Medicine › Surgery

Anorectal Disease Treatments and Outcomes

Works Count: 41433

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Description

This cluster of papers encompasses advancements in anorectal surgical procedures, including the treatment of hemorrhoids, fistulas, pilonidal sinus, and rectovaginal fistulas. It covers various techniques such as stapled hemorrhoidopexy, anal fistula plug, endorectal advancement flap, ligation of intersphincteric fistula tract, and transanal hemorrhoidal dearterialization.

Keywords

Hemorrhoids; Fistulas; Stapled Hemorrhoidopexy; Anal Fistula Plug; Pilonidal Sinus; Endorectal Advancement Flap; Rectovaginal Fistula; Ligation of Intersphincteric Fistula Tract; Fibrin Glue Treatment; Transanal Hemorrhoidal Dearterialization

The Syndrome of the Descending Perineum

1966-06-01

A G Parks , N Porter , J D Hardcastle

A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter.

1995-04-01

K Morinaga , Keitaro Hasuda , Tetsuo Ikeda

To assess the usefulness of hemorrhoidal artery ligation (HAL) for internal hemorrhoids with a newly devised instrument (the Moricorn).We devised a new instrument (the Moricorn) that is used in conjunction … To assess the usefulness of hemorrhoidal artery ligation (HAL) for internal hemorrhoids with a newly devised instrument (the Moricorn).We devised a new instrument (the Moricorn) that is used in conjunction with a Doppler flowmeter. This instrument allows for easy and safe ligation of the hemorrhoidal artery. HAL with the Moricorn was performed on 116 patients with internal hemorrhoids who had episodes of anal pain, bleeding, and prolapse. One month after treatment, the effect was evaluated on the basis of improvement of symptoms and the shrinkage of hemorrhoidal tissue.The treatment's effect was observed in 50 of 52 patients (96%) with pain, 50 of 64 (78%) with prolapse, and 92 of 96 (95%) with bleeding. No patient required anesthesia throughout the entire procedure. No major complications were encountered with this treatment.HAL with the Moricorn is a simple, safe, and effective method. However, further observations predicated on a longer follow-up, a larger number of patients, and comparisons with other conventional treatments are called for.

Healing by primary versus secondary intention after surgical treatment for pilonidal sinus

2010-01-18

Ahmed Alkhamis , Iain McCallum , Peter King +1 more

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Who Is At Risk for Developing Chronic Anal Fistula or Recurrent Anal Sepsis After Initial Perianal Abscess?

2009-02-01

Ali Hamadani , Philip I. Haigh , In-Lu A. Liu +1 more

This study was designed to determine factors that contribute to chronic anal fistula or recurrent sepsis after initial perianal abscess.A retrospective cohort study was conducted in patients with a first-time … This study was designed to determine factors that contribute to chronic anal fistula or recurrent sepsis after initial perianal abscess.A retrospective cohort study was conducted in patients with a first-time perianal abscess who were treated at Kaiser Permanente Los Angeles between 1995 and 2007. Univariate and multivariable analyses were performed with the Cox proportional hazards model to determine predictors of risk for recurrent disease.One hundred and forty-eight patients met inclusion criteria (105 men, 43 women; mean age, 43.6 years). During a mean follow-up of 38 months, the cumulative incidence of chronic anal fistula or recurrent sepsis was 36.5 percent. Univariate and multivariable analyses showed more than two-fold increased risk of recurrence in patients <40 years vs. those >/=40 years (P < 0.01), and univariate analysis showed nondiabetics were 2.69 times as likely to experience recurrence as diabetics (P = 0.04). No significant differences in risk of recurrence were noted for men vs. women (HR = 0.78; P = 0.39), nonsmokers vs. smokers (HR = 1.17; P = 0.58); perioperative antibiotics vs. no antibiotics (HR = 1.51; P = 0.19); or HIV-positive vs. HIV- negative status (HR = 0.72; P = 0.44).Age younger than 40 years significantly increased risk of chronic anal fistula or recurrent anal sepsis after a first-time episode of perianal abscess. Patients with diabetes may have a decreased risk compared with nondiabetic patients. Gender, smoking history, perioperative antibiotic treatment, and HIV status were not risk factors for chronic anal fistula or recurrent anal sepsis.

ACG Clinical Guideline: Management of Benign Anorectal Disorders

2014-07-16

Arnold Wald , Adil E. Bharucha , Bard C. Cosman +1 more

These guidelines summarize the definitions, diagnostic criteria, differential diagnoses, and treatments of a group of benign disorders of anorectal function and/or structure. Disorders of function include defecation disorders, fecal incontinence, … These guidelines summarize the definitions, diagnostic criteria, differential diagnoses, and treatments of a group of benign disorders of anorectal function and/or structure. Disorders of function include defecation disorders, fecal incontinence, and proctalgia syndromes, whereas disorders of structure include anal fissure and hemorrhoids. Each section reviews the definitions, epidemiology and/or pathophysiology, diagnostic assessment, and treatment recommendations of each entity. These recommendations reflect a comprehensive search of all relevant topics of pertinent English language articles in PubMed, Ovid Medline, and the National Library of Medicine from 1966 to 2013 using appropriate terms for each subject. Recommendations for anal fissure and hemorrhoids lean heavily on adaptation from the American Society of Colon and Rectal Surgeons Practice Parameters from the most recent published guidelines in 2010 and 2011 and supplemented with subsequent publications through 2013. We used systematic reviews and meta-analyses when available, and this was supplemented by review of published clinical trials.

Practice Parameters for the Treatment of Perianal Abscess and Fistula-in-Ano (Revised)

2005-06-01

Mark H. Whiteford , John Kilkenny , Neil Hyman +7 more

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, … The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

COLON AND RECTAL SURGERY

2006-05-01

Marvin L. Corman

Outcomes of Primary Repair of Anorectal and Rectovaginal Fistulas Using the Endorectal Advancement Flap

2002-12-01

Toyooki Sonoda , Tracy L. Hull , Marion Piedmonte +1 more

The endorectal advancement flap is a surgical procedure used in the treatment of anorectal and rectovaginal fistulas. There is a wide range of success rates published in the literature. This … The endorectal advancement flap is a surgical procedure used in the treatment of anorectal and rectovaginal fistulas. There is a wide range of success rates published in the literature. This study was undertaken to examine the success rate of primary endorectal advancement flap in our own institution. We attempted to identify factors that influence the rate of healing.A retrospective review was performed on 105 patients (43 males) who underwent their first endorectal advancement flap at our institution between January 1, 1994, and June 30, 1999. Ninety-nine patients were available for follow-up. Sixty-two patients had anorectal and 37 had rectovaginal fistulas. The causes of fistula included cryptoglandular (48 patients), Crohn's disease (44), obstetric injury (5), trauma (1), and other (1).The median follow-up was 17.1 (range, 0.4-66.9) months. The median age was 42 (range, 16-78) years. Recurrence was seen in 36 patients (36.4 percent); thus, the primary rate of healing was 63.6 percent. Factors that were associated with higher rates of success were increased age (P = 0.011), greater body surface area (P = 0.012), history of incision and drainage of a perianal abscess preceding advancement flap (P = 0.010), previous placement of a seton drain (P = 0.025), and short duration of fistula (P = 0.003). Factors that negatively influenced the healing rate of the flap were the diagnoses of Crohn's disease (P = 0.027) and rectovaginal fistula (P = 0.002). Length of hospitalization, discharge on oral antibiotics, and the presence of a diverting stoma did not influence the rate of healing. Prednisone was associated with a distinct trend toward failure, with none of the patients on high-dose prednisone (greater than 20 mg/day) having achieved long-term healing. No fistulas recurred after a period of 15 months.The endorectal advancement flap is an effective method of repair for both anorectal and rectovaginal fistulas, even though the success rate may not be as optimistic as in some other published studies. Patient selection is imperative, realizing that a higher rate of failure may be present in Crohn's disease and rectovaginal fistulas. Control of sepsis before endorectal advancement flap with drainage of a perianal abscess and/or seton placement, whenever possible, is indicated.

