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Reza L, Gottgens K, Kleijnen J, Breukink S, Ambe PC, Aigner F, Aytac E, Bislenghi G, Nordholm-Carstensen A, Elfeki H, Gallo G, Grossi U, Gulcu B, Iqbal N, Jimenez-Rodriguez R, Leventoglu S, Lisi G, Litta F, Lung P, Millan M, Ozturk E, Sackitey C, Shalaby M, Stijns J, Tozer P, Zimmerman D. European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula. Colorectal Dis 2024; 26:145-196. [PMID: 38050857 DOI: 10.1111/codi.16741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 12/07/2023]
Abstract
AIM The primary aim of the European Society of Coloproctology (ESCP) Guideline Development Group (GDG) was to produce high-quality, evidence-based guidelines for the management of cryptoglandular anal fistula with input from a multidisciplinary group and using transparent, reproducible methodology. METHODS Previously published methodology in guideline development by the ESCP has been replicated in this project. The guideline development process followed the requirements of the AGREE-S tool kit. Six phases can be identified in the methodology. Phase one sets the scope of the guideline, which addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care. The target population for this guideline are healthcare practitioners in secondary care and patients interested in understanding the clinical evidence available for various surgical interventions for anal fistula. Phase two involved formulation of the GDG. The GDG consisted of 21 coloproctologists, three research fellows, a radiologist and a methodologist. Stakeholders were chosen for their clinical and academic involvement in the management of anal fistula as well as being representative of the geographical variation among the ESCP membership. Five patients were recruited from patient groups to review the draft guideline. These patients attended two virtual meetings to discuss the evidence and suggest amendments. In phase three, patient/population, intervention, comparison and outcomes questions were formulated by the GDG. The GDG ratified 250 questions and chose 45 for inclusion in the guideline. In phase four, critical and important outcomes were confirmed for inclusion. Important outcomes were pain and wound healing. Critical outcomes were fistula healing, fistula recurrence and incontinence. These outcomes formed part of the inclusion criteria for the literature search. In phase five, a literature search was performed of MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews by eight teams of the GDG. Data were extracted and submitted for review by the GDG in a draft guideline. The most recent systematic reviews were prioritized for inclusion. Studies published since the most recent systematic review were included in our analysis by conducting a new meta-analysis using Review manager. In phase six, recommendations were formulated, using grading of recommendations, assessment, development, and evaluations, in three virtual meetings of the GDG. RESULTS In seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations. CONCLUSION This is an up-to-date international guideline on the management of cryptoglandular anal fistula using methodology prescribed by the AGREE enterprise.
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Affiliation(s)
| | | | - Jos Kleijnen
- KSR Ltd & Maastricht University Medical Center (MUMC+) -CAPHRI, Maastricht, Netherlands
| | | | | | | | | | | | | | | | | | - Ugo Grossi
- Treviso Regional Hospital, Treviso, Italy
| | | | | | | | | | | | | | | | - Monica Millan
- La Fe University and Polytechnic Hospital, Valencia, Spain
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Hosseini SV. Lifestyle Modifications and Dietary Factors versus Surgery in Benign Anorectal Conditions; Hemorrhoids, Fissures, and Fistulas. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:355-357. [PMID: 37456202 PMCID: PMC10349156 DOI: 10.30476/ijms.2023.49356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Muacevic A, Adler JR. The Efficacy of Sitz Baths as Compared to Lateral Internal Sphincterotomy in Patients with Anal Fissures: A Systematic Review. Cureus 2022; 14:e30847. [PMCID: PMC9622030 DOI: 10.7759/cureus.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
An anal fissure is a common condition that affects patients of all ages. Its clinical presentation is a sharp pain on defecation with or without blood. It is treated by conservative or surgical means. This study aims to assess the efficacy of a sitz bath as compared to lateral internal sphincterotomy in the treatment of anal fissures. The search strategy used keywords related to the topic of study. Three databases were used: PubMed, Google Scholar, and Science Direct. A total of 551 articles were screened. A quality assessment check was done on the articles leaving 11 articles. Four aspects of sitz bath outcomes were evaluated in the articles. In terms of analgesia, articles showed conflicting evidence. However, the overall evidence supports the use of sitz baths for their analgesic properties. In terms of healing, most articles had similar recovery rates of around 80%. Much of the research supported the use of sitz baths as the primary treatment to heal acute fissures. When compared to lateral internal sphincterotomy, the recovery rates of lateral internal sphincterotomy are superior to those of conservative treatment, including sitz baths. However, studies showed incontinence as a side effect of lateral internal sphincterotomy, and no studies reported side effects from the sitz baths. To conclude, the results of the articles support the use of sitz baths to treat anal fissures. Sitz baths have been found to have analgesic properties, as well as a good healing time. But, compared to lateral internal sphincterotomy, there is a significant difference in the healing rate at the end stage of treatment, lateral internal sphincterotomy is found to be superior. With regards to the side effects, none have been reported from using a sitz bath.
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Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030418. [PMID: 35334594 PMCID: PMC8955987 DOI: 10.3390/medicina58030418] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results: Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.
