Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: An effective alternative

AIM: To compare biofeedback-guided pelvic floor exercise therapy (BFT) with the use of oral polyethylene glycol (PEG) for the treatment of obstructive defecation.

How we can improve patients’comfort after Milligan- Morgan open haemorrhoidectomy

AIM:To demonstrate the value of Diosmin(flavonidic fraction)in the management of post-haemorhoidectomic symptoms.METHODS:Eighty-six consecutive patients with grades ⅢandⅣacute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital,Xinjiang Medical University from April 2009 to April 2010,were enrolled in this study.An observerblinded,randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo.Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk(n=43)or placebo(n=43).The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method.Pain,bleeding,heaviness,pruritus,wound edema and mucosal discharge were observed after surgery.The postoperative symptoms and hospitalization time were recorded.RESULTS:The mean age of the Diosmin group and controls was 53.2 and 51.3 years,respectively.In Diosmin group,haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10;and in the control group,29 were of the third degree and 14 were of the fourth degree.There was no statistically significance in age,gender distribution,degree and number of excised haemorrhoid piles,and the mean duration of haemorrhoidal disease between the two groups.There was a statistically significant improvement in pain,heaviness,bleeding,pruritus from baseline to the 8th week after operation(P<0.05).Patients taking Diosmin had a shorter hospitalization stay after surgery(P< 0.05).There was also a significant improvement on the proctoscopic appearance(P<0.001).However,there was no statistical difference between the two groups in terms of wound mucosal discharge.Two patients experienced minor bleeding at the 8th week in Diosmin group,and underwent surgery.CONCLUSION:Diosmin is effective in alleviating postoperational symptoms of haemorrhoids.Therefore,it should be considered for the initial treatment after haemorrhoid surgery.However,further prospective randomized trials are needed to confirm the findings of this study.

Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula

AIM: To compare the efficacy and safety of acellular dermal matrix (ADM) bioprosthetic material and endorectal advancement flap (ERAF) in treatment of complex anorectal fistula. METHODS: Ninety consecutive patients with complex anorectal fistulae admitted to Anorectal Surgical Department of First Affi liated Hospital, Xinjiang Medical University from March 2008 to July 2009, were enrolled in this study. Complex anorectal fistula was diagnosed following its clinical, radiographic, or endoscopic diagnostic criteria. Under spinal anesthesia, patients underwent identification and irrigation of the fistula tracts using hydrogen peroxide. ADM was securely sutured at the secondary opening to the primary opening using absorbable suture. Outcomes of ADM and ERAF closure werecompared in terms of success rate, fecal incontinence rate, anorectal deformity rate, postoperative pain time, closure time and life quality score. Success was defined as closure of all external openings, absence of drainage without further intervention, and absence of abscess formation. Follow-up examination was performed 2 d, 2, 4, 6, 12 wk, and 5 mo after surgery, respectively. RESULTS: No patient was lost to follow-up. The overall success rate was 82.22% (37/45) 5.7 mo after surgery. ADM dislodgement occured in 5 patients (11.11%), abscess formation was found in 1 patient, and fistula recurred in 2 patients. Of the 13 patients with recurrent fistula using ERAF, 5 (11.11%) received surgical drainage because of abscess formation. The success rate, postoperative pain time and closure time of ADM were significantly higher than those of ERAF (P < 0.05). However, no difference was observed in fecal incontinence rate and anorectal deformity rate after treatment with ADM and ERAF. CONCLUSION: Closure of fistula tract opening with ADM is an effective procedure for complex anorectal fistula. ADM should be considered a first line treatment for patients with complex anorectal fistula.

Experimental porcine model of complex fistula-in-ano

AIM To establish and evaluate an experimental porcine model of fistula-in-ano.METHODS Twelve healthy pigs were randomly divided into two groups. Under general anesthesia, the experimental group underwent rubber band ligation surgery, and the control group underwent an artificial damage technique. Clinical magnetic resonance imaging(MRI) and histopathological evaluation were performed on the 38 th d and 48 th d after surgery in both groups, respectively. RESULTS There were no significant differences between the experimental group and the control group in general characteristics such as body weight, gender, and the number of fistula(P > 0.05). In the experimental group, 15 fistulas were confirmed clinically, 13 complex fistulas were confirmed by MRI, and 11 complex fistulas were confirmed by histopathology. The success rate in the porcine complex fistula model establishment was 83.33%. Among the 18 fistulas in the control group, 5 fistulas were confirmed clinically, 4 complex fistulas were confirmed by MRI, and 3 fistulas were confirmed by histopathology. The success rate in the porcine fistula model establishment was 27.78%. Thus, the success rate of the rubber band ligation group was significantly higher than the control group(P < 0.05). CONCLUSION Rubber band ligation is a stable and reliable method to establish complex fistula-in-ano models. Large animal models of complex anal fistulas can be used for the diagnosis and treatment of anal fistulas.