The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience

PURPOSE: Surgery is the only treatment for anal fistula. Many surgical techniques have been described. The aim of this study was to communicate the authors' preliminary experience in the use of a recently proposed, simplified technique. METHODS: This was a prospective study of 28 patients admitted from January 13, 2016 through July 20, 2017. Patients were managed with the ligation of intersphincteric fistula tract (LIFT) technique and results were observed and documented, including recurrence rate, incontinence rate, and other postoperative complications. RESULTS: A total of 28 patients were studied. The mean operation time was 31 minutes (range, 23–44 minutes), and there were no intra- and postoperative complications. The overall complete healing rate was 85.7%, and the recurrence rate was 14.2%. Follow-up was conducted at 1, 3, and 6 months. CONCLUSION: Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors' experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition.

An empirical study on medical selection of flying cadets with anal diseases between PLAAF and USAF / 军事医学

Objective To analyze the spectrum of anus disease during the medical selection of flying cadets and com-pare the medical standard between US Air Force and Chinese Air Force in order to improve the system of medical selection. Methods The data on flying cadets of Chinese Air Force medical selection from 2012 to 2015 were retrospectively analyzed and these data were re-analyzed by medical standards for US Air Force flying cadets.Results Ninety students were elimi-nated because of anal disease,including 65 hemorrhoids,14 fistula and 11 fissure.The rate of disqualification from 2012 to 2015 was 48.28%, 33.33%, 31.37%, 39.69%and there was no significant statistical difference between each two years (x2 =2.6154,P=0.4548).There was statistically significant difference(P=0<0.05)in hemorrhoids standards between CAF and USAF,and significant difference in fistula and fissure standards.Conclusion Compared with Chinese medical se-lection standards,the US Air Force standards focus on whether the symptoms of disease have effect on air safety and effi-ciency.To improve our medical selection standards,we need to learn from foreign air forces and take our own conditions into account.

Healthcare Spending and Performance of Specialty Hospitals: Nationwide Evidence from Colorectal-Anal Specialty Hospitals in South Korea

PURPOSE: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. MATERIALS AND METHODS: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. RESULTS: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. CONCLUSION: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.

Treatment on postoperative pain of anal disease by ear-point taping and pressuring：118 cases clinical observation / 国际中医中药杂志

Objective To observe the efficacy and safety of the treatment on postoperative pain of anal disease by ear-point taping and pressuring. Methods Using random number table method,118 patients with postoperative pain of anal diseases were divided into 5 groups, namely 26 cases of analgesia group treated by main ear-point, 20 cases of group one treated by analgesia compatibility ear-point, 22 cases of group two treated by analgesia compatibility ear-point, 27 patients of group three treated by analgesia compatibility ear-point, and 23 patients of control group. The main ear-point for analgesia included TF(4) and the sensitive point matching with diseased area;Based on the main ear-point, compatibility ear-point group one add to AT(4)、CO(18)、AH(6a);compatibility ear-point group two add to CO(7)、HX(2)、HX(5);compatibility ear-point group three add to AH(6a)、AT(4)、HX(5);and the control group was treated with oral indomethacin tablets. All five groups were treated for 30 min, and the clinical analgesic efficacy and safety were evaluated. Results Pain scores decreased rates of the main ear-point analgesia group, compatibility ear-point analgesia group one, compatibility ear-point analgesia group two, compatibility ear-point analgesia group three, and the control analgesia group at 10 min after treatment was (6.49±1.98)%, (5.90±1.52)%, (6.10±2.22)%, (6.64±2.25)%, and (7.61± 1.10)%respectively. Compared with the control group , the main ear-point analgesia group or the compatibility ear-point analgesia group one or the compatibility ear-point analgesia group two, the difference was significant (P0.05). Conclusion The effects of 10 min treatment of ear-point taping and pressuring treating postoperative pain of anal disease was significantly better than the control group,however the 30 min treatment did not show significant difference.

