A comparative study of ligation of intersphincteric fistula tract (LIFT) and conventional fistulotomy in treatment of fistula-in-ano

2021 ◽  
Vol 19 (1) ◽  
pp. 13-17
Author(s):  
Gopi Krishna Mishra ◽  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Complete Healing ◽  
Fistula Tract ◽  
Care Hospital ◽  
Fistula In Ano ◽  
Post Operative Pain ◽  
Intersphincteric Fistula ◽  
The Difference ◽  
Duration Of Operation

Background: A hospital randomized control study was conducted at a tertiary care Hospital, to compare outcomes between the Ligation of Intersphincteric Fistula Tract (LIFT) technique and conventional fistulotomy for the treatment of low trans-sphincteric fistula in ano, including 50 patients of low trans-sphincteric fistula in ano randomly divided into two groups. LIFT technique was used in first group while Conventional Fistulotomy was performed in another. Mean duration of operation was significantly less and mean hospital stay, post-operative pain and analgesics need was significantly less in cases operated with LIFT. Mean time for complete healing was significantly less in cases operated with LIFT technique and the difference in complication rate was statistically nonsignificant. Recurrence was reported in 3 (12%) and 1 (4%) cases operated by LIFT and fistulotomy respectively. Ligation of Intersphincteric Fistula Tract (LIFT) procedure is effective and preferred sphincter saving technique for fistula-in-ano. Despite slightly more recurrence, LIFT procedure has certain advantages over standard fistulotomy like shorter operative time, less postoperative pain, shorter hospital stay and faster wound healing and early resumption of normal duties.

scholarly journals A comparative study between manual vacuum aspiration and electronic suction for surgical treatment of abortion

2021 ◽  
Vol 10 (9) ◽  
pp. 3342
Author(s):  
Gira C. Dabhi ◽  
Twinkle S. Patel ◽  
Nimisha J. Chaudhary ◽  
Janki M. Pandya
Keyword(s):  
Hospital Stay ◽  
Success Rate ◽  
Pain Perception ◽  
Tertiary Care ◽  
Uterine Perforation ◽  
Care Hospital ◽  
Trimester Abortion ◽  
Vacuum Aspiration ◽  
Post Operative Pain ◽  
Manual Vacuum Aspiration

Background: Present study is done to study the safety, efficacy and complications of using manual vacuum aspiration (MVA) for surgical management of first trimester abortion in comparison to electronic suction.Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at tertiary care hospital. Out of 100 cases taken, 50 abortions were terminated by MVA and 50 were terminated by electric suction/vacuum aspiration (EVA).Results: In this study, majority of the patients were primigravida (60%). Most of the patients had period of gestation between 7 to 9 weeks (40%) followed by up to 6 weeks (33%) in both groups. Time taken for the procedure was less in MVA (5-9 min.) than electronic suction (7-11 min.). In terms of complications, blood loss ≥100 ml was more with EVA (18%) compared to MVA (6%). Uterine perforation was seen with EVA (4%) and none with MVA. As far as success rate is concerned, EVA got 98% while MVA got 90%. Post-operative hospital stay was less with MVA (≤12 hours) than EVA (up to 24 hours). Post-operative pain perception was less with MVA (18% severe pain) while with EVA, 36% with severe pain.Conclusions: Both the evacuation techniques are almost equally effective and safe, still duration; post-operative pain and hospital stay are less with MVA. Success rate is better with EVA.

scholarly journals LIGATION OF INTERSPHINCTERIC FISTULA TRACT AS AN ALTERNATIVE TREATMENT FOR PERIANAL FISTULA AT TERTIARY CARE HOSPITAL

2021 ◽  
Vol 3 (3) ◽  
pp. 53-58
Author(s):  
Nawaz Ali Dal ◽  
Ishrat Raheem Katyar ◽  
Mohammad Qasim Mallah ◽  
Ahsan Laghari ◽  
Shiraz Shaikh ◽  
...  
Keyword(s):  
Fistulous Tract ◽  
Tertiary Care ◽  
Perianal Fistula ◽  
Perianal Abscess ◽  
Sampling Technique ◽  
Fistula Tract ◽  
Care Hospital ◽  
Therapeutic Success ◽  
Preoperative Symptom ◽  
Intersphincteric Fistula

This study was aimed to evaluate clinical outcome of patients with perianal fistula operated with the ligation of intersphincteric fistula tract (LIFT) technique. The study was conducted at Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro from July 2018 and August 2019. A total of 22 patients diagnosed with perianal fistula operated with the Ligation of Intersphincteric Fistula Tract (LIFT) technique were selected using non-probability consecutive sampling technique. Physical examination and magnetic resonance imaging (MRI) and/or endosonography (ES) were performed to make a confirmed diagnosis of fistula. They were classified according to Parks classification. All patients were subjected to intersphincteric fistulous tract ligation using the technique defined by Rojanasakul modified. There were 16 males and 6 females. Mean age was 42 years (range 23-68 years of age). Out of 22 patients, 17 patients had a history of perianal abscess drainage prior to surgery and an average preoperative symptom presentation was 2.2 years (range 0-10 years). Therapeutic success with first surgery was achieved in 77% and with a second surgery in 90%. None of this patients modified their preoperative Wexner. It was concluded that LIFT technique appears to be a convenient, reproducible, and effective surgical alternative. This provides an appropriate closing rate and without continence modification, Therefore indicated for complex cryptoglandular fistulas.  

scholarly journals Clinical study of various modalities of treatment for fistula in ano at a tertiary care hospital

