scholarly journals Incision and drainage of perianal abscess with primary fistulotomy in case of co-existing low variety fistula

2020 ◽  
Vol 28 (1) ◽  
pp. 85-89
Author(s):  
Mohammad Nazmul Hoque Masum ◽  
Asif Yazdani ◽  
Md Shahnawas Biswas ◽  
Mohammad Masum ◽  
Masfique Ahmed Bhuiyan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Digital Rectal Examination ◽  
Perianal Abscess ◽  
Healing Time ◽  
Complete Healing ◽  
Repeat Surgery ◽  
Average Hospital ◽  
Incision And Drainage ◽  
Patient’S Satisfaction

Background: Perianal abscess is a clinical condition frequently encountered by surgeons. Perianal abscess originates from an infection arising in the cryptoglandular epithelium lining the anal canal. Occasionally; bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess. About half of perianal abscess may manifest as fistula-in-ano which increases the risk of abscess recurrence requiring repeated drainage. Treating the fistula at the same time of incision and drainage of abscess reduce chances of recurrent abscess development and therefore likelihood of repeat surgery. Primary fistulotomy in case of low variety fistula may be advantageous for perianal abscess because fistulas are more commonly traceable and can be laid open with full preservation of external anal sphincters. Methods: 216 consecutive patients (91.6% males, 8.33% females); mean age, 39 (range 18-70 years) from July, 2015 to January, 2019 with perianal abscesses were treated by incision and drainage and primary fistulotomy. 38 patients had comorbidities as diabetes mellitus, obesity (BMI>26), tuberculosis. Patients were followed up clinically for 2 months. Digital rectal examination performed to assess anal tone before, one week and one month after surgery. Results: Operative time was on average 17 minutes (15-20 minutes). Average hospital stay was 1 day and complete healing time ranged from 30-60 days. Persistent fistulas developed in four patients after surgery (1.85%). Bleeding occurred in 2 patients (1%). Many patients had transient minor incontinence in the form of flatus and loose stool incontinence but eventually resolved after two weeks. No major incontinence was found. Patient’s satisfaction of the treatment maneuver in relation to abscess recurrence and fistula occurrence was 95%. All patients remained fully continent. Operative time, hospital stay, and time for complete wound healing were the same in both groups. Conclusion: Primary fistulotomy for co-existing low variety fistula at the time of drainage of perianal abscess results in very few persistent fistulas and no added risk of fecal incontinence. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 85-89

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.

Day-Case Limberg Flap for Recurrent Pilonidal Sinus: Does Obesity Complicate the Issue?

2010 ◽  
Vol 76 (9) ◽  
pp. 995-999 ◽  
Author(s):  
Khaled M. Madbouly
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Operative Time ◽  
Day Surgery ◽  
Complete Healing ◽  
Limberg Flap ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Rhomboid Excision

The purpose of this study was to analyze the long-term outcome of rhomboid excision with Limberg flap reconstruction (LF) as one-day surgery in treatment of recurrent pilonidal sinus (RPS). The effect of obesity on outcome will be addressed. Forty-nine patients with RPS were treated by rhomboid excision and LF as one-day surgery. Data collected included demographics, body mass index, operative time, flap ischemia, wound infection, length of hospital stay, time of complete healing, and recurrence. Patients’ mean age was 33.4 years and mean number of previous operations was 3.4. Operative time ranged from 40 to 70 minutes. Two patients developed sterile seroma (4.1%) and two patients (4.1%) had wound infections. No wound dehiscence or flap ischemia was reported. All patients returned to normal activity within 7 days. No recurrences were reported after a mean follow-up of 32.1 months. Obesity significantly increased the operative time, however, it affected neither the postoperative outcome nor the long-term recurrence. Rhomboid excision and LF as one-day surgery is a safe and reliable method for treatment of RPS. It guarantees low morbidity, short hospital stay, short time off work, and carries low risk of recurrence, even in obese patients.

Analysis of treatment methods and outcomes for perianal abscess (PA) and fistula in ano (FIA) in infants

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (2) ◽  
Author(s):  
Michał Puliński ◽  
Natalia Hawryluk ◽  
Wojciech Choiński
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Retrospective Analysis ◽  
Perianal Abscess ◽  
Paediatric Surgery ◽  
Common Condition ◽  
Incision And Drainage ◽  
Treatment Methods ◽  
Fistula In Ano ◽  
Children's Hospital

