A COMPARATIVE STUDY OF 0.2% NIFEDIPINE VERSUS LATERAL SPHINCTEROTOMY IN THE MANAGEMENT OF ANAL FISSURE

2021 ◽  
pp. 32-35
Author(s):  
Apoorv Chauhan ◽  
Piyush Kumar Shrivastava ◽  
C.P. Lahariya
Keyword(s):  
Informed Consent ◽  
Anal Canal ◽  
Internal Sphincter ◽  
Dentate Line ◽  
Treatment Result ◽  
Special Treatment ◽  
Lateral Sphincterotomy ◽  
Routine Medical Care ◽  
Patient Pain

Introduction:Anal ssures are longitudinal tears in the squamous epithelium of the anal canal. Anal ssures are located distal to the dentate line, and in around 90% of cases they are located on the posterior midline. The most common pathologies of the anorectal region and can change the quality of life as it causes patient pain and emotional stress while defecation. With a lifetime risk of 11%, anal ssure is a common problem in routine medical care. Anal ssure is mainly treated by relaxing the spasm of the internal sphincter either by dilating the anal canal or sphincterotomy. Reduction of spasticity of anal sphincters is the special treatment for ssure healing. For this purpose, the treatment of anal ssures is performed by lateral sphincterotomy or by anal dilatation. Methods: Out of 100 randomly selected 50 patients with inclusion and exclusion criteria and informed consent were treated with nifedipine ointment and 50 patients with informed consent were treated with lateral sphincterotomy for management of anal ssure. Observations after treatment were recorded at second week, sixth week and twelfth week interval for bleeding, pain and healing and at the twelfth week follow up was documented to analyse the result of treatment. Result: Out of 50 patients undergoing treatment with Nifedipine ointment 42 patients healed completely. 36 patients in the nifedipine group had complaint of bleeding, after treatment with nifedipine ointment 30 patients were relieved from bleeding while 6 were complaining of bleeding on follow up after 3 months. Patients in lateral sphincterotomy group underwent surgery under spinal anaesthesia. In lateral sphincterotomy group, ssure healing was found in 49 (98%)out of 50 patients. In our study out of 50 patients, 48 (96%)were completely relieved from pain and 2 ( 4% ) had pain on follow up at the end of 3 months. In our study , in the lateral sphincterotomy group 34 patients out of 50 patients were complaining of bleeding and after surgery 32 were relieved from bleeding within 12 weeks and 2 were complaining of bleeding. Conclusion:Topical 2% nifedipine should be given as the rst option of treatment for anal ssure. Lateral sphincterotomy, which gives better result to relieve the symptoms but require hospitalization, should be offered to patient who present with relapse and does not respond to pharmacological treatment.

Comparison of Glyceryl Trinitrate Ointment versus Internal Lateral Sphincterotomy for Anal Fissure Pain Relief

2021 ◽  
Vol 15 (10) ◽  
pp. 2600-2601
Author(s):  
Imran Sadiq ◽  
Muhammad Javed Shakir ◽  
Ruqqia Naheed Khan ◽  
Muhammad Akhlaq Ahmed ◽  
Syeda Samina Ashfaq ◽  
...  
Keyword(s):  
Pain Relief ◽  
Anal Canal ◽  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Distal Part ◽  
Chronic Anal Fissure ◽  
Lateral Sphincterotomy ◽  
Reliable Procedure ◽  
Glyceryl Trinitrate Ointment