2017 ◽  
Vol 4 (11) ◽  
pp. 3670
Author(s):  
Sushrut Pradeep Tated ◽  
Kuldeep Sharma ◽  
Ashish Ashokrao Hatkar
Keyword(s):  
Tertiary Care ◽  
Fistula Tract ◽  
Outpatient Basis ◽  
Care Hospital ◽  
Internal Opening ◽  
Cross Sectional ◽  
Fistula In Ano ◽  
Clinical Presentations ◽  
Perineal Region ◽  
Local Examination

Background: Despite the ease of diagnosis, establishing a cure is problematic as many patients tend to let their disease nag them rather than treatment. Also, due to site of this disease many patients delay the treatment. Objectives was to study the various etiologies of fistula in ano, to study the different modes of clinical presentations of these fistulae-in-ano, efficacy of different modalities of surgical approach with reference to recurrence of fistulae.Methods: Hospital based cross sectional descriptive study was carried out among 81 eligible patients of fistula in ano. Local Examination, Per Rectal Examination, Proctoscopy was done to assess the external opening, internal opening and fistula tract. Patients were advised Fistulogram and sent to Department of radiology on outpatient basis for the same. Patients with fistulography report were admitted and surgical treatment was planned according to the fistulography report. Appropriate surgery was planned. Specimens were sent to histopathology.Results: Commonest age of presentation was between 30-40 years. Males were more commonly affected. Swelling in perineal region was commonest mode of presentation. Fistula with only one opening was around 85.18%. Anteriorly situated fistula was around 14.81%. Low level fistula was more common. Majority of patients i.e. 74.07% underwent fistulectomy. 9.87% patients underwent fistulotomy. 16.04% patients underwent setonthresd placement. Three Patients developed recurrence.Conclusions: Fistulotomy is associated with slightly high recurrence but low chances of anal incontinence as compared to fistulectomy.

scholarly journals Ligation of the intersphincteric fistula tract for the treatment of fistula-in-ano: experience of a tertiary care centre in South India

2016 ◽  
Vol 18 (5) ◽  
pp. 496-502 ◽  
Author(s):  
R. Parthasarathi ◽  
R. M. Gomes ◽  
S. Rajapandian ◽  
R. Sathiamurthy ◽  
P. Praveenraj ◽  
...  
Keyword(s):  
South India ◽  
Tertiary Care ◽  
Fistula Tract ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Fistula In Ano ◽  
Intersphincteric Fistula

scholarly journals Comparison of “medicated seton versus fistulectomy” in the management of fistula-in-ano in tertiary care hospital

2018 ◽  
Vol 5 (8) ◽  
pp. 2857
Author(s):  
Swapnil P. Madankar ◽  
Girish L. Jatkar ◽  
Bhagwat Bhusari
Keyword(s):  
Controlled Trial ◽  
Tertiary Care ◽  
Perineal Wound ◽  
Complete Healing ◽  
Care Hospital ◽  
Care Level ◽  
Fistula In Ano ◽  
Medical College ◽  
Time Required ◽  
A Minor

Background: Fistula-in-ano is defined as communication between anal canal or rectum to external surface.  The main objectives of the study are to compare management of fistula-in-ano by “Medicated seton Vs Fistulectomy” and its outcome in term of complications and the recurrences if any.Methods: This study is a randomized controlled trial. Total 46 consecutive patients presenting to the Department of Surgery at SVNGMC Medical College Yavatmal with fistula-in-ano during the time of Sep-13 to Oct-15 were included in the study.  All the patients were studied as per the proforma and treated by either medicated seton or fistulectomy.Results: It was observed that operative time required (min) in medicated seton was significantly less than fistulectomy procedure. Hospital stay (days) required was significantly more in fistulectomy procedure as compared to medicated seton. Time required for complete healing (days) was significantly more in medicated seton as compared to fistulectomy.Conclusions: It is concluded that treatment of fistula-in-ano by medicated seton is simple, easy, and safe. Medicated seton treatment is an outpatient procedure and can be done in a minor operation theatre or even at Primary Health Care level. Procedure not left with a large perineal wound and its associated morbidity.

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals A Comparative Analysis of Outcomes of Conventional Cold Dissection Versus Laser Tonsillectomy in Pediatric Cases in a Tertiary Care Hospital in Haryana

2021 ◽  
Author(s):  
Amit Kumar ◽  
Surender Kumar ◽  
Anand Krishnan ◽  
Manish Verma ◽  
Uma Garg ◽  
...  
Keyword(s):  
Operative Time ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Paediatric Population ◽  
Care Hospital ◽  
Secondary Complications ◽  
Post Operative Pain ◽  
Secondary Bleeding ◽  
Paediatric Age ◽  
Cold Dissection

AbstractTonsillectomy is one of the commonest ENT procedures done in paediatric population, the technique of which has evolved over years to decrease the morbidity associated with the surgery. This prospective randomized comparative study is done to evaluate the efficacy of two different techniques of this surgery, conventional cold dissection and laser tonsillectomy based on operative time, blood loss, post-operative pain and occurrence of secondary complications. The study was done in 68 patients of paediatric age group, 34 in each group underwent cold dissection and laser tonsillectomy. Operative time and bleeding were significantly low for laser group. Pain score was comparable in early post-operatives days, but was high towards the end of first week. Our study reported only one incidence of complication in the form of a secondary bleeding.

scholarly journals The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Carlos Placer-Galán ◽  
Jose Mª Enriquez-Navascués ◽  
Tania Pastor-Bonel ◽  
Ignacio Aguirre-Allende ◽  
Yolanda Saralegui-Ansorena
Keyword(s):  
Systematic Review ◽  
Anal Fistula ◽  
Meta Analysis ◽  
Fistula Tract ◽  
Cochrane Library ◽  
Fistula In Ano ◽  
Intersphincteric Fistula ◽  
The Impact ◽  
Seton Placement ◽  
Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

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