Clinical efficacy of ligation of intersphincteric fistula tract for the treatment of high anal fistula / 中华消化外科杂志

Objective To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) for the treatment of high anal fistula.Methods The clinical data of 77 patients with high anal fistula who were admitted to the Puren Hospital and Chaoyang Hospital from January 2011 to June 2012 were retrospectively analyzed.All the patients were treated using the LIFT method (LIFT group,37 patients) or fistulectomy + threaddrawing therapy (thread-drawing group,40 patients).The operation time,healing time,time and severity of postoperative pain,recurrence and anal sphincter dysfunction were compared between the 2 groups.The measurement data,the count data and the rank data were analyzed using the t test,chi-square test,and the rank sum test,respectively.Results The operation time of the LIFT group and the thread-drawing group were (21.4 ± 2.0) minutes and (20.6 ± 1.9) minutes,with no significant difference between the 2 groups (t =1.911,P ＞ 0.05).In the LIFT group,17 patients felt low-grade pain,no patient felt medium-grade or severe pain.In the thread-drawing group,7 patients felt low-grade pain,14 patients felt medium-grade pain,19 patients felt severe pain.The duration of postoperative pain in the LIFT group and the thread-drawing group were (3.0 ± 1.3) days and (14.1 ± 1.5)days,respectively.The severity and duration of postoperative pain of the LIFT group were significant lower and shorter than those of the thread-drawing group (u =-7.189,t =34.534,P ＜ 0.05).The healing time,anal scar area and anal sphincter function score were (26.0 ± 1.9) days,(1.24 ± 0.20) cm2 and 1 in the LIFT group,and (40.7 ± 2.8) days,(2.64 ± 0.25) cm2 and 4 in the thread-drawing group,with no significant difference between the 2 groups (t =26.574,26.868,Z =-7.513,P ＜ 0.05).The effective rate of the 2 treatment methods were 100％.The cure rate and recurrence rate were 51.4％ (19/37) and 5.4％ (2/37) in the LIFT group,and 42.5％ (17/40) and 2.5％ (1/40) in the thread-drawing group.There were no significant differences in the cure rate and recurrence rate between the 2 groups (x2=0.605,0.433,P ＞ 0.05).Conclusion LIFF method has higher cure rate for high anal fistula with short time of postoperative pain and healing,good anal sphincter function and low recurrence rate.

Anal Diseases from Ingested Foreign Bodies

PURPOSE: Anal problems due to ingested foreign bodies are rare and usually present as acute anal pain. However, various clinical presentations are possible. This study was performed to identify the diverse manifestations of and the outcomes of treatments for anal diseases caused by ingested foreign bodies. METHODS: Between September 1995 and June 2003, seven patients were treated for anal diseases due to the impaction of ingested foreign bodies in Seoul National University Hospital and Daehang Hospital. We retrospectively reviewed the medical records of those unusual patients. RESULTS: All patients were males, and their mean age was 49.4 yr (range, 37 to 74 yr). The detected foreign bodies were fish bones (n=3), fish fins (n=2), a chicken bone (n=1), and a toothpick (n=1). Four patients had acute anal pain as the primary symptom while two patients presented anal pus discharge, and one patient presented anal bleeding. In the four patients with acute anal pain, the foreign bodies were easily found on digital rectal examination and inspection with anoscopy. Those patients underwent simple removal of the foreign body at the outpatient clinic. In three patients, the foreign bodies were found during surgery for hemorrhoids or fistulas. The two fistulas detected were complex types and needed seton placement. CONCLUSION: Anal problems caused by ingested foreign bodies usually involve acute anal pain, but our results indicate that, in some cases, the anal foreign bodies are also the cause or an aggravating factor in chronic anal disease.

Anal Diseases among Patients with Leukemia

PURPOSE: Anal diseases are a common complication among patients with leukemia, and the perianal abscess may prove to be the most fatal among anal diseases. We report here the prevalence, the treatment methods, and the prognosis for anal diseases among patients with leukemia. METHODS: Among the 310 patients who were diagnosed with and treated for leukemia between October 1999 and September 2000, we investigated the medical records of 53 patients with complications due to anal diseases. RESULTS: Among the 310 patients with leukemia, 53 (17.1%) reported anal diseases. There were 30 patients with hemorrhoids, 15 patients with a perianal abscess, 3 patients with an anal fistula, 3 patients with a fissure and 2 patients with hemorrhoids and fistulas. Anal pain was the most common complaint. Conservative treatment improved the symptoms in 42 patients (79.2%) while surgery was necessary in the remaining 11 patients (20.8%). A hemorrhoidectomy was undertaken in 4 patients, a drainage procedure in 4 paients, and a fistulotomy in 3 patients. Throughout the study period, 6 patients died (11.3%), 3 of them with perianal abscesses. Among the 15 patients with a perianal abscess, 13 showed fever (87%), and 9 patients underwent drainage (4 surgical drainages and 5 natural drainages). E. coli was the most commonly cultured organism. CONCLUSIONS: The incidence of anal diseases in patients with leukemia was high. Nonsurgical methods were sufficient for hemorrhoids and fistulas. For a perianal abscess, drainage should be undertaken when abscess formation is evident. When abscess formation is not evident, medical treatment is the primary modality, and surgery should be considered only when medical treatment fails to improve or worsens the patient's condition, but the prognosis is poor.

