Fissure, Fistula, and Abscesses

2014 ◽  
Author(s):  
Ira J. Kodner ◽  
Elisa H. Birnbaum
Keyword(s):  
Surgical Treatment ◽  
Patient Positioning ◽  
Fistula Tract ◽  
Operating Table ◽  
Anal Fissures ◽  
Intersphincteric Fistula ◽  
Advancement Flaps ◽  
The Relationship

This review described the etiology and symptoms associated with anal fissures. The physical examination, medical and surgical treatment, and follow-up are detailed. The symptoms and treatment of abscesses and fistula are reviewed. Figures show chronic anal fissures, the relationship between the location of anal fissures and their cause, patient positioning on the operating table, injection of bupivacaine, the closed and open approaches to posterior lateral internal sphincterotomy, classification of anorectal abscesses, alternatives for treating abscess or fistula associated with Crohn disease, a patient with a cryptoglandular abscess/fistula, drainage of an ischiorectal abscess, surgical treatment of a horseshoe fistula, classification of fistula, Goodsall’s rule, ligation of the intersphincteric fistula tract, and advancement flaps. An algorithm outlines the approach to the patient with fissure, abscess or fistula. This review contains 15 figures and 40 references.

scholarly journals LONG-TERM OUTCOMES OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT FOR COMPLEX FISTULA-IN-ANO: MODIFIED OPERATIVE PROCEDURE EXPERIENCE

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Ke WEN ◽  
Yun-Fei GU ◽  
Xue-Liang SUN ◽  
Xiao-Peng WANG ◽  
Shuai YAN ◽  
...  
Keyword(s):  
Success Rate ◽  
Operative Procedure ◽  
Cleveland Clinic ◽  
Fistula Tract ◽  
Long Term Outcomes ◽  
Fistula In Ano ◽  
Complex Fistula ◽  
Intersphincteric Fistula

ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.

Extensor Carpi Ulnaris Problems at the Wrist–Classification, Surgical Treatment and Results

2005 ◽  
Vol 30 (3) ◽  
pp. 265-272 ◽  
Author(s):  
C. ALLENDE ◽  
D. LE VIET
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Styloid ◽  
Wrist Motion ◽  
Extensor Carpi Ulnaris ◽  
Lunotriquetral Ligament ◽  
Triangular Fibrocartilage

Twenty-eight extensor carpi ulnaris lesions at the wrist were treated surgically between 1990 and 2002. Fifteen patients had an isolated extensor carpi ulnaris tenosynovitis or tendinopathy, five had extensor carpi ulnaris dislocation, four had an extensor carpi ulnaris subluxation and four had an extensor carpi ulnaris rupture. Seventeen patients first developed their symptoms while playing sports. At a mean follow-up of 23 months, twenty-two patients had returned to their previous activities. Seven of the 27 patients had lost more than 30% of their grip strength and five had restricted wrist motion. Two needed an extensor carpi ulnaris tenolysis. Pure isolated extensor carpi ulnaris lesions are rare and associated ulnar sided lesions (eleven triangular fibrocartilage complex tears and four lunotriquetral ligament tears), as well as possible predisposing factors (seven anomalous tendon slips, four ulnar styloid non-unions and one flat extensor carpi ulnaris tendon groove), were frequent. A classification of extensor carpi ulnaris tendon and subsheath lesions was developed to allow the surgeon to adequately evaluate the different components of these lesions.

scholarly journals COMPARISON OF MODIFIED METHOD OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) AND STANDARD OPERATIONS IN PATIENTS WITH TRANSSPHINCTERIC RECTAL FISTULAS

2019 ◽  
Vol 6 (2) ◽  
pp. 82-87
Author(s):  
Igor Kryvoruchko ◽  
Tetiana Firsyk ◽  
Oleksandr Bozhko
Keyword(s):  
Surgical Treatment ◽  
Anal Sphincter ◽  
Standard Procedure ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Modified Method ◽  
Intersphincteric Fistula ◽  
Sphincter Insufficiency ◽  
Standard Operations

