Publications by authors named "Vipul D Yagnik"

114 Publications

TROPIS (Transanal Opening of Intersphincteric Space) Procedure for the Treatment of Horseshoe Anal Fistulas.

J Gastrointest Surg 2022 Jun 16. Epub 2022 Jun 16.

Department of General Surgery, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India.

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http://dx.doi.org/10.1007/s11605-022-05384-zDOI Listing
June 2022

Re: Neuroendocrine tumour within a Meckel's diverticulum.

ANZ J Surg 2022 06;92(6):1577

Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India.

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http://dx.doi.org/10.1111/ans.17596DOI Listing
June 2022

Including video and novel parameter-height of penetration of external anal sphincter-in magnetic resonance imaging reporting of anal fistula.

World J Gastrointest Surg 2022 Apr;14(4):271-275

Department of Surgery, SSR Medical College, Belle Rive 744101, Belle Rive, Mauritius.

The main purpose of a radiologist's expertise in evaluation of anal fistula magnetic resonance imaging (MRI) is to benefit patients by decreasing the incontinence rate and increasing the healing rate. Any loss of vital information during the transfer of this data from the radiologist to the operating surgeon is unwarranted and is best prevented. In this regard, two methods are suggested. First, a short video to be attached with the standardized written report highlighting the vital parameters of the fistula. This would ensure minimum loss of information when it is conveyed from the radiologist to the operating surgeon. Second, inclusion of a new parameter, the amount of external sphincter involvement by the anal fistula. This parameter is usually not included in the MRI report. This can be evaluated as the height of penetration of the external anal sphincter (HOPE) by the fistula. The external anal sphincter plays a pivotal role in maintaining continence. This parameter (HOPE) is distinct from the 'height of internal opening' and assumes immense importance as its knowledge is paramount to prevent damage to the external anal sphincter by the surgeon during surgery.
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http://dx.doi.org/10.4240/wjgs.v14.i4.271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131832PMC
April 2022

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas.

World J Gastroenterol 2022 Apr;28(16):1608-1624

Department of Statistics, Indian Council of Medical Research,New Delhi 110029, India.

Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.
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http://dx.doi.org/10.3748/wjg.v28.i16.1608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048780PMC
April 2022

Conservative (non-surgical) management of cryptoglandular anal fistulas: is it possible? A new insight and direction.

ANZ J Surg 2022 05;92(5):1284-1285

Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan, India.

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http://dx.doi.org/10.1111/ans.17538DOI Listing
May 2022

Re: Bowel perforation: a 'not so rare' complication of biliary stent migration.

ANZ J Surg 2022 05;92(5):1283

Department of Medicine, Sadbhav hospital, Patan, Gujarat, India.

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http://dx.doi.org/10.1111/ans.17466DOI Listing
May 2022

Re: Hepatobiliary tuberculosis: a notorious mimic to be considered within the differential.

ANZ J Surg 2022 04;92(4):933

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

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http://dx.doi.org/10.1111/ans.17423DOI Listing
April 2022

Pilonidal Sinus Is Like an Ordinary Abscess and Should Be Treated Like One.

Dermatol Surg 2022 Jun 24;48(6):690-691. Epub 2022 Mar 24.

Surgery, SSR Medical College, Belle Rive, Mauritius.

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http://dx.doi.org/10.1097/DSS.0000000000003426DOI Listing
June 2022

Re: Littre hernia: rare presentation of computed tomography-diagnosed strangulated umbilical Littres hernia repaired with mesh.

ANZ J Surg 2022 03;92(3):621

Department of colorectal surgery, Garg Fistula Research Institute (GFRI), Panchkula, India.

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http://dx.doi.org/10.1111/ans.17392DOI Listing
March 2022

Re: Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge.

ANZ J Surg 2022 03;92(3):619

Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, India.

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http://dx.doi.org/10.1111/ans.17351DOI Listing
March 2022

Re: Perforated Meckel's diverticulum from foreign body presenting with pain in the right iliac fossa.

ANZ J Surg 2022 01;92(1-2):299

Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, India.

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http://dx.doi.org/10.1111/ans.17317DOI Listing
January 2022

Re: Littre hernia: rare presentation of computed tomography-diagnosed strangulated umbilical Littres hernia repaired with mesh.

ANZ J Surg 2022 01;92(1-2):298-299

Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, India.

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http://dx.doi.org/10.1111/ans.17289DOI Listing
January 2022

A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas.

