ABSTRACT
Purpose@#This study aimed to evaluate long-term outcomes after anal fistula surgery from university hospitals in Thailand. @*Methods@#A prospectively collected database of patients with cryptoglandular anal fistula undergoing surgery from 2011 to 2017 in 2 university hospitals was reviewed. Outcomes were treatment failure (persistent or recurrent fistula), fecal continence status, and chronic postsurgical pain. @*Results@#This study included 247 patients; 178 (72.1%) with new anal fistula and 69 (27.9%) with recurrent fistula. One hundred twenty-one patients (49.0%) had complex fistula; 53 semi-horseshoe (21.5%), 41 high transsphincteric (16.6%), 24 horseshoe (9.7%), and 3 suprasphincteric (1.2%). Ligation of intersphincteric fistula tract (LIFT) was the most common operation performed (n=88, 35.6%) followed by fistulotomy (n=79, 32.0%). With a median follow-up of 23 months (interquartile range, 12–45 months), there were 18 persistent fistulas (7.3%) and 33 recurrent fistulae (13.4%)—accounting for 20.6% overall failure. All recurrence occurred within 24 months postoperatively. Complex fistula was the only significant predictor for recurrent fistula with a hazard ratio of 4.81 (95% confidence interval, 1.82–12.71). There was no significant difference in healing rates of complex fistulas among seton staged fistulotomy (85.0%), endorectal advancement flap (72.7%), and LIFT (65.9%) (P=0.239). Four patients (1.6%) experienced chronic postsurgical pain. Seventeen patients (6.9%) reported worse fecal continence. @*Conclusion@#Overall failure for anal fistula surgery was 20.6%. Complex fistula was the only predictor for recurrent fistula. At least 2-year period of follow-up is suggested for detecting recurrent diseases and assessing patient-reported outcomes such as chronic pain and continence status.
ABSTRACT
Background and Objective: Primary hyperparathyroidism is now being diagnosed with increasing frequency. Simultaneously there has been an apparent change in the presentation of the disease and indication for surgery. The aim of this study was to examine the clinical presentation and pathology of parathyroid glands for primary hyperparathyroidism.Methods : This retrospective descriptive study was carried out over 14 years, from 1994 to 2008, at Srinagarind Hospital, Faculty of Medicine, KhonKaen University. Information on the clinical presentation, parathyroid hormone level, serum calcium level and pathological report of parathyroid glands was obtained from retrospective parathyroid surgical database.Results: Out of 40 patients diagnosed with primary hyperparathyroidism at Srinagarind Hospital, there were 27 female, mean age 47.22(13 – 73) years and 13 male patients. Bone fracture was the most common clinical presentation found in 19 patients, the second was renal calculi found in 11 patients, one patient was presented with bone fracture and renal calculi and 8 patients were presenteded with non-specific symptoms. Pathological reports were adenoma in 39 glands of 39 patients and hyperplasia 4 glands in one patient. Mean serum parathyroid hormone level 481.69 pg/ml (79 - 1361.7 pg/ml)and mean serum calcium level was 12.66 md/dl (9.5-16.5 mg/dl)calcium was 12.66 mg/dl (9.5 – 16.5 mg/dl) and levelConclusion: This study shows that severe bone disease with fractures are the most common presentation of primary hyperparathyroidism. The second is renal calculi. The most common pathological report was adenoma.Keywords: Primary hyperparathyroidism; clinical spectrum, pathology