COMPARISON OF MODIFIED METHOD OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) AND STANDARD OPERATIONS IN PATIENTS WITH TRANSSPHINCTERIC RECTAL FISTULAS Kryvoruchko I.A. , Firsyk T.M.,.  Bozhko O. P. Background. The search for and development of new minimally invasive methods for the surgical treatment of anal fistulas is a relevant area of surgery. Such methods combine less traumatization and preservation of the sphincter’s complex. Employment of such methods for surgical treatment of anal fistulas reduced the time of stay of patients in the hospital and improved their quality of life. Subjects and methods. A retro- and prospective study involved 58 patients with uncomplicated transsphincteric anal fistulas. All patients were treated in the hospital from January 2014 to April 2019.  The patients were divided into two groups: the first group included 32 patients who were operated on according to the standard procedure using fistulotomy and Seton procedure; the second group consisted of 26 patients who were operated on using the modified LIFT method. Results. Most of these patients (72.4%) were men at the age of 42.536.79. The median of BMI was 25.7 kg/m2. There wasn’t mortality after operations. The median follow-up was 21 (6-48) weeks. In the first group there were 3 cases (9.3%) of anal sphincter insufficiency and 7 cases of recurrent fistulas (21.9%) at different times after surgery.  In the second group there were no anal sphincter failure following administration of the modified method LIFT, but there were 15.4% of recurrent anal fistulas. Conclusion. The proposed modified method of ligation of intersphincteric fistula tract is an effective method for the treatment of anal fistulas. The results obtained suggest that the developed method can be used to treat other types of anal fistulas.  Keywords: transsphincteric anal fistula, surgical treatment, LIFT technique, postoperative complications.   Резюме. ПОРІВНЯННЯ МОДИФІКОВАНОГО МЕТОДУ ЛІГАЦІЇ ІНТЕРСФІНКТЕРНОГО  ФІСТУЛЬНОГО ТРАКТУ (LIFT) ТА СТАНДАРТНИХ ОПЕРАЦІЙ У ХВОРИХ З ТРАНСФІНКТЕРНИМИ РЕКТАЛЬНИМИ СВИЩАМИ Криворучко I.A., Фірсик Т.М., Божко О. П. Вступ. Пошук та розробка нових малоінвазивних методів хірургічного лікування анальних свищів є актуальною областю хірургії. Такі методи поєднують меншу травматизацію і збереження сфінктерного комплексу прямої кишки. Застосовання таких методів хірургічного лікування анальних свищів скоротило час перебування хворих у стаціонарі і поліпшило їх якість життя. Об'єкт  і методи.  Ретро- і проспективне дослідження було проведено у 58 пацієнтів з неускладненими транссфінктерними анальними свищами. Всі пацієнти проходили лікування в лікарні з січня 2014 року по квітень 2019 року. Пацієнти були розділені на дві групи: перша група включала 32 пацієнтів, яких оперували за стандартною процедурою з використанням фістулотомії та процедури Сетона; другу групу склали 26 хворих, яких оперували за допомогою модифікованого нами способу лігування інтрасфінктерного фістульного тракту (LIFT). Результати. Більшість цих пацієнтів (72,4%) були чоловіками у віці 42,536,79  років.  Медіана ІМТ склала 25,7 кг/м2.  Після операцій летальних випадків не було. Медіана спостереження після операції склала 21 (6-48) тиждень. У першій групі ми отримали 3 випадки (9,3%) недостатності анального сфінктеру і у 7 випадках  рецидив свищів (21,9%) в різний час після операції. У другій групі після застосування модифікованого методу LIFT ми не отримали жодної недостатності анального сфінктеру, але у цих пацієнтів спостерігалося 15,4% рецидивів анальних свищів. Висновок. Запропонований модифікований спосіб лігування інтрасфінктерного фістульного тракту є ефективним методом лікування анальних свищів. Отримані результати свідчать про те, що розроблений метод може бути використаний для лікування інших видів анальних свищів. Ключові слова: транссфінктерні анальні свищі, хірургічне лікування, техніка LIFT, післяопераційні ускладнення.   Резюме. СРАВНЕНИЕ МОДИФИЦИРОВАННОГО МЕТОДА ЛИГАЦИИ ИНТЕРСФИНКТЕРНОГО ФИСТУЛЬНОГО ТРАКТА (LIFT) И СТАНДАРТНЫХ ОПЕРАЦИЙ У БОЛЬНЫХ С ТРАНСФИНКТЕРНИМЫ РЕКТАЛЬНЫМИ СВИЩАМИ Криворучко I.A., Фирсик Т.М., Божко А. П.  Введение. Поиск и разработка новых малоинвазивных методов хирургического лечения анальных свищей является актуальной проблемой хирургии. Такие методы сочетают в себе меньшую травматизацию и сохранение сфинктерного комплекса прямой кишки. Применение таких методов хирургического лечения анальных свищей сократило время пребывания больных в стационаре и улучшило их качество жизни. Объект и методы. Ретро- и проспективное исследование было проведено у 58 пациентов с неосложненными транссфинктерными анальными свищами. Все пациенты проходили лечение в больнице с января 2014 по апрель 2019 года. Пациенты были разделены на две группы: первая группа включала 32 пациентов, оперированных по стандартной процедуре с использованием фистулотомии и процедуры Сетона; вторую группу составили 26 больных, оперированных с помощью модифицированного нами способа лигирования интрасфинктерного фистульного тракта (LIFT). Результаты. Большинство этих пациентов (72,4%) были мужчинами в возрасте 42,536,79 лет. Медиана ИМТ составила 25,7 кг/м2. После операций летальных исходов не было. Медиана наблюдения после операции составила 21 (6-48) неделю. В первой группе мы получили 3 случая (9,3%) недостаточности анального сфинктера и в 7 случаях  рецидив свищей (21,9%) в разное время после операции. Во второй группе после применения модифицированного метода LIFT мы не получили ни недостаточности анального сфинктера, но у этих пациентов наблюдалось 15,4% рецидивов анальных свищей. Вывод. Предложенный модифицированный способ лигирования интрасфинктерного фистульного тракта является эффективным методом лечения анальных свищей. Полученные результаты свидетельствуют о том, что разработанный метод может быть использован для лечения других видов анальных свищей. Ключевые слова: транссфинктерные анальные свищи, хирургическое лечение, техника LIFT, послеоперационные осложнения

