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

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.

The importance of physiotherapy in the puerperium

The gestational period promotes changes in the woman's body, so that the baby can develop in a healthy way in the uterus. These transformations can interfere in a woman's daily life. Physiotherapy promotes re-education of the abdominal muscles, analgesia in the perineum region, restoration of gastrointestinal function, in addition to helping them with psychological changes. To verify the benefits of physiotherapy in the puerperium. A non-systematic review of the literature was carried out, through randomized clinical trials, published between 1999 and 2018. The search involved the databases PubMed, MEDLINE, SciELO, LILACS and PEDro. The following keywords were used: postpartum physiotherapy. 6 RCTs were included. There was a significant decrease in pain in the treatment group in four studies, increase in strength of the pelvic floor muscles (PFM) and decrease in urinary incontinence in two studies, but 3 postpartum women presented voiding symptoms; in another study, there was a decrease in the score related to anal incontinence; in another study, immediate physiotherapy after delivery reduced abdominal diastasis. Postpartum physiotherapy, through an exercise program, contributes to pain reduction, increase in pelvic floor strength, decrease in urinary incontinence, anal incontinence and abdominal diastasis.

Short-, long-, and very long-term results of secondary anterior sphincteroplasty in 20 patients with obstetric injury

Purpose More long-term follow-up studies beyond 10 years after secondary sphincteroplasty for obstetric damage are warranted. This prospective study aimed to compare reported data on incontinence and satisfaction in a cohort of such patients examined at short-, long-, and very long-term follow-up. Methods Twenty out of 33 obstetric patients (61%) operated with secondary anterior overlapping sphincteroplasty during February 1996 to April 2004 were evaluated preoperatively and at short-, long-, and very long-term follow-up. Anal incontinence was scored by a combination of Wexner’s and St. Mark’s incontinence scores. The patients also reported degree of treatment satisfaction. Results Twenty patients were examined preoperatively and after a median (range) of 5 (2–62), 102 (64–162), and 220 (183–278) months. Corresponding incontinence scores were 11.5 (5–18), 5.5 (1–17) (p < 0.01), 10.0 (0–18) (p > 0.05), and 12.0. (1–18) (p > 0.05). With increasing follow-up times, patients reporting a better outcome were 75%, 65%, and 45%. At very long-term follow-up patients, reports were more dismal than expected in those also reporting improved incontinence cores. Incontinence scores did not improve in patients with neuropathy (n = 5) or patients (n = 5) with more than 10 years of symptoms. Conclusion Initial improvement of anal incontinence attenuated with time, in particular from short- to long-term follow-up. Patients with neuropathy experienced no improvement of incontinence. Beyond stoma formation, in compliant patients, one should consider other treatment options like sacral nerve stimulation and neosphincter formation.

Physiotherapy in the Сomplex Rehabilitation of Children with Anorectal Malformations: Systematic Review

Medical rehabilitation is an integral part of the treatment for surgical patients. Regarding pediatric patients with anorectal malformations, the success of the result of surgical treatment is mainly a correctly selected rehabilitation program, including methods of individual physiotherapy. Disturbances of intestinal transit, such as chronic constipation and anal incontinence, according to the world literature, occur in the study group in up to 30% of cases. According to the social significance of constipation and anal incontinence, the psychological aspects, the disabling component, children with anorectal malformations need early and long-term rehabilitation, adapted to their needs. At the moment, there are regulatory documents describing the principles of medical rehabilitation of children, its main characteristics, however, there are no protocols for the use of physiotherapy methods regarding the manifestations of colon transit disorders. Aim. Analysis of modern literature data on physiotherapeutic methods of rehabilitation of children with anorectal malformations. Material and methods. After determining the research criteria, a basic literature review using Web of Science, PubMed, electronic library was conducted, as a result 186 articles were selected that met the search criteria. After the initial assessment, 10 full-text articles were accepted for the analysis. Results. We have assessed the opportunity and mechanisms of the therapeutic action of sacral stimulation and tibial neuromodulation, the effect of various types of currents and a high-intensity magnetic field on the muscles of the complex, studied the possibility and results of using biofeedback therapy in children with colon transit disorders after operations on the anorectal body area in 421 children in 10 studies. Conclusion. Based on the results of scientific research, a range of physiotherapy methods have been established that are effective in relation to rehabilitation measures in children with anorectal malformations.

Treatment of anal incontinence with “Noltrex” bulking gel

The article presents the results of treatment of 27 patients aged 3 to 18 years with a diagnosis of postoperative anal incontinence. Who performed the operation of gel plastic surgery of the anal canal with polyacrylamide gel "Noltrex". Morphological studies were carried out on 10 labarotor mice, body weight 20-22 grams, in the department of experimental biomodelling. The analysis of the conducted studies showed that in 22 (78.3%) patients, after a single injection of the bulking polyacrylamide gel "Noltrex", complete closure of the anus was noted and normal continence was achieved. When choosing a tactic for the treatment of postoperative anal incontinence in children, an individual approach is required, taking into account the cause leading to this condition. Gel plasty of the anal canal in patients with postoperative anal incontinence is the method of choice and is an alternative to reconstructive plastic surgery. However, it should be noted that it is appropriate and effective in cases where there is no cicatricial change in the anal canal. Key words: anal incontinence, volume forming gel, proctoplasty, treatment

Concurrence of rectocoele and anal incontinence, and outcome of their simultaneous surgical correction

Rectocoele and faecal incontinence coexist in most patients. We determined an excellent one-year outcome of simultaneous repair of the former and correction of the latter can be achieved.