Comparative characteristics of the results of surgical treatment of combined anorectal pathology using modern radiosurgical and high-frequency electrosurgical technologies

Annotation. Surgery of combined anal canal and rectal diseases requires an unconventional tactics and methods of treatment of these pathologies, which provide minimal impact on tissues, preventing postoperative complications. The purpose of the study was conduction a comparative evaluation of the results of surgical treatment of combined anorectal pathology using modern radiosurgery and electrosurgery technologies by analyzing the clinical course of the postoperative period and studying the depth of impact of these technological devices on the structure of operated tissues. The results of treatment of 635 patients with combined diseases of the anal canal and rectum, divided into four study groups, were analyzed. The control group consisted of 112 patients operated with a surgical scalpel. After surgery 30 patients from each study group underwent morphological investigation of rectal and anal tissues for measurement of the thickness of thermal impacts on them, which was performed using an eyepiece-micrometer scale. Statistical analysis of the obtained data was performed using IBM SPSS STATISTICS SUBSCRIPTIONAL TRIAL software. License number: L-CZAA-BHG85V. The following are used in the work: Kolmogorov-Smirnov test with Lilliefors and Shapiro-Wilk correction, Levene's criterion at p<0.05; applied one-way analysis of variance, Bonferroni test; used the Welch test and the Brown-Forsyth test, the Games-Howell test; used the Kruskal-Wallis test, the Mann-Whitney test. It is established that due to the minimal and shallow impact on the tissues during application of electrosurgery devices “KLS Martin”, “EFA” and “ERBE ICC 200”, as well as radiosurgery device “Surgitron”, there were no detected neither scar anal strictures in any of the four study groups nor scarring deformities of the pararectal areas, which contributed to the cosmetic nature of the combined operations and caused rapid rehabilitation of patients in the study groups. In the control group in 2 (1,8%) patients diagnosed the formation of scar anal stricture which required conservative (1 patient) and operative (1 patient) measures to eliminate them. Using of modern radiosurgical and electrosurgical technologies for the treatment of combined anal and rectal diseases reduces the duration of surgery, intraoperative blood loss, postoperative pain and prevents scar strictures of the anal canal.

Early results of different types of anorectoplasty for anorectal malformations

Objective: To document our experience with the technique of surgical repair in anorectal malformations (ARM) and the short term anatomical and functional outcomes. Methods: This study included total 31 babies. Fourteen were perineal fistula cases with age range between 1 to 4 days. Ten patients had vestibular fistula and seven had rectourinary fistula. Primary diverting colostomy was done for vestibular and rectourinary fistula patients. On the other hand low imperforate anus with anoperineal fistula without associated major anomalies had undergone fistulectomy and simple anoplasty. Results: Simple anoplasty was done for fourteen perineal fistula cases. Anterior sagittal anorectoplasty (ASARP) was done for 10 vestibular fistulae and posterior sagittal anorectoplasty (PSARP) was done in 10 recto-urinary fistula cases. Simple anoplasty and vestibular anus scored good (5-6) in 70% to 71% while PSARP scored fair in 58% of the cases. Postoperative mucosal prolapse, anal stenosis and retraction occurred in two, six and one patient respectively. Redo surgery was done in mucosal prolapse and retraction cases. Four responded to anal dilation and the other needed redo surgery by a simple cutback technique for anal stricture. Continence was assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty one patients had a good score and two had a fair score. No patients had a poor score. Conclusion: Our approach has the following advantages: (i) The operative technique is simple and easy to perform. (ii) Minimal complication rate with good cosmetic results. Mediscope 2021;8(2): 75-79

P614 A strategy to solve complexity of physician diagnosis using a mixture of Patient Reports and Provider Reports: A Case Study of Crohn’s Disease Phenotypes

Background The IBD Plexus® Registry, established by the US Crohn’s & Colitis Foundation, combines patient and provider reported survey data collected from doctors’ visits and historical data in electronic medical record (EMR) systems. This multi-resource dataset presents data discrepancies in assessing phenotypes of Crohn’s disease (CD). The aim of this analysis is to describe a strategic process to solve data challenges related to CD phenotype definitions based on the IBD Plexus data. Methods This cross-sectional, multicenter, US based study used data from 11/2016 to 06/2020 from the IBD Plexus® Sparc program to assess demographics, symptoms and treatments among CD patients. Data discrepancies between CD phenotype status reported and as described in historical EMRs were identified. Physicians may use the Montreal classification with/without the Paris modification for phenotype evaluation. To resolve this discrepancy, we explored and evaluated several study phenotype definitions: 1) using phenotypes at visits, the registry suggested method; 2) using phenotype and history of fistula/abscess or stricture in EMR; and 3) using definition 2 without anal stricture. The implementation included two steps: 1) severe conditions (penetrating, stricturing or both) were considered irreversible and defined using the data at any time before 30 days after the registry consent date; 2) the inflammatory condition was positive in the absence of any other reported severe condition during the entire study period. Results The frequency results by phenotypes show small differences across definitions (Figure 1). The discrepancy in frequency by definition1 demonstrated the phenotypes recorded at visits contradicted phenotypes in the EMR. For instance, 0.1%-3.2% or 0.1–0.7% of CD inflammatory patients had subtypes of stricture and subtypes of fistula/abscess, respectively. About 0.5% of CD stricturing patients had intra-abdominal abscess or other fistula (Figure 2). Among CD penetrating patients, 32.0% had history of ileal stricture (Figure 3). Including EMR phenotype variables in definition 2, all discrepancies were resolved. With verification, anal strictures are due to perianal disease which should not be used in the stricturing definition; therefore, the anal stricture was exempt from definition 3. All subtype phenotypes showed 0% discrepancy with study phenotype. A small percentage of positive anal stricture patients was allowed in definition 3. Figure 1. Figure 2. Figure 3. Figure 4. Conclusion When handling the mixture of patient reported and provider-reported data, data discrepancies have many causes. Clarifying the clinical rationale is a key process to resolve discrepancies and accurately define measures of interest.

