PMID- 36991427
OWN - NLM
STAT- MEDLINE
DCOM- 20230830
LR  - 20230830
IS  - 1471-2482 (Electronic)
IS  - 1471-2482 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Mar 29
TI  - The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula 
      Tract (LIFT) procedure in management of Fistula in ano a prospective 
      observational study.
PG  - 70
LID - 10.1186/s12893-023-01969-w [doi]
LID - 70
AB  - BACKGROUND: Fistula in ano is always a troublesome condition for the clinician 
      and the patients owing to its complexity, recurrences, and high morbidity since 
      ancient times. There is no gold standard treatment modality to date documented in 
      the literature for complex fistula in ano. MATERIAL AND METHODS: We enrolled 60 
      consecutive adult patients attending the surgical outpatient department of a 
      tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 
      20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy 
      andKsharsutra(Special medicated seton) group were respectively recruited 
      randomly. A prospective observational study was conducted. The primary outcomes 
      were postoperative recurrence and morbidity. Post-operative morbidity is measured 
      in terms of postoperative pain, postoperative bleeding, pus discharge and 
      post-operative incontinence. The result of the study were analysed after 6 months 
      of follow-up by clinical examination at outpatient department and at 18 months 
      follow up done telephonically. RESULTS: At 6 months of follow-up, 2 patients 
      (10%) had a recurrence in the Ligation of intersphincteric fistula tract 
      procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) 
      in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed 
      recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and 
      Ksharsutra group respectively at 18 month of follow-up. The differences in the 
      recurrence were not statistically significant.The mean Visual analogue score for 
      postoperative pain after 24 h as well as after 48 h were statistically 
      significant in Ligation of intersphincteric fistula tract versus Ksharsutra group 
      (p < 0.05). The Visual analogue score for post-operative pain was also 
      significant in the Ligation of the intersphincteric fistula tract versus the 
      Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and 
      Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation 
      of intersphincteric fistula tract procedure. Postoperative morbidity was 
      statistically significant between the Ligation of intersphincteric fistula tract 
      versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus 
      Fistulectomy. CONCLUSION: Ligation of intersphincteric fistula tract had less 
      postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; 
      although recurrence was less compared to other methods it was statistically not 
      significant.
CI  - (c) 2023. The Author(s).
FAU - Hariprasad, Chinniahnapalaya Pandurangaiah
AU  - Hariprasad CP
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Kumar, Anil
AU  - Kumar A
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India. dranilk@aiimspatna.org.
FAU - Kumar, Manoj
AU  - Kumar M
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Kumar, Manoj
AU  - Kumar M
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Paswan, Shiv Shankar
AU  - Paswan SS
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Rohit, Gupta
AU  - Rohit G
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Kishor, Shiv
AU  - Kishor S
AD  - Department of General Surgery, All India Institute of Medical Sciences, Patna, 
      India.
FAU - Kumar, Prem
AU  - Kumar P
AD  - Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, 
      India.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20230329
PL  - England
TA  - BMC Surg
JT  - BMC surgery
JID - 100968567
SB  - IM
MH  - Adult
MH  - Humans
MH  - Anal Canal/surgery
MH  - Fecal Incontinence/etiology
MH  - *Ligation/adverse effects
MH  - Pain, Postoperative/epidemiology/etiology
MH  - *Rectal Fistula/surgery/etiology
MH  - Recurrence
MH  - Treatment Outcome
PMC - PMC10061687
OTO - NOTNLM
OT  - Fistula in Ano
OT  - Fistulectomy
OT  - Ksharsutra
OT  - Ligation of intersphincteric fistula tract
COIS- All authors have nothing to disclose.
EDAT- 2023/03/30 06:00
MHDA- 2023/03/31 06:42
PMCR- 2023/03/29
CRDT- 2023/03/29 23:49
PHST- 2022/12/03 00:00 [received]
PHST- 2023/03/22 00:00 [accepted]
PHST- 2023/03/31 06:42 [medline]
PHST- 2023/03/29 23:49 [entrez]
PHST- 2023/03/30 06:00 [pubmed]
PHST- 2023/03/29 00:00 [pmc-release]
AID - 10.1186/s12893-023-01969-w [pii]
AID - 1969 [pii]
AID - 10.1186/s12893-023-01969-w [doi]
PST - epublish
SO  - BMC Surg. 2023 Mar 29;23(1):70. doi: 10.1186/s12893-023-01969-w.