scholarly journals COMPARISON OF MODIFIED METHOD OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) AND STANDARD OPERATIONS IN PATIENTS WITH TRANSSPHINCTERIC RECTAL FISTULAS

2019 ◽  
Vol 6 (2) ◽  
pp. 82-87
Author(s):  
Igor Kryvoruchko ◽  
Tetiana Firsyk ◽  
Oleksandr Bozhko
Keyword(s):  
Surgical Treatment ◽  
Anal Sphincter ◽  
Standard Procedure ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Modified Method ◽  
Intersphincteric Fistula ◽  
Sphincter Insufficiency ◽  
Standard Operations

COMPARISON OF MODIFIED METHOD OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) AND STANDARD OPERATIONS IN PATIENTS WITH TRANSSPHINCTERIC RECTAL FISTULAS Kryvoruchko I.A. , Firsyk T.M.,.  Bozhko O. P. Background. The search for and development of new minimally invasive methods for the surgical treatment of anal fistulas is a relevant area of surgery. Such methods combine less traumatization and preservation of the sphincter’s complex. Employment of such methods for surgical treatment of anal fistulas reduced the time of stay of patients in the hospital and improved their quality of life. Subjects and methods. A retro- and prospective study involved 58 patients with uncomplicated transsphincteric anal fistulas. All patients were treated in the hospital from January 2014 to April 2019.  The patients were divided into two groups: the first group included 32 patients who were operated on according to the standard procedure using fistulotomy and Seton procedure; the second group consisted of 26 patients who were operated on using the modified LIFT method. Results. Most of these patients (72.4%) were men at the age of 42.536.79. The median of BMI was 25.7 kg/m2. There wasn’t mortality after operations. The median follow-up was 21 (6-48) weeks. In the first group there were 3 cases (9.3%) of anal sphincter insufficiency and 7 cases of recurrent fistulas (21.9%) at different times after surgery.  In the second group there were no anal sphincter failure following administration of the modified method LIFT, but there were 15.4% of recurrent anal fistulas. Conclusion. The proposed modified method of ligation of intersphincteric fistula tract is an effective method for the treatment of anal fistulas. The results obtained suggest that the developed method can be used to treat other types of anal fistulas.  Keywords: transsphincteric anal fistula, surgical treatment, LIFT technique, postoperative complications.   Резюме. ПОРІВНЯННЯ МОДИФІКОВАНОГО МЕТОДУ ЛІГАЦІЇ ІНТЕРСФІНКТЕРНОГО  ФІСТУЛЬНОГО ТРАКТУ (LIFT) ТА СТАНДАРТНИХ ОПЕРАЦІЙ У ХВОРИХ З ТРАНСФІНКТЕРНИМИ РЕКТАЛЬНИМИ СВИЩАМИ Криворучко I.A., Фірсик Т.М., Божко О. П. Вступ. Пошук та розробка нових малоінвазивних методів хірургічного лікування анальних свищів є актуальною областю хірургії. Такі методи поєднують меншу травматизацію і збереження сфінктерного комплексу прямої кишки. Застосовання таких методів хірургічного лікування анальних свищів скоротило час перебування хворих у стаціонарі і поліпшило їх якість життя. Об'єкт  і методи.  Ретро- і проспективне дослідження було проведено у 58 пацієнтів з неускладненими транссфінктерними анальними свищами. Всі пацієнти проходили лікування в лікарні з січня 2014 року по квітень 2019 року. Пацієнти були розділені на дві групи: перша група включала 32 пацієнтів, яких оперували за стандартною процедурою з використанням фістулотомії та процедури Сетона; другу групу склали 26 хворих, яких оперували за допомогою модифікованого нами способу лігування інтрасфінктерного фістульного тракту (LIFT). Результати. Більшість цих пацієнтів (72,4%) були чоловіками у віці 42,536,79  років.  Медіана ІМТ склала 25,7 кг/м2.  Після операцій летальних випадків не було. Медіана спостереження після операції склала 21 (6-48) тиждень. У першій групі ми отримали 3 випадки (9,3%) недостатності анального сфінктеру і у 7 випадках  рецидив свищів (21,9%) в різний час після операції. У другій групі після застосування модифікованого методу LIFT ми не отримали жодної недостатності анального сфінктеру, але у цих пацієнтів спостерігалося 15,4% рецидивів анальних свищів. Висновок. Запропонований модифікований спосіб лігування інтрасфінктерного фістульного тракту є ефективним методом лікування анальних свищів. Отримані результати свідчать про те, що розроблений метод може бути використаний для лікування інших видів анальних свищів. Ключові слова: транссфінктерні анальні свищі, хірургічне лікування, техніка LIFT, післяопераційні ускладнення.   Резюме. СРАВНЕНИЕ МОДИФИЦИРОВАННОГО МЕТОДА ЛИГАЦИИ ИНТЕРСФИНКТЕРНОГО ФИСТУЛЬНОГО ТРАКТА (LIFT) И СТАНДАРТНЫХ ОПЕРАЦИЙ У БОЛЬНЫХ С ТРАНСФИНКТЕРНИМЫ РЕКТАЛЬНЫМИ СВИЩАМИ Криворучко I.A., Фирсик Т.М., Божко А. П.  Введение. Поиск и разработка новых малоинвазивных методов хирургического лечения анальных свищей является актуальной проблемой хирургии. Такие методы сочетают в себе меньшую травматизацию и сохранение сфинктерного комплекса прямой кишки. Применение таких методов хирургического лечения анальных свищей сократило время пребывания больных в стационаре и улучшило их качество жизни. Объект и методы. Ретро- и проспективное исследование было проведено у 58 пациентов с неосложненными транссфинктерными анальными свищами. Все пациенты проходили лечение в больнице с января 2014 по апрель 2019 года. Пациенты были разделены на две группы: первая группа включала 32 пациентов, оперированных по стандартной процедуре с использованием фистулотомии и процедуры Сетона; вторую группу составили 26 больных, оперированных с помощью модифицированного нами способа лигирования интрасфинктерного фистульного тракта (LIFT). Результаты. Большинство этих пациентов (72,4%) были мужчинами в возрасте 42,536,79 лет. Медиана ИМТ составила 25,7 кг/м2. После операций летальных исходов не было. Медиана наблюдения после операции составила 21 (6-48) неделю. В первой группе мы получили 3 случая (9,3%) недостаточности анального сфинктера и в 7 случаях  рецидив свищей (21,9%) в разное время после операции. Во второй группе после применения модифицированного метода LIFT мы не получили ни недостаточности анального сфинктера, но у этих пациентов наблюдалось 15,4% рецидивов анальных свищей. Вывод. Предложенный модифицированный способ лигирования интрасфинктерного фистульного тракта является эффективным методом лечения анальных свищей. Полученные результаты свидетельствуют о том, что разработанный метод может быть использован для лечения других видов анальных свищей. Ключевые слова: транссфинктерные анальные свищи, хирургическое лечение, техника LIFT, послеоперационные осложнения