Clin Exp Gastroenterol 2022 17;15:27-40. Epub 2022 Feb 17.

National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India.

Background: Anal fistulas cause great uncertainty and anxiety in patients and surgeons alike. This is largely because of the inability to accurately confirm postoperative fistula healing, especially long-term healing. There is no scoring system available that can objectively assess cryptoglandular anal fistulas for postoperative healing and can also accurately predict long-term healing.

Methods: Several parameters that could indicate anal fistula healing were assessed. Out of these, six parameters (four MRI-based and two clinical) were finalized, and a weighted score was given to each parameter. A novel scoring system (NSS) was developed. A minimum possible score (zero) indicated complete healing whereas the maximum weighted score (n = 20) indicated confirmed non-healing. Scoring was done with postoperative MRI (at least 3 months post-surgery), then compared with the actual healing status, and subsequently correlated with the final long-term clinical outcome.

Results: The NSS was validated in 183 operated cryptoglandular fistula-in-ano patients over a 3-year period in whom 283 MRIs (preoperative plus postoperative) were performed. The postoperative follow-up was 12-48 months (median-30 months). The NSS was found to have a very high positive predictive value (98.2%) and moderately high negative predictive value (83.7%) for long-term fistula healing. Additionally, its sensitivity and specificity in predicting healing were 93.9% and 94.7%, respectively.

Conclusion: Thus, this new scoring system is highly accurate and would be a useful tool for surgeons and radiologists managing anal fistulas. By objectivizing the assessment of postoperative healing, it can both ease and streamline management. Moreover, reliable prediction of recurrence-free long-term healing will greatly allay the apprehensions associated with this dreaded disease.
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http://dx.doi.org/10.2147/CEG.S343254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860728PMC
February 2022

Increased Risk of Bleeding with Topical Metronidazole in a Postoperative Wound after Anal Fistula and Hemorrhoid Surgery: A Propensity Score-Matched Case-Control Study.

Clin Pract 2022 Feb 18;12(1):133-139. Epub 2022 Feb 18.

Department of Pharmacology, Adesh Medical College and Hospital, Shahbad 136135, India.

Background: Topical metronidazole (TM) is commonly used in many infective conditions and postoperative wounds including after anorectal surgery. TM was prescribed in patients operated for benign anorectal conditions (anal fistula and hemorrhoids) to hasten wound healing. After the initiation of this protocol, the incidence of postoperative wound bleeding seemed to increase. There are no data in the literature suggesting that topical metronidazole increases the risk of bleeding.

Objective: Analysis of the association of TM with an increased risk of bleeding in postoperative anorectal wounds.

Design: This was an observational and a retrospective study. Propensity score matching was performed.

Setting: This study was conducted at a specialized center for anorectal disorders in postoperative patients suffering from anal fistula and hemorrhoids.

Materials: The incidence of postoperative bleeding in the patients in whom TM was used (study group) was retrospectively compared with the patients operated one year before this period in whom TM was not used (control group).

Sample Size: There were 35 patients in the study group and 181 patients in the control group.

Main Outcome Measures: The incidence of bleeding and the number of bleeding episodes were evaluated.

Results: The incidence of bleeding was significantly higher in the study group as compared to the control group (8/35 (22.8%) vs. 8/181 (4.4%), respectively, = 0.0011). In most cases, bleeding was controlled with conservative measures. The number of bleeding episodes was also significantly higher in the study group (14 vs. 11, respectively, = 0.0001). The number of patients requiring operative intervention was also higher in the study group (2/35-5.7%) as compared to the control group (1/181-0.56%), but this was not statistically significant ( = 0.069).

Conclusions: The study highlighted that application of topical metronidazole in postoperative anorectal wounds increased the risk of bleeding. Most of the bleeding episodes were controlled with conservative measures but they caused considerable patient anxiety and apprehension.
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http://dx.doi.org/10.3390/clinpract12010017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870643PMC
February 2022

Left-sided Amyand hernia: a rare presentation.

ANZ J Surg 2022 Feb 4. Epub 2022 Feb 4.

Department of Radiology, Sanskar X-ray and Sonography Clinic, Patan, India.

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http://dx.doi.org/10.1111/ans.17532DOI Listing
February 2022

Gossypiboma: a rare complication diagnosed on esophagogastroduodenoscopy.

ANZ J Surg 2022 Feb 3. Epub 2022 Feb 3.

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

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http://dx.doi.org/10.1111/ans.17533DOI Listing
February 2022

Spontaneous involvement of penile shaft (corpora cavernosa) by anal fistula.