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Affiliation(s)
- Artaza Gilani
- UCL Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Hospital Campus), London NW3 2PF, UK
| | - Gillian Tierney
- Royal Derby Hospital, Derby DE22 3NE, UK; University of Nottingham, Nottingham NG7 2RD, UK
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Kim JH, Kim DH, Baik SY, Lee YP. Pain control and early wound healing effect using sitz bath with ozonised water after haemorrhoidectomy. J Wound Care 2020; 29:289-294. [PMID: 32421480 DOI: 10.12968/jowc.2020.29.5.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Studies have shown that ozone in an aqueous state on a scar, because of its antibacterial effect, aids wound-healing. This study aimed to compare the pain control effect, based on the time to wound healing, of using a sitz bath with ozonised water with that of using a sitz bath with ordinary tap water in patients who have had a haemorrhoidectomy. METHOD Patients were divided into two equal-sized groups: Group O used a sitz bath with ozonised water after haemorrhoidectomy and patients in Group T used a sitz bath with ordinary tap water. Different concentrations (1ppm, 2ppm and 4ppm) of ozonized water were tested to determine their bactericidal activities. Pain levels were measured using the Visual Analogue Scale (ranging from 0-10 where 0 is 'no pain' and 10 is 'unbearable pain'), on days two, three and seven. Cohort analysis was retrospectively performed on the prospectively randomised collected data for this study. RESULTS A total of 80 patients participated in the study. No case showed any signs of bacterial growth. On postoperative day seven, patients in Group O showed a significantly lower pain level than those in Group T (1.35±0.48 versus 2.40±0.9; p<0.001). The time needed for anus scars to be completely healed was significantly shorter for Group O than that for Group T (2.75±0.63 weeks versus 3.85±0.80 weeks; p<0.001). CONCLUSION The results of this study showed that using a sitz bath with ozonised water reduced pain and accelerated healing in patients who have had a haemorrhoidectomy.
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Affiliation(s)
- Joo Hyung Kim
- Department of Surgery, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 16499, Republic of Korea
| | - Dae Hyun Kim
- Department of Health Services Administration, University of Alabama at Birmingham 1720, 2nd Ave S, Birmingham, AL, 35294, US
| | - Sae Yun Baik
- Department of Laboratory Medicine, Seoul Clinical Laboratories, A-dong, Heungdok IT valley 13, Heungdeok 1-ro, Giheung-gu, Yongin, 16954, Republic of Korea
| | - Yong Pyo Lee
- Department of Surgery, Hanvit Hospital, 1017 Gyeongsu-daero, Jangan-gu, Suwon, Gyeonggi-do 16300, Republic of Korea
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Jacobi T. Nachbehandlung bei offenen Wunden und sekundärer Wundheilung nach proktologischen Eingriffen. COLOPROCTOLOGY 2019. [DOI: 10.1007/s00053-019-0343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Garg P. Sitz bath and keyhole deformity in benign anorectal disorders. Tech Coloproctol 2018; 22:471-472. [PMID: 29766341 DOI: 10.1007/s10151-018-1791-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
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Balta AZ, Ozdemir Y, Sucullu I, Filiz A, Yucel E, Akin ML. The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial. Am Surg 2015. [DOI: 10.1177/000313481508100232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.
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Affiliation(s)
- Ahmet Ziya Balta
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Yavuz Ozdemir
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ilker Sucullu
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Aliilker Filiz
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ergun Yucel
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Mehmet Levhi Akin
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
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Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:199-209. [PMID: 24926444 PMCID: PMC4049052 DOI: 10.4103/1947-2714.132935] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of water for various treatments (hydrotherapy) is probably as old as mankind. Hydrotherapy is one of the basic methods of treatment widely used in the system of natural medicine, which is also called as water therapy, aquatic therapy, pool therapy, and balneotherapy. Use of water in various forms and in various temperatures can produce different effects on different system of the body. Many studies/reviews reported the effects of hydrotherapy only on very few systems and there is lack of studies/reviews in reporting the evidence-based effects of hydrotherapy on various systems. We performed PubMed and PubMed central search to review relevant articles in English literature based on "effects of hydrotherapy/balneotherapy" on various systems of the body. Based on the available literature this review suggests that the hydrotherapy has a scientific evidence-based effect on various systems of the body.
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Affiliation(s)
- A Mooventhan
- Naturopathy Clinical, SDM College of Naturopathy and Yogic Sciences, Ujire, India
| | - L Nivethitha
- Department of Research and Development, S-VYASA University, Bangalore, Karnataka, India
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Harris CL, Laforet K, Sibbald RG, Bishop R. Twelve common mistakes in pilonidal sinus care. Adv Skin Wound Care 2012; 25:324-32; quiz 333-4. [PMID: 22713784 DOI: 10.1097/01.asw.0000416004.70465.8a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healing of pilonidal sinus wounds (PSWs) by secondary intention requires an average of 2 to 6 months, but delayed healing may require 1 to 2 years or even longer. Characteristically, these midline wounds are in the natal cleft of the buttocks or sacrococcygeal area of the back. These PSWs have costly financial consequences to the healthcare system and negatively affect the quality of life of the individual with the wound. This article contains an evidence-based literature review supplemented by the clinical expert opinion of the authors. Twelve leading mistakes in assessment and treatment have been identified with appropriate solutions to optimize patient outcomes. A case study is included to illustrate the common clinical challenges with strategies to optimize healing.
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Affiliation(s)
- Connie L Harris
- South West Regional Wound Care Framework Initiative, London, Ontario, Canada
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