scholarly journals MODIFIED METHODS OF SURGICAL TREATMENT REST OF THE RECT

2020 ◽  
pp. 151-155
Author(s):  
I. A. Kryvoruchko ◽  
I. V. Sorokina ◽  
K. Y. Parkhomenko ◽  
T. N. Firsik ◽  
A. P. Bozhko
Keyword(s):  
Surgical Treatment ◽  
Anal Fistula ◽  
Fistula Tract ◽  
Rectal Fistula ◽  
Complete Excision ◽  
Modified Method ◽  
Minimal Damage ◽  
Significant Addition ◽  
Standard Techniques

Summary. The use of mini-invasive technologies for the treatment of rectal fistula prevents many postoperative complications. Complete excision of the rectal fistula is not the only important result of treatment. Ensuring a high quality of life for patients is also very important. The proposed methods of surgical correction are a significant addition to the list of existing operations. Objective. To compare and analyze the results of the treatment patients with anal fistula by using standard techniques, the modified method LIFT and excision anal fistula with biowelding. Materials and methods. A retro- and prospective study of the surgical treatment of 90 patients with uncomplicated transsphincteric anal fistula using different techniques from September 2018 to February 2020 was conducted. Results. The introduction of these methods has shown a decrease in the number of relapses. This was achieved by combining complete excision of the fistula tract and minimal damage to the sphincter complex. Conclusion. The use of combined methods of surgical treatment of rectal fistula has significant advantages over standard techniques.

