What every gastroenterologist needs to know about common anorectal disorders

Schubert, Moonkyung Cho; Sridhar, Subbaramiah; Schade, Robert R.; Wexner, Steven D.

doi:10.3748/wjg.15.3201

Cited by 96 publications

(72 citation statements)

References 89 publications

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“…The prevalence rate of symptomatic haemorrhoids in the United States is 4.4% of the total adult population. 5 which matches with our findings.…”

supporting

confidence: 93%

GENERAL SURGEONS; WORK LOAD & MANAGEMENT PATTERN IN MEDICAL TEACHING INSTITUTION LADY READING HOSPITAL PESHAWAR

Qayyum¹,

Khan²

2016

TPMJ

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ABSTRACT… Objectives:The objectives of this study were to find out the frequency of surgical cases and types of surgical interventions in a tertiary care hospital of Peshawar. Study Design: Descriptive observational study Period: Jan to June 2015. Setting: Surgical "D" Unit of Medical Teaching institution, Lady Reading Hospital Peshawar. Material and methods: Relevant information's were recorded on a pre-designed proforma prepared in accordance with the objectives of the study. Results: A total of 842 patients who were admitted in the MTI-LRH Surgical D Unit were enrolled in the study irrespective of age, gender and geographical representation. Out of total 58% were males and 42% females. The age range of patient was from 2 years to 92 years the maximum. The mean of age with SD was 30 years +3.5 SD. Mode of age was 27 years. The frequency of surgical cases presentation (via emergency or outdoor department) were; Acute appendicitis 26%, cholilithiasis 17%, acute abdomen 9.2%, fire arm injuries/medico-legal cases 3.3%, peri-anal problems (pilonodal sinuses, hemorrhoids, fistula, anal fissure) 8.8%, Hernia (RIH& LIH 13%), carcinoma cases (stomach, rectum, pancreas) 1.5%, diabetic foot 3%, intestinal perforation & ileostomy 2.8%, etc. The frequency of types of surgical procedures were; The frequency of types of surgical procedures were; Open appendicectomy 25%, Exploration laprotomy 8.4%, debridement 2%, Peri anal surgeries (EUA, Haemorridictomy, anal dilatation, fistulectomy 9.4%), hernirraphy and hernitomy 16%, open cholecystectomy 13%, laproscopic cholecystectomy 4.4%, orchiodectomy & orchidopexy 5%, and colostomy reversal 2.2% etc. 2% patients managed conservatively. Eight patients expired during the treatment (1%). 97% discharged satisfactorily. There were 2 medico-legal cases that after discharged went in law in forces custody. Conclusion: The commonest cause of seeking surgical care was acute abdomen, FAI/MLC, cholilithiases, perianal disorders, hernia and testicular/scrotal problem are major surgical emergencies that we receive in our unit. In response the major types of surgical interventions are appendicectomy, Exploration laprotomy, open cholecystectomy, laproscopic cholecystectomy, hernirraphy and hernitomy, orchiodectomy &orchidopexy and colostomies. There is 1% moratlity rate as observed.

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“…The prevalence rate of symptomatic haemorrhoids in the United States is 4.4% of the total adult population. 5 which matches with our findings.…”

supporting

confidence: 93%

GENERAL SURGEONS; WORK LOAD & MANAGEMENT PATTERN IN MEDICAL TEACHING INSTITUTION LADY READING HOSPITAL PESHAWAR

Qayyum¹,

Khan²

2016

TPMJ

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“…(13) Persistent minor fecal incontinence has been reported in 1.2% to 3.5% of patients; however, this does not appear to be significantly different to the rate of minor fecal incontinence experienced by patients treated with topical GTN. (9) However, in a systematic review carried out by Garg P et al to analyse continence at 2 years or more after lateral internal sphincterotomy for chronic anal fissure, the long term risk of anal incontinence after lateral internal sphincterotomy was found to be quite significant. (14) He had 324 studies screened, 22 (n=4512) were included in the study and he reported an overall continence disturbance rate was 14%.…”

