scholarly journals A Simple Protocol to Effectively Manage Anal Fistulas with No Obvious Internal Opening

2021 ◽  
Vol Volume 14 ◽  
pp. 33-44
Author(s):  
Pankaj Garg ◽  
Baljit Kaur ◽  
Konica Singla ◽  
Geetha R Menon ◽  
Vipul D Yagnik
Keyword(s):  
Internal Opening ◽  
Anal Fistulas ◽  
Simple Protocol

scholarly journals Evaluation of Diagnostic Accuracy of Anal Fistula by 360° Endoanal Ultrasound

2019 ◽  
Vol 10 (2) ◽  
pp. 66-69
Author(s):  
Jawhar Lal Singha ◽  
Sami Ahmad ◽  
Nadim Ahmed ◽  
SM Zulker Nayeem ◽  
Ferdoush Rayhan ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Anal Fistula ◽  
Imaging Modality ◽  
Endoanal Ultrasound ◽  
Internal Opening ◽  
Surgical Results ◽  
Anal Fistulas ◽  
Imaging Tool ◽  
Endoanal Sonography ◽  
Noninvasive Imaging Modality

Introduction: 360° endoanal ultrasound (EAUS) has become an effective imaging tool to diagnose anal fistulas for last three decades. Objectives: To assess the diagnostic accuracy of 360° endoanal ultrasound imaging comparing pre and peroperative diagnosis in anal fistulas. Methods: Between Jauary 2015 and June 2018, 240 patients with clinical anal fistula underwent endoanal sonographic assessment using a 360° endoanal transducer (7–15 MHz The sonographic findings, including the fistulas and other inflammatory lesions, were correlated with surgical results. The types of fistulas on endoanal sonography based on classification of Park and the internal opening of the fistula, both pre and peroperative, were compared to those of other studies. Results: The 240 patients studied included 165 male and 75 female patients. Endoanal sonography was able to show and track hypoechoic lesions, their locations, and internal openings of the fistulas. Compared with surgical results, endoanal sonography had sensitivity of 94.6%, specificity of 100%, and accuracy of 94.1% for the diagnosis of perianal fistulas. Also, endoanal sonography had accuracy of 86.1% for determining fistula types based on the Parks classification and 92.8% for identifying internal openings of the fistulas. Conclusions: Endoanal ultrasound is an accurate and noninvasive imaging modality for evaluation of fistulas. It is a very useful tool for preoperative management and surgical planning by providing precise and detailed information on fistulas. J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 66-69

scholarly journals a Video Assisted Anal Fistula Treatment “VAAFT Technique” for Anal Fistulas

2018 ◽  
Vol 6 (04) ◽  
Author(s):  
Devashis Biswas ◽  
Kavya ramrao Kadapi
Keyword(s):  
External Surface ◽  
Fistulous Tract ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Fistula In Ano ◽  
Infection Treatment ◽  
Anorectal Region ◽  
Fistula Treatment ◽  
Histopathological Investigation ◽  
Rule Out

Fistula in ano -: It is a complete tract with two openings in anorectal region, one in the external surface, second in the anal canal or in higher anatomical structures1. Fistula in ano commonly develops as a symptomatic or asymptomatic abscess due to cryptoglandular infection; treatment depends upon the location of the anatomy or tract of the fistula. General principle for management of Fistula in ano-Irrigation of the whole fistulous tract, part of the fistulous track which is opened outside  should be excised, obliteration of the internal opening is the key of success, excised tract should be send for histopathological investigation to rule out other pathology e.g Tuberculosis.

scholarly journals Video Assisted Anal Fistula Treatment, a Paradigm Shift in the Treatment of Complex Anal Fistulas

2021 ◽  
Vol 8 (06) ◽  
pp. 313-318
Author(s):  
Anshu Atreya ◽  
Ankit Raikhy ◽  
Srinivasa Rao Geddam ◽  
Abhishekh Bhartia ◽  
Vishnu Kumar Bhartia
Keyword(s):  
Anal Fistula ◽  
Small Subset ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Fistula In Ano ◽  
Video Assisted ◽  
Wide Range ◽  
Ancient Times ◽  
Fistula Treatment ◽  
Complex Anal Fistulas

BACKGROUND Fistula-in-ano or anal fistulas are documented since ancient times and their management has always been a challenge. Various modalities of treatment are available and newer ones are being added each day. The aim of this retrospective study is to analyse the outcome of the video assisted anal fistula treatment (VAAFT), one of the modalities of treatment for complex anal fistulas done at our centre. METHODS Records of patients who had been treated through VAAFT by single senior consultant surgeon of Minimal Access Surgery unit between April 2013 and March 2019, were collected and analysed. RESULTS Altogether, records of 48 (forty-eight) patients who had undergone VAAFT during the period were analysed. Data revealed that 38 male (79.17 %) and 10 female (20.83 %) patients with mean age of 49.96 ± 12.22 years were operated. Most commonly, trans sphincteric followed by inter sphincteric type of fistulae were encountered. In 3 cases, internal opening couldn’t be visualised. Six patients were documented to have a recurrence within 6 months of the procedure and in the rest were cured except in a small subset of patients who did not follow up. CONCLUSIONS Amongst the wide range of armamentarium available today for the treatment of complex anal fistulas, video assisted anal fistula treatment (VAAFT) is a novel sphincter saving technique. The recurrence rate at our centre was at par with other studies and with zero incontinence rate, however further RCTs are required. KEYWORDS Complex Anal Fistula, Fistula-in-Ano, MEINERO Fistuloscope, VAAFT

