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 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 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.

scholarly journals Monopolar Diathermy Tonsillectomy Versus Dissection Method Tonsillectomy

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 21-24
Author(s):  
Md Abdus Salam ◽  
Md Mahbub Alam ◽  
Rezwan Ahmed ◽  
Md Sultan Mahmud
Keyword(s):  
Postoperative Pain ◽  
Postoperative Bleeding ◽  
Throat Pain ◽  
Medical College ◽  
Advantages And Disadvantages ◽  
Case Surgery ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Dissection Method

Background: Tonsillectomy is one of the most common surgical procedures performed worldwide by otorhinolaryngologists for different indications. Tonsillectomy is often performed as day-case surgery, which increases the demands of a satisfactory postoperative pain control and a low risk of early postoperative bleeding. Objective: The aim of the study was to compare the Monopolar diathermy and Dissection methods of tonsillectomy and evaluate their advantages and disadvantages during surgery, convalescence. Materials and Methods: Two hundred children were recruited for this study during the period of five years from January, 2014 to December, 2018 at Otolaryngology department of Khwaja Yunus Ali Medical College and Hospital (KYAMCH). Subjects between the age of 5 and 25 years listed for tonsillectomy were included. Subjects were recommended not to have aspirin within the 2 weeks before surgery. Results: The mean duration of operation was found 10.6±0.4 minutes in group A and 17.0±0.7 minutes in group B. The difference was statistically significant (p<0.05) between two groups. At 1st day, 11(11.0%) patients had throat pain in group A and 23(23.0%) in group B. At 2nd day, 14(14.0%) patients had throat pain in group A and 25(25.0%) in group B. Which were statistically significant (p<0.05) between two groups. Conclusion: The monopolar diathermy tonsillectomy appears to cause less bleeding, postoperative pain and less time consuming in compare with the dissection tonsillectomy although patients experience slightly more pain than dissection Method. KYAMC Journal Vol. 10, No.-1, April 2019, Page 21-24

Modified Lift Versus Cutting Seton for Transphincteric Fistula -Experience at Tertiary Care Hospital

2021 ◽  
Vol 15 (12) ◽  
pp. 3257-3260
Author(s):  
Muhammad Najam Iqbal ◽  
Ashfaq Nasir
Keyword(s):  
Comparative Study ◽  
Anal Incontinence ◽  
Complete Healing ◽  
Fistula Tract ◽  
Fistula Closure ◽  
Fistula In Ano ◽  
Group A ◽  
Prospective Comparative Study ◽  
Cutting Seton ◽  
Group B

Background: Fistula in ano is a common disease which has high recurrence rate and high fecal incontinence rate after surgery. We compared modified LIFT (Ligation of the intersphincteric fistula tract (LIFT) through lateral approach ) with cutting seton for transphincteric fistula. Aim: This study is aimed at which procedure is better with respect to postoperative complications Study design: It was a prospective comparative study. Methods: This was a prospective comparative study from 01-01-2019 to 30-06-2021 which was conducted on 50 patients who presented with transsphincteric fistula in ano (FIA) in surgical ward of Bahawal Victoria Hospital Bahawalpur. Patients were divided into two groups .Patients of Group A underwent modified lift procedure and patients of group B underwent cutting seton procedure. Data was collected on a proforma which included patients’ name ,age ,sex, age group, comorbid disease like diabetes mellitus ,chronic liver disease, cardiovascular disease and chronic renal failure, fistula tract involving less than 50% or more than 50% external sphincter ,procedure done, healing time of wound, complications like recurrence and incontinence. Patients were followed for 6 months for healing rate ,recurrence and incontinence. Data was analysed on spss 22 version Results: In Group A, complete healing (fistula closure without recurrence) was achieved in 20 patients (80%) out of 25. There was no case of anal incontinence after the procedure. 5 (20%) patients experienced recurrence in 6 months . In Group B, complete healing (fistula closure without recurrence) was achieved in 21 patients (84%), in 6 months follow up . 4(16%) patients were diagnosed as a case of anal incontinence. There were 4 (16%) patients with recurrence. Conclusion: Modified LIFT is better in terms of incontinence where as cutting seton is better in terms of recurrence.it is suggested that for high lying fistula modified LIFT is better procedure and for low lying fistula involving less than 50% sphincter cutting seton is better procedure.. Keywords: Modified LIFT (ligation of ineter sphincteric fistula tract) ,Cutting seton , transphincteric fistula.

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.

scholarly journals AshwathaKsheer Sutra and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano): An Ayurvedic management protocol for treatment of fistula in ano

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1357-1361
Author(s):  
Monika Meshram ◽  
Kiran Khandare
Keyword(s):  
Internal Opening ◽  
Anal Abscess ◽  
Female Ratio ◽  
Fistula In Ano ◽  
Management Protocol ◽  
Group A ◽  
Group B ◽  
Male To Female ◽  
Single Blind

Fistula in ano is tract lined by granulation tissue having internal opening in anal canal and rectum and external opening in the perianal region. The incidence of a fistula-in-ano developing from an anal abscess ranges from 26-38%. The prevalence of non-specific anal fistula has been estimated to be 8.6 to 10/100,000 of the population per year, with a male to female ratio of 8:1.in contemporary sciences Bhagandara  can be correlated with Fistula in Ano. To compare the efficacy of AshwathaKsheer Sutra  and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano).  The present study is designed as a  Randomized single blind parallel in which 40 patients will be enrolled. Patients will be distributed in two group with 20 patients in each group. In group A AshwathaKsheerSutra and in group B UdumbarKsheerSutra will be changed after 7 days till the cure of fistula. Assessment of the patients will be done on day 1st, 8th, 15th, and 22nd after intervention, follow up will be taken on 29th day.  Results will be drawn from the observations of objective parameters. Conclusion of the study will be drawn on the basis of statistical data calculated from the collected data.

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 Comparative randomized controlled clinical trial of diathermy versus scalpel incision in midline laparotomy

2018 ◽  
Vol 6 (1) ◽  
pp. 28
Author(s):  
Bhavin P. Vadodariya ◽  
Nimish J. Shah ◽  
Mrudul Patel
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Midline Laparotomy ◽  
Medical College ◽  
Randomized Clinical Study ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Laparotomy incisions have traditionally been made using a scalpel. Diathermy, a latest technique, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that diathermy may offer likely advantages with respect to blood loss, incision time and postoperative pain. The aim of this study was to compare the efficacy and safety of surgical diathermy incisions versus conventional scalpel incisions for midline laparotomy in our hospital with an aim to evaluate diathermy as an operational alternative to scalpel incision.Methods: This was a prospective randomized clinical study which was conducted in the surgical wards of Medical College & SSG hospital, Vadodara, between December 2013 and December 2014.  Patients were randomly assigned to two groups i.e. Group A (scalpel group) and Group B (diathermy group).Results: A total of 148 patients were enrolled in the study. Of these, 74 patients were randomized to Group A (scalpel group) and 74 patients to Group B (diathermy group). The two groups did not vary significantly in relation to age and sex (p>0.001). Laparotomy skin incisions using diathermy were significantly quicker than scalpel incisions (p=0.624). There was significantly less blood loss in the diathermy group compared with the scalpel group (P=0.15). The mean visual analogue scale was significantly reduced more in the diathermy group than in scalpel group patients on postoperative day 1 (p=0.81), day 3 (p=0.71) and day 5 (p=0.79) respectively. Postoperative complication rates did not differ significantly between the scalpel and diathermy groups (p=0.624).Conclusions: We concluded that diathermy incision in midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and postoperative wound infection.

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.

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

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