Role of Kshara Sootra in complicated cases of Arsha (interno-externo haemorrhoids) -A case series

Kasharasutra is being practiced in Indian system of medicine since ancient time in various ano-rectal disorders. In this case series, 2 patients of arsha (internal external haemorrhoids) underwent ksharasutra trans fixation at 3,7,11 o’ clock under spinal anaesthesia. Ksharasutra prepared as per the ayurvedic pharmacopeia of India (API). Ligated pile mass sloughed out on 5th post-operative day. Wound healed within 30 days. Panchavalkal kwatha for sitz bath, jatyadi taila for local application, gud haritaki were used as adjuvant drugs. Follow up after 4 weeks, no recurrence was observed, sphincter tone was normal and there was no evidence of anal stricture after complete wound healing.

Laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children: 5 years of experience

Purpose The purpose of this study was to summarize the clinical experience of the laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children. Methods In total, 186 children with Hirschsprung disease participated in this study from January 2014 to January 2019. The Soave operation was used to treat Hirschsprung disease with laparoscopic assistance. Symptoms and signs were followed up at one week, one month, three months, six months, one year and every 1-2 years after the first year. Results All 186 children underwent laparoscopic surgery successfully, and none progressed to open surgery. During hospitalization and follow-up, there were 49 patients with complications, including 1 patient with an anastomotic leakage, 1 with an anal stricture, 5 with constipation recurrence, 5 with dirty defecation, 22 with enterocolitis, and 15 with perianal erosion. There were no complications such as abdominal bleeding, abdominal infection, ureter injury, adhesive intestinal obstruction, anastomotic stricture, incontinence. Conclusion The laparoscopic-assisted Soave operation is a safe and feasible method for the treatment of Hirschsprung disease in children. This method has the advantages of less trauma and good cosmetic effects.

Laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children: 5 years of experience

Purpose: The purpose of this study was to summarize the clinical experience of the laparoscopic-assisted Soave operation for the treatment of Hirschsprung disease in children. Methods: In total, 186 children with Hirschsprung disease participated in this study from January 2014 to January 2019. The Soave operation was used to treat Hirschsprung disease with laparoscopic assistance. Symptoms and signs were followed up at one week, one month, three months, six months, one year and every 1-2 years after the first year. Results: All 186 children underwent laparoscopic surgery successfully, and none progressed to open surgery. During hospitalization and follow-up, there were 49 patients with complications, including 1 patient with an anastomotic leakage, 1 with an anal stricture, 5 with constipation recurrence, 5 with dirty defecation, 22 with enterocolitis, and 15 with perianal erosion. There were no complications such as abdominal bleeding, abdominal infection, ureter injury, adhesive intestinal obstruction, anastomotic stricture, incontinence. Conclusion: The laparoscopic-assisted Soave operation is a safe and feasible method for the treatment of Hirschsprung disease in children. This method has the advantages of less trauma and good cosmetic effects.

Management of staple line stricture with new laser four quadrant stricturoplasty: a case series

Background: To assess the outcomes of Laser Four Quadrant stricturoplasty surgery in patients with staple line anal stricture post MIPH and STARR surgery.Methods: A prospective observational study was planned with purposive sampling. Cases with staple line stricture during the period February 2014 to July 2015 were included. There were 30 patients included in the study after informed consent and ethical clearance from hospital ethical committee. The data collected was background data, history of previous surgery, duration of Laser Four Quadrant stricturoplasty and Hospital stay, post-operative relief of symptoms and any complications, assessment of pain on VAS up to one year follow up period, overall patients’ satisfaction.Results: Out of 30 patients, 22 anal stricture patients were post STARR surgery and 8 were post MIPH surgery. The mean surgery and hospitalization duration were 24.48±6.31 minutes and 13.72±4.30 hours respectively. Symptoms reported were Obstructed defecation (n=30), painful evacuation (n=30) and episodes of minor rectal bleeding (n=9). There was significant (p<0.0001) reduction in pain from preoperative 7.13±1.04 to 1.13±0.54, 0.27±0.45, 0.16±0.38 and 0.06±0.25 at baseline (post-operative), day 7, month 1 and month 3 respectively. At the end of one year, 86.67% patient were highly satisfied, 13.33 % were not satisfied. Recurrence was reported by 3 patients within 6 to 10 weeks post-surgery.Conclusions: Laser Four Quadrant Stricturoplasty is an easy and effective surgery for the treatment of staple line stricture with a low recurrence rate.