OBJECTIVE: To assess and compare the effectiveness of topical 0.2% glycerl trinitrate (GTN) and topical 2% diltiazem (DTZ), in the management of chronic anal fissure. STUDY DESIGN: Comparative, descriptive study. PLACE AND DURATION OF STUDY: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2004 to ...

PURPOSE: The objective of this study is to analyze the clinical outcomes and anorectal manometry (AM) in infants with congenital high anorectal malformations treated with posterior sagittal anorectoplasty (PSARP) and laparoscopically assisted anorectal pull through (LAARP). MATERIALS AND METHODS: From August 2005 to December 2008, 23 patients with congenital high ...

AIM: To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS: The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients (Group ...

OBJECTIVE: The isolated use of Doppler-guided haemorrhoidal artery ligation (DGHAL) may fail for advanced haemorrhoids (HR; grades III and IV). Suture haemorrhoidopexy (SHP) and mucopexy by rectoanal repair (RAR) result in haemorrhoidal lifting and fixation. A prospective evaluation was performed to evaluate the results of DGHAL combined with adjunctive procedures. ...

BACKGROUND/AIMS: Preoperative radiotherapy and/or chemotherapy have been reported as effective treatment for locally advanced low rectal carcinoma. However, recent follow-up studies represented severe postoperative evacuatory disorder, which annoys patients' quality of life. METHODOLOGY: The present study was a part of a randomized trial protocol comparing between intraoperative radiotherapy with pelvic ...

BACKGROUND: The aim of this study was to compare the effect of topical glycerol trinitrate ointment (GTN) with topical diltiazem hydrochloride ointment (DTZ) in the treatment of chronic anal fissure. METHOD: Prospectively, 102 patients were treated randomly with either GTN ointment (0.2%) or DTZ ointment (2%) a couple of times ...

AIM: To compare surgical and chemical sphincterotomy for treatment of chronic anal fissure. METHODS: The 160 patients studied were randomly divided into four equal groups, treated by lateral internal sphincterotomy (group S), local diltiazem ointment (group D), local glyceryl trinitrate ointment (group GTN), or injection of botulinum toxin into the ...

Postpartum hemorrhage (PPH) is the principal cause of maternal death. Blood loss during delivery is often underestimated. The aim of this study was to evaluate the validity of using an underbuttocks collection pouch in the diagnosis of PPH. The study included a prospective series of 122 patients, over a period ...

OBJECTIVES: Gut-directed hypnotherapy (HT) has recently been shown to be highly effective in treating children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). This study was conducted to determine the extent to which this treatment success is because of an improvement in rectal sensitivity. METHODS: A total of ...

PURPOSE: The aim of this study was to determine whether overactivity of the anal sphincter in patients with hemorhhoids is primary or secondary and thus assess indication of lateral internal sphincterotomy to surgical treatment of hemorrhoids. Tonic contraction of the sphincter muscle in patients with advanced stages of hemorrhoids is ...

BACKGROUND: The risk of developing cancer in the ileal pouch of patients with surgery for ulcerative colitis has not been defined. Dysplasia in the pouch is quite rare. Although some suggest pouch surveillance based on previous histological assessments, there are no guidelines for surveillance of these patients. The aim of ...

OBJECTIVE: To evaluate the outcomes of three surgical techniques for the closure of urethrocutaneous fistula (UCF) after hypospadias repair. MATERIALS AND METHODS: Fifty-one patients (mean age 6.5 years) who underwent UCF closure between June 1998 and February 2008 were divided in to three groups depending on fistula size; group I ...

Chemical sphincterotomy, the use of pharmacological agents to reduce anal sphincter resting pressure, has become more and more popular in the treatment of chronic anal fissures (CAFs). It offers the possibility to avoid a lateral internal sphincterotomy and its associated risk of incontinence. In our hospital, patient with a chronic ...

AIM: To analyze our experience in the treatment of anorectal malformations (ARM) with the posterior sagittal anorectoplasty (PSARP), and our modifications through the last few years and the outcomes. MATERIALS AND METHODS: We reviewed 107 cases divided into two groups: Former (F: 1994-2003) and Recent (R: 2004-2008). Type of ARM, ...

BACKGROUND: Acute pouchitis, an idiopathic inflammatory condition of the ileal pouch anal anastomosis, is the most frequent complication after proctocolectomy for ulcerative colitis. AIM: To test the hypothesis that sulfasalazine (SASP) might have a synergistic beneficial effect in acute pouchitis, by combining the anti-inflammatory activity of 5-aminosalicylic Acid and the ...

PURPOSE: Horseshoe fistulae are challenging due to configuration and sphincter involvement. In view of the new treatment options for fistulae (e.g. collagen plug), aim of our study was to review the outcome of patients primarily treated with a traditional approach. METHODS: We retrospectively reviewed patients who presented between 2003 and ...

BACKGROUND: The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA). METHODS: Patients undergoing a primary IPAA (1983-2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional ...