Section: Discussionmentioning

confidence: 99%

“…(8) Lateral internal sphincterotomy is the preferred method of surgery for persons with chronic anal fissures and is generally used when medical therapy has failed. (9) The procedure has been shown to be very effective with 96% of fissures healing at a median of 3 weeks in one trial. (10) It is associated with a lower rate of side effects than older techniques, such as posterior internal sphincterotomy and anoplasty.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lateral Internal Sphincterotomy and Controlled Intermittent Anal Dilatation in the Treatment of Chronic Anal Fissures: A Prospective, Randomised Study

Correia¹,

Audi²,

Noronha³

2016

jemds

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AIMS AND OBJECTIVEThe main aim of this study was to assess the relief of symptoms and the healing of the anal fissure using the two techniques of lateral internal sphincterotomy and controlled intermittent anal dilatation. MATERIALS AND METHODSThirty patients who were randomised into two groups underwent lateral internal sphincterotomy or controlled intermittent anal dilatation. Randomisation to treatment by either lateral internal sphincterotomy or controlled intermittent anal dilatation was done on the basis whether the patient's registration number was odd or even. A total of 16 patients were treated by lateral internal sphincterotomy and 14 patients by controlled intermittent anal dilatation. All cases were done under general anaesthesia. The improvement in patient's symptoms as well as healing of the fissure were recorded and the results were compared. No serious complications were observed in either group. Patients were followed up for six months post procedure. RESULTSNo differences were observed with respect to immediate relief of pain, bleeding, mucous discharge, healing of the anal fissure, surgical complications and time off work. The post-operative symptoms in the form of pain, bleeding and constipation did not differ significantly between the two groups and were easily controlled with analgesic, stool softeners and sitz baths. The patients were also asked to hydrate themselves well and advised to have a diet rich in vegetables and fruit. Two months post-operatively, 16 patients in the lateral sphincterotomy group and 14 patients in the controlled intermittent anal dilatation group had healed completely and had no anal incontinence or other serious complications. At 6 months follow-up however 2 patients in the anal dilatation group complained of impaired control of flatus and faeces, although there was no soiling of the underwear. At the same point in time, one patient in the sphincterotomy group and 3 patients in the anal dilatation group had a recurrence. No statistical difference however existed in either treatment groups as regards to the relief of symptoms, the healing of the fissure and anal incontinence. CONCLUSIONLateral internal sphincterotomy is one of the most favoured procedures. The reason for this is the simplicity of the procedure, the minimal anaesthesia requirements and excellent results. Controlled intermittent anal dilatation applied with a standardised technique reduced anal canal resting pressure, cured symptoms and provided symptomatic healing that was equivalent to that of a lateral internal sphincterotomy. Since there were no findings of incontinence or situations which resulted in anal sphincter damage, we conclude that controlled intermittent anal dilatation is suitable for patients with chronic anal fissures because of its less invasive nature as compared to lateral sphincterotomy with equivalent efficacy and safety. In addition, the controlled intermittent anal dilatation method may be an alternative procedure in older and multiparous women who has a higher risk o...

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“…Rekürrens ve komplikasyonların azaltılabilmesi için preoperatif görüntüleme önemle vurgulanmaktadır [8,9]. MRG temel görüntüleme yöntemidir [10].…”

Section: Görüntüleme Yöntemleriunclassified

Perianal Fistüllerde MR Görüntüleme

Şentürk¹,

Açar²

2015

Trd Sem

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What every gastroenterologist needs to know about common anorectal disorders

Cited by 96 publications

References 89 publications

GENERAL SURGEONS; WORK LOAD & MANAGEMENT PATTERN IN MEDICAL TEACHING INSTITUTION LADY READING HOSPITAL PESHAWAR

GENERAL SURGEONS; WORK LOAD & MANAGEMENT PATTERN IN MEDICAL TEACHING INSTITUTION LADY READING HOSPITAL PESHAWAR

Comparison of Lateral Internal Sphincterotomy and Controlled Intermittent Anal Dilatation in the Treatment of Chronic Anal Fissures: A Prospective, Randomised Study

Perianal Fistüllerde MR Görüntüleme

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