Background: Anal fissure is a linear painful mucosal tearing in the distal part of anal canal. It extends from dentate to anal edge. Aim: To compare the glyceryltrinitrate ointment and internal lateral sphincterotomy for anal fissure pain relief in acute/chronic pts. Study Design: Prospective study Place and duration of study: Department of Surgery Unit-II, Fatima Memorial Hospital, Shadman Lahore from 1st October 2018 to 31stDecember 2020. Methodology: 40 pts with acute and chronic anal fissure were enrolled. Half of the patients undergo internal lateral sphincterotomy while other opted 0.2% use of glyceryl trinitrate ointment. Each patient was followed for pain, recovery, complications and recurrence until 12 months for internal lateral sphincterotomy and 18 months in glyceryl trinitrate ointment. Results: There were 24 males and 16 females with a mean age of patients as 30±3.2 years. Initial follow-up of patients showed 100% pain and fissure improvement in internal lateral sphincterotomy group as compared to 60% in glyceryl trinitrate ointment group respectively. Conclusion: Internal lateral sphincterotomy is most efficient and reliable procedure in relieving anal fissure pains. Keywords: Anal fissure, Internal lateral sphincterotomy, Glyceryl trinitrate

scholarly journals Results of tailored lateral sphincterotomy for chronic fissure in-ano

2019 ◽  
Vol 6 (11) ◽  
pp. 3947
Author(s):  
Ahemadi Firdous Nikhat ◽  
Mohd Zaheeruddin Ather
Keyword(s):  
Anal Fissure ◽  
Gold Standard ◽  
Chronic Anal Fissure ◽  
Internal Sphincter ◽  
Treatment Options ◽  
Lateral Internal Sphincterotomy ◽  
Fissure In Ano ◽  
Lateral Sphincterotomy ◽  
Internal Sphincterotomy

Background: Fissure-in-ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of lateral anal sphincterotomy remains the gold standard of treatment for chronic anal fissure, however it is associated with the significant rate of incontinence. This study reviews using a tailored lateral sphincterotomy by selecting the height of internal sphincter to be divided with aim of preserving more sphincter and hence reducing the incontinence rates.Methods: The study was carried out in 50 patients who were diagnosed clinically as chronic anal fissure attending Surgery department of ESIC medical college and hospital, Kalburagi over a period of 6 months from January 2019 to August 2019. Tailored left lateral internal sphincterotomy was performed in all patients. The date was recorded and analysed. Early post-operative follow-up was maintained every week for four weeks or till the fissure healed. Complications mainly incontinence rate was assessed.Results: Common age group was third and fourth decade of life. Pain (100%) was the commonest symptom. Majority of the patients (96%) had posterior fissure. Postoperatively about 97% patients had complete pain relief. Only one patient (2%) in the study reported incontinence to flatus during the first follow-up visit and had minor incontinence and other minimal complications were found.Conclusions: Tailored lateral anal internal sphincterotomy is safe and effective surgical procedure for the management for chronic anal fissure with lower rate of incontinence rate compared to gold standard lateral internal sphincterotomy.

Anatomy, Physiology and Pathophysiology of Haemorrhoids

2020 ◽  
Vol 15 ◽  
Author(s):  
Francesco Pata ◽  
Alessandro Sgrò ◽  
Francesco Ferrara ◽  
Vincenzo Vigorita ◽  
Gaetano Gallo ◽  
...  
Keyword(s):  
Anal Canal ◽  
Dentate Line ◽  
Cochrane Library ◽  
Systematic Research ◽  
Literature Searching ◽  
Patient History ◽  
Haemorrhoidal Disease ◽  
Faecal Continence ◽  
Vascular Component ◽  
Key Events

Background: Haemorrhoidal disease (HD) is a frequent anal disorder and one of the most common findings identified at colorectal clinic. This article aims to provide an overview of the anatomy, physiology and pathophysiology of haemorrhoids and haemorrhoidal disease. Introduction: Internal haemorrhoids are vascular cushions located in the anal canal, above the dentate line and covered by columnar epithelium. They contribute to the faecal continence and to the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce symptoms and complications, the so-called haemorrhoidal disease. Method: A systematic research was realized, looking at the best evidence in literature , searching PubMed, Embase, Cochrane library and most renowned text of colorectal surgery from January 1980 to January 2020. Result: Aetiology and pathophysiology of HD are still controversial, but multifactorial. Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and rectal redundancy represent key events in the development and complications of the disease. Local inflammation may play also a role. Goligher’s classification remains the most widely used. A careful patient history and examination are paramount to diagnose HD, excluding other anal or colonic pathologies. Conclusion: Several aspects of etiopathogenesis and pathophysiology remain controversial. Further studies are needed to obtain a better understanding of the disease.

