Perianal abscess and fistula-in-ano in children – evaluation of treatment’s efficacy. Are we able to avoid the recurrence?

2020 ◽  
Vol 92 (1) ◽  
pp. 1-5
Author(s):  
Katarzyna Bałaż ◽  
Agata Trypens ◽  
Dariusz Polnik ◽  
Katarzyna Pankowska-Woźniak ◽  
Piotr Kaliciński
Keyword(s):  
Antibiotic Therapy ◽  
Recurrence Rate ◽  
Perianal Abscess ◽  
High Recurrence Rate ◽  
Invasive Approach ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Fistula In Ano ◽  
Group I ◽  
Group Ii

AIM Perianal abscess and fistula-in-ano are common findings in infants and children. The perianal abscess is usually a manifestation of the fistula-in-ano. Experience of our center indicates a general lack of knowledge of the abscess’s origin therefore it is usually treated by incision and drainage which leads to numerous recurrence. We aimed to present the optimal management of the fistula-in-ano and perianal abscess to lower or even eliminate recurrences. METHOD The retrospective study consisted of 24 infants treated in our center with perianal abscess from 2013 to 2015. The patients were divided into two groups: group I (50%) was primary treated in our center, group II had prior surgical interventions in other hospitals. Fistula-in-ano was intraoperatively identified in all patients (100%) and fistulotomy was performed. RESULTS No recurrence of the perianal abscess or fetal incontinence were observed in any patient. In the group II, the ailment was associated with severe inflammation, some patients underwent an additional surgical intervention such as incision and drainage of the extensive buttock’s abscess; the patients required longer antibiotic therapy and longer hospitalization. CONCLUSION Low-invasive approach (hip-bath, antibiotic therapy, puncture or incision and drainage of the abscess) seems to be tempting due to its simplicity and no need of general anesthesia but it is associated with high recurrence rate. Fistulotomy and fistulectomy, which are slightly more invasive procedures, significantly lower the recurrence rate of fistula-in-ano and perianal abscess.

scholarly journals The role of intraoperative angiography in the treatment of an acute impassability of the lower extremity artery

2019 ◽  
Vol 86 (7) ◽  
pp. 27-31
Author(s):  
S. M. Didenko ◽  
V. Yu. Subbotin
Keyword(s):  
Lower Extremity ◽  
Recurrence Rate ◽  
Acute Ischemia ◽  
Fogarty Catheter ◽  
Intraoperative Angiography ◽  
Surgical Interventions ◽  
Group I ◽  
Group Ii ◽  
And Performance ◽  
Atherosclerotic Process

Objective. To compare the results of surgical treatment of patients, suffering an acute impassability of the lower extremity arteries (LEA) , using and not using intraoperative angiography. Materials and methods. Comparative analysis of the surgical treament results was done in the Centre of Vascular Surgery of Clinical Hospital “Feofania”, where in 2010-2017 yrs 119 patients, suffering an acute impassability of the LEA, were treated. All 119 patients investigated were divided into two groups: the Group I - 70 (58.8%) patients, in whom open thrombectomy, using Fogarty catheter, was performed to correct an acute ischemia of the lower extremity, and the Group II - 49 (41.2%) patients, in whom open thrombectomy, using Fogarty catheter, was followed by the control intraoperative angiography. Taking into account the results of angiography after thrombectomy, the balloon angioplasty was conducted, open surgical interventions on the arteries or thrombectomy only. Results. Performance of intraoperative angiography after thrombectomy gives possibility to determine the origin of an acute impassability of the arteries precisely, to accomplish intraoperative roentgenological control of the thrombectomy conduction  and to estimate its quality, to establish a substantiated indications for endovascular and open surgical interventions on the arteries in presence of their stenotic-occlusive affections on background of atherosclerotic process. Expediency of application of intraoperative angiography was witnessed by trustworthily higher rate of thrombectomy performance with positive immediate result in the patients of Group II (97.9%), comparing with the patients of Group I (88.6%) (p < 0.05), as well as the recurrence rate for an acute arterial impassability during a year, which was trustworthily higher in the Group I patients, comparing with the Group II patients – 30.7 and 8.2% (p < 0.001), accordingly. Conclusion. Application of intraoperative angiography and performance of interventions on the arteries in accordance to indications while doing thrombectomy for an acute impassability of the LEA gives possibility to enhance the rate of immediate positive results of the operation and to lower the recurrence rate for an acute arterial impassability during a year trustworthily.

Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial

Surgery ◽  
2017 ◽  
Vol 162 (5) ◽  
pp. 1017-1025 ◽  
Author(s):  
Leila Ghahramani ◽  
Mohammad Reza Minaie ◽  
Peyman Arasteh ◽  
Seyed Vahid Hosseini ◽  
Ahmad Izadpanah ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Antibiotic Therapy ◽  
Perianal Abscess ◽  
Incision And Drainage ◽  
Fistula In Ano ◽  
Single Blind

scholarly journals Does antibiotic therapy prevent fistula in-ano after incision and drainage of simple perianal abscess?

2020 ◽  
Vol 63 (4) ◽  
pp. E362-E364
Author(s):  
Mantaj S. Brar ◽  
Feza Remzi ◽  
Janindra Warusavitarne ◽  
Indraneel Datta ◽  
Keyword(s):  
Antibiotic Therapy ◽  
Perianal Abscess ◽  
Incision And Drainage ◽  
Fistula In Ano

RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

2021 ◽  
pp. 51-54
Author(s):  
Md. Shafiqur Rahman ◽  
Sanjeeb Bhakta Bista ◽  
Md. Sayedul Islam ◽  
A. S. M. Shafiul Azam ◽  
Md. Shamim Hossain ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Recurrence Rate ◽  
Transurethral Resection ◽  
Tumor Recurrence ◽  
Controlled Trial ◽  
Intravesical Therapy ◽  
Newly Diagnosed ◽  
Group I ◽  
Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

scholarly journals Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial

2019 ◽  
Vol 101 (1) ◽  
pp. 21-29 ◽  
Author(s):  
M Arnous ◽  
H Elgendy ◽  
W Thabet ◽  
SH Emile ◽  
SA Elbaz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Primary Closure ◽  
Randomised Clinical Trial ◽  
Limberg Flap ◽  
Complication Rates ◽  
Cosmetic Results ◽  
Group I ◽  
Group Ii

BackgroundAlthough several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND.MethodsThis was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes.ResultsSixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence.ConclusionsThe Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.

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 ADVANTAGES OF INTRATHECAL BUPIVACAINE AND DEXMEDETOMIDINE COMBINATION OVER BUPIVACAINE AND CLONIDINE: A COMPARATIVE ANALYSIS IN GYNAECOLOGICAL INTERVENTIONS

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Aruna Mahanta ◽  
Keshav Saran Agrawal
Keyword(s):  
Regional Anaesthesia ◽  
Motor Block ◽  
Surgical Intervention ◽  
Average Duration ◽  
Sensory Block ◽  
Lower Side ◽  
Regional Analgesia ◽  
Surgical Interventions ◽  
Group I ◽  
Group Ii

Background: most of the gynaecological interventions are generally done under regional anaesthesia. Currently dexmedetomidine came out as a beneficial adjunct for regional analgesia as well as anaesthesia. It is a highly selective α-2 agonist. Aims & objectives: to compare the effects & behavior of dexmedetomidine with clonidine when both are used with bupivacaine for spinal analgesia. Material and Methods: 100 cases of ASA grade 1 & 2 who were undergoing elective gynaecological surgical intervention were studied. They were divided into two groups (50 each). Group I received combination of bupivacaine & clonidine while group II received combination of bupivacaine + dexmedetomidine. Results: Average duration of onset of sensory block was earlier in group II. Arrival of motor block in Group I was slightly on lower side than Group II. Ten cases in Group I and eighteen cases from group II had notable bradycardia and hypotension. Discussion: Our study concludes that dexmedetomidine when used in combination with bupivacaine is very effective in gynaecological surgical interventions that demand longer duration & have comparatively lesser side effects. Keywords: dexmedetomidine, clonidine, Bupivacaine, gynaecological procedures.

Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents

2006 ◽  
Vol 105 (2) ◽  
pp. 242-247 ◽  
Author(s):  
Brian T. Ragel ◽  
Samuel R. Browd ◽  
Richard H. Schmidt
Keyword(s):  
Antibiotic Therapy ◽  
Prophylactic Antibiotic ◽  
Shunt Infection ◽  
Controlled Study ◽  
Csf Shunt ◽  
Antibiotic Administration ◽  
Systemic Antibiotic ◽  
Group I ◽  
Group Ii ◽  
Antibiotic Agents

