Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess

AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression(SDPC)] and control group [fistulotomy(FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score(visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter(24.33 d in SDPC vs 31.57 d in FSLT,P < 0.01) and the patient satisfaction score at 1 mo postoperative followup was significantly higher in the SDPC group(4.07 in SDPC vs 3.37 in FSLT,P < 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups.The maximal anal squeeze pressures after treatment were reduced(23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures(12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT),but there were neither significant differences between the two groups and nor significant differences before or after treatment.CONCLUSION:Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe,effective and less invasive.

Effects of the pestle needle therapy,a type of acupoint stimulation,on post-hemorrhoidectomy pain:A randomized controlled trial

Background:Hemorrhoids are one of the most common conditions that lead to surgery,and until now surgical hemorrhoidectomy has been the major effective treatment.Post-operative pain from hemorrhoidectomy has been experienced by thousands of patients and remains a major inconvenience of the operation.Objective:This study evaluates the clinical efficacy of the pestle needle therapy,an acupoint stimulation method,for relief of post-hemorrhoidectomy pain.Design,setting,participants and interventions:This was a single-center,patient-assessor-blinded and randomized controlled trial with 154 patients receiving Milligan hemorrhoidectomy surgery.Eligible patients were randomly assigned to either a treatment group or a control group at a ratio of 1:1.The treatment group received the pestle needle therapy,with manual stimulation at Yaoshu(DU2),Mingmen(DU4),Changqiang(DU1),Chengshan(BL57),Erbai(EX-UE2)and the perianal points(1,3,5,7,9,and 11 o’clock around the lesion);while the control group received a sham treatment with very light pressure.Three sessions of treatment were performed at 30 min,4 h and 12 h after the surgery,and each lasted for 15 min.Main outcome measures:The primary outcome was post-operative pain measured with the visual analogue scale(VAS)at 12 h after surgery.The secondary outcomes included the VAS scores measured at0.5,2,4,6,8,24 and 48 h after surgery,the analgesic dose,the time and the VAS score of the patients’first defecation after surgery,as well as the Hamilton Rating Scale for Anxiety(HAMA)evaluated before discharge.Results:The mean pain score of the treatment group was significantly lower than that of the control group(3.10±1.27 vs 4.82±1.29;P<0.001)at 12 h after surgery.Compared with the control group,patients in the treatment group needed a smaller dose of analgesic within the first 24 hours after surgery(P=0.002);and their HAMA scores before discharge were lower(4.07±2.40 vs 5.10±2.45,P=0.009).Compared to the treatment group,patients in the control group had a greater time to the first defecation after surgery([52.34±15.72]h vs[27.08±13.68]h;P<0.001),but there was no difference in their VAS scores at the first defecation(P=0.092).Conclusion:The pestle needle therapy was effective for relieving pain,reducing anxiety and improving bowel function after hemorrhoidectomy,and it is worthy of clinical application.