scholarly journals Dental Calculus Is Associated with Death from Heart Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Birgitta Söder ◽  
Jukka H. Meurman ◽  
Per-Östen Söder
Keyword(s):  
Cardiac Death ◽  
International Classification Of Diseases ◽  
Dental Calculus ◽  
Chi Square ◽  
Heart Infarction ◽  
Classification Of Diseases ◽  
The Difference ◽  
The Relationship

Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm.Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI). Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpairedt-test, Chi-square tests, and multiple logistic regressions were used.Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (P<0.01). In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death.Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction.

Syndactyly—A Review and Long Term Results

HAND ◽  
1977 ◽  
Vol os-9 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Peter M. Brown
Keyword(s):  
Surgical Treatment ◽  
Long Term Results ◽  
Anatomical Distribution ◽  
Long Term Follow Up ◽  
Relationship Of ◽  
The Relationship ◽  
Results Of Surgery

Syndactyly is classified and the principles of its surgical treatment discussed. The notes of eighty-five patients who had 222 webs between them were reviewed. A long term follow-up was carried out on thirty-two of these patients who had seventy-six clefts separated. The sexual and anatomical distribution of the syndactyly was investigated. The results of surgery were assessed including complications, and the relationship of complications to the type of graft used and the age at operation. It is suggested that complicated syndactyly is often separated at too early an age.

Efficacy of Lift (Ligation of Intersphincteric Fistula Tract) for Complex and Recurrent Anal Fistulas - A Single-Center Experience and A Review of the Literature

2015 ◽  
Vol 86 (11) ◽  
Author(s):  
Michał Romaniszyn ◽  
Piotr Julian Walega ◽  
Wojciech Nowak
Keyword(s):  
Success Rate ◽  
Current Literature ◽  
Operating Time ◽  
Late Complications ◽  
Fistula Tract ◽  
Single Center ◽  
Anal Fistulas ◽  
Single Center Experience ◽  
Intersphincteric Fistula