Alexander Gordon, M.D., of Aberdeen

1958-10-01

Leonard Colebrook

Surgery of the Anus, Rectum and Colon

1976-01-01

J C Goligher

Volume One: Principles. Part I: Anatomy & Physiology, M R B Keighley & D Lubowski. Running a Coloproctology Service (To Include Physiology, Imaging, Stomatherapy, And Psychology), M R B Keighley. … Volume One: Principles. Part I: Anatomy & Physiology, M R B Keighley & D Lubowski. Running a Coloproctology Service (To Include Physiology, Imaging, Stomatherapy, And Psychology), M R B Keighley. Mechanical Bowel Preparation, M R B Keighley. Nutritional Care, N S Williams. Sepsis and the Use of Antibiotic Cover in Colorectal Surgery, M R B Keighley. Surgical Principles & Laparoscopy, N S Williams & S Wexner. Anaesthesia for Coloproctology, A Wilkey & P Hutton. Part Ii: Stomas and Related Problems. Ileostomy (& Laparoscopy), M R B Keighley (& S Wexner). Colostomy (& Laparoscopy), M R B Keighlye (& S Wexner). Persistent Perineal Sinus , M R B Keighley. Impaired Sexual Function After Renal Surgery, M R B Keighley. Part Iii: Anal Diseases. Haemorrhoidal Disease. Causes, Natural History and Assessment. History of the Management of Haemorrhoidal Disease. Conservative Management of Haemorrhoidal Disease. Operative Treatment of Haemorrhoidal Disease, N S Williams. Fissure in Ano, M R B Keighley. Hidradenitis Suppurativa, M R B Keighley. Anorectal Abscess, M R B Keighley. Anorectal Fistula, M R B Keighley. Pilonidal Sinus, M R B Keighley. Perianal Warts, M R B Keighley. Pruritus Ani, M R B Keighley. Part Iv: Functional Bowel Disorders. Faecal Incontinence. Aetiology. Investigation. Conventional Treatment. Electrically Stimulated Gracilis Transposition, M R B Keighley and N S Williams. Constipation: Rectocoele & Sigmoidocoele, M R B Keighley and N S Williams. Adult Megacolon & Megarectum, M R B Keighley. Rectal Prolapse (& Laparoscopy), M R B Keighley (& S Wexner). Solitary Rectal Ulcer Syndrome, M R B Keighley. Irritable Bowel Syndrome, M R B Keighley. Chronic Idiopathic Perineal Pain, M R B Keighley and N S Williams. Part V: Precancer and Cancer. The Genetics of Colorectal Neoplasia, S Derudi. Polypoid Disease, N S Williams. Polyposis Syndromes, N S Williams. Colorectal Cancer: Epidemiology, Aetiology, Pathology, Clinical Features and , Diagnosis Screening, N S Williams. Surgical Treatment of Carcinoma in the Colon and Rectum (With Particular Reference to Colon Cancer), N S Williams. Surgical Treatment of Rectal Cancer + Tem, N S Williams. Radiotherapy and Chemotherapy for Primary Colorectal Cancer, Surveillance, And Recurrence, N S Williams. Malignant Tumours of the Anal Canal and Anus, N S Williams. Rare Tumours of the Anal Canal and Anus, N S Williams. Role of Laparoscopy in Neoplasia of the Anus, Rectum and Colon (Fap, , Polyps, Early Ca, Established Ca, Palliation), S Wexner. Volume Two: Inflammatory Bowel Disease. Part Vi: Left-Sided and Right-Sided Colonic Diverticular Disease (& Laparoscopy), M R B Keighley (& S Wexner). Left Sided Dd. Aetiology. Incidence, Associated Factors. Natural History. Clinical Presentation & Investigation. Differential Diagnosis. Treatment. Right Sided. Part Vii: Other Inflammatory Disorders. Miscellaneous Inflammatory Disorders Collagenous Lymphocytic Microcytic Colitis , M R B Keighley and N S Williams. Part Viii: Ulcerative Colitis. Aetiology, Epidemiology and Natural History of Ulcerative Colitis, M R B Keighley. Pathology and Diagnosis and Differential Diagnosis, M R B Keighley. Medical Treatment, M R B Keighley. Ulcerative Proctitus, M R B Keighley. Associated Disorders and Special Management Problems, M R B Keighley. Colorectal Cancer in Ulcerative Colitis, M R B Keighley. Acute Fulminating Colitis and Emergency Colectomy, M R B Keighley. Conventional Proctocolectomy with Ileostomy and Proctectomy Alone in Ulcerative Colitis, M R B Keighley. Subtotal Colectomy and Ileorectal Anastomosisin Ulcerative Colitis, M R B Keighley. Reservoir Ileostomy in Ulcerative Colitis, M R B Keighley. Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis (& Laparoscopy), M R B Keighley (& S Wexner). Crohns Disease. Aetiology, Incidence and Epidemiology, M R B Keighley. Pathology, Diagnosis and Differential Diagnosis, M R B Keighley. Natural History, Morbidity and Mortality, M R B Keighley. Medical Treatment, M R B Keighley. Special Surgical Considerations in Crohns Disease & Roleof Laparoscopy, M R B Keighley & S Wexner. Surgical Treatment of Crohns Disease: General Principles , M R B Keighley. Surgical Treatment of Small Bowel Crohns Disease (& Laparoscopy), M R B Keighley (& S Wexner). Surgical Treatment of Colorectal Crohns Disease ( & Laparoscopy), M R B Keighley (& S Wexner). Surgical Treatment of Perianal Crohns Disease (& Laparoscopy), M R B Keighley (& S Wexner). Part Ix: Laparoscopy for Ibd. Role of Laparoscopy for Inflammatory Bowel Disease, S Wexner. Part X: Emergencies. Large Bowel Obstruction, N S Williams. Injuries to the Colon and Rectal + (Iatrogenic), S Galandiuk. Bleeding from the Colon and Rectum, M R B Keighley. Colonic Ischaemia and Ischaemic Colitis, M R B Keighley. Radiation Injury to Colon and Rectum, N S Williams. Intestinal Fistulas, M R B Keighley. Management of Intra-Abdominal Sepsis Complicating Colorectal Disease, M R B Keighley. Part Xi: Infections. Diarrhoea and Acute Specific Colitis, M R B Keighley. Sexually Transmitted Disease in Coloproctology, L Gotesmann. Tropical Coloproctology, M J G Farthing. Part Xii: Specialist Considerations. Urological Consideration in Coloproctology, C Fowler. Gynaecological Conditions Relevant to the Coloproctological Surgeon, J Shepherd, A Lower & G Jarvis. Part Xiii: Paediatric Coloproctology. Anorectal Agenesis, M Stringer. Hirschprung Disease, M Stringer. Other Paediatric Colorectal Disorders, C Doig. ,

CONSTRUCTION OF A RECTAL SPHINGTER AND RESTORATION OF ANAL CONTINENCE BY TRANSPLANTING THE GRACILIS MUSCLE

1952-06-01

KENNETH PICKRELL , T. Ray Broadbent , Frank W. Masters +1 more

PICKRELL, KENNETH L. M.D.; BROADBENT, T. RAY M.D.; MASTERS, FRANK W. M.D.; METZGER, JAMES T. M.D. Author Information PICKRELL, KENNETH L. M.D.; BROADBENT, T. RAY M.D.; MASTERS, FRANK W. M.D.; METZGER, JAMES T. M.D. Author Information

A Comparison of Injections of Botulinum Toxin and Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure

1999-07-08

Giuseppe Brisinda , Giorgio Maria , Anna Rita Bentivoglio +3 more

Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared two nonsurgical treatments … Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared two nonsurgical treatments that avert the risk of fecal incontinence. We randomly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks.

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Sensory nerve-endings and sensation in the anal region of man

1960-05-01

H L Duthie , F. W. Gairns

Journal Article Sensory nerve-endings and sensation in the anal region of man Get access H L Duthie, H L Duthie Departments of Surgery and Physiology, University of Glasgow, Scotland Search … Journal Article Sensory nerve-endings and sensation in the anal region of man Get access H L Duthie, H L Duthie Departments of Surgery and Physiology, University of Glasgow, Scotland Search for other works by this author on: Oxford Academic Google Scholar F W Gairns F W Gairns Departments of Surgery and Physiology, University of Glasgow, Scotland Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 47, Issue 206, May 1960, Pages 585–595, https://doi.org/10.1002/bjs.18004720602 Published: 14 December 2005

Comparison of hemorrhoidal treatment modalities

1995-07-01

Helen MacRae , Robin S. McLeod

PURPOSE: The purpose of this study was to assess whether any method of hemorrhoid therapy has been shown to be superior in randomized, controlled trials. METHOD: A meta-analysis was performed … PURPOSE: The purpose of this study was to assess whether any method of hemorrhoid therapy has been shown to be superior in randomized, controlled trials. METHOD: A meta-analysis was performed of all randomized, controlled trials assessing two or more treatment modalities for symptomatic hemorrhoids. Outcome variables included response to therapy, need for further therapy, complications, and pain. RESULTS: A total of 18 trials were available for analysis. Hemorrhoidectomy was found to be significantly more effective than manual dilation of the anus (P=0.0017), with less need for further therapy (P=0.034), no significant difference in complications (P=0.60), but significantly more pain (P< 0.0001). Patients undergoing hemorrhoidectomy had a better response to treatment than did patients treated with rubber band ligation (P=0.001), although complications were greater (P=0.02) as was pain (P< 0.0001). Rubber band ligation was better than sclerotherapy in response to treatment for all hemorrhoids (P=0.005) as well as for hemorrhoids stratified by grade (Grades 1 to 2; P=0.007; Grade 3 hemorrhoids, P=0.042), with no difference in the complication rate (P=0.35). Patients treated with sclerotherapy (P=0.031) or infrared coagulation (P=0.0014) were more likely to require further therapy than those treated with rubber band ligation, although pain was greater after rubber band ligation (P=0.03 for sclerotherapy; P< 0.0001 for infrared coagulation). CONCLUSION: Rubber band ligation is recommended as the initial mode of therapy for Grades 1 to 3 hemorrhoids. Although hemorrhoidectomy showed better response rates, it is associated with more complications and pain than rubber band ligation, thus should be reserved for patients who fail to respond to rubber band ligation.

Patient characteristics and symptoms in chronic pilonidal sinus disease

1995-02-01

K. S�ndenaa , E. Andersen , I. Nesvik +1 more

Anal fistula surgery

1996-07-01

Julio García‐Aguilar , Carlos Belmonte , Douglas W. Wong +2 more

This study was undertaken to assess results of surgery for fistula-in-ano and identify risk factors for fistula recurrence and impaired continence.We reviewed the records of 624 patients who underwent surgery … This study was undertaken to assess results of surgery for fistula-in-ano and identify risk factors for fistula recurrence and impaired continence.We reviewed the records of 624 patients who underwent surgery for fistula-in-ano between 1988 and 1992. Follow-up was by mailed questionnaire, with 375 patients (60 percent) responding. Mean follow-up was 29 months. Fistulas were intersphincteric in 180 patients, transsphincteric in 108, suprasphincteric in 6, extrasphincteric in 6, and unclassified in 75. Procedures included fistulotomy and marsupialization (n = 300), seton placement (n = 63), endorectal advancement flap (n = 3), and other (n = 9). Factors associated with recurrence and incontinence were analyzed by univariate and multivariate regression analysis.The fistula recurred in 31 patients (8 percent), and 45 percent complained of some degree of postoperative incontinence. Factors associated with recurrence included complex type of fistula, horseshoe extension, lack of identification or lateral location of the internal fistulous opening, previous fistula surgery, and the surgeon performing the procedure. Incontinence was associated with female sex, high anal fistula, type of surgery, and previous fistula surgery.Surgical treatment of fistula-in-ano is associated with a significant risk of recurrence and a high risk of impaired continence. Degree of risk varies with identifiable factors.