Benign Anal Diseases on Patients with HIV Disease

PURPOSE: The number of patients with HIV disease has been increasing rapidly, with anorectal discomfort being the most common complaint of these patients. However, there are no data on HIV disease relating to the benign anorectal area in Koreans. METHODS: A retrospective chart review was performed on patients diagnosed with benign anal diseases, combined with HIV disease, between 1996 and 2001. Their clinical aspects were compared with HIV patients registered with the National Institute of Health in Korea between 1985 and 2001. RESULTS: A total of 1,613 patients were registered, with the National Institute of Health in Korea, as having HIV disease. The ratio of sex was 7.2:1, with a male predominance. The disease was most common in the 3rd & 4th decades, with 64.2%, of the patients in this age range. As for the routes of transmission, sexual contact was the most common (96.9%), followed by blood transfusion (including blood products) (2.8%), vertical transmission (0.1%) and drug injection (0.1%). With regard to the sexual contact routes, homosexuality accounted for 28.0%. Of the cases of HIV disease presenting with a benign anal disease, 32 patients, with a sex ratio of 31:1, with an overwhelming male predominance, were selected. Twenty-six cases had been newly diagnosed at our hospital. As for the routes of the transmission, the disease had been transmitted by sexual contact in all cases. In 43.8% of these cases, the disease had been transmitted by homosexual contact, which showed a marked difference to that of the National database (P<0.05). For those associated with an anal diseases, there were 10 cases of anal fistula, 9 of perianal abscess, 7 of condyloma acuminata, 7 of anal fissure, 5 of hemorrhoids and 2 of ulceration on the lower rectum, noted. CONCLUSIONS: Nowadays, the numbers of anorectal-disease patients with HIV are increasing in Korea. Since HIV is common in the area of benign proctology, all proctologists must consider the possibility of HIV when managing patients.

Anal Manometric Assessment of Patients with Anal Diseases and Defecation Disorders

A manometric assessment of anal pressure is known to be an objective method in evaluating anorectal physiology and the function of the anal sphincter. We employed anal menometry to study the anal pressure in patients with hemorrhoids, anal fistulas, anal fissures, constipation, and fecal incontinence. This study was performed in the period from April 1994 to May 1996. The total number of patients with defecation disorder or anal disease assessed in this period at our rectal clinic by using anal manometry was 227; A control group was comprised of 10 patients with no known anal diseases or symptoms. The patient group was catergorized as follows:123 cases of hemorrhoids, 24 cases of anal fistulas, 35 cases of anal fissures, 29 cases of constipation, and 16 cases of fecal incontinence. We measured the maximal anal resting pressure (MARP) and the maximal anal squeeze pressure (MASP) in these patients as well as in the control group. We found the MARP to be higher in patients with hemorrhoids, anal fistulas, and anal fissures, compared to the control group, while the MARP was lower in the constipation group; however, these results were not statistically significant. The anal pressures of hemorrhoid patients were studied with respect to symptom, classification, past history, and the duration of symptoms. The results were as follows:The MARP was found to be increased in hemorrhoid patients with prolapse and pain and for thrombosed external hemorrhoids while it was decreased in patients with a previous hemorrhoidectomy. Furthermore, the MARP was increased in anal fissure patients when the duration of the symptom was short. In conclusion, anal manometric assessment of patients with anal diseases or defecation disorders could be valuable in determining the surgical procedure; furthermore, it could be valuable in evaluating postoperative results in fecal incontinence patients.