Introduction. Perianal abscess (PA) is a relatively common condition in children and occurs in 0.5 to 4.3% of the infant population. In the majority of cases, it is associated with fistula in ano (FIA). Surgical treatment of FIA includes fistulectomy, fistulotomy or, rarely, cryptotomy. Aim. The aim of the study is to perform a retrospective analysis of treatment methods and outcomes for PA and FIA in infants at the Department of Paediatric Surgery and Urology of the Regional Specialised Children’s Hospital in Olsztyn, Poland, in 2014-2019. Material and methods. From January 2014 to December 2019, 44 infants with diagnosed PA and FIA were treated. The majority of patients were boys: 41 (93%) and only 3 (7%) were girls. For PA, three different treatment methods were used: incision and drainage, fistulotomy or fistulectomy. Results. Out of 44 treated infants with diagnosed PA and FIA, 29 were treated only by incision and drainage. Among them, 19 were cured. FIA was identified in 9 patients and fistulectomy or fistulotomy was performed. In this group, there was 1 recurrence, which was retreated with fistulectomy and cured. In 6 patients, PA drained spontaneously; in 3 of them there was recurrence and FIA was diagnosed during another hospital stay. There were 7 fistulotomies and 14 fistulectomies performed and their efficacy was 100 vs 93%, respectively. Conclusions. Fistulotomy is the most effective and safest method of FIA treatment in infants. In every case of perianal abscess diagnosis, a fistula in ano should be looked for.

scholarly journals Effect of marsupialization on the healing of fistulotomy wounds of simple anal fistula: a randomized control trial

2018 ◽  
Vol 5 (6) ◽  
pp. 2035
Author(s):  
Mohamed M. Raslan
Keyword(s):  
Postoperative Pain ◽  
Anal Fistula ◽  
Operative Time ◽  
Operating Time ◽  
Healing Time ◽  
Complete Healing ◽  
Female Ratio ◽  
Inadequate Sample Size ◽  
Male Female Ratio

Background: An anal fistula is traditionally treated by fistulotomy, adding marsupialization of fistulotomy wounds is optional. The aim of the current study was to compare the outcomes of fistulotomy with marsupialization and fistulotomy alone for simple anal fistula on healing rates and post-operative complicationsMethods: 50 patients with simple anal fistula randomly allocated to two groups fistulotomy alone group (F)and fistulotomy with marsupialization group(FM). The primary outcome was the healing time secondary outcomes included postoperative pain, operating time, incontinence and recurrence.Results: Mean age of group (F) patients was 37.55 ± 1.96 years with a male: female ratio of 19:6 while the mean age of group (FM) patients was 36.30 ± 3.03 years with a male: female ratio of 21:4. Mean operative time in the group (F) was 23.5±3.3 minutes while in the group (FM) It was 29.00± 4.595 minutes difference is statistically significant. Mean time for complete healing in group (F) was 6.9 ±0.73 weeks while in group (FM) was 4.80 ±0.96 weeks difference is significant statistically. Mean postoperative pain score by visual analogue scale in the group (F) was 3.4 ± 1.2 while in the group (FM) it was 3.3 ± 1.3 this difference is statistically non-significant. No recurrences or incontinence.Conclusions: Study demonstrated faster-wound healing when adding marsupialization to fistulotomy compared to fistulotomy alone. There is an increase operative time with marsupialization. This effect is minimal when compared with the benefits of enhanced healing. Limitations are mainly the inadequate sample size and inadequate follow-up period. 

scholarly journals A comparative study of collagenase ointment versus povidone-iodine dressing in non-healing ulcers

2017 ◽  
Vol 4 (6) ◽  
pp. 1992
Author(s):  
Amul Bhedi ◽  
Mithun Panchal ◽  
Hitesh Patel ◽  
Arnab Sarkar
Keyword(s):  
Hospital Stay ◽  
Povidone Iodine ◽  
Age Distribution ◽  
Complete Healing ◽  
Chi Square ◽  
Average Hospital ◽  
Female Ratio ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The aim of the study was to evaluate effect of collagenase ointment and povidone-iodine on non-healing ulcer in the form of duration of ulcer covered with red granulation tissue and total hospital stay.Methods: The Study was conducted on 80 patients admitted in Surgery Department, SSG Hospital and Medical College Baroda, Gujarat, India during November 2006 to October 2008. All ulcers due to trauma, chronic ulcer or infected ulcer following debridement and incision and drainage were included in this study. In group A were wounds dressed in collagenase ointment and in group B were wounds dressed in povidone-iodine ointment till second surgery or complete healing. All data from both groups were collected and analyzed by chi-square test.Results: In this study, there was no difference in age distribution (p=0.62, p>0.05) with similar male to female ratio in both groups and also no significant difference in distribution of wounds size in both groups (p=0.92, p>0.05). Average size of wound in group A was 43 sq. cm and group B was 44 sq. cm. The significant difference was seen on floor of ulcer by healthy granulation which came on an average of within 11days in group A and within 18 days in group B (p=0.005, p<0.05). There was also a significant difference in average hospital stay, which was 25 days in group A and 35 days in group B (p=0.01, p<0.05).Conclusions:Collagenase ointment is clinically more efficient as a topical dressing and lowers the morbidity by reducing the hospital stay and the duration of dressing by promoting healing in non-healing wounds than povidine-iodine ointment. 