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

scholarly journals Treatments and outcomes of untreated cerebral cavernous malformations in China: study protocol of a nationwide multicentre prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037957
Author(s):  
Fuxin Lin ◽  
Qiu He ◽  
Zhuyu Gao ◽  
Lianghong Yu ◽  
Dengliang Wang ◽  
...  
Keyword(s):  
Informed Consent ◽  
Natural History ◽  
Study Protocol ◽  
Treated Group ◽  
Secondary Outcome ◽  
Long Term Outcomes ◽  
Cavernous Malformations ◽  
Electronic Data Capture System

IntroductionThe treatment decision and long-term outcomes of previously untreated cerebral cavernous malformation (U-CCM) are still controversial. Therefore, we are conducting a nationwide multicentre prospective registry study in China to determine the natural history and effect of surgical treatment on long-term outcomes in Chinese people with U-CCM.Methods and analysisThis study was started on 1 January 2018 and is currently ongoing. It is a cohort follow-up study across a 5-year period. Patients will be followed up for at least 3 years after inception. Patients with U-CCM will be enrolled from 24 Grade III, level A hospitals distributed all over China. The cohort size is estimated to be 1200 patients. Patients are registered in surgically treated group and conservatively treated group. Clinical characteristics, radiology information and laboratory data are prospectively collected using an electronic case report form through an electronic data capture system. The primary outcome of this study is poor clinical outcome at the last follow-up (modified Rankin Scale score >2 lasting at least 1 year). The secondary outcome includes symptomatic haemorrhage, drug refractory epilepsy, focal neurological deficits, morbidity and all-cause mortality during follow-up. Univariate and multivariate regression analysis will be performed to determine the risk factors for poor outcomes in all patients, and to estimate the effect of surgery. Life tables, Kaplan-Meier estimates, log-rank test and proportional hazards Cox regression will be used to analyse the follow-up data of conservatively treated patients to determine the natural history of U-CCM. Initial presentation and location of U-CCM are prespecified subgroup factors.Ethics and disseminationThe study protocol and informed consent form have been reviewed and approved by the Research Ethical Committee of First Affiliated Hospital of Fujian Medical University (FAHFMU-2018-003).Written informed consent will be obtained from each adult participant or from the guardian of each paediatric participant. The final results will be published in peer-reviewed journals.Trial registration numberNCT03467295.

scholarly journals Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jin Li ◽  
◽  
Sheng Ping Tang ◽  
Guo Xin Nan ◽  
Ming Li ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Classification System ◽  
Forearm Fracture ◽  
Pediatric Trauma ◽  
Treatment Strategies ◽  
Treatment Result ◽  
Level Of Evidence ◽  
Radial Neck ◽  
Radial Neck Fractures

Abstract Background The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies. Methods Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers. Patients diagnosed with ipsilateral olecranon with associated radial neck fractures and followed up for at least 24 months were included. Fracture characteristics, treatment, outcome, and complications were assessed. The clinical outcome of treatments was evaluated by the Mayo Elbow Performance Score (MEPS) and the Flynn criteria. Fisher’s exact test and ANOVA test were used; significance was defined as P < 0.05. Results One hundred thirty-seven consecutive patients (54 girls and 83 boys) from 8292 forearm fractures patients, the mean age of 7.5 years (1.5 to 14.8), with fractures of the ipsilateral olecranon with associated radial neck fractures were identified. One hundred twenty-five patients had radiologic and clinical follow-up. According to a simplified classification system with “operate” and “don’t operate” groups, including five subtypes proposed in this study, ipsilateral olecranon with associated radial neck fractures subtypes could be classified with significantly different characteristics and outcome in treatment and complications. Conclusions Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. Complications and poor outcomes were easy to encounter without knowing this type of fracture. Appropriate treatment strategies could be made according to a simple classification system based on the treatment result of follow-up. Level of evidence Retrospective comparative study; Level III