BACKGROUND AND AIM: Botox injection treatment (BIT) is a potentially effective but yet unproven treatment of functional anal outlet obstruction that is caused by non-relaxing internal anal sphincter. We present a single institution experience of BIT from 2005 to 2008. PATIENTS AND METHODS: Sixteen patients (11 males), eight with Hirschsprung's ...

Because 401(k) balances can fluctuate with market returns from year to year, meaningful analysis of 401(k) plans must examine how participants' accounts have performed over the long term. Looking at consistent participants in the EBRI/ICI 401(k) database over the five-year period from 2003 to 2008 (which included one of the ...

OBJECTIVE: To compare the symptomatic relief, healing and side-effects of topical diltiazem (DTZ) and glyceryl trinitrate in the treatment of chronic anal fissure. STUDY DESIGN: Randomized controlled trial. PLACE AND DURATION OF STUDY: The Surgical Outpatient Department of Civil Hospital, Karachi, from March 2006 to February 2007. METHODOLOGY: Patients with ...

PURPOSE: This prospective study was designed to assess the efficacy and safety of a novel technique in treating outlet obstruction syndrome using a transanal double-stapling procedure. METHODS: Two hundred thirty patients (187 female) with obstructed defecation underwent stapled transanal rectal resection over a six-year period with follow-up at 2, 6, ...

CONTEXT: Management of complex anal fistulas is associated with the risk of sphincter injury and fecal incontinence. In recent years, fibrin glue has emerged as an alternative sphincter-preserving treatment for anal fistulas. To date, however, there is no consensus about the efficacy of the method. OBJECTIVE: To specifically evaluate the ...

PURPOSE: Deterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined. We conducted a prospective study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients. METHODS: There were 26 patients in ...

OBJECTIVES:Anti-tumor necrosis factor (TNF) therapy heals Crohn's fistulas clinically, but the rate, extent, and duration to achieve fistula track healing are unknown.METHODS:We sought to monitor deep healing, as indicated by magnetic resonance imaging (MRI), and to use this to determine treatment duration. Clinical and MRI fistula healing (at 6, 12, ...

BACKGROUND: Complex anal fistulas are unsuitable for fistulotomy because of the risk of fecal incontinence. The anal fistula plug (AFP) has demonstrated fistula healing without sphincter division. This study aims to evaluate the cost-effectiveness of the AFP compared to the endoanal advancement flap (EAAF) as an alternative sphincter-preserving option for ...

OBJECTIVE: To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's open haemorrhoidectomy. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Surgical Unit 1, Ward-3, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, from March to September 2006. METHODOLOGY: Sixty patients of late 2nd, 3rd and 4th ...

OBJECTIVE: The authors describe an experience with a newly developed technique for the treatment of Hirschsprung's disease (HD)-transanal Swenson pull-through operation (TSPT). METHODS: The records of 27 children (15 males and 12 females) with HD proven on the basis of rectal biopsy or barium enema who underwent primary TSPT between ...

OBJECTIVE: The conventional treatment of Hirschsprung's disease involves colostomy creation, excision of aganglionic segment, pullthrough using normally ganglionated proximal bowel segment and colostomy closure. The ultrashort segment variety is treated with posterior anorectal myectomy which requires no prior colostomy creation. This study sought to evaluate the benefits and outcomes of ...

OBJECTIVE: Repair of high perianal fistulas presents a major surgical challenge. Transanal advancement flap repair (TAFR) provides a useful tool in the treatment of these fistulas. Initially promising results have been reported. More recent studies indicate that TAFR fails in one out of three patients. The aim of the present ...

BACKGROUND: The aim of this study was to compare the effect of topical glycerol trinitrate ointment (GTN) with topical diltiazem hydrochloride ointment (DTZ) in the treatment of chronic anal fissure. METHOD: Prospectively, 102 patients were treated randomly with either GTN ointment (0.2%) or DTZ ointment (2%) couple of times daily ...

We sought to determine whether changes exist in location and movement of pelvic floor structures at 1 and 7 months postpartum. Midsagittal magnetic resonance images from 13 primiparous women with birth events associated with levator ani damage at early ( approximately 1 month) and late ( approximately 7 months) postpartum ...

PURPOSE: We analyzed a new urethra preserving approach, double-cross flap protection, during tubularized incised plate urethroplasty. We compared the results of 57 patients treated with this new procedure and 80 patients treated with 2 different techniques. MATERIALS AND METHODS: We studied 137 patients with hypospadias between October 2002 and March ...

INTRODUCTION: In a previous uncontrolled study, a reduction of rectal distensibility and volume thresholds for sensations have been related to the occurrence of fecal urgency and/or increased stool frequency after stapled hemorrhoidopexy. AIM OF THE STUDY: The aim of this study was to compare rectal symptoms and sensory-motor function after ...