scholarly journals Comparative evaluation of sublay versus onlay meshplasty in incisional and ventral hernias

2017 ◽  
Vol 5 (1) ◽  
pp. 187
Author(s):  
B. D. Dhaigude ◽  
Aneesh Sugunan ◽  
S. V. Pancbhai ◽  
Merry Francis ◽  
Keyur Patel ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Wound Dehiscence ◽  
Good Alternative ◽  
Related Complication ◽  
Average Hospital ◽  
Medical College ◽  
Group A ◽  
Group B ◽  
Duration Of Operation

Background: Hernia derived from the Latin word, is a protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity. Objectives of present study were to evaluate sublay Vs onlay meshplasty in incisional and ventral hernia and to compare and determine duration of operation and hospital stay, post-operative complications and recurrences.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2015 - September 2017) and is a prospective and comparative randomized type of study using 100 cases (Group A Onlay and Group B Sublay - 50 each). The study was approved by the Institute’s Ethics Committee.Results: 100 patients were operated in our study. In group B, the mean operative time [70.72±18.56], and in group A mean operative time (50.96±12.61). The duration of hospital stay was an of average 7.62±1.78 days in group B, and an average hospital stay of 8.84±1.89 in group A. Suture site infection was18%. group A (26%) and group B (12%). Seroma was seen in 5 patients, group A (8 %) and in group B (2%). Flap necrosis was 8% in group A and in 6% in group B. 10 patients had wound dehiscence, group A (14%) and group B (6%). 4 patients were reported with mesh infection (6%) in group A and (2%) in group B. Recurrence was 1% group A.Conclusions: Sublay meshplasty is good alternative to onlay meshplasty that may be applicable to all forms of ventral and incisional hernias. The mesh related complication rate and recurrence was found to be minimal.

PS01.245: COMPARISON OF ONCOLOGIC RESECTION OF LAPROSCOPIC VERSUS ROBOTIC VATS ESOPHAGECTOMY FROM A REGIONAL CANCER CENTER IN INDIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Swamyvelu Krishnamurthy
Keyword(s):  
Robotic Surgery ◽  
Hospital Stay ◽  
Operative Time ◽  
Conflicts Of Interest ◽  
Oncologic Outcomes ◽  
Robotic Arm ◽  
Cancer Center ◽  
Average Hospital ◽  
Lymph Node Yield ◽  
Vats Esophagectomy

Abstract Background Robotic surgery being a new technology in developing countries little is known about its oncological safety and outcome in esophageal surgeries. Methods We evaluated 46 consecutive patients of esophageal cancer who underwent laproscopic (n = 30) and Robotic VATS (Video Assisted Thoracic Surgery) (n = 16) esophagectomy, both with cervical anastomosis. All cases were operated by a single surgeon over a period of 2 years. Results 30 patients (18 male, 12 female), average age 54 years underwent laproscopic VATS procedure and 16 patients (8 male, 8 female), average age 57 years underwent Robotic VATS esophagectomy. Compared to laproscopic group, Robotic VATS procedure averaged a slightly longer operative time (190 mins versus 168 mins) with almost similar blood loss (160 ml versus 150 ml). Lymph node yield for Robotic procedure was slightly better than laproscopic group (18 versus 14.3). None of the patients in both groups had positive margins. 8 patients in laproscopic group and 4 in Robotic arm underwent Neo-adjuvant therapy. Clinical and pathologic staging was similar in both groups. Average hospital stay was better for Robotic arm (8 days versus 11 days). Conclusion Laproscopic and Robotic VATS esophagectomy yield almost similar peri-operative oncologic results with Robotic surgery taking slightly longer operative time but yielding better lymph nodes and shorter hospital stay in comparison to laproscopic arm. Shifting from laproscopic to Robotic surgery is easy and is non-inferior in terms of immediate oncologic outcomes. Disclosure All authors have declared no conflicts of interest.