ANZ J Surg 2022 Jan 19. Epub 2022 Jan 19.

Department of General Surgery, SSR Medical College, Belle Rive, Mauritius.

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http://dx.doi.org/10.1111/ans.17479DOI Listing
January 2022

Migration of biliary stent into the gallbladder: A surprising intraoperative finding.

J Minim Access Surg 2022 Jan-Mar;18(1):151-153

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

Post-endoscopic retrograde cholangiopancreatography stenting is a well-established treatment for benign as well as malignant biliary obstruction. The most frequently encountered complication is stent clogging. Stent migration (proximal or distal), on the other hand, is not very common. Proximal migration of a choledochal endoprosthesis into the gallbladder has not yet been reported in the literature.
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http://dx.doi.org/10.4103/jmas.JMAS_47_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830582PMC
January 2022

Re: Chilaiditi's sign: a rare presentation of pseudo-pneumoperitoneum masquerading as an acute abdomen.

ANZ J Surg 2021 12;91(12):2853

Department of colorectal surgery, Garg Fistula Research Institute (GFRI), Panchkula, India.

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http://dx.doi.org/10.1111/ans.17257DOI Listing
December 2021

Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management.

Tzu Chi Med J 2021 Oct-Dec;33(4):374-379. Epub 2021 Apr 1.

Indian Council of Medical Research, National Institute of Medical Statistics, New Delhi, India.

Objectives: Extreme horseshoe anal fistulas are rare, and there are little data on the diagnosis and management of these fistulas.

Materials And Methods: Patients with horseshoe anal fistula, in which the fistula tract encircled more than 75% of the anal circumference were included in the study. All patients were assessed by a preoperative magnetic resonance imaging (MRI). The patients were managed by a sphincter-sparing procedure. The continence was evaluated by an objective continence scoring system (Vaizey's scores).

Results: 1059 anal fistula patients were operated on over 7-years with a median follow-up of 36 months (range: 5-79 months). There were 47/1059 (4.4%) patients with extreme horseshoe anal fistulas. In 4/47 patients, the fistulas were complete circumanal (encircling anal canal completely). The mean age was 39.5 ± 10.9 years, M/F-41/6. The fistula was supralevator in 12/47 (25.5%), had an associated abscess in 28/47 (59.6%), and was recurrent in 33/47 (70.2%) patients. The tracts were intersphincteric in 27/47, transsphincteric in 2/47, and both (intersphincteric and transsphincteric) in 18/47 patients. All patients ( = 47) were managed by a sphincter-sparing procedure. Four patients were lost to follow-up. The fistula healed completely in 34/43 (79%) patients. There was no significant difference between preoperative and postoperative Vaizey's continence scores 0.031 ± 0.17 and 0.033 ± 0.18 respectively (=0.90, Mann-Whitney U-test).

Conclusion: Extreme horseshoe fistulas are rare, with an incidence of about 4% (in a referral practice). The missed diagnosis of circumferential tracts could lead to a recurrence. MRI was pivotal to confirm the diagnosis. Proper identification and management of internal opening and adequate drainage of all tracts were crucial for successfully treating extreme horseshoe fistulas.
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http://dx.doi.org/10.4103/tcmj.tcmj_287_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532580PMC
April 2021

A New Anatomical Pathway of Spread of Pus/Sepsis in Anal Fistulas Discovered on MRI and Its Clinical Implications.

Clin Exp Gastroenterol 2021 7;14:397-404. Epub 2021 Oct 7.

SSR Medical College, Belle Rive, Mauritius.

Background: In the anal sphincter complex, the intersphincteric space between the internal and external sphincters is the only conventionally recognized pathway for the spread of sepsis. However, there is another unrecognized space discovered on MRI, the "outer-sphincteric space", between the external anal sphincter and its lateral fascia along which pus can spread. An abscess in the intersphincteric space is easily drained into the rectum via the transanal route and is more likely to spread into the supralevator space. Conversely, an abscess in the outer-sphincteric space is difficult to drain transanally into the rectum and is more likely to become a transsphincteric abscess/fistula.

Methods: The MRIs of anal fistula patients operated over four years on intersphincteric abscesses were analyzed. The pattern of spread into the ischiorectal fossa and/or supralevator space and ease of drainage into the rectum through the transanal route were studied.

