techniques in the treatment of intersphincteric and transsphincteric FIA. Results In total, 147 (43%) surgeons responded and completed the survey. Magnetic resonance imaging was the preferred diagnostic imaging modality (97%) followed by the endo-anal ultrasound (12%). In case of a high FIA, 86% used a non-cutting seton. Most respondents removed a seton between 6 weeks and 3 months (n = 84, 58%). Fistulotomy was the procedure of preference in low transsphincteric (86%) and low intersphincteric FIA (92%). Mucosal advancement flap (MAF) and ligation of intersphincteric fistula tract (LIFT), with 78% and 46%, respectively, were the procedures that were applied most often in high transsphincteric FIA. In high intersphincteric FIA 67% performed a MAF and 33% a fistulotomy. Thirty-three percent of all respondents stated that they habitually closed the internal fistula opening, half of them used a Z-plasty. For debridement of the fistula tract the preferred method was curettage (78%). Conclusions Dutch gastrointestinal surgeons use various techniques in the management of FIA. Novel promising techniques should be investigated adequately in sufficient large trials to increase consensus. A core outcome measurement and a prospective international database would help in comparing results. Until then, treatment should be adjusted to the individual patient, governed by fistula characteristics and patient choice.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Comparison of wavelet continuous transform and signal averaged ECG for high frequency content and late potential detection in healthy individuals

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Garcia Iglesias ◽  
J.M Rubin Lopez ◽  
D Perez Diez ◽  
C Moris De La Tassa ◽  
F.J De Cos Juez ◽  
...  
Keyword(s):  
High Frequency ◽  
Classical Method ◽  
Total Power ◽  
Frequency Content ◽  
Healthy Individuals ◽  
Time Frequency ◽  
Qt Intervals ◽  
Long Time ◽  
Power Content ◽  
High Frequency Content

Abstract Introduction The Signal Averaged ECG (SAECG) is a classical method forSudden Cardiac Death (SCD) risk assessment, by means of Late Potentials (LP) in the filtered QRS (fQRS)[1]. But it is highly dependent on noise and require long time records, which make it tedious to use. Wavelet Continuous Transform (WCT) meanwhile is easier to use, and may let us to measure the High Frequency Content (HFC) of the QRS and QT intervals, which also correlates with the risk of SCD [2,3]. Whether the HFC of the QRS and QT measured with the WCT is a possible subrogate of LP, has never been demonstrated. Objective To demonstrate if there is any relationship between the HFC measured with the WCT and the LP analyzed with the SAECG. Methods Data from 50 consecutive healthy individuals. The standard ECG was digitally collected for 3 consecutive minutes. For the WCT Analysis 8 consecutive QT complexes were used and for the SAECG Analysis all available QRS were used. The time-frequency data of each QT complex were collected using the WCT as previously described [3] and the Total, QRS and QT power were obtained from each patient. For the SAECG, bipolar X, Y and Z leads were used with a bidirectional filter at 40 to 250 Hz [1]. LP were defined as less than 0.05 z in the terminal part of the filtered QRS and the duration (SAECG LP duration) and root mean square (SAECG LP Content) of this LP were calculated. Pearson's test was used to correlate the Power content with WCT analysis and the LP in the SAECG. Results There is a strong correlation between Total Power and the SAECG LP content (r=0.621, p<0.001). Both ST Power (r=0.567, p<0.001) and QRS Power (r=0.404, p=0.004) are related with the SAECG LP content. No correlation were found between the Power content (Total, QRS or ST Power) and the SAECG LP duration. Also no correlation was found between de SAECG LP content and duration. Conclusions Total, QRS and ST Power measured with the WCT are good surrogates of SAECG LP content. No correlation were found between WCT analysis and the SAECG LP duration. Also no correlation was found between the SAECG LP content and duration. This can be of high interest, since WCT is an easier technique, not needing long recordings and being less affected by noise. Funding Acknowledgement Type of funding source: None

scholarly journals Internet page content analysis of north European Sea ports

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Olli-Pekka Hilmola ◽  
Andres Tolli ◽  
Ain Kiisler
Keyword(s):  
Content Analysis ◽  
Environmental Issues ◽  
Basic Design ◽  
Time Period ◽  
Long Time ◽  
Sea Ports ◽  
Selection Of

Abstract This study analyses 98 Internet pages of sea ports located in Sweden, Finland and Estonia during years 2017–2019. Aim of the study is to find, how website basic design is completed (colours and languages), how slogans, environmental issues, statistics and hinterland transports are reported. Based on the analysis, it appears as rather common that sea ports follow conservative selection of colours in their websites, where blue and white are clearly most popular. Typically, English and Swedish are as the most common used language, followed by Finnish, Russian and Estonian. In some rare cases, websites are offered in Chinese or German. Larger sea ports do have clear “slogans”, where smaller ones are just having lengthy justification for their existence. Environmental issues are increasing concern among sea ports, and these are mostly mentioned in details within Swedish actors. Providing statistics varies among companies, and in some sea ports these are provided from very long time period, where in others from just previous years or then only from last year (or even at all). It is common for companies to report that they have sustainable hinterland access, railway available.

scholarly journals The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Carlos Placer-Galán ◽  
Jose Mª Enriquez-Navascués ◽  
Tania Pastor-Bonel ◽  
Ignacio Aguirre-Allende ◽  
Yolanda Saralegui-Ansorena
Keyword(s):  
Systematic Review ◽  
Anal Fistula ◽  
Meta Analysis ◽  
Fistula Tract ◽  
Cochrane Library ◽  
Fistula In Ano ◽  
Intersphincteric Fistula ◽  
The Impact ◽  
Seton Placement ◽  
Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

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