AbstractLigation of intersphincteric fistula tract in treatment of anal fistulas (LIFT) is being said to have satisfactory results in short and long follow up, with low risk of complications. This study was designed to evaluate the results in patients with complex and recurrent fistulas in comparison with simple transsphincteric anal fistulas.was to present a single-center experience in LIFT procedure in treatment of both simple and complex anal fistulas, including recurrent fistulas, in comparison with a review of current literature.A series of 17 patients were qualified to LIFT procedure. 5 patients were treated for simple transsphincteric, 6 for complex fistulas, 6 with fistulas recurrent after fistulotomy. Median age was 47, most of the patients were male (16/17). Mean follow up was 11 months.Mean operating time was 55 minutes counting from surgical site disinfection to final dressing of the wound. Of the 17 patients the overall success rate was 53%. As expected, best results were achieved in patients with simple fistulas (80% success rate), then complex (50%), and recurrent fistulas (only 33%). There were no early nor late complications of the surgery.As expected, in simple transsphincteric fistulas the results were satisfactory, taking into account low complication rate. Complex and recurrent fistulas seem to be risk factors of LIFT failure. The results are consistent with data published by other authors, based on the review of the current literature, and it seems there is still room for improvement, so further research is required.

scholarly journals INTERESFINCTERIAL LIGATION OF FISTULA TRACT (LIFT) FOR PATIENTS WITH ANAL FISTULAS: A BRAZILIAN BI-INSTITUTIONAL EXPERIENCE

2017 ◽  
Vol 30 (4) ◽  
pp. 235-238 ◽  
Author(s):  
Sérgio Eduardo Alonso ARAÚJO ◽  
Marcelli Tainah MARCANTE ◽  
Carlos Ramon Siveira MENDES ◽  
Alexandre Bruno BERTONCINI ◽  
Victor Edmond SEID ◽  
...  
Keyword(s):  
Success Rate ◽  
Operative Time ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Modified Technique ◽  
External Orifice ◽  
Institutional Experience ◽  
Observational Cohort ◽  
Intersphincteric Fistula

ABSTRACT Background : The best treatment for anal fistula should extirpate infection and promote healing of the tract, whilst preserving the anal sphincter complex and full continence. Aim: To analyze the success rate after a modified technique for ligation of the intersphincteric fistula tract (LIFT) for patients with anal fistulas. Methods: A prospective (observational cohort study) Brazilian bi-institutional experience with a modified (ligation of the intersphincteric fistula tract without excision) LIFT technique was undertaken. A clinical database was settled for the following variables: age, gender, BMI, comorbidities, distance between external orifice and the anus, previous fistula surgery, type of fistula, operative time, intra- and postoperative complications, duration of follow-up, and success rate. Results: Between November 2015 and January 2017, 38 patients with transsphincteric fistulas were operated on using the modified LIFT procedure. Seventeen (44.7%) were men. Median age was 41 (18-67) years. Median BMI was 26.4 (22-38) kg/m2. Five (13.2%) had undergone previous surgery. The fistula was transsphincteric in all cases. Median follow-up was 32 (range, 14-56) weeks. Success was observed in 30 (79%) patients. Conclusions: The LIFT technique without excision of the fistula tract proved to be safe and effective for transsphincteric anal fistulas.

Transanal Opening of Intersphincteric Space for Fistula-in-Ano

2021 ◽  
pp. 000313482198904
Author(s):  
Yu-bo Li ◽  
Ju-hua Chen ◽  
Meng-di Wang ◽  
Jun Fu ◽  
Bing-chuan Zhou ◽  
...  
Keyword(s):  
Fistula Tract ◽  
Resonance Imaging ◽  
Clinical Database ◽  
Fistula In Ano ◽  
Fistula Surgery ◽  
P 16 ◽  
Preoperative Magnetic Resonance ◽  
Intersphincteric Fistula