Pathogenesis and Treatment of Fistula-in-Ano

1961-02-18

A G Parks

AMOEBIC LIVER ABSCESS MEDIATLSH JRNAL 463 needling of the liver and produced 30 ml. of "anchovy" pus.Some air was returned, and X'-ray films showed the abscess cavity.He made an uneventful … AMOEBIC LIVER ABSCESS MEDIATLSH JRNAL 463 needling of the liver and produced 30 ml. of "anchovy" pus.Some air was returned, and X'-ray films showed the abscess cavity.He made an uneventful recovery on emetine.Discussion Amoebic abscess of the liveT is relatively common in this country: apart from the two patients recorded above, I have seen 15 further cases in civilian practice since 1946, 14 of these in Ipswich since 1949.For comparison during the same period I have seen two examples of liver abscess, apparently not amoebic one contained Haernophiluis influenzae the other Staphylo- coccius auireuis.Of the series of 15 patients all but one were men, all had been in the tropics or subtropics at some time, though in many instances the " incubation period" was long enough to raise doubts whether their infection may not have been indigenous in origin.Cases of Liver A mtoebic A bscess Seen During 1946-

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A classification of fistula-in-ano

1976-01-01

A G Parks , Gordon Gilbert , J D Hardcastle

A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past 15 years, based on the pathogenesis of the disease … A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past 15 years, based on the pathogenesis of the disease and the normal muscular anatomy of the pelvic floor. Four main types were found but numerous variations of each occur, which are described. It is hoped that this will alert the surgeon to the various complex situations that he may encounter.

Expanded Adipose-Derived Stem Cells for the Treatment of Complex Perianal Fistula

2009-01-01

Damián García‐Olmo , Dolores Herreros , Isabel Pascual +6 more

PURPOSE: The feasibility and safety of stem cell-based therapy with expanded adipose-derived stem cells (ASCs) has been investigated in a phase I clinical trial. The present study was designed as … PURPOSE: The feasibility and safety of stem cell-based therapy with expanded adipose-derived stem cells (ASCs) has been investigated in a phase I clinical trial. The present study was designed as a phase II multicenter, randomized controlled trial to further investigate the effectiveness and safety of ASCs in the treatment of complex perianal fistulas. METHODS: Patients with complex perianal fistulas (cryptoglandular origin, n = 35; associated with Crohn's disease, n = 14) were randomly assigned to intralesional treatment with fibrin glue or fibrin glue plus 20 million ASCs. Fistula healing and quality of life (SF-12 questionnaire) were evaluated at eight weeks and one year. If healing was not seen at eight weeks, a second dose of fibrin glue or fibrin glue plus 40 million ASCs was administered. RESULTS: Fistula healing was observed in 17 (71 percent) of 24 patients who received ASCs in addition to fibrin glue compared with 4 (16 percent) of 25 patients who received fibrin glue alone (relative risk for healing, 4.43; confidence interval, 1.74-11.27); P < 0.001). The proportion of patients with healing was similar in Crohn's and non-Crohn's subgroups. ASCs were also more effective than fibrin glue alone in patients with a suprasphincteric fistulous tract (P = 0.001). Quality of life scores were higher in patients who received ASCs than in those who received fibrin glue alone. At one year follow-up, the recurrence rate in patients treated with ASCs was 17.6 percent. Both treatments were well tolerated. CONCLUSION: Administration of expanded ASCs (20 to 60 million cells) in combination with fibrin glue is an effective and safe treatment for complex perianal fistula and appears to achieve higher rates of healing than fibrin glue alone.

SURGICAL ANATOMY OF THE ANAL CANAL, AND THE OPERATIVE TREATMENT OF HÆMORRHOIDS

1937-11-01

Eleanor Milligan , C. Naunton Morgan , LionelE. Jones +1 more

NEW APPROACH TO THE PROBLEM OF PILONIDAL SINUS

1973-12-01

G. Karydakis

THE OPERATIVE TREATMENT OF PECTUS EXCAVATUM

1949-04-01

Mark M. Ravitch

Baltimore, Md. FROM THE DEPARTMENT OF SURGERY, THE JOHNS HOPKINS UNIVERSITY AND THE JOHNS HOPKINS HOSPITAL, BALTIMORE, MARYLAND Baltimore, Md. FROM THE DEPARTMENT OF SURGERY, THE JOHNS HOPKINS UNIVERSITY AND THE JOHNS HOPKINS HOSPITAL, BALTIMORE, MARYLAND

Surgery of the Anus, Rectum and Colon

1984-11-01

Robert W. Beart

New grading and scoring for anal incontinence

1992-05-01

Mario Pescatori , Gerardo Anastasio , Corrado Bottini +1 more

A grading system of anal incontinence (AI) is described that takes into account both degree and frequency of symptoms. A, B, and C indicate AI for flatus/mucus, liquid stool, and … A grading system of anal incontinence (AI) is described that takes into account both degree and frequency of symptoms. A, B, and C indicate AI for flatus/mucus, liquid stool, and solid stool, respectively; 1, 2, and 3 indicate occasional, weekly, and daily AI. A scoring system, ranging from 0 (continence) to 6 (severe AI, i.e., daily AI for solid stool or C3) also is reported. Three hundred thirty-five patients have been evaluated by this method in our institution: 30 percent had severe AI, graded as C3; only 9 percent had mild symptoms graded as A. Both males and females could not control diarrhea (Grade B) in 44 percent of cases. Nearly half of the 110 patients who underwent surgery had a C3 incontinence before treatment. Positive results were achieved in 75 percent of cases after surgery: e.g., AI score significantly improved from 4.2 +/- 1.6 to 1.5 +/- 1.9 (P less than 0.001) in those with AI and rectal prolapse. Most of the failures were the patients with idiopathic C3 incontinence. In conclusion, this grading and scoring system allowed a satisfactory assessment of patients' AI before and after treatment. It may also be used to achieve an objective comparison between different series.

Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy

2001-05-01

Ezio Ganio , Donato F. Altomare , Francesco Gabrielli +2 more

Abstract Background The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular … Abstract Background The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2). Methods One hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8–19) months patients were administered a standardized questionnaire by telephone. Results Postoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5·3 (range 0–19) days compared with 3·1 (range 0–10) days in group 2 (P = 0·01), while severe pain was present for 2·3 (range 0–24) days in group 1 but only for 1 (range 0–14) day in group 2 (P = 0·03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0·01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0·01), but after 30 days the continence score was better in group 2 (P = 0·04). Conclusion Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.

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Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis

2008-04-07

Iain McCallum , Peter King , Julie Bruce

Objective To determine the relative effects of open healing compared with primary closure for pilonidal sinus and optimal closure method (midline v off-midline). Design Systematic review and meta-analyses of randomised … Objective To determine the relative effects of open healing compared with primary closure for pilonidal sinus and optimal closure method (midline v off-midline). Design Systematic review and meta-analyses of randomised controlled trials. Data sources Cochrane register of controlled trials, Cochrane Wounds Group specialised trials register, Medline (1950-2007), Embase, and CINAHL bibliographic databases, without language restrictions. Data extraction Primary outcomes were time (days) to healing, surgical site infection, and recurrence rate. Secondary outcomes were time to return to work, other complications and morbidity, cost, length of hospital stay, and wound healing rate. Study selection Randomised controlled trials evaluating surgical treatment of pilonidal sinus in patients aged 14 years or more. Data were extracted independently by two reviewers and assessed for quality. Meta-analyses used fixed and random effects models, dichotomous data were reported as relative risks or Peto odds ratios and continuous data are given as mean differences; all with 95% confidence intervals. Results 18 trials (n=1573) were included. 12 trials compared open healing with primary closure. Time to healing was quicker after primary closure although data were unsuitable for aggregation. Rates of surgical site infection did not differ; recurrence was less likely to occur after open healing (relative risk 0.42, 0.26 to 0.66). 14 patients would require their wound to heal by open healing to prevent one recurrence. Six trials compared surgical closure methods (midline v off-midline). Wounds took longer to heal after midline closure than after off-midline closure (mean difference 5.4 days, 95% confidence interval 2.3 to 8.5), rate of infection was higher (relative risk 4.70, 95% confidence interval 1.93 to 11.45), and risk of recurrence higher (Peto odds ratio 4.95, 95% confidence interval 2.18 to 11.24). Nine patients would need to be treated by an off-midline procedure to prevent one surgical site infection and 11 would need to be treated to prevent one recurrence. Conclusions Wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Benefits were clearly shown with off-midline closure compared with midline closure. Off-midline closure should become standard management for pilonidal sinus when closure is the desired surgical option.

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The prevalence of hemorrhoids in adults

2011-09-19

Stefan Riss , F. A. Weiser , Katrin Schwameis +4 more

Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract.

2007-03-01

Arun Rojanasakul , Jirawat Pattana-arun , Chucheep Sahakitrungruang +1 more

To describe a new technique for fistula-in-ano surgery aimed at total sphincter preservation, and evaluate the preliminary results concerning non-healing and intact anal function.A prospective observational study in eighteen fistula-in-ano … To describe a new technique for fistula-in-ano surgery aimed at total sphincter preservation, and evaluate the preliminary results concerning non-healing and intact anal function.A prospective observational study in eighteen fistula-in-ano patients treated by ligation of intersphincteric fistula tract (LIFT) technique, from January to June 2006.Fistula-in-ano in seventeen patients healed primarily (94.4%). There was one non-healing case (5.6%). The mean healing time was four weeks. None had disturbances in clinical anal continence.The early outcome of the LIFT technique is quite impressive. Results warrant a larger study with long-term evaluation. This technique has the potential to become a viable option for fistula-in-ano surgery.

Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn's disease

2003-02-01

G. Van Assche , Dirk Vanbeckevoort , Didier Bielen +7 more

Although the clinical efficacy of infliximab as measured by closure of fistulas in Crohn's disease has been demonstrated, its influence on the inflammatory changes in the fistula tracks is less … Although the clinical efficacy of infliximab as measured by closure of fistulas in Crohn's disease has been demonstrated, its influence on the inflammatory changes in the fistula tracks is less clear. The aim of the present study was to assess the behavior of perianal fistulas before and after infliximab treatment.Magnetic resonance imaging (MRI) and clinical evaluation were performed in a total of 18 patients before and after treatment with infliximab. An MRI-based score of perianal Crohn's disease severity was developed using both criteria of local extension of fistulas (complexity, supralavetoric extension, relation to the sphincters and of active inflammation (T2 hyperintensity, presence of cavities/abscesses, and rectal wall involvement).The MRI score was reliable in assessing the fistula tracks, with a good interobserver concordance (p < 0.001). Fistula tracks with signs of active inflammation were found in all 18 patients at baseline and collections in seven. After short-term infliximab treatment, active tracks persisted in eight of 11 patients who had clinically responded to infliximab. After long-term (46 wk) infliximab therapy, MRI signs of active track inflammation had resolved in three of six patients.We have developed an MRI-based score of perianal Crohn's disease severity to assess the anatomical evolution of Crohn's fistulas. Our study demonstrates that despite closure of draining external orifices after infliximab therapy, fistula tracks persist with varying degrees of residual inflammation, which may cause recurrent fistulas and pelvic abscesses. Whether complete fistula fibrosis occurs over time with repeated infliximab infusions needs further study.