PURPOSE: Widely differing surgical methods have been propagated to correct symptomatic rectocele. With transvaginal rectal repair (TVRR), we evaluate a method to reestablish the continuity of the rectal muscle wall, strengthen the weakened tunica muscularis, and restore normal rectal capacity and function. METHODS: Between 1997 and 2003, 102 female patients ...

PURPOSE: Continent ileostomy is considered an alternative for patients with a failed ileal pouch-anal anastomosis. The aim of this study is to investigate outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis at our institution. METHODS: Patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis were ...

Background. A 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria. The patient had undergone a staged total proctocolectomy with ileal-pouch-anal anastomosis and a loop ileostomy 8 months previously to treat her steroid-refractory ulcerative ...

The two main factors leading to a functional fistula are maturity and accessibility. The aim of this review was to describe a technique of superficialization for inaccessible brachiocephalic fistulas, and to identify the patients that benefit from superficialization. One hundred and thirty-two brachiocephalic arteriovenous fistulas developed from November 2003 to ...

The purpose of the study was to analyse the outcomes of all patients requiring a reoperation after an initial circular stapled haemorrhoidopexy (SH) for prolapsing haemorrhoids. Data of all patients undergoing a circular SH from 1998 thru 2007 available in a prospectively collected database were reviewed, and all patients who ...

Pouchitis is believed to occur as a reaction to dysbiosis. In this study we assessed differences between mucosal bacterial communities cultured from noninflamed and inflamed ileal pouches. Thirty-two ileal pouch patients, 22 with ulcerative colitis (UC) and 10 with familial adenomatous polyposis (FAP), underwent symptomatic, endoscopic, and histological assessment. The ...

OBJECTIVE: Subcutaneous lateral internal sphincterotomy (SLIS) is an effective treatment for fissure in ano but carries a definite risk of incontinence. The aim of this study was to assess the efficacy and complications of SLIS in patients with chronic fissure in ano. MATERIALS AND METHODS: All patients presenting with a ...

Complex anal fistulas (CFs) are difficult to treat. Endoanal advancement flap (EAF) is one of the standard treatment options for such clinical conditions. Immediate sphincter repair after fistulectomy (ISR) is not commonly performed because of the fear of causing postoperative incontinence. The objective of this study was to compare the ...

BACKGROUND/AIMS: The aim of the present article was to compare stapled haemorrhoidectomy, and haemorrhoidal artery ligation with open haemorrhoidectomy with respect to the postoperative pain, symptom control, and manometric alterations. METHODOLOGY: Forty five patients with third or fourth-degree haemorrhoids were randomly classified into three groups; first group managed by stapled ...

BACKGROUND/AIM: Stapled hemorrhoidopexy for prolapsing hemorrhoids is conceptually different from excision hemorrhoidectomy. It does not accompany the pain that usually occurs after resection of the sensitive anoderm. This study was carried out to evaluate the clinical outcome of stapled hemorrhoidopexy at The Aga Khan University Hospital. MATERIALS AND METHODS: A ...

BACKGROUND: To clarify the neurologic function with respect to puborectalis muscle (PM) in patients after low anterior resection (LAR) for low rectal cancer, author examined the sacral nerve terminal motor latency (SNTML) of the PM. METHODS: The latency of the response in the PM following transcutaneous magnetic stimulation of the ...

BACKGROUND: Outcomes remain controversial for patients undergoing straight (SIAA) vs J pouch (JPAA) ileoanal anastomosis, particularly in children where fewer such cases are performed. Our 3 centers have had extensive experience with both techniques. Thus, we had the unique opportunity to compare outcomes within the same centers. METHODS: We retrospectively ...

The aim of this study was to retrospectively evaluate the outcome of stapled, functional, end-to-end anastomosis (FEEA) for the reconstruction of right hemicolectomy. We enrolled 204 patients who underwent a right hemicolectomy for colon carcinomas or adenomas by open surgery. One hundred two patients received an FEEA, and 102 patients ...

PURPOSE: Stapled transanal rectal resection is advocated for the treatment of obstructed defecation syndrome. Supporting evidence for its safety and effectiveness has been lacking. To address this, the European Stapled Transanal Rectal Resection Registry was initiated in January 2006. This study was designed to analyze 12-month postoperative outcomes of this ...

OBJECTIVES: To determine the efficacy and safety of 'healer' cream as monotherapy in the treatment of acute and chronic anal fissure. STUDY DESIGN: A prospective, randomized, single blinded, comparative trial. METHODS: Sixty patients suffering from anal fissure were included in the study. Patients were randomly divided into three groups: group ...

OBJECTIVE: The aim of this study was to determine the efficacy of the anal fistula plug in the treatment of high fistula-in-ano. METHOD: Twenty-three patients with high cryptoglandular fistula-in-ano were prospectively studied over 1 year. The number of tracks, number of previous procedures and co-morbid conditions that could potentially affect ...

BACKGROUND: The aim of this study was to evaluate the necessity of preventive colostomy for Fournier's gangrene of the anorectal region. METHODS: The medical records of 37 patients with perianal Fournier's gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was ...