Surgical Examination Under Anesthesia

Crepsi, Michele; Colombo, Francesco; Foschi, Diego

doi:10.1007/978-88-470-2847-0_10

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…1 Indeed, the prehabilitation studies to date have shown mixed results both in-favor of exercise interventions 2,3 equivocal 4 and others have shown no effect. 5 In our opinion, ''prehabilitation" within the context of cancer surgery, may have several moving parts. These are likely related to the type of cancer, type of prehabilitation (uni, bi, or multimodal), and type of outcomes measured (functional, clinical, or other).…”

Section: Replymentioning

confidence: 99%

Comment on “Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial”

2021

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endpoint. Was this performed in an attempt to demonstrate superiority, noninferiority or equivalence between the 2 arms? Given lack of a homogenous control (surgeon preference) group, what parameters (from previously published data) informed the sample size calculation? 3. MRI has a significant impact on the diagnosis and management of these patients. 2 The eligibility criteria and the need to have an MRI 6 months before randomization are clearly described. Thirteen of patients in the fistula plug arm and 10% in the surgeon preference arm did not have a trans-sphincteric fistula at MRI. MRI results, however, did not appear to affect inclusion in the trial. Was consideration given to exclude patients where the condition was excluded on MRI, as this would be a reasonable reason for post randomization exclusion? 3 4. The authors highlight in their limitation the fact that blinding was not attempted in this trial. They also highlight how this is unlikely to have affected the primary outcome. The chosen primary outcome is, however ''patient reported" and susceptible to bias in an open trial. Nonblinding of patients in the context of patient reported outcomes has been shown to introduce significant bias. 4 Was consideration given to choose an objective primary outcome? 5. The level of experience of the surgeon performing the EUA has been shown to affect sensitivity of such procedures. 5 Are data on experience of the surgeons performing the original diagnostic EUA for the patients included in the study? 6. The author specified how minimization was performed for the preoperatively (pre randomization) planned procedure. It is quite common, however, for the surgeon performing the procedure to change their approach based on EUA findings. Are data on this available and could this have affected outcomes? Overall, the results of this trial indicate that surgisis plug is unlikely to significantly improve outcomes of trans-sphincteric fistula repair in settings where a variety of different treatments are used, but the lack of specific pairwise comparisons preclude conclusions about the superiority of the plug over individual treatments.

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Section: Replymentioning

confidence: 99%

Comment on “Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial”

2021

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“…After performing DRE, additional usage of the metal probe with insertion through fistula canal should be done to identify which type of fistula patient has so one can decide which surgical option should be performed. In case of pain, this can be performed under anesthesia (EUA: examination under anesthesia) [12]. In the case of a simple anal fistula, it is usually sufficient to examine as mentioned above, but in cases of a complex anal fistula in most cases, additional diagnostic methods should be done.…”

Section: Diagnostic Methods For Anal Fistulasmentioning

confidence: 99%

Anal Fistula: Contemporary View of Complex Problem

Karlović¹,

Kršul²,

Jerković³

et al. 2023

Benign Anorectal Disorders - An Update

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Anal fistulas are still a huge challenge for surgeons because of their high incidence, high recurrence rate, prolonged healing time and possible complications such as fecal incontinence. Even though many surgical options have been described, we still do not have the standardized procedure. Patients who suffered from this problem have a low quality of life because of constant anal pain and soiling from anal tracts. Aside from cryptoglandular etiology, fistulas associated with Crohn’s disease are separate entity that requires a multidisciplinary approach. This chapter will be an overview of modern approaches in anal fistula treatment regardless of etiology with special consideration on how to avoid adverse outcomes and to improve patients’ quality of life.

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“…c) anal surgeon, cutting the proctoderma between the internal and external opening of the AF probed, mainly in SAF, may estimate the amount of sphincter system involved in fistula formation and mainly the participation of the external sphincter in fistula formation, thus may decide a fistulotomy or a saving sphincter surgical technique. [24] According to preoperative clinical examination of the anorectal canal, MRI and EUA, patients were classified in two groups: a)patients with SAF were subdivided in two subgroups; those with simple intersphincteric linear fistulas treated by fistulotomy, and those with low intersphincteric fistulas containing an amount of external sphincter less than 30% treated by LIFT or laser therapy , b)patients with CAF were sub grouped in 3 subgroups; a) transphincteric AF with affected sphincter system and route of the fistulous tract in ischio-anal/ischio-rectal fossa, b)suprashincteric AF and c)supralevator AF. All complex fistulas were treated by peripheral fistulectomy and LIFT.…”

Section: Methodsmentioning

confidence: 99%

Chronic Cryptoglandular Anal Fistulas: Surgical Outcomes; A Retrospective Case Control Study In 148 Patients with No Risk Factors for Recurrence

Charalampopoulos¹,

Bagias²,

Papaconstantinou³

et al. 2022

JCRR

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Background: The success rate of surgery for anal fistulas in the literature is variable, ranging between 30-90% due to differences in etiology, risk factors for recurrences and variety of surgical and innovative techniques used in therapy of anal fistulas. Aim: We try to evaluate the surgical outcomes in patients without any known risk factor for recurrence. Materials and Methods: A retrospective study with 148 patients was performed. Fistulas were classified according to: Parks system, the modified Parks’s and the St James’s University Hospital system. MRI, TRUS and EUA were the most useful examinations. The age, duration of symptoms, location of the fistula according to the transvers anal line, the grade of complexity of AF were studied. Only patients with cryptoglandular anal infection were enrolled excluding patients with acute, subacute phase of inflammation and risk factors for recurrence. Operations performed in treatment of AF were registered. Various parameters studied underwent statistical analysis; Student t test and chi-square or Fisher exact test were used for comparisons between continuous and categorical data respectively Results: 148 patients (112 males,36 females, age range 21-74yrs, mean age 44±13, male to female ratio 3.1/1) were studied; 52(52/148, 35%) with simple and 96(96/148, 65%) with complex fistulas. MRI was necessary for classification of anal fistulas and identified the internal opening of fistula in134 patients (134/148, 93%) and in 14 inconclusive cases was identified by TRUS. LIFT was performed in complex fistulas and low intersphinceric fistulas in 102 patients (102/148, 68.6%). Fistulotomy in 41(41/148, 27.7%) with simple linear intersphincteric fistulas and laser therapy in 5(5/148, 3.4%) with simple low intersphincteric fistulas. A successful surgical outcome was achieved in 51 patients with simple (51/52, 98%) and 91(91/96, 94.8%) with complex fistulas.6 recurrences were detected (6/148, 4.05%). Conclusion: Chronic anal fistulas, in selected patients present postoperative healing rates at 98% and 94.8% for simple and complex fistulas respectively and recurrence rate at 4.05%. The most common operations were LIFT and fistulotomy.

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Surgical Examination Under Anesthesia

Cited by 5 publications

References 11 publications

Comment on “Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial”

Comment on “Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial”

Anal Fistula: Contemporary View of Complex Problem

Chronic Cryptoglandular Anal Fistulas: Surgical Outcomes; A Retrospective Case Control Study In 148 Patients with No Risk Factors for Recurrence

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