Preoperative MR Imaging of Anal Fistulas: Does It Really Help the Surgeon?

2001-01-01

Regina G. H. Beets‐Tan , Geerard L. Beets , A. Gerritsen van der Hoop +4 more

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative … PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative MR imaging, as compared with surgery alone. MATERIALS AND METHODS: Fifty-six patients with anal fistulas underwent high-spatial-resolution MR imaging. Twenty-four had a primary fistula; 17, a recurrent fistula; and 15, a fistula associated with Crohn disease. MR imaging findings were withheld from the surgeon until surgery ended and verified, and surgery continued when required. RESULTS: MR imaging provided important additional information in 12 (21%) of 56 patients. In patients with Crohn disease, the benefit was 40% (six of 15); in patients with recurrent fistulas, 24% (four of 17); and in patients with primary fistulas, 8% (two of 24). The difference between patients with or without Crohn disease and between patients with a simple fistula versus the rest was significant (P < .05). The sensitivity and specificity for detecting fistula tracks were 100% and 86%, respectively; abscesses, 96% and 97%, respectively; horseshoe fistulas, 100% and 100%, respectively; and internal openings, 96% and 90%, respectively. CONCLUSION: High-spatial-resolution MR imaging is accurate for detecting anal fistulas. It provides important additional information in patients with Crohn disease–related and recurrent anal fistulas and is recommended in their preoperative work-up.

Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial

2000-03-01

M. Rowsell , Mariana De Carlo Bello , DM Hemingway

The nature of haemorrhoids

1975-07-01

W H F Thomson

An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized 'cushions' of … An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized 'cushions' of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacement.

Hemorrhoids: From basic pathophysiology to clinical management

2012-01-01

Varut Lohsiriwat

This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of … This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs. Non-operative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when non-operative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are thoroughly discussed.

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Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial

2000-03-01

Brian Mehigan , John R.T. Monson , John E. Hartley

Pilonidal sinus: Finding the right track for treatment

1990-02-01

T G Allen-Mersh

Abstract Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience, and low recurrence -but … Abstract Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience, and low recurrence -but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En bloc excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.

Clinical Examination, Endosonography, and MR Imaging in Preoperative Assessment of Fistula in Ano: Comparison with Outcome-based Reference Standard

2004-12-01

G. N. Buchanan , Steve Halligan , Clive I. Bartram +3 more

PURPOSE: To prospectively evaluate the relative accuracy of digital examination, anal endosonography, and magnetic resonance (MR) imaging for preoperative assessment of fistula in ano by comparison to an outcome-derived reference … PURPOSE: To prospectively evaluate the relative accuracy of digital examination, anal endosonography, and magnetic resonance (MR) imaging for preoperative assessment of fistula in ano by comparison to an outcome-derived reference standard. MATERIALS AND METHODS: Ethical committee approval and informed consent were obtained. A total of 104 patients who were suspected of having fistula in ano underwent preoperative digital examination, 10-MHz anal endosonography, and body-coil MR imaging. Fistula classification was determined with each modality, with reviewers blinded to findings of other assessments. For fistula classification, an outcome-derived reference standard was based on a combination of subsequent surgical and MR imaging findings and clinical outcome after surgery. The proportion of patients correctly classified and agreement between the preoperative assessment and reference standard were determined with trend tests and κ statistics, respectively. RESULTS: There was a significant linear trend (P < .001) in the proportion of fistula tracks (n = 108) correctly classified with each modality, as follows: clinical examination, 66 (61%) patients; endosonography, 87 (81%) patients; MR imaging, 97 (90%) patients. Similar trends were found for the correct anatomic classification of abscesses (P < .001), horseshoe extensions (P = .003), and internal openings (n = 99, P < .001); endosonography was used to correctly identify the internal opening in 90 (91%) patients versus 96 (97%) patients with MR imaging. Agreement between the outcome-derived reference standard and digital examination, endosonography, and MR imaging for classification of the primary track was fair (κ = 0.38), good (κ = 0.68), and very good (κ = 0.84), respectively, and fair (κ = 0.29), good (κ = 0.64), and very good (κ = 0.88), respectively, for classification of abscesses and horseshoe extensions combined. CONCLUSION: Endosonography with a high-frequency transducer is superior to digital examination for the preoperative classification of fistula in ano. While MR imaging remains superior in all respects, endosonography is a viable alternative for identification of the internal opening. © RSNA, 2004

Influence of pudendal block on the function of the anal sphincters.

1975-06-01

Björn Frenckner , Curt von Euler

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during … The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block, making it possible to record the activity from the internal sphincter alone. The results show that the internal sphincter contributes about 85% of the pressure in the anal canal at rest but only about 40% after a sudden substantial distension of the rectum. During constant substantial rectal distension, the internal sphincter accounts for about 65% of the anal pressure. It is concluded that the internal sphincter in the adult is chiefly responsible for anal continence at rest. In the event of sudden substantial distension of the rectum, continence is maintained by the striated sphincter muscles, whereas both sphincter systems probably have an important function during constant distension of the rectum.

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A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure

1997-01-01

Jonathan N. Lund , J H Scholefield

Haemorrhoids: Pathology, pathophysiology and aetiology

1994-07-01

P B Loder , Michael A. Kamm , R J Nicholls +1 more

Abstract Haemorrhoidal disease is the consequence of distal displacement of the anal cushions, which are normal structures with an important role in continence. The causes of haemorrhoidal disease are unknown; … Abstract Haemorrhoidal disease is the consequence of distal displacement of the anal cushions, which are normal structures with an important role in continence. The causes of haemorrhoidal disease are unknown; constipation and abnormal bowel habit are commonly blamed despite largely contrary evidence. The most consistently demonstrated physiological abnormality is an increased maximum resting anal pressure. Most evidence points to this being a secondary phenomenon rather than the cause of haemorrhoidal disease. Among the many unexplored areas are the function of the longitudinal muscle in relation to haemorrhoidal disease, the description and pharmacological responsiveness of the anal subepithelial muscle, and the clinical role of specific pharmacological agents that might reverse some of the observed physiological changes.

Persistent pain and faecal urgency after stapled haemorrhoidectomy

2000-08-01

Mark Cheetham , Neil Mortensen , Per-Olof Nyström +2 more

MR Imaging Classification of Perianal Fistulas and Its Implications for Patient Management

2000-05-01

James Morris , J A Spencer , N. S. Ambrose

Until recently, imaging had a limited role in the preoperative assessment of perianal fistulas. Magnetic resonance (MR) imaging has been shown to demonstrate accurately the anatomy of the perianal region. … Until recently, imaging had a limited role in the preoperative assessment of perianal fistulas. Magnetic resonance (MR) imaging has been shown to demonstrate accurately the anatomy of the perianal region. In addition to showing the anal sphincter mechanism, MR imaging clearly shows the relationship of fistulas to the pelvic diaphragm (levator plate) and the ischiorectal fossae. This relationship has important implications for surgical management and outcome and has been classified into five MR imaging-based grades. If the ischioanal and ischiorectal fossae are unaffected, disease is likely confined to the sphincter complex (simple intersphincteric fistulization, grade 1 or 2), and outcome following simple surgical management is favorable. Involvement of the ischioanal or ischiorectal fossa by a fistulous track or abscess indicates complex disease related to trans-sphincteric or suprasphincteric disease (grade 3 or 4). Correspondingly more complex surgery may be required that may threaten continence or may require colostomy to allow healing. If the track traverses the levator plate, a translevator fistula (grade 5) is present, and a source of pelvic sepsis should be sought.

A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas

2001-11-01

David A. Schwartz , Maurits J. Wiersema , Kika M. Dudiak +7 more

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EASY AND SUCCESSFUL TREATMENT OF PILONIDAL SINUS AFTER EXPLANATION OF ITS CAUSATIVE PROCESS

1992-05-01

G. Karydakis

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of … Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.

Procidentia of the rectum studied with cineradiography

1968-09-01

Bror Brodén , B Snellman

The prevalence of hemorrhoids and chronic constipation

1990-02-01

John F. Johanson , Amnon Sonnenberg

Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula

2016-11-08

Jon D. Vogel , Eric K. Johnson , Arden M. Morris +4 more

Vogel, Jon D. M.D.; Johnson, Eric K. M.D.; Morris, Arden M. M.D.; Paquette, Ian M. M.D.; Saclarides, Theodore J. M.D.; Feingold, Daniel L. M.D.; Steele, Scott R. M.D. Author Information Vogel, Jon D. M.D.; Johnson, Eric K. M.D.; Morris, Arden M. M.D.; Paquette, Ian M. M.D.; Saclarides, Theodore J. M.D.; Feingold, Daniel L. M.D.; Steele, Scott R. M.D. Author Information

Fusobacterium nucleatum promotes colorectal cancer by inducing Wnt/β‐catenin modulator Annexin A1

2019-03-04

Mara Roxana Rubinstein , Jung Eun Baik , Stephen M. Lagana +6 more

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Treatment of amosbic dysentery.

1948-02-14

Alex Wright , A.E.R. Coombes

Surgery of the Anus, Rectum and Colon.