Bowen’s Disease of the Anal Canal Treated with Radiation Therapy: A Case Report

2021 ◽  
Vol 2 (1) ◽  
pp. 01-04
Author(s):  
I. Mbarki Mbarki
Keyword(s):  
Anal Canal ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Intraepithelial Neoplasia ◽  
Bowen’S Disease ◽  
Bowen's Disease ◽  
Radiological Response ◽  
Slow Growing

Bowen’s disease, also known as intraepithelial neoplasia, is a very slow-growing carcinoma in situ. It can progress to an invasive squamous cell cancer and infiltrate mucosa or skin in 3 to 5% of cases. The anal localization of this disease is very rare. Surgical resection is the standard of treatment. Radiotherapy keeps its place in recurrent or unresectable cases. We report a case of Bowen’s anal canal disease in order to verify the effectiveness of Radiotherapy. He is a 59-years-old patient diagnosed with Bowen’s anal canal disease at the National Institute of Oncology in Rabat. He was treated with exclusive radiotherapy at a dose of 60 Gray in 30 fractions over 49 days. The evolution was marked by a complete clinical and radiological response and preservation of the anal sphincter with an 18 months follow-up.

scholarly journals Use of Seton in Management of High Variety of Anal Fistula

2017 ◽  
Vol 8 (2) ◽  
pp. 100-104
Author(s):  
Mohammad Noor A Alam ◽  
Sharmin Abbasi
Keyword(s):  
Anal Fistula ◽  
Low Cost ◽  
Dentate Line ◽  
Internal Opening ◽  
Efficacy And Safety ◽  
Medical College ◽  
Small Channel ◽  
A Prospective Study ◽  
Low Rate

Background: Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula.Objectives: Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 57 patients in BIRDEM hospital and some other clinic of Dhaka city in 3 years period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction.Result: Among 57 patients mean age was 38.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 51 patients, incontinence occurred in 2 patients and recurrence occurred in 4 patients.Conclusion: Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 100-104

Accuracy of endoanal ultrasound in the follow-up assessment for squamous cell carcinoma of the anal canal treated with radiochemotherapy

2008 ◽  
Vol 23 (5) ◽  
pp. 1054-1057 ◽  
Author(s):  
Jacopo Martellucci ◽  
Gabriele Naldini ◽  
Caterina Colosimo ◽  
Luca Cionini ◽  
Mauro Rossi
Keyword(s):  
Squamous Cell Carcinoma ◽  
Anal Canal ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Endoanal Ultrasound

scholarly journals INDICATIONS FOR INJECTION OF BULKING AGENTS FOR THE TREATMENT OF ANAL INCONTINENCE

2017 ◽  
pp. 43-48
Author(s):  
A. I. Nedozymovany ◽  
E. A. Dementeva ◽  
D. E. Popov ◽  
S. V. Vasiliev
Keyword(s):  
Comparative Analysis ◽  
Anal Canal ◽  
Anal Incontinence ◽  
Bulking Agents ◽  
Study Objective ◽  
Relevant Today ◽  
Surgical Methods ◽  
The Mean ◽  
Methods Of Treatment

Despite of lots conservative and surgical methods of treatment, the problem of anal incontinence is relevant today and remains unresolved. Since the beginning of the 1990s attempts ofimplantation of bulking agents in order to increase the basal pressure in the anal canal were begun. Domestic product “ДАМ+” used in the study. OBJECTIVE. To determine the indications for injection of bulking agents for the treatment of anal incontinence. Research the possibility of using the drug “ДАМ+,” with assessment of treatment outcomes. During a period of 2014 to 2016 there were 30 patients with anal incontinence of various etiologies involved in research. The mean age was 47,5 ± 6,5 years. Injection of bulking agent “ДАМ+” were performed by the punction of submucosa of the anal canal in 3 points, andfollowed by a comparative analysis of the survey after treatment. Average follow-up was 12,1 ± 0,97 months. The study we have identified indications for the implementation of bulking agents for correction of anal incontinence, and the estimation results.

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