scholarly journals Diagnostic and the surgical treatment tactics in the rectal mucosa prolapse with the anal sphincter insufficiency

2021 ◽  
Vol 88 (5-6) ◽  
pp. 8-11
Author(s):  
S. S. Imanova
Keyword(s):  
Surgical Treatment ◽  
Anal Sphincter ◽  
Rectal Mucosa ◽  
Functional Results ◽  
Women Patients ◽  
Treatment Results ◽  
Submucosal Injection ◽  
Life Improvement ◽  
Sphincter Insufficiency

Objective. To improve the results of diagnosis and surgical treatment of rectal mucosa prolapse, complicated by the anal sphincter insufficiency. Materials and methods. Analysis of the diagnosis and surgical treatment results in the rectal mucosa prolapse with the anal sphincter insufficiency was done in 23 patients, ageing 31 - 65 yrs old and the age median (41.5 ± 1.8) yrs old, of them 17 women-patients. Results. There was revealed, that most frequently and in mostly progressive forms the rectal mucosa prolapse with the anal sphincter insufficiency occurs in women, aged more than 36 yrs old. Conclusion. Miniinvasive transanal operations, submucosal injection procedures and sphincteroplasty “end-to-end” were used predominantly, owing less morbidity potency (26.1%), favorable remote functional results - the recurrence rate lowering (4.3%), the fecal incontinence degree lowering (78.6%), and the patients’ quality of life improvement.

scholarly journals Simple fistula-in-ano: is it all simple? A systematic review

2021 ◽  
Author(s):  
F. Litta ◽  
A. Parello ◽  
L. Ferri ◽  
N. O. Torrecilla ◽  
A. A. Marra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Fecal Incontinence ◽  
Anal Fistula ◽  
Randomized Clinical Trials ◽  
Weighted Average ◽  
Anal Fistulas ◽  
Postoperative Continence ◽  
Average Success Rate

Abstract Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

scholarly journals Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results

2014 ◽  
Vol 27 (2) ◽  
pp. 101-103 ◽  
Author(s):  
Sergio Danilo Tanahara TOMIYOSHI ◽  
Carlos Henrique Marques DOS SANTOS
Keyword(s):  
Fecal Incontinence ◽  
Anal Fistula ◽  
Anorectal Manometry ◽  
Fistulous Tract ◽  
Complete Healing ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Intersphincteric Fistula ◽  
The Mean ◽  
Initial Results

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.

scholarly journals THE EFFICIENCY OF THE LIGATION OF INTERSPHINCTERIC FISTULA TRACT IN THE TREATMENT OF TRANSSPHINCTERIC ANAL FISTULAS

2018 ◽  
Vol 67 (3) ◽  
pp. 99-102
Author(s):  
V.V. Homochkin ◽  
◽  
S.S. Maskin ◽  
N.V. Homochkina ◽  
YU.V. Perov ◽  
...  
Keyword(s):  
Fistula Tract ◽  
Anal Fistulas ◽  
Intersphincteric Fistula

Ligation of intersphincteric fistula tract procedure for the management of cryptoglandular anal fistulas

2012 ◽  
Vol 16 (3) ◽  
pp. 120-121 ◽  
Author(s):  
Oswens S.H. Lo ◽  
Rockson Wei ◽  
Dominic C.C. Foo ◽  
W.L. Law
Keyword(s):  
Fistula Tract ◽  
Anal Fistulas ◽  
Intersphincteric Fistula

scholarly journals POST-TRAUMATIC ANAL SPHINCTER INSUFFICIENCY

2017 ◽  
pp. 52-54
Author(s):  
A. V. Muravyev ◽  
V. I. Linchenko ◽  
K. A. Muravyev ◽  
P. I. Chumakov ◽  
C. І. Petrosyans ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Anal Sphincter ◽  
Conservative Therapy ◽  
Surgical Care ◽  
Emergency Procedure ◽  
Sphincter Injury ◽  
Defunctioning Stoma ◽  
Wound Debridement ◽  
Post Traumatic ◽  
Sphincter Insufficiency