Background The role of the intersphincteric space in the pathogenesis of fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric rectal abscesses have been surgically managed by laying open and draining the intersphincteric space as well as by the modified ligation of intersphincteric fistula tract (LIFT) procedure. In 2017, the transanal opening of intersphincteric space (TROPIS) technique was reported for the treatment of high, complex anal fistulae. Aim We aim to investigate the advantages of performing the TROPIS procedure in patients with fistula-in-ano. Methods This was a prospective cohort study investigating the outcomes in patients who had undergone a procedure using the TROPIS technique for the treatment of fistula-in-ano. Preoperative magnetic resonance imaging scans and electronic colonoscopies were performed on all patients. A clinical database evaluating the following variables was constructed: age, gender, body mass index (BMI), previous fistula surgery, type of fistula, postoperative complications, duration of follow-up, success rate, and incontinence scores pre- and postoperatively. Results The TROPIS procedure was performed on 41 patients with fistula-in-ano with a follow-up time of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 females, mean age 38.6±13.2 years, and mean BMI 23.5±3.9 kg·m−2. All patients (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% (6) of patients, and the healing of high fistula was 86.5% (32). Of those patients who had not healed completely, 2 were found to have contracted iatrogenic infections due to foreign residues and underwent surgery with the passing of a loose seton. The additional 4 patients who had not healed underwent a fistulotomy and healed completely thereafter. There were no significant changes in incontinence scores. The incontinence scores were .15 ± .36 preoperatively and .22 ± .47 3 months postoperatively (t = −1.438, P = .16). Conclusions The TROPIS technique is a novel sphincter-preserving procedure, which can be effectively used in treating fistula-in-ano.

scholarly journals Differential diagnostics of adrenal incidentalomas

2011 ◽  
Vol 57 (6) ◽  
pp. 3-8
Author(s):  
D G Bel'tsevich ◽  
T V Soldatova ◽  
N S Kuznetsov ◽  
O V Remizov ◽  
A V Vorontsov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Research Centre ◽  
Differential Diagnostics ◽  
Specific Method ◽  
Suppression Test ◽  
Ct Density ◽  
The Relationship ◽  
Malignancy Potential

We have analysed the results of radiological investigations (USI, CT, and MRT) involving 177 patients given surgical treatment at the Endocrinological Research Centre during 2006-2010. In addition, the study included measurement of cortisol levels in the dexamethasone suppression test, fractionated metanephrins, and the relationship between aldosterone levels and plasma rennin activity (in the patients presenting with arterial hypertension). Twenty two patients underwent tumour puncture. Seventy six (55.9%) of the 136 patients having incidentalomas were found to have no indications for the surgical intervention (because of the absence of hormonal activity and low malignancy potential of the neoplasm). The follow-up period averaged 24.9±19 months. The choice of indications for the surgical treatment should be based on the results of standardized hormonal studies and the determination of malignancy potential using the native CT density above 20 UH as the principal criterion. Differential diagnostics by USI, MRT, and descriptive CT is believed to be inadequate. USI may be applied as a highly specific method for the detection of cysts and myelolopomas. Native CT density should be taken into consideration for the interpretation of the results of fractionated metanephrin measurements. Diagnosis of pheochromocytoma is very unlikely in the patients presenting with low CT density. Puncture biopsy is indicated only when the presence of metastases in the adrenal glands is suspected.

The Bearing of Treatment on the Classification of the Affective Disorders

1970 ◽  
Vol 117 (538) ◽  
pp. 251-255 ◽  
Author(s):  
Clair Gurney ◽  
Martin Roth ◽  
T. A. Kerr ◽  
Kurt Schapira
Keyword(s):  
Forearm Blood Flow ◽  
Function Analysis ◽  
Depressive Illness ◽  
Anxiety State ◽  
Flow Measurements ◽  
Clinical Indices ◽  
Blood Flow Measurements ◽  
The Relationship

The relationship between anxiety state and depressive illness has been debated for many years. On clinical grounds, Mapother (1926) and Lewis (1966) expressed the view that the various forms of anxiety and depressive states merge imperceptibly into one another, while Garmany (1956, 1958) and Stenback (1963) considered that they were fundamentally different disorders. Gurney, Roth and Garside (1970) showed that the two conditions differ significantly in respect of a large number of biographical, personality and clinical indices. They also demonstrated that the disorders could be separated by means of a discriminant function analysis and that the distribution of the patients' scores was clearly bimodal. In a four year follow-up study of the same group of patients, Kerr, Gurney, Schapira and Roth (1970) showed that depressive illnesses carry a significantly better prognosis. Moreover, physiological evidence based on forearm blood-flow measurements has also given tentative support to the differentiation of the disorders (Kelly and Walter, 1969).

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