Track topics on Twitter Track topics that are important to you
This study comprises a prospective study of 40 patients with transphincteric anal fistula. The patients were classified into two groups: Group I: Fistulectomy, closure of internal sphincter and rectal advancement flap includes mucosa, submucosa, and circular muscle layer sutured 1cm below the level of internal opening. Group II: The same as group one but the flap includes only mucosa and submucosa.
This study comprises a prospective study of 40 patients with transphincteric anal fistula. They were referred to our colorectal surgery unit, Mansoura University Hospital during the period from May 2005 to May 2008. Patients with acute sepsis, specific cause of fistula, strictured anorectum, and any degree of incontinence were excluded from the study.
All patient were evaluated by digital examination, procto-sigmoidoscopy, fistulography and MRI fistulography without contrast media, using a 1.5 Tesla super conducting magnet (Magnetom Symphony MRease VA12 Siemens medical system), (either STIR or SPIR in addition to T1 weighted or T2 weighted sequences). Axial, coronal and sometimes sagittal planes were used. Preoperative assessment of anal sphincter dysfunction was done by conventional manometry using a standard low compliance water perfusions system and eight-channels catheters with pressure transducer connected to 5.5 mm manometric probe with spirally located ports at 0.5cm interval, which measured along the length of the anal canal, as well as inflatable rectal balloon. The protocol of performance is stationary pull through technique with recording the functional length of the anal canal (FL), mean maximum resting pressure in the anal canal (MRP), mean maximum squeeze pressure in the anal canal (MSP). Pressure was recorded using a computerized recording device (MMS ;Holland) which included menu-driven software to aid with data acquisition. Data were analyzed with the use of a complied software package that automatically produced numeric reports and graphs.
The patients were then classified into 2 groups. After carefully explaining the purpose of the study, an informed consent was taken from every patient. Group I: Fistulectomy, closure of internal sphincter with loose vicryl 3(0) suture and rectal advancement flap (the length 5cm of the flap is twice its width) includes mucosa, submucosa, circular muscle layer sutured 1cm below the level of internal opening. Group II: The same as group one but the flap includes only mucosa and submucosa.
Fleet enema was used for preoperative bowel preparation in all cases. Operation was done under general anesthesia in the lithotomy position. Prophylactic antibiotics were used with ciprofloxacin 500 mg and metronidazole 500 mg preoperatively and twice daily for 5 days. Examination under anaesthesia (EUA) was firstly performed and the extent of the disease was established by cannulating the fistulas with probes and by laying open all primary tracts, extensions, and abscesses. All the incisions and dissections were made by electrocautery. The standard procedure was to perform core fistulectomy and traversing the external sphincter until the internal sphincter was exposed the track was then transected. The crypt-bearing tissue around the internal opening of the fistula is excised, if there is difficulty in excising the main tract, the granulation tissue of the remaining tract is scraped with a curette. Advancement flap was constructed in both group.
1. Group I: - The flap comprised mucosa, submucosa and circular muscle fibers. It is raised from the dentate line and mobilized 4-6 cm cephaled and advanced to the new dendentate line (1 cm below the dentate line) and sutured with absorbable sutures (vicryl; ethicone 3/0). Also the defect is closed with absorbable sutures.
2. Group II: - The flap comprised mucosa, submucosa only.
Rectal pack was removed after 24 hours. The patients were allowed to drink freely for 5 days, then normal diet and laxatives. The external fistulectomy wound was dressed daily. Histopatho;ogical examination of all excised fistulous tract was done.
1. Follow up of our patients had been done for about 12 months with clinical assessment of the patients as regard. Incidence of any postoperative complications as bleeding, haematoma, ecchymosis, and disruption. Incidence of any degree of postoperative incontinence according to Cliveland clinic incontinence Score (Rockwood et al., 1999). Recurrence was defined as a discharge or abscess arising in the same area or by obvious evidence of fistulation.
Postoperative assessment of physioanatomical changes in the anal sphincter using anal manometry: 6 months post-operative after wound healing to measure MRP & MSP.
Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment
partial rectal wall advancement flap, mucosal advancement flap
Mansoura University Hospital
Published on BioPortfolio: 2014-07-23T21:11:13-0400
The purpose of this study is to determine whether the Surgisis anal fistula plug is just as effective in healing anal fistulas as compared to the advancement flap procedure.
Comparison of cronally advanced lingual flap to modified periosteal releasing incision (MPRI)
The investigators want to compare two different surgical techniques for the treatment of a condition called velopharyngeal dysfunction (VPD). VPD is a condition in which the nasal part of ...
The purpose of this study is to examine the different outcomes of breast reconstruction in women who are treated for breast cancer with mastectomy and subsequently have delayed breast reco...
Anal fistula is a very common disease with a high impact on life quality. The only commonly accepted treatment option is surgery. A wide range of operations and techniques have been develo...
The anterolateral thigh (ALT) flap plays an essential part in plastic and reconstructive surgery. However, repair of the anterolateral donor site has not been the focus of the clinicians.To assess the...
Lower lip reconstruction requires consideration of esthetic and functional outcome in selecting a surgical procedure, and reconstruction with local tissue is useful. The authors reconstructed full-thi...
Many types of flaps are available if surgical reconstruction of a pressure ulcer is indicated, including a gluteus maximus flap, V-Y advancement flap, and superior gluteal artery perforator flap. Regi...
The "reading man" flap (RMF), a double advancement transposition cutaneous flap named for its appearance, has been described in the reconstruction of various circular skin defects, particularly in the...
Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present...
Endonucleases that remove 5' DNA sequences from a DNA structure called a DNA flap. The DNA flap structure occurs in double-stranded DNA containing a single-stranded break where the 5' portion of the downstream strand is too long and overlaps the 3' end of the upstream strand. Flap endonucleases cleave the downstream strand of the overlap flap structure precisely after the first base-paired nucleotide, creating a ligatable nick.
A surgical procedure to correct MYOPIA by CORNEAL STROMA subtraction. It involves the use of a microkeratome to make a lamellar dissection of the CORNEA creating a flap with intact CORNEAL EPITHELIUM. After the flap is lifted, the underlying midstroma is reshaped with an EXCIMER LASER and the flap is returned to its original position.
A surgical technique to correct REFRACTIVE ERRORS of the EYE, such as MYOPIA and ASTIGMATISM. In this method, a flap of CORNEAL EPITHELIUM is created by exposure of the area to dilute alcohol. The flap is lifted and then replaced after laser ablation of the subepithelial CORNEA.
A consistent pattern of food and drink consumption that contributes to the development and advancement of DENTAL CARIES.
A mass of tissue, including skin and muscle, that has been cut away from surrounding areas for transplantation.
Arthritis Fibromyalgia Gout Lupus Rheumatic Rheumatology is the medical specialty concerned with the diagnosis and management of disease involving joints, tendons, muscles, ligaments and associated structures (Oxford Medical Diction...