Results: Thirty-six patients were operated on to drain their intersphincteric abscesses through the anal canal. Two distinct patterns were noted. Twenty patients had abscesses in the intersphincteric space, which were easily drained into the rectum. Of them, 6/20 had supralevator extension, while only 1/20 had spread to the ischiorectal fossa. In 16/36 patients, the abscess was in the outer-sphincteric space and could not be drained into the rectum. In 9/16 of these patients, pus spread into the ischiorectal fossa but supralevator spread did not happen in any patient.

Conclusion: Apart from the intersphincteric space, there is perhaps another unrecognized anatomical space - the outer-sphincteric space - discovered on MRI, through which pus can spread in anal fistulas or abscesses.
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http://dx.doi.org/10.2147/CEG.S335703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504714PMC
October 2021

Re: Three pathologies in one: band adhesion strangulating neuroendocrine tumour-containing Meckel's diverticulum.

ANZ J Surg 2021 10;91(10):2225-2226

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

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http://dx.doi.org/10.1111/ans.17091DOI Listing
October 2021

Fecal diversion in complex anal fistulas: Is there a way to avoid it?

World J Clin Cases 2021 Sep;9(25):7306-7310

Surgery, SSR Medical College, Belle Rive 744101, Mauritius.

Temporary fecal diversion by a diverting colostomy or ileostomy is occasionally performed for serious complex fistulas. The main indications are highly complex and extensive cryptoglandular anal fistula, anal fistula associated with severe anorectal Crohn's disease, recurrent rectovaginal fistula, radiation-induced fistula and anal fistula with associated necrotizing fasciitis. The purpose of stoma formation is to divert the fecal stream away from the anorectum and the perianal region so as to control the infective process and prevent trauma to the operated repaired tissues. Once the fistula has healed, the diverting stoma is closed. However, two questions are relevant. First, is it certain that the same disease would not relapse (or the fistula would not recur) once the colostomy is closed? Second, is there a non-surgical method which can obviate the need for a diverting colostomy? An attempt is made to answer both these questions in this review.
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http://dx.doi.org/10.12998/wjcc.v9.i25.7306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464477PMC
September 2021

Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans.

World J Gastroenterol 2021 Sep;27(33):5460-5473

Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India.

Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.
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http://dx.doi.org/10.3748/wjg.v27.i33.5460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433608PMC
September 2021

Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI.

Abdom Radiol (NY) 2021 12 29;46(12):5550-5563. Epub 2021 Aug 29.

Department of Statistics, Indian Council of Medical Research, New Delhi, India.

Background: As experience with anal fistula imaging (MRI) has increased, new pathways of fistula extension have been identified. A recently described pathway is the  'outer-sphincteric space' present between the external anal sphincter and its covering outer fascia. A new type of complex fistula is being described which is present in the outer-sphincteric space and continues superiorly along the lateral border of the external anal sphincter to the infero-lateral surface of the puborectalis and levator-ani. In effect, these outer-sphincteric fistulas are at the roof of the ischiorectal fossa inside the levator muscle (RIFIL). These fistulas are not transsphincteric fistulas as they remain inside the levator muscle and do not enter the ischiorectal fossa.

Methods: The MRI scans of consecutive anal fistula patients operated over the last two years were analyzed retrospectively.

Results: Of 419 operated fistula patients analyzed, 42(10%) had RIFIL and 377 non-RIFIL fistulas. Compared to non-RIFIL fistulas, there were significantly more recurrent, multiple tracts, horseshoe, supralevator, and suprasphincteric fistulas in the RIFIL group. RIFIL fistulas were significantly more complex than non-RIFIL fistulas(85.7% vs 38.5%, p < 0.00001) and the surgery failure rate was also significantly higher in the RIFIL group (30.6%) than in the non-RIFIL fistula (7.2%) group(p = 0.0001).

Conclusion: RIFIL are highly complex fistulas. Proper diagnosis by MRI, surgical access, and subsequent management of these fistulas is quite challenging and they are associated with poor prognosis. Missing their diagnosis would lead to higher recurrence rate. These have not been described previously and were perhaps confused with high transsphincteric infralevator fistulas in ischiorectal fossa.
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http://dx.doi.org/10.1007/s00261-021-03261-yDOI Listing
December 2021

Surgical management of abdominal tuberculosis: A prospective single-center study.

Tzu Chi Med J 2021 Jul-Sep;33(3):282-287. Epub 2020 Dec 24.

Department of Surgery, SSR Medical College, Belle Rive, Mauritius.

Objective: Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management.

Materials And Methods: From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data.

Results: Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes.