1968-07-01

Surgery of the Anus, Rectum and Colon

1980-09-01

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Evaluation of the effect of intracanal cryotherapy on postoperative pain after retreatment: a randomized controlled clinical trial

2025-06-25

Arzu Kaya Mumcu , Ecenur Tuzcu , Safa Kurnaz +1 more | Clinical Oral Investigations

Pilonidal sinus of perianal location. Difficult differential diagnosis with perianal fistula

2025-06-25

Laura Rubio López , Silvia Benito-Barbero , Paloma Guillamot-Ruano +1 more | Cirugía y Cirujanos (English Edition)

Efficacy of Sacral Erector Spinae Plane Block for Postoperative Pain Management in Hemorrhoid and Pilonidal Sinus Surgeries: A Prospective Randomized Controlled Study

2025-06-25

Alparslan Koç , Fethi Akyol , Mehmet Tahir Huyut +4 more | Ibnosina Journal of Medicine and Biomedical Sciences

Abstract This study was conducted to evaluate the efficacy of the sacral erector spinae plane block (ESPB) in postoperative pain management. We aimed to demonstrate the effectiveness of sacral ESPB … Abstract This study was conducted to evaluate the efficacy of the sacral erector spinae plane block (ESPB) in postoperative pain management. We aimed to demonstrate the effectiveness of sacral ESPB implemented alongside analgesic treatment in patients undergoing hemorrhoid and pilonidal sinus (PS) surgeries. The study design involves a prospective randomized controlled. Sixty-eight patients were randomly divided into a sacral ESPB group and a control group. Following surgery, the ESPB group received an ultrasound-guided injection of a local anesthetic. Both groups received standardized pain management protocols. Pain scores were recorded using the numeric rating scale at 30 minutes, 2 hours, 8 hours, and 24 hours after surgery. Additionally, tramadol consumption and hospital length of stay were also recorded. Patients in the sacral ESPB group had significantly lower pain scores at 8 and 24 hours compared with the control group. They also consumed less tramadol on average. There were no significant differences in pain scores or tramadol use between patients who underwent hemorrhoid surgery and those who underwent PS surgery. Sacral ESPB effectively managed postoperative pain and reduced analgesic consumption in hemorrhoid and PS surgeries. The results of this study suggest that incorporating sacral ESPB into multimodal analgesic protocols for anorectal surgery may be clinically beneficial.

[Application of anorectal manometry in diagnosis and treatment of low anterior resection syndrome].

2025-06-25

Jing Kang , Z Zhang | PubMed

With the advancement of rectal cancer surgery, low anterior resection syndrome (LARS) has emerged as a significant issue impacting the postoperative quality of life for patients. Anorectal manometry (ARM), an … With the advancement of rectal cancer surgery, low anterior resection syndrome (LARS) has emerged as a significant issue impacting the postoperative quality of life for patients. Anorectal manometry (ARM), an essential diagnostic tool, possesses principles and methodologies that are crucial for assessing anorectal function. In the context of LARS diagnosis, ARM plays a pivotal role by providing objective evidence for clinical evaluations. Concurrently, the implications and efficacy of this technology in treatment are gaining increasing attention. Nonetheless, several challenges remain regarding its current application. Through an analysis of existing research, this article aims to elucidate the value of ARM in both the diagnosis and treatment of LARS, with the ultimate goal of enhancing the diagnostic and therapeutic approaches to LARS and improving patients' quality of life.

The Role of Buccal Fat Pad in the Hermetic Closure of Oro-Antral Fistulas: Systematic Review

2025-06-24

Narjiss Akerzoul | International Journal of Oral and Maxillofacial Surgery

Stepwise Surgical Management of Binder Syndrome with Skeletal Class III Malocclusion in Adults

2025-06-24

Jun Li | International Journal of Oral and Maxillofacial Surgery

The Perimeatal Modification of Inviscision: In the Search of the Ideal Preauricular Incision

2025-06-23

Sonal Anchlia , Ankita Sahal , Utsav Bhatt +3 more | Journal of Maxillofacial and Oral Surgery

Antwort auf Leserbrief zu Langzeitergebnisse einer Pilotstudie über das zweizeitige Verfahren mit primärer Exzision und Limberg-Plastik im Intervall zur Therapie einer sakrokokzygealen Pilonidalsinuserkrankung

2025-06-23

Michael Ardelt , Utz Settmacher | Deleted Journal

Postprimäre Limberg-Plastik – ein neuer Ansatz in der Chirurgie des Pilonidalsinus

2025-06-23

Dietrich Doll , Matthias Maak , Jannik Seifert | Deleted Journal

ĐẶC ĐIỂM LÂM SÀNG SẸO SAU PHẪU THUẬT TREO VÚ SA TRỄ CÓ ĐẶT LƯỚI ĐỊNH TUYẾN

2025-06-23

Lục Trần Sinh , Long Dương Đình , Dung Phạm Thị Việt | Tạp chí Y học Việt Nam

Mục tiêu: Nghiên cứu đặc điểm lâm sàng của sẹo sau phẫu thuật treo vú sa trễ có sử dụng lưới định tuyến. Đối tượng và phương pháp: Nghiên cứu … Mục tiêu: Nghiên cứu đặc điểm lâm sàng của sẹo sau phẫu thuật treo vú sa trễ có sử dụng lưới định tuyến. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang được thực hiện trên 31 bệnh nhân trải qua phẫu thuật treo vú sa trễ có đặt lưới định tuyến tại Phòng khám thẩm mỹ Davinci. Kết quả: Tuổi trung bình của bệnh nhân là 37,13 tuổi; nhóm tuổi từ 30–49 chiếm tỷ lệ cao nhất (80,64%). Tất cả bệnh nhân đều thuộc tuýp da Fitzpatrick III và IV. Về kích thước sẹo, 74,19% có sẹo rộng dưới 2mm, 19,35% từ 2–5mm, và 6,45% trên 5mm. Màu sắc mạch máu tại vùng sẹo chủ yếu là bình thường (54,84%) và hồng (38,71%), trong khi đỏ chiếm 6,45%, không có trường hợp tím. Tăng sắc tố chiếm 64,52%, không tăng sắc tố chiếm 35,48%, và không có trường hợp giảm sắc tố. Về hình dạng, tất cả sẹo đều phẳng, không ghi nhận sẹo lồi hay lõm. Không có trường hợp nào bị thải loại mảnh ghép. Kết luận: Vú sa trễ là vấn đề ảnh hưởng đáng kể đến thẩm mỹ, tâm lý và sức khỏe bệnh nhân. Việc ứng dụng lưới định tuyến trong phẫu thuật treo vú sa trễ bước đầu cho thấy hiệu quả tích cực và là một phương pháp đầy hứa hẹn trong việc kết hợp với các biện pháp khác nhằm ngăn ngừa hình thành sẹo xấu sau phẫu thuật.

NGHIÊN CỨU ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ TRẺ DẬY THÌ SỚM TRUNG ƯƠNG VÔ CĂN

2025-06-23

Linh Nguyễn Thị Diệu , Đinh Thị Thảo | Tạp chí Y học Việt Nam

Đặt vấn đề Dậy thì sớm là sự xuất hiện các đặc tính sinh dục thứ phát (phát triển vú, hệ thống lông mu, lông nách, tinh hoàn, dương vật, … Đặt vấn đề Dậy thì sớm là sự xuất hiện các đặc tính sinh dục thứ phát (phát triển vú, hệ thống lông mu, lông nách, tinh hoàn, dương vật, mụn...) trước 8 tuổi ở bé gái hoặc có kinh nguyệt trước 9,5 tuổi ở bé gái và trước 9 tuổi ở bé trai1. Số lượng trẻ bị dậy thì sớm ngày càng tăng cao và được dự báo sẽ còn tăng trong các năm tới, làm ảnh hưởng lớn đến sức khỏe tâm lý và thể chất của trẻ. Mục tiêu: Mô tả đặc điểm lâm sàng, cận lâm sàng và khảo sát kết quả điều trị dậy thì sớm trung ương vô căn với Triptoreline. Phương pháp nghiên cứu: mô tả cắt ngang, tiền cứu. Đối tượng: Gồm 32 trẻ gái được chẩn đoán dậy thì sớm trung ương vô căn và điều trị thuốc Diphereline 3,75 mg liên tục trong 6 tháng từ 6/2023 – 10/2024 tại bệnh viện Sản Nhi tỉnh Quảng Ngãi. Kết quả Tuổi trung bình 7,28±0,58, nhóm từ 6 đến < 8 tuổi chiếm 2/3 (65,6%); 100% số trẻ gái có tuyến vú phát triển từ giai đoạn Tanner 2 trở lên, phân độ B2 (71,9%). Thời gian xuất hiện triệu chứng đầu tiên, trung bình: 7,33 ± 3,34 tháng. Nồng độ LH, FSH từ 0,93±1,42 UI/L và 3,48±3,19 UI/L giảm đạt mức 0,52±0,4 UI/L và 1,14±0,73 UI/L. Sau 6 tháng điều trị, chiều cao trung bình tăng khoảng 2,25 cm so với trước khi điều trị. Tăng chiều cao trưởng thành dự đoán khoảng 1,51 (cm). Kết luận Điều trị dậy thì sớm trung ương bằng Triptoreline: kìm hãm, ngừng sự phát triển của tuyến vú, kinh nguyệt và phát triển lông mu. Nồng độ LH, FSH cơ bản giảm có ý nghĩa thống kê sau 6 tháng điều trị; Tăng chiều cao trưởng thành dự đoán.

