Prospective evaluation of a new device for the treatment of anal fistulas

AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5(range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion(on the 10 th postoperative day), the persistence of inflammatory tissue around the fistula tract(at the 2-mo follow up), and the persistence of serum discharge(at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results.

Post-Operative Mortality after Ileal Perforation at a Teaching Hospital in Dhaka City

Background: Ileal perforation is a very critical condition. Objectives: The purpose of the present study was to see the post-operative mortality after ileal perforation. Methodology: This prospective cohort study was conducted in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2000 to December 2002 for period of 2 years and 3 months. All the patients presented with ileal perforation at any age with both sexes were included in this study. Patients were selected consecutively and the patients who showed ileal perforation at laparotomy were included in this study. Preoperative diagnosis was based on detailed history, complete physical examinations supported by plain x-ray abdomen in erect posture including both domes of diaphragm. After immediate resuscitation surgical treatment was undertaken as soon as possible following admission in all cases. The patients were followed up and the mortality profiles were recorded after surgical intervention. Result: Out of 53 patients having postoperative complications 38 patients were survived and 15 patients were expired. So total survivors were 85% and non-survivors 15%. In this study most of the mortality (12%) was attributed to septicemia and mode of death was multiple organ failure. Respiratory complications caused 2% mortality one patient died of ARDS and another elderly patient with preexisting bronchial asthma developed respiratory failure and was unresponsive to treatment. One death was related to faecal fistula followed by severe fluid, electrolyte and acid-base imbalance with peritonitis and gross sepsis. Conclusion: In conclusion, the mortality is significantly high due to septicemia, ARDS and faecal fistula.