scholarly journals A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

2020 ◽  
Author(s):  
Hassan Al-Turaihi ◽  
Blears Elizabeth ◽  
Sugumar Kavin ◽  
Deshmukh Maya ◽  
Deshmukh Ganesh
Keyword(s):  
Fecal Incontinence ◽  
Advancement Flap ◽  
Absorbable Suture ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Fistula In Ano ◽  
Endorectal Advancement Flap ◽  
Flap Failure ◽  
Complex Fistula

Abstract Background Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods A retrospective review of patients with complex fistula-in-ano who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using Chi-squared test and student’s t-test or Mann-Whitney U test with statistical significance at alpha <0.05. Results With a median follow-up of 6.6 months (range: 1.6-84.5 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 3% (3/99) experienced postoperative fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of flap failure.Conclusion EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (3%) and a valid treatment option for complex fistula-in-ano.

How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas

2009 ◽  
Vol 395 (8) ◽  
pp. 1055-1059 ◽  
Author(s):  
Andrzej Sygut ◽  
Michal Mik ◽  
Radzislaw Trzcinski ◽  
Adam Dziki
Keyword(s):  
Internal Opening ◽  
Anal Fistulas ◽  
Treatment Results

scholarly journals A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

2020 ◽  
Author(s):  
Hassan Al-Turaihi ◽  
Blears Elizabeth ◽  
Sugumar Kavin ◽  
Deshmukh Ganesh
Keyword(s):  
Fecal Incontinence ◽  
Statistical Significance ◽  
Advancement Flap ◽  
Systemic Steroid ◽  
Absorbable Suture ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Endorectal Advancement Flap ◽  
Flap Failure

Abstract Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.

scholarly journals A Novel Modification of the Endorectal Advancement Flap for Complex Anal Fistulas: Surgical Technique and Outcomes

2021 ◽  
Vol 105 (1-3) ◽  
pp. 720-728
Author(s):  
Hassan Al-Turaihi ◽  
Elizabeth Ellen Blears ◽  
Kavin Sugumar ◽  
Ganesh Deshmukh
Keyword(s):  
Fecal Incontinence ◽  
Advancement Flap ◽  
Adverse Outcomes ◽  
Systemic Steroid ◽  
Absorbable Suture ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Endorectal Advancement Flap ◽  
New Onset

Objective A modification of the endorectal advancement flap (EAF) procedure is described with outcomes in a single-center, large retrospective cohort study. Summary of background data Fistula-in-ano is a common problem encountered by surgeons that can be classified as either simple or complex. Complex fistulas (CFs) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Methods Charts were reviewed of patients with CF who underwent EAF between 2004 and 2019. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of new-onset fecal incontinence and recurrence were analyzed at the last available date of in-person follow-up. Results With a median follow-up of 6.6 months (range, 3.3–24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92 of 99) had resolution of fistula without adverse outcomes, 7% (7 of 99) experienced recurrence, and 1% (1 of 99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (P = 0.001) and patients with diagnosed inflammatory bowel disease (P &lt; 0.0001) were associated with increased rate of recurrence. Conclusions EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and is a valid treatment option for CFs.

scholarly journals A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

2020 ◽  
Author(s):  
Hassan Al-Turaihi ◽  
Elizabeth Blears ◽  
Kavin Sugumar ◽  
Ganesh Deshmukh
Keyword(s):  
Fecal Incontinence ◽  
Statistical Significance ◽  
Advancement Flap ◽  
Systemic Steroid ◽  
Absorbable Suture ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Endorectal Advancement Flap ◽  
Flap Failure

Abstract Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.

scholarly journals Electrochemical multicomponent synthesis of 4-selanylpyrazoles under catalyst- and chemical-oxidant-free conditions

2021 ◽  
Author(s):  
Yan Wu ◽  
Jin-Yang Chen ◽  
Jing Ning ◽  
Xue Jiang ◽  
Jie Deng ◽  
...  
Keyword(s):  
Multicomponent Reaction ◽  
Raw Materials ◽  
Multicomponent Synthesis ◽  
Mild Conditions ◽  
Simple Protocol ◽  
High Yields

An electrochemical multicomponent reaction was established under catalyst-, chemical-oxidant-free and mild conditions, which provides an eco-friendly and simple protocol for constructing 4-selanylpyrazoles from easily available raw materials with high yields.

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