scholarly journals Stuttering after Intravenous Anesthesia: A Case Report

2021 ◽  
Vol 59 (241) ◽  
pp. 929-931
Author(s):  
Suraj Lamichhane ◽  
Murari Raj Upreti ◽  
Yogesh Dhakal
Keyword(s):  
Case Report ◽  
Hospital Stay ◽  
Male Patient ◽  
Speech Therapy ◽  
Past History ◽  
Perianal Abscess ◽  
Speech Disorder ◽  
Intravenous Anesthesia ◽  
Incision And Drainage ◽  
Significant Challenge

Stuttering is a form of speech disorder characterized by involuntary prolongation and repetition of sound, words, syllables or phrases as well as involuntary silent pauses or blocks. We report a case of a healthy twenty-six-year-old male patient without significant past history, who underwent short intravenous anesthesia for incision and drainage for perianal abscess. Postoperatively, the patient presented with prominent stuttering after six hours of surgery. To our knowledge, this is the first reported case of stuttering following short intravenous anesthesia without any airway manipulation. He was diagnosed with a functional speech disorder after excluding organic causes. His speech eventually normalized with six weeks of intensive speech therapy. This event posed a significant challenge for the surgical and anesthesia team to find the potential cause, to plan further management, and lead to two days prolongation of hospital stay.

scholarly journals Karydakis Flap: A preferred procedure for Sacrococcygeal Pilonidal Sinus Disease (SPNSD).

2020 ◽  
Vol 27 (11) ◽  
pp. 2284-2288
Author(s):  
Durr-I- Chaman ◽  
Tayyaba Fatima ◽  
Muhammad Akram ◽  
Bashir Ahmed ◽  
Sajid Rehman ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Pilonidal Sinus Disease ◽  
Average Hospital ◽  
Surgical Department ◽  
Removal Time ◽  
Drain Removal ◽  
Flap Procedure ◽  
Rate Study

Objectives: To evaluate patients with SPNSD who underwent Karydakis Flap procedure with reference to operative time, drain removal time, hospital stay, complications and recurrence rate. Study Design: Prospective study. Setting: Surgical Department of Allied Hospital, Faisalabad. Period: September 2009 to January 2018. Material & Methods: A total of 117 patients underwent Karydakis Flap procedure. Data was collected according to the above said parameters .Patients were followed up for 12 months. Results:  The operative time was 35.5 minutes. Average Hospital stay was 2 days. Drain removed at median of 8 days.17 patients (14%) developed seroma. Wound Infection occurred in 5 patients (4%). Wound burst opened in 1 patient (0.8%).No recurrence was noted (0%) in any patient during a follow up of 1 year. Conclusion: Karydakis Flap procedure is a relatively simple and easy technique with minimal chances of recurrence.

scholarly journals LigaSure vessel sealing system versus conventional tools in Milligan and Morgan Haemorrhoidectomy: A Randomized control trial.

2020 ◽  
Vol 27 (04) ◽  
pp. 746-751
Author(s):  
Manzoor Ahmed ◽  
Mukhtar Mehboob ◽  
Fida Ahmed ◽  
Saleem Javeed ◽  
Abdullah Khan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Randomized Control Trial ◽  
Operative Time ◽  
Healing Time ◽  
Controlled Study ◽  
P Value ◽  
Vessel Sealing System ◽  
Vessel Sealing ◽  
Ligasure Vessel Sealing System ◽  
Randomized Control

Objectives: To evaluate the efficacy and safety of the LigaSure vessel sealing system in Milligan – Morgan Haemorrhoidectomy and compare to conventional tools. Study Design: Randomized control trial. Setting: Department of surgery Bolan University of Medical and Health Sciences at Sandeman (prov) Hospital Quetta. Period: January 2017 to June 2018. Material & Methods: Randomized controlled study designed for comparison was carried out. Total 86 patients of both gender had grade III and IV hemorrhoids were enrolled and randomly divided in two groups. LigaSure group and Conventional group. After obtained institutional permission and informed consent all patients were prepared for surgery as per unit protocol. Patients of both groups were evaluated for operative time, per operative bleeding, post-operative pain, hospital stay, wound healing time, and time return to work. Data collected and analyzed on SPSS version 20. Results: Total 86 patients enrolled for study 58 (66.4%) males and 28 (32.6%) females, age range 22-76 years. Patients randomly divided in LigaSure and conventional groups (43 in each group). Operative time and per operative bleeding was significantly less in LigaSure group as compared to conventional (P-Value, 0.001). Post-operative complications like pain and urine retention ware significantly less in LigaSure group (P-Value <0.001). Hospital stay, Healing time and return to routine life were significantly early in LigaSure group (p-Value <0.001). Conclusion: LigaSure sealing and cutting system is safe and effective tool in Milligan & Morgan Haemorrhoidectomy.

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