KẾT QUẢ PHẪU THUẬT NỘI SOI CẮT GAN

2025-06-23

Linh Hồ Văn , Phương Hồ Võ Hoài , Ái Đặng Quốc | Tạp chí Y học Việt Nam

Đặt vấn đề: Phẫu thuật nội soi cắt gan ngày càng trở thành lựa chọn phổ biến trong điều trị ung thư gan, đặc biệt đối với những khối u … Đặt vấn đề: Phẫu thuật nội soi cắt gan ngày càng trở thành lựa chọn phổ biến trong điều trị ung thư gan, đặc biệt đối với những khối u nhỏ. Nghiên cứu nhằm đánh giá các đặc điểm lâm sàng, cận lâm sàng, kỹ thuật và kết quả của phẫu thuật này. Đối tượng và phương pháp nghiên cứu: Nghiên cứu tiến cứu và mô tả, theo dõi dọc 87 bệnh nhân phẫu thuật cắt gan tại Bệnh viện Trung ương Huế từ tháng 01/2019 đến tháng 05/2024. Kết quả: Tuổi trung bình của bệnh nhân là 56,7 ± 10,6 (25 - 80). Tỷ lệ nam/nữ là 88% và 12%. Tỷ lệ ung thư gan giai đoạn BCLC-A là 90,8%. Kích thước khối u trung bình là 3,7 ± 1,3 (2,5 - 5,0) cm, trong đó 82,8% là khối u đơn độc. Tỷ lệ kiểm soát cuống phải và cuống trái là 65,5% và 34,5%. Phương pháp cầm máu tại diện cắt sử dụng bipolar và Bioglue lần lượt là 86,2% và 13,8%. Thời gian phẫu thuật trung bình là 115,6 ± 37,9 (70 - 235) phút, với lượng máu mất trung bình là 390 ± 271,5 (100 - 1150) ml. Tỷ lệ tai biến tổn thương tĩnh mạch gan là 5,7%. Biến chứng sau phẫu thuật ghi nhận là 16%. Thời gian nằm viện trung bình là 9,7 ± 5,3 (7 - 25) ngày và tỷ lệ tử vong sau phẫu thuật là 1,1%. Kết luận: Phẫu thuật nội soi cắt gan là phương pháp khả thi, có thể thực hiện tại các trung tâm lớn với trang thiết bị hiện đại và đội ngũ phẫu thuật viên có kinh nghiệm. Đây là phương pháp an toàn và hợp lý cho các khối u kích thước dưới 5 cm, với tỷ lệ biến chứng và tử vong thấp cũng như thời gian nằm viện ngắn.

KẾT QUẢ PHẪU THUẬT HẠ TINH HOÀN ĐƯỜNG BÌU Ở BỆNH NHÂN ẨN TINH HOÀN SỜ THẤY TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

2025-06-23

Hoa Nguyễn Việt , Ngoc Bich , Hùng Phạm Quang | Tạp chí Y học Việt Nam

Đặt vấn đề: Ẩn tinh hoàn là dị tật sinh dục phổ biến ở trẻ nam. Điều trị ATH chủ yếu là phẫu thuật với phương pháp kinh điển sử … Đặt vấn đề: Ẩn tinh hoàn là dị tật sinh dục phổ biến ở trẻ nam. Điều trị ATH chủ yếu là phẫu thuật với phương pháp kinh điển sử dụng 2 đường rạnh ở bẹn và ở bìu. Hạ tinh hoàn đường bìu đối với tinh hoàn sờ thấy là phương pháp tiếp cận ít xâm lấn ngày càng được áp dụng rộng rãi được chứng minh tính hiệu quả, an toàn và thẩm mỹ. Mục tiêu: Đánh giá kết quả phẫu thuật hạ tinh hoàn sờ thấy qua đường bìu tại Bệnh viện Hữu nghị Việt Đức. Đối tượng và phương pháp: Nghiên cứu hồi cứu trên 116 bệnh nhân được phẫu thuật hạ tinh hoàn qua đường bìu tại Khoa Phẫu thuật Nhi và Trẻ sơ sinh - Bệnh viện Hữu nghị Việt Đức từ tháng 01/2022 đến 12/2023. Kết quả: Tuổi trung bình của bệnh nhân khi phẫu thuật là 48,9 ± 10,7 tháng tuổi (7-160). Tỷ lệ ẩn tinh hoàn 1 bên là 65,5%. Tinh hoàn ẩn nằm ngoài ống bẹn có tỷ lệ 76,9%. Kích thước trước mổ của tinh hoàn ẩn trung bình là 225,2±112mm3 Thời gian phẫu thuật trung bình là 19,7±3,5 phút, 97,4% tinh hoàn được đưa xuống đáy bìu, thời gian nằm viện trung bình 0,8 ngày. Tỷ lệ biến chứng phẫu thuật tương đối thấp 1,7% với 2 trường biến chứng nhẹ: Bìu sưng nề đều được điều trị nội khoa. Không ghi nhận thoát vị bẹn hay teo tinh hoàn sau mổ. Tỷ lệ hài lòng về thẩm mỹ của sẹo mổ 99,2%. Kết luận: Phẫu thuật hạ tinh hoàn qua đường bìu là một phương pháp an toàn, hiệu quả.

Process to determine the level of the primary internal opening of anal fistula on magnetic resonance imaging

2025-06-23

Pankaj Garg , Baljit Kaur , Mahak Garg | Annals of Coloproctology

ĐẶC ĐIỂM NỘI SOI, MÔ BỆNH HỌC VÀ KẾT QUẢ ĐIỀU TRỊ BẰNG PHƯƠNG PHÁP EMR KẾT HỢP VỚI KẸP CLIP KHÉP DIỆN CẮT POLYP KHÔNG CUỐNG ĐẠI TRỰC TRÀNG TỪ 10-19 MM

2025-06-23

Liêm Nguyễn Thanh , Loan Lê Thị Thúy , Lộc Huỳnh Văn | Tạp chí Y học Việt Nam

Đặt vấn đề: Chảy máu chậm là một biến chứng thường gặp sau khi cắt polyp không cuống đại trực tràng bằng kỹ thuật cắt niêm mạc nội soi (EMR). … Đặt vấn đề: Chảy máu chậm là một biến chứng thường gặp sau khi cắt polyp không cuống đại trực tràng bằng kỹ thuật cắt niêm mạc nội soi (EMR). Việc sử dụng kẹp clip khép diện cắt EMR có thể giúp phòng ngừa biến chứng này. Mục tiêu nghiên cứu: Mô tả hình ảnh nội soi, mô bệnh học và kết quả điều trị của phương pháp EMR kết hợp với kẹp clip khép diện cắt polyp không cuống đại trực tràng. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang được thực hiện trên 51 bệnh nhân có 70 polyp không cuống ở đại trực tràng, có kích thước từ 10-19 mm. Tất cả các polyp không cuống được cắt qua nội soi bằng kỹ thuật EMR kết hợp với kẹp clip khép diện cắt. Kết quả: Tỷ lệ bệnh nhân có 1 polyp chiếm cao nhất, đạt 74,5%. Vị trí polyp phân bố tại trực tràng, đại tràng trái và đại tràng phải lần lượt là 17,1%, 50,0% và 32,9%. Polyp tuyến ống chiếm tỷ lệ 60,0%, polyp tăng sản chiếm 31,4%. Tỷ lệ polyp tân sinh có nghịch sản độ thấp và độ cao tương ứng là 97,9% và 2,1%. Kỹ thuật EMR kết hợp với kẹp clip khép diện cắt polyp không cuống đại trực tràng qua nội soi đạt kết quả thành công 100%. Tất cả bệnh nhân sau khi cắt polyp không gặp tai biến hay biến chứng. Kết luận từ nghiên cứu cho thấy, việc sử dụng kỹ thuật EMR kết hợp với kẹp clip khép diện cắt có hiệu quả cao trong điều trị polyp không cuống đại trực tràng, giúp ngăn ngừa các biến chứng, đặc biệt là chảy máu chậm.

Percutaneous Laser-Assisted Annuloplasty

2025-06-20

Steven D. Waldman | Elsevier eBooks

Rectovaginal Fistulas, Their Surgical Management, and Outcomes: An Indian Experience

2025-06-19

Ashok Kumar , Shahrukh Rauf , Manas Aggarwal +1 more | Cureus

Correction to: Perianal Infections Update

2025-06-19

Boris Garber , Jonathan Glauser | Current Emergency and Hospital Medicine Reports

Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes

2025-06-19

Mohammedsadeq A. Shweliya , Arkan Shubber AbdulKhaliq Al-Hamdany , Mohmed Ahmed +7 more | F1000Research

<ns3:p>Background Anorectal hemorrhoids are a common condition that frequently needs surgery in more challenging situations. Both stapled hemorrhoidectomy and conventional hemorrhoidectomy are standard surgical procedures, each one with various advantages … <ns3:p>Background Anorectal hemorrhoids are a common condition that frequently needs surgery in more challenging situations. Both stapled hemorrhoidectomy and conventional hemorrhoidectomy are standard surgical procedures, each one with various advantages and disadvantages as well. The purpose of this study is to compare the outcomes of these two operations concerning patient satisfaction, complications, recovery time and postoperative pain. Method This retrospective cohort analysis was conducted in Karbala, Iraq, at AL-Kafeel Hospital and AL-Safeer Hospital. Information has been collected from patients who had stapled hemorrhoidectomy in 2023–2024 and those who had conventional hemorrhoidectomy from 2015–2018. To account for baseline variations, especially those related to the kind of anesthetic and extent of hemorrhoids, propensity score matching (caliper = 0.05) was employed. SPSS version 29.0 was used for statistical analysis, and comparisons were made by using t-tests, chi-square tests, and correlation analyses. Statistical significance was defined as a p-value of less than 0.05. Results Out of 114 patients (50 conventional, 64 stapled), the stapled group had a higher percentage of fourth-degree hemorrhoids, postoperative pain and bleeding were significantly lower in the stapled group (p < 0.001), and only the conventional group had wound infections and anal stenosis (p < 0.05). The stapled group also showed better postoperative outcomes. Conclusion Stapled hemorrhoidectomy is linked to less pain, fewer complications, and faster recovery than conventional hemorrhoidectomy, but the risk of recurrent hemorrhoidectomy is still a concern. These findings support that surgical decision-making in hemorrhoid management can be optimized.</ns3:p>

Mesenchymal Stem Cell Therapy for Perianal Crohn's Disease: Surgical Appraisal of Evidence and Translational Potential

2025-06-19

Rathin Gosavi , Charlotte Keung , Gregory Moore +5 more | ANZ Journal of Surgery

Battle on two fronts: Fournier’s gangrene as a devastating complication of targeted radiotherapy for advanced adenocarcinoma rectum

2025-06-19

Adithyan Athiyaman , Shavinder Kumar , Vinslet Prissilla Norbert Victor | Indian Journal of Case Reports

Fournier’s gangrene (FG), as a complication of rectal carcinoma, is exceptionally rare and life-threatening. This case reports an unusual presentation of radiotherapy-induced FG in a 75-year-old male patient with advanced … Fournier’s gangrene (FG), as a complication of rectal carcinoma, is exceptionally rare and life-threatening. This case reports an unusual presentation of radiotherapy-induced FG in a 75-year-old male patient with advanced rectal adenocarcinoma. Multiple surgical debridements provided temporary stabilization, supported by targeted antibiotics and airway management. However, progressive polymicrobial sepsis necessitated a multidisciplinary approach, which was unsuccessful due to underlying poor prognostic factors. This case underscores the need for standardized clinical guidelines and management protocols to improve patient outcomes and reduce mortality in similar cases.

