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   2021| September-December  | Volume 4 | Issue 3  
    Online since May 24, 2022

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A prospective, noncomparative, study to evaluate the efficacy and safety of sphincter saving distal laser proximal ligation surgery in complex fistula-in-ano
Ashwin Porwal, Paresh Gandhi, Deepak Kulkarni
September-December 2021, 4(3):61-67
Background: Distal laser proximal ligation technique (DLPL) is a minimally invasive sphincter-saving surgery which addresses the inter sphincteric space, which is the root cause of complex fistula. Objective: To evaluate efficacy and safety outcomes of new technique. Design: A prospective, noncomparative. Settings: A single-center study. Patients: Complex fistula-in-ano cases were included. Patients with uncomplicated fistula, inflammatory bowel disease, Chronic immunosuppressive treatment, and cancer were excluded. Interventions: Laser debridement of fistula tract by use of Radial Fiber with 1470 nm Diode laser at a power of 10W and proximal Ligation technique. Outcome Measures: Data were collected prospectively on effectiveness (disease severity, ODSscore, hospitalization, time to resume routine), safety (morbidity, adverse outcomes), Wexner incontinence score and quality of life score before surgery and after surgery at week 6, at 6 months and 12 months physically and thereafter telephonically for 2 years. Outcomes other than overall complete healing were considered as failure. Results: 683 patients underwent DLPL, predominantly male with a median age of 41.06 years (range, 11-86y). The overall success rate was 98.98%with a minimum long term follow-up period of 30 months. Complete healing time was average 10 weeks for most of the cases. No case reported permanent(major or minor) anal incontinence.The difference between quality of lifescore wasstatistically highly significant (p<0.001). Limitations: Single-institution and noncomparative data. Conclusion: DLPL is a minimally invasive, sphincter saving surgery for complex fistula.
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Pilonidal sinus extended to create transsphincteric anal fistula treated by Kshara Sutra (A medicated herbal seton) without antibiotics: A rare case report
Prasad Bapat, Vaidehi Bapat, Deepak Sadashiv Phalgune
September-December 2021, 4(3):73-75
Multiple treatments have been described for fistula-in-ano; however, the ideal treatment remains elusive. The treatment of fistula-in-ano is a tightrope walk between preserving continence and preventing recurrence. A 70-year-old male patient from Mumbai (India) was suffering pilonidal sinus along with fistula-in-ano for 3 years. Kshar Sutra thread was used for the treatment. No internal medication was given for wound healing or infection control. There were no complications, such as infection, severe pain, or severe bleeding, and incontinence after the procedure. The patient was completed cured and is disease free for the last 5 years. Kshar Sutra is an effective treatment without any complications with complete healing.
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PNR-bleed classification and the prospects of future research for the management of hemorrhoids
Mudassir Ahmad Khan, Zubair Afzal Khan, Fazl Q Parray, Mir Fahiem ul Hassan, Asif Mehraj, Arshad Ahmed Baba, Rauf Ahmad Wani, Nisar A Chowdri
September-December 2021, 4(3):68-72
The classification and diagnostic and therapeutic protocols are yet to reach to an unequivocal and shared vision level. There is a dire need of some decisive guidelines for the management of hemorrhoids, but these new guidelines could not have any significant clinical impact unless they are based on a sound classification system. To overcome the drawbacks of previous classifications and to set the stage for further research for devising some robust guidelines for the management of hemorrhoids, our recently published classification system for hemorrhoids, viz., “PNR-Bleed Classification for hemorrhoids,” describes the hemorrhoidal disease more vividly. In the present article, we have discussed the possible directions for future research for the management of hemorrhoids based on this classification. The future studies may redefine the treatment options for hemorrhoids more clearly based on this classification. Initial theoretical and intuitive assessment of the “PNR-Bleed Classification” suggests that future studies on this project may have profound clinical and research consequences. Moreover, these future studies may help in revising and rediscovering the protocols for the management of hemorrhoidal disease. For regular follow-up of the hemorrhoidal patients, the “PNR-Bleed Classification”-based hemorrhoid severity score may prove a useful outpatient department-based assessment tool to the general surgeons and coloproctologist.
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Minimally Invasive Proctology: Myths and Realities
Niranjan Agarwal
September-December 2021, 4(3):59-60
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A rare case of appendicular intussusception in an adult due to adenocarcinoma of appendix
Chitrawati Bal Gargade, Archana Hemant Deshpande
September-December 2021, 4(3):76-78
Intussusception is primarily a pediatric disorder and is infrequent in adults. Intussusception of the appendix is a rare disorder with much surgical curiosity. Here we present a rare case of adenocarcinoma of appendix that presented as appendiculocaecal Intussusception. This case is presented to address the importance of understanding clinical presentation, radiological findings, treatment modalities and histopathological examination in evaluating a case of appendicular intussusception in adult.
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Solitary mass of the male pelvis
Raunaq Chhabra, Seena George, Marzi Mehta, Paresh Jain
September-December 2021, 4(3):79-81
Solitary fibrous tumor (STF) initially described as a tumor of the pleura has now been recognized at multiple anatomical sites. Pelvic STFs consist about 6% of all STFs. We present the case of a man with a long standing pelvic STF. He had symptoms of increased frequency of loose stools with passage of mucus since 2 years. A laparotomy and excision of the mass was done, but the patient developed complications and was re-explored on postoperative day 4 which showed a small rent in the anterior rectal wall mucosa. A colostomy was done after which the patient had a steady recovery. These lesions can be tricky to deal with due to their vascular nature and size. With no defined management protocol, the treatment must be tailor made and be more cautious especially when the pathology is long standing, causing pressure symptoms.
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