AIM. To develop tactics of treatment for post-traumatic anal sphincter insufficiency in emergency surgery. MATERIALS AND METHODS. 472 patients with anal sphincter insufficiency were treated between 1977-2015. Of them 125 had conservative therapy. Surgical treatment was performed in 347 patients. Twenty-four patients had emergency procedure. RESULTS AND CONCLUSIONS. The success of the rehabilitation of these patients depends on the timely and adequate surgical care at the time of the sphincter injury. 3 degrees of perineum tears in labor should be sutured by experienced obstetricians and only in layers. Sphincteroplasty without colostomy is indicated within 24 hours after injury, while later admission ot hospital requires defunctioning stoma. Gunshot sphincter damage require wound debridement without sphincteroplasty and defunctioning stoma.

scholarly journals MODIFICATION OF THE METHOD FOR DETERMINING THE WETTABILITY OF CELLULOSE FIBROUS RAW MATERIALS FOR POLYMER COMPOSITE MATERIALS

2021 ◽  
pp. 111-117
Author(s):  
Д.В. Чащилов ◽  
А.А. Генина
Keyword(s):  
Composite Materials ◽  
Polymer Composite ◽  
Raw Materials ◽  
Standard Procedure ◽  
Polymer Composite Materials ◽  
Test Material ◽  
Plant Fibers ◽  
Modified Method ◽  
Cellulose Materials

Для полимерных композиционных материалов (ПКМ) с армирующим наполнителем из натуральных волокон одними из проблем являются оценка качества подготовки волокон и определение динамики взаимодействия волокон и полимерной матрицы. Актуальность проблем обусловлена расширяющимся объёмом исследований ПКМ с растительными волокнами и разнообразными видами и глубиной предварительной обработки растительных волокон. Предметом исследования выступил стандартный метод определения смачиваемости целлюлозных материалов. Цель экспериментального исследования – предложить модифицированный метод определения смачиваемости, потенциально пригодный для оценки качества подготовки армирующих наполнителей ПКМ из растительных волокон. Использован стандартный по ГОСТ и модифицированный метод определения смачиваемости. В качестве пробного материала использовали целлюлозу древесную, полубелёную сульфитную из хвойной древесины в форме целлюлозной папки. Образцы целлюлозы механически разрыхляли до элементарных волокон и испытывали на смачиваемость. Использовали три схемы испытаний – взвешивание стаканчика с навеской, погруженного в воду (схема 1), взвешивание сосуда с водой (схема 2), стандартную методику по ГОСТ (схема 3). По схемам 1 и 2 измерения проводили в течение до 120 секунд, по схеме 3 – 30 секунд. Эксперименты проводили в трёхкратной повторности. Сущность модифицированного метода определения смачиваемости основана на постоянном контроле массы навески по мере сорбции водной влаги. Полученные закономерности кинетики процесса показали, что количество водной влаги, впитываемой образцами, нелинейно меняется во времени. Величины смачиваемости, определённых по различным схемам, с учётом отклонений, соответствуют друг другу. Определение смачиваемости по модифицированному методу предложено проводить в течение 120 секунд, периодически контролируя показания весов. Предложенный модифицированный метод может быть использован в исследовательских целях для изучения динамики впитывания воды и сравнения поведения различных целлюлозных материалов для ПКМ с матрице на основе гидрофильных полимеров. For polymer composite materials (PCM) with a reinforcing filler made of natural fibers, one of the problems is to assess the quality of fiber preparation and determine the dynamics of the interaction of fibers and a poly-dimensional matrix. The urgency of the problems is due to the expanding volume of research on PCM with plant fibers and various types and depth of pretreatment of plant fibers. The subject of the study was a standard method for determining the wettability of cellulose materials. The purpose of the experimental study is to propose a modified method for determining wettability, potentially suitable for assessing the quality of preparation of reinforcing fillers of PCM from plant fibers. The standard GOST and modified method for determining wettability were used. As a test material, wood cellulose, semi-green sulfite from coniferous wood in the form of a cellulose folder was used. Cellulose samples were mechanically loosened to elementary fibers and tested for wettability. Three test schemes were used – weighing a cup with a suspension immersed in water (scheme 1), weighing a vessel with water (scheme 2), standard procedure according to GOST (scheme 3). According to schemes 1 and 2, measurements were carried out for up to 120 seconds, according to scheme 3 – 30 seconds. The experiments were carried out in threefold repetition. The essence of the modified method for determining the permeability is based on the constant control of the weight of the suspension as the sorption of water moisture. The obtained laws of the kinetics of the process showed that the amount of water moisture absorbed by the samples varies non-linearly over time. The wettability values determined according to various schemes, taking into account deviations, correspond to each other. The determination of wettability by the modified method is proposed to be carried out within 120 seconds, periodically monitoring the readings of the scales. The proposed modified method can be used for research purposes to study the dynamics of water absorption and compare the behavior of various cellulose materials for PCM with a matrix based on hydrophilic polymers.