Object Infection represents the most common serious complication of shunt surgery, and typically its incidence ranges between 5 and 15%, despite the use of systemic antibiotic agents. Because systemic antibiotic medications generally penetrate the cerebrospinal fluid (CSF) poorly, the authors investigated, in a controlled study, whether the addition of intraventricular antibiotic treatment decreases the incidence of perioperative infection in adult patients. Methods Data pertaining to all CSF shunt procedures conducted at the authors’ institution during an 11-year period were reviewed. Perioperative infection was defined as culture-positive CSF and the clinical presence of infection-related symptoms occurring within 90 days of surgery. All patients underwent intraoperative systemic antistaphylococcal antibiotic therapy. Before May 16, 1999, the senior author (R.H.S.) also administered 4 mg of gentamicin intraventricularly at surgery (Group I); thereafter, 10 mg of vancomycin was additionally administered (Group II). Other neurosurgeons at this institution did not use intraventricular antibiotic therapy, and their patients served as additional controls in identical time periods (Groups III and IV). A total of 802 shunt procedures were performed in 534 patients. Control infection rates were 5.4% (eight of 147) in Group I; 6.2% (nine of 145) in Group III; and 6.7% (18 of 267) in Group IV. With the combination of systemic antibiotic and intraventricular gentamicin and vancomycin (Group II), the infection rate fell significantly to 0.4% (one of 243). No complications were noted in association with intraventricular antibiotic administration. Conclusions The combination of intraventricular gentamicin and vancomycin with systemic antibiotic therapy significantly decreased the incidence of perioperative shunt infection. It is presumed that intraventricular antibiotic therapy extends prophylactic antibiotic coverage into the CSF and prevents bacterial seeding.

scholarly journals Method of Enteral Insufficiency Syndrome Correction in Patients with Generalized Peritonitis

2021 ◽  
Vol 14 (3) ◽  
pp. 182-192
Author(s):  
Evgeny A. Korymasov ◽  
Sergey A. Ivanov ◽  
Mariya Kenarskaya ◽  
Maxim U. Khoroshilov
Keyword(s):  
Rating Scale ◽  
Study Groups ◽  
Albumin Level ◽  
C Reactive Protein ◽  
Surgical Interventions ◽  
Reactive Protein ◽  
Generalized Peritonitis ◽  
Group I ◽  
Group Ii ◽  
Insufficiency Syndrome

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis. The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis. Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm. Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less. Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

scholarly journals Results of transforaminal endoscopic discectomy for lumbosacral disc herniation added by nucleoplasty

2021 ◽  
Vol 27 (2) ◽  
pp. 243-248
Author(s):  
M.D. Abakirov ◽  
◽  
O.A. Al-Bawareed ◽  
M.A. Panin ◽  
R.M. Nurmukhametov ◽  
...  
Keyword(s):  
Health Status ◽  
Recurrence Rate ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Pain Scale ◽  
Lumbar Spine Surgery ◽  
Group I ◽  
Endoscopic Discectomy ◽  
Group Ii ◽  
Complete Data Analysis

Introduction Herniated disks are very common. Percutaneous endoscopic lumbar spine surgery for the lumbar disc herniation facilitates minimalized access ports to the operating site with decreased risk of infection, reduced blood loss and less tissue dissection and muscle trauma. The goal was to compare the results of standard transforaminal endoscopic discectomy for lumbosacral herniation and outcomes of the procedure added by nucleoplasty. Material and methods Percutaneous transforaminal endoscopic discectomy was performed for 92 patients and added by nucleoplasty in 43 patients of group I. Preoperative and postoperative evaluation was produced with the Visual Analog Pain Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire (ODI) and the MacNab clinical outcome score. Complication and recurrence rate was reviewed. Microsoft Office Excell and Statistica 8.0 were used to complete data analysis reports. Results VAS scores decreased from 7.9 to 3.1 showing 2.5-fold decrease (p < 0.05), and ODI scores decreased from 71.09 to 18.58) (p < 0.001) demonstrating fourfold decrease at one-year follow-up. There were no significant differences in VAS and ODI scores between the groups preoperatively and postoperatively (p > 0.05). The majority of patients of group I (41.86 %) rated their health status as excellent on the MacNab scale, and the majority of patients of group II (53.06 %) rated their health status as good. Postoperative complication rate was 11.63% in group I and 12.24% in group II (p > 0.05). There was no recurrence in group I with the recurrence rate of 6.1% (p < 0.001) in group II. Conclusion Endoscopic discectomy for lumbosacral herniation supplemented with nucleoplasty can reduce the recurrence rate.

Sign in / Sign up

Export Citation Format

Share Document