Trans-Sphincteric Horseshoe Anal Fistula Managed with Interception of Fistulous Tract with Application of Ksharasutra (IFTAK) procedure: clinical outcomes and benefits: A Case Report

2025-06-18

Bharat Mansukhbhai Dulera , P Sreenadh , Joshi Pashmina +1 more | International Journal of AYUSH Case Reports

The management of complex anal fistula presents a significant challenge to surgeons due to high recurrence rates and complications such as sphincter injury. Ksharasutra therapy is a well-established treatment modality … The management of complex anal fistula presents a significant challenge to surgeons due to high recurrence rates and complications such as sphincter injury. Ksharasutra therapy is a well-established treatment modality for managing fistula-in-ano; however, it has certain limitations, including prolonged treatment duration, the need for frequent hospital visits for dressing, and pain during Ksharasutra change. A 42 year old male patient presented with pus discharge from perianal area and pruritis was diagnosed as posterior horseshoe trans-sphincteric anal fistula through clinical examination and ultrasonography findings. it was successfully managed through the principle of Interception of Fistulous Tract with Application of Ksharasutra (IFTAK). Following an initial course of antibiotics and analgesics, the patient was transitioned to Ayurvedic oral medications. Postoperative pain was minimal, with a gradual reduction in pus drainage, and complete wound healing was achieved in less than two months, with a cosmetically acceptable scar. A follow-up period of 10 months revealed no recurrence. The IFTAK technique, a modified form of conventional Ksharasutra therapy, significantly reduces healing time by precisely targeting the source of infection while minimizing postoperative scarring. Proper postoperative wound assessment and care are critical to the success of the treatment.

Complex transsphincteric perianal fistula

2025-06-18

Hnayda Alani | Radiopaedia.org

The Comparison Between Endoscopic Ligation and Sclerotherapy on the Treatment Effect and Anorectal Function in Patients With Internal Hemorrhoids

2025-06-18

Di Zhang , Rui Huang , Tao Ma +4 more | Surgical Laparoscopy Endoscopy & Percutaneous Techniques

Objective: To evaluate the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function … Objective: To evaluate the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed. Methods: Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited, with a 3-month follow-up. Patients were divided into 2 groups, with Group A undergoing endoscopic ligation (n=14) and Group B receiving CAES (n=18). The Clinical efficacy and anorectal function between the 2 groups before and after treatment were compared, and the psychological changes in patients before and after treatment were evaluated by various scales. Results: There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding. The comprehensive multiscale psychological evaluation showed no significant difference between the 2 groups before and after treatment, but the psychological condition of patients in both groups was significantly improved after treatment. Besides, patients in Group A were better in the improvement of constipation scale, and patients in Group B had a greater improvement in the pain scale. As for anorectal function, there was no significant difference before and after treatment, except for the squeeze duration before treatment. In the comparison pretreatment and post-treatment, patients in Group A had significant differences in resting (average), first defecation and squeeze (average), while patients in Group B had significant differences in resting (average) and first defecation. Conclusions: Two endoscopic therapies were effective in treating internal hemorrhoids, with no significant difference in terms of treatment effect, symptom relief, complication rate, psychological condition, and anorectal function when compared between 2 groups. However, when compared within each group, the different methods had their own advantages in the evaluation of treatment effect and anorectal function.

Different tightening schemes in thread-drawing therapy and their effects on anal function recovery in patients with high simple anal fistula

2025-06-18

Pengfei Zhao , Li‐Fang Wang , Song Qian +4 more | Frontiers in Physiology

Objective We aimed to compare the effects of different tightening schemes in thread-drawing therapy on the recovery of anal function in patients with high simple anal fistulas after treatment. Methods … Objective We aimed to compare the effects of different tightening schemes in thread-drawing therapy on the recovery of anal function in patients with high simple anal fistulas after treatment. Methods One hundred patients with high simple anal fistulas who met the inclusion criteria were randomly divided into four groups of 25 patients each. All patients underwent low-level incision and high-level thread-drawing surgery. In the 1/5, 1/4, 1/3, and 1/2 groups, the rubber band cutting force was applied by tightening the surrounding muscle bundle to 1/5, 1/4, 1/3, and 1/2 of its circumference, respectively (using a graduated rubber band). Subsequent tightenings were also performed to the corresponding fractions of the circumference. The overall clinical efficacy, wound healing time, wound symptom score, anal function, and Wexner score were compared among the four groups. Results The 1/5 group had the longest wound healing time, longer than those of the 1/4, 1/3, and 1/2 groups ( p &lt; 0.05). On the seventh postoperative day, the 1/2 group had a higher wound symptom score than the 1/5, 1/4, and 1/3 groups ( p &lt; 0.05). Three months after surgery, patients in the 1/5 group had higher resting anal canal pressure and maximum anal canal systolic pressure than the other three groups; the 1/4 and 1/3 groups had higher values than the 1/2 group ( p &lt; 0.05). One month and 3 months after surgery, patients in the 1/2 group had the highest Wexner scores, higher than those in the 1/5, 1/4, and 1/3 groups ( p &lt; 0.05). Conclusion Tightening schemes of the 1/4 and 1/3 groups were found to be optimal as they resulted in less postoperative pain and minimal impact on anal function.

Review of the surgical methods of rectovaginal fistula treatment

2025-06-17

Maksymilian Seweryn , Katarzyna Kutyła , Alicja Smoleńska +2 more | MEDICAL SCIENCE PULSE

<ns3:p>Background: Rectovaginal fistula (RVF) is an abnormal connection between the rectum and the vagina, significantly impairing women’s quality of life and leading to psychological consequences. Despite advancements in various surgical … <ns3:p>Background: Rectovaginal fistula (RVF) is an abnormal connection between the rectum and the vagina, significantly impairing women’s quality of life and leading to psychological consequences. Despite advancements in various surgical techniques, a universally accepted treatment standard has yet to be established.Aim of the study: This review aims to summarize current strategies and emerging trends in the surgical management of RVF.Material and methods: A narrative review was conducted using PubMed and Google Scholar, with no publication year restrictions, up to February 2025. Keywords such as “rectovaginal fistula,” “surgery,” “Crohn’s disease,” and specific surgical techniques were combined using logical operators (AND, OR). Out of 2,578 records, 39 articles—original papers, meta-analyses, and case reports published in English—met the inclusion criteria and were analyzed.Results: Conservative management is recommended for small, minimally symptomatic fistulas. However, many patients ultimately require surgery, which varies depending on the fistula’s etiology and complexity. Minimally invasive procedures are preferred for simple, low-level fistulas. The Martius flap is suitable for low- and mid-level cases. Transabdominal approaches are reserved for high or radiation-induced fistulas and carry higher complication risks. Surgical decisions should be based on etiology, fistula size and location, anal sphincter function, tissue condition, and surgeon experience.Conclusions: RVF remains a challenging condition that requires individualized, multidisciplinary care. Future research should aim to refine surgical techniques, compare treatment outcomes by etiology and method, and include larger patient populations to support the development of robust clinical guidelines. Additionally, prospective comparative studies are essential to determine the most effective interventions for different RVF subtypes.</ns3:p>

Transanal Hemorrhoidal Dearterialization (THD) — an Effective Minimally Invasive Technique for the Treatment of Chronic Hemorrhoids

2025-06-17

V Pyrohovskyi , S Zlobynets , A Taranenko +4 more | Perioperaciina Medicina

Relevance. Hemorrhoids remain one of the most common rectal pathologies, affecting approximately 12% of the population, with 40% of all rectal disease cases attributed to it. In Ukraine, traditional surgical … Relevance. Hemorrhoids remain one of the most common rectal pathologies, affecting approximately 12% of the population, with 40% of all rectal disease cases attributed to it. In Ukraine, traditional surgical interventions dominate, accounting for 97% of treatments, whereas in the USA and EU countries, minimally invasive techniques comprise up to 83% of cases. Objective. To evaluate the effectiveness of Transanal Hemorrhoidal Dearterialization (THD), specifically the rate of postoperative complications and recurrences. Materials and Methods. From 2007 to 2021, 1,629 THD procedures were performed at the Proctology Department of the Kyiv Regional Clinical Hospital in patients aged 21–73 years (mean age — 37.6 years). Of these, 77.3% had stage III hemorrhoids, 12.7% — stage IV, and 10% — stage II. The procedure was performed using the THD Evolution device (GF s.r.l., Italy) by ligating branches of the superior rectal artery under Doppler guidance, with mucosal pexy conducted to correct mucosal prolapse. Results. Only 7.4% of patients required narcotic analgesics in the early postoperative period. Documented complications included: wound infection (0.2%), profuse bleeding (0.6%), and node thrombosis (6.8%). The overall recurrence rate was 4%. Recurrence management included vacuum ligation (26.2%), classical hemorrhoidectomy (12.3%), or local excision of hemorrhoidal nodes and skin tags (61.5%). Conclusions. The THD technique has proven to be an effective alternative to both traditional and minimally invasive approaches in hemorrhoid treatment. It combines radicality with minimal invasiveness, shortens the postoperative recovery period, and allows for simultaneous treatment of concomitant anal fissures.

Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes

2025-06-16

Ahmet Cihangir Emral , Sinan Efe Yazıcı | Lasers in Medical Science

Outcomes of Karydakis Flap Procedure for Primary Pilonidal Sinus Disease at a Teaching Hospital in Pakistan: A Prospective Study of a Single-Arm Surgical Intervention

2025-06-16

Wasif Majeed Chaudhry , Waleed Ahmad , Hugo Gonzalez +3 more | Journal of Lahore Medical and Dental College

Background: Pilonidal sinus disease (PSD) of natal cleft is a long-term illness characterized by a blind epithelial tract containing hair, commonly affecting young males with excessive body hair. Various surgical … Background: Pilonidal sinus disease (PSD) of natal cleft is a long-term illness characterized by a blind epithelial tract containing hair, commonly affecting young males with excessive body hair. Various surgical techniques have been developed to treat PSD, yet no universally accepted standard exists.Objective: To evaluate the clinical outcomes of the Karydakis flap procedure in patients who were diagnosed with primary natal cleft pilonidal sinus disease.Methods: This research was carried out at a teaching hospital in Lahore, Pakistan in which 100 patients suffering from primary sacrococcygeal pilonidal sinus disease underwent Karydakis flap procedure. Patient data, including procedure duration, hospital stay, postoperative pain levels, wound infection rates, seroma formation, flap necrosis, and recurrence, were systematically recorded and analysed using SPSS version 21.0.Results: The results demonstrated favourable outcomes, with an 86% primary healing rate. The average procedure time was 47.50 ± 5.14 minutes, and the average length for hospitalization was 1.87 ± 0.80 days. Postoperative pain was measured by using the Visual Analog Scale (VAS), which had a mean score of 3.45. Surgical site infections were observed in 8% of cases, while 6% experienced seroma formation. No case of flap necrosis was reported, and disease recurrence occurred in only 2% of patients within six months.Conclusion: Karydakis flap procedure is a reliable and effective surgical approach for treating primary pilonidal sinus disease of the natal cleft. Its design supports faster recovery, minimal postoperative issues, and reduced recurrence, making it a preferred option in clinical practice.

Sự khác biệt về đặc điểm lâm sàng và xét nghiệm giữa các thể mày đay mạn tính tại Việt Nam

2025-06-16

Nguyễn Thị Kim Cúc , Lê Huyền My , Chu Nhật Uyên +2 more | Tạp chí Nghiên cứu Y học

Nghiên cứu cắt ngang trên 1340 bệnh nhân được chẩn đoán mày đay mạn tính (CU) tại phòng khám chuyên đề mày đay và mày đay mạn tính, Bệnh viện … Nghiên cứu cắt ngang trên 1340 bệnh nhân được chẩn đoán mày đay mạn tính (CU) tại phòng khám chuyên đề mày đay và mày đay mạn tính, Bệnh viện Da liễu Trung ương từ tháng 2/2023 đến tháng 7/2024 nhằm mô tả sự phân bố và phân tích sự khác biệt giữa các thể lâm sàng CU tại Việt Nam. Kết quả cho thấy mày đay mạn tính tự phát đơn thuần (CSU) là thể CU chiếm ưu thế (81,8%). Chứng da vẽ nổi là thể mày đay mạn tính cảm ứng (CIndU) hay gặp nhất (89,3%). Cả hai thể CU đều có tỉ lệ nữ giới chiếm ưu thế. Thời gian diễn biến đợt bệnh của CSU ngắn hơn với với CIndU (p < 0,001). Tỉ lệ giảm bạch cầu ái toan, giảm nồng độ IgE toàn phần, tăng máu lắng, tăng IgG kháng TPO và test huyết thanh tự thân dương tính ở nhóm CSU đơn thuần cao hơn so với nhóm CSU đồng mắc CIndU và nhóm CIndU đơn thuần (p < 0,05). Không có sự khác biệt về độ tuổi khởi phát, tiền sử bệnh cơ địa giữa các thể CU. Như vậy, sự phân bố các thể CU tại Việt Nam cũng tương tự như trên thế giới với CSU và chứng da vẽ nổi chiếm ưu thế. CIndU đơn thuần và CIndU đồng mắc CSU mang nhiều đặc điểm lâm sàng và cận lâm sàng tương tự nhau.

Surgery Versus Flexible Endoscopic Rubber Band Ligation for Grade 2 and 3 Internal Hemorrhoids

2025-06-15

Diyaree Nihad Ismael | UHD Journal of Science and Technology

Surgery has traditionally been the primary treatment for symptomatic internal hemorrhoids. However, office-based interventions such as rubber band ligation (RBL) are increasingly used for Grades 1–3 hemorrhoids. Flexible endoscopic RBL … Surgery has traditionally been the primary treatment for symptomatic internal hemorrhoids. However, office-based interventions such as rubber band ligation (RBL) are increasingly used for Grades 1–3 hemorrhoids. Flexible endoscopic RBL offers a minimally invasive alternative, whereas surgery remains standard for Grade 4. To compare the effectiveness of flexible endoscopic RBL versus surgical hemorrhoidectomy in managing symptomatic Grades 1–3 internal hemorrhoids, focusing on bleeding control, pain, recovery time, and recurrence. A comparative study of 55 patients treated with flexible endoscopic RBL (using Olympus kits) and 55 matched patients undergoing conventional excisional hemorrhoidectomy (open technique). Patients choose their treatment after counseling. Outcomes were assessed over 1 year, with follow-up at 1 week, 3, 6, and 12 months. Pain was measured using a Visual Analog Scale (≥4 defined significant pain). Statistical analysis used a statistical package for the social sciences v26 (t-tests for continuous variables, Chi-square for categorical; P < 0.05 significant). Both groups showed comparable efficacy: Bleeding control (95% vs. 93%), mucosal prolapse resolution (96% vs. 97%), and 1-year recurrence (30% vs. 29%). RBL had superior post-procedural outcomes: Lower pain (10% vs. 90%), fewer work absences (5% vs. 95%), and no bed-boundness (0% vs. 100%; all P < 0.05). Flexible endoscopic RBL is as effective as surgery for Grades 1–3 hemorrhoids but significantly reduces pain, recovery time, and work absenteeism. RBL should be considered a first-line option for eligible patients.

Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study

2025-06-15

Antonio Brillantino , Francesca Iacobellis , Luigi Marano +7 more | Annals of Coloproctology

Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease

2025-06-14

Jörg König , Utz Settmacher , Aladdin Ali Deeb +5 more | Langenbeck s Archives of Surgery

Abstract Background Pilonidal sinus disease (PSD) is a frequently occurring condition that can have a significant impact on quality of life (QoL). In addition to severe pain, particularly with movement … Abstract Background Pilonidal sinus disease (PSD) is a frequently occurring condition that can have a significant impact on quality of life (QoL). In addition to severe pain, particularly with movement or while sitting, this disease imposes restrictions that affect one’s professional and private life. These patients frequently suffer from recurrence requiring multiple interventions and hospital stays. Methods The study enrolled forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery at University Hospital, Jena. Forty- one of these patients were questioned retrospectively in writing or by telephone interviews between July 2021 to September 2022. The data processed using SPSS software. Results The median follow-up for all patients was 86 months (range, 23–140 months). Only one recurrence (2.4%) was reported. While the participants’ BMIs remained unchanged, they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated. Conclusion The low rate of recurrence suggests that LP is an effective option for post-excision surgical repair of pilonidal sinus. The use of this procedure has no impact on patient’s BMI but can significantly improve patients’ QoL.

Treatment of perianal abscess and anal fistula in infants: a systematic review

2025-06-13

Jinlan Chen , Yi Xiong , Cong Wang +1 more | Frontiers in Surgery

Introduction The optimal treatment approach for perianal abscess (PA) and fistula-in-ano (FIA) in infants remains a subject of debate. Material and Methods A thorough literature search was conducted across multiple … Introduction The optimal treatment approach for perianal abscess (PA) and fistula-in-ano (FIA) in infants remains a subject of debate. Material and Methods A thorough literature search was conducted across multiple databases, including Embase, PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Results A total of eighteen retrospective studies, encompassing 1,770 patients, were analyzed. Of the 702 cases (38.7%) that underwent conservative treatment, 528 cases (75.2%) achieved a cure, while 174 cases (24.8%) were unsuccessful, with 93 experiencing PA recurrence and 81 developing FIA. In contrast, among the 1,068 cases (61.3%) that received surgical interventions, 784 cases (73.4%) were cured, whereas 284 cases (26.6%) were not, with 151 experiencing PA recurrence and 133 developing FIA. Conclusion The available studies indicate minimal differences in the cure and recurrence rates of PA and FIA between the conservative and surgical treatment groups. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , PROSPERO (CRD42023472249).

Exploratory Study of Minimally Invasive Therapy: Laser Ablation Combined with ADM Implantation in Recurrent Sacrococcygeal Pilonidal Disease

2025-06-13

Zhicheng Li , Lei Jin , Jialin Qin +2 more | Research Square (Research Square)

<title>Abstract</title> Purpose: Recurrent sacrococcygeal pilonidal disease (SPD) presents considerable challenges in clinical management. In recent years, minimally invasive techniques, such as laser ablation, have emerged as promising alternatives for treatment. … <title>Abstract</title> Purpose: Recurrent sacrococcygeal pilonidal disease (SPD) presents considerable challenges in clinical management. In recent years, minimally invasive techniques, such as laser ablation, have emerged as promising alternatives for treatment. Furthermore, the application of acellular dermal matrix (ADM) has demonstrated potential benefits in wound healing and tissue regeneration. This clinical study aims to assess the efficacy and safety of the combined approach of laser ablation and ADM in the management of recurrent SPD. Basic procedures: We retrospectively analyzed the data of our five patients who diagnosed with recurrent SPD between October 2023 and April 2024. All patients underwent laser ablation in conjunction with ADM placement. We recorded clinical outcomes, including the healing rate and recurrence rate, as well as surgical data. Postoperative pain was assessed using the visual analog scale (VAS), and we documented the time taken for patients to return to their regular work and daily activities. Main findings: A total of five patients underwent laser ablation combined with ADM. Patients experienced minimal postoperative pain. All patients satisfied with this surgery. Conclusion: This pilot study suggests laser ablation with ADM may be a viable minimally invasive option for recurrent SPD, showing favorable outcomes. Larger comparative studies are needed to validate these findings.

Efficacy of botulinum toxin in the treatment of chronic anal fissure: a comprehensive systematic review

2025-06-12

Sarika Oad , Maqbool Qadir , F. Alam +7 more | Annals of Medicine and Surgery

Conservative Management of Perianal Fistulas Described By İbn Al-Quff Al Karaki (1232-1286 CE): Old Contributions to Modern Practice

2025-06-12

Ali Bekraki | Diseases of the Colon & Rectum