Video-Assisted Modified Ligation of the Intersphincteric Fistula Tract, an Integration of 2 Minimally Invasive Techniques for the Treatment of Parks Type II Anal Fistulas

2020 ◽  
pp. 155335062097802
Author(s):  
Yi-Feng Wu ◽  
Bi-Chun Zheng ◽  
Quan Chen ◽  
Xu-Dong Chen ◽  
Shao-Shun Ye ◽  
...  
Keyword(s):  
Anal Fistula ◽  
Test Group ◽  
Severity Index ◽  
Fistula Tract ◽  
Control Group ◽  
Type Ii ◽  
Anal Fistulas ◽  
Video Assisted ◽  
Significant Difference ◽  
Intersphincteric Fistula

Introduction. Complex anal fistula (CAF) is a challenging anorectal condition. Although numerous treatments for its management have been proposed, none is ideal. Herein, we investigated the clinical efficacy of video-assisted modified ligation of the intersphincteric fistula tract (LIFT) in comparison with the incision-thread-drawing procedure for Parks type II anal fistulas. Methods. Male and female adult patients with Parks type II anal fistula who were randomized to receive one of two procedures in the Anorectal Surgery Unit of the Affiliated People’s Hospital of Ningbo University: video-assisted modified LIFT (test group, 30 cases) or incision thread drawing (control group, 30 cases). Healing and recurrence, postoperative pain, and postoperative autonomous anal control ability were compared. Results. In the test group, the pain scores were significantly lower ( P = .001) and wound healing was faster ( P = .001). However, there were no marked differences between groups in operative efficacy or postoperative infection rate (all P > .05). We followed all the patients for more than 18 months, with the test group having lower Jorge–Wexner incontinence ( P = .005) and fecal incontinence (FI) severity index ( P = .000) scores. No significant difference in recurrence ( χ2 = .351, P = .554) or healing ( χ2 = 1.071, P = .301) rate was found between the 2 groups. Conclusions. We established that video-assisted modified LIFT is superior in repairing Parks type II anal fistulas, with less trauma, quicker recovery, and better anal function.

Fissure, Fistula, and Abscesses

2014 ◽  
Author(s):  
Ira J. Kodner ◽  
Elisa H. Birnbaum
Keyword(s):  
Surgical Treatment ◽  
Patient Positioning ◽  
Fistula Tract ◽  
Operating Table ◽  
Anal Fissures ◽  
Intersphincteric Fistula ◽  
Advancement Flaps ◽  
The Relationship

This review described the etiology and symptoms associated with anal fissures. The physical examination, medical and surgical treatment, and follow-up are detailed. The symptoms and treatment of abscesses and fistula are reviewed. Figures show chronic anal fissures, the relationship between the location of anal fissures and their cause, patient positioning on the operating table, injection of bupivacaine, the closed and open approaches to posterior lateral internal sphincterotomy, classification of anorectal abscesses, alternatives for treating abscess or fistula associated with Crohn disease, a patient with a cryptoglandular abscess/fistula, drainage of an ischiorectal abscess, surgical treatment of a horseshoe fistula, classification of fistula, Goodsall’s rule, ligation of the intersphincteric fistula tract, and advancement flaps. An algorithm outlines the approach to the patient with fissure, abscess or fistula. This review contains 15 figures and 40 references.

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