Conclusion: Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.
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http://dx.doi.org/10.4103/tcmj.tcmj_206_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323646PMC
December 2020

Comparison Between the Modified Parks and Garg Classifications of Cryptoglandular Anal Fistulas.

Dis Colon Rectum 2021 10;64(10):e589

Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India.

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http://dx.doi.org/10.1097/DCR.0000000000002208DOI Listing
October 2021

Diagnosis of anorectal tuberculosis by polymerase chain reaction, GeneXpert and histopathology in 1336 samples in 776 anal fistula patients.

World J Gastrointest Surg 2021 Apr;13(4):355-365

Department of Statistics, Indian Council of Medical Research, New Delhi 110029, India.

Background: The association of tuberculosis (TB) with anal fistulas can make its treatment quite difficult. The main challenge is timely detection of TB in anal fistulas and its proper management. There is little data available on diagnosis and management of TB in anal fistulas.

Aim: To detect TB in fistula-in-ano patients were analyzed in different methods utilized.

Methods: A retrospective analysis of different methods, polymerase chain-reaction (PCR), GeneXpert and histopathology (HPE), utilized to detect tuberculosis in fistula-in-ano patients, treated between 2014-2020, was performed. The sampling was done for tissue (fistula tract lining) and pus (when available). The detection rate of various tests to detect TB and prevalence rate of TB in simple complex fistulae were studied.

Results: In 1336 samples (776 patients) tested, TB was detected in 133 samples (122 patients). TB was detected in 52/703 (7.4%) samples tested by PCR-tissue, in 77/331 (23.2%) samples tested by PCR-pus, 3/197 (1.5%) samples tested with HPE-tissue and 1/105 (0.9%) samples tested by GeneXpert. To detect TB, PCR-tissue was significantly better than HPE-tissue (52/703 3/197 respectively) ( = 0.0012, significant, Fisher's exact test) and PCR-pus was significantly better than PCR-tissue (77/331 52/703 respectively) ( < 0.00001, significant, Fisher's exact test). TB fistulas were more complex than non-tuberculous fistulas [78/113 (69%) 278/727 (44.3%) respectively] ( < 0.00001, significant, Fisher's exact test) but the overall healing rate was similar in tuberculous and non-tuberculous fistula groups [90/102 (88.2%) 518/556 (93.2%) respectively] ( = 0.10, not significant, Fisher's exact test).

Conclusion: This is the largest study of anorectal TB to be published. The detection of TB by polymerase chain-reaction was significantly higher than by histopathology and GeneXpert. Amongst polymerase chain-reaction, pus had a higher detection rate than tissue. TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups.
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http://dx.doi.org/10.4240/wjgs.v13.i4.355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069068PMC
April 2021

Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review.

World J Gastrointest Surg 2021 Apr;13(4):340-354

Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India.

Background: A complex anal fistula is a challenging disease to manage.

Aim: To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.

Methods: Anal fistulas operated on by a single surgeon over 14 years were analyzed. Preoperative magnetic resonance imaging was done in all patients. Four procedures were performed: fistulotomy; two novel sphincter-saving procedures, proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts (PERFACT) and transanal opening of intersphincteric space (TROPIS), and anal fistula plug. PERFACT was initiated before TROPIS. As per the institutional GFRI algorithm, fistulotomy was done in simple fistulas, and TROPIS was done in complex fistulas. Fistulas with associated abscesses were treated by definitive surgery. Incontinence was evaluated objectively by Vaizey incontinence scores.

Results: A total of 1351 anal fistula operations were performed in 1250 patients. The overall fistula healing rate was 19.4% in anal fistula plug ( = 56), 50.3% in PERFACT ( = 175), 86% in TROPIS ( = 408), and 98.6% in fistulotomy ( = 611) patients. Continence did not change significantly after surgery in any group. As per the new algorithm, 1019 patients were operated with either the fistulotomy or TROPIS procedure. The overall success rate was 93.5% in those patients. In a subgroup analysis, the overall healing rate in supralevator, horseshoe, and fistulas with an associated abscess was 82%, 85.8%, and 90.6%, respectively. The 90.6% healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess (94.5%, = 0.057, not significant).

Conclusion: Fistulotomy had a high 98.6% healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously. The sphincter-sparing procedure, TROPIS, was safe, with a satisfactory 86% healing rate for complex fistulas. This is the largest anal fistula series to date.
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http://dx.doi.org/10.4240/wjgs.v13.i4.340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069067PMC
April 2021
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