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World Journal of Gastroenterology 2021年第33期27卷 5460-5473页

作者： Pankaj Garg baljit kaur Vipul D Yagnik Sushil Dawka Geetha R Menon Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle RiveMauritius Department of Statistics Indian Council of Medical ResearchNew Delhi 110029New DelhiIndia

Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal *** is sufficient literature available outlining the interpretation of fistula MRI before performing ***,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been ***,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative *** this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field.

关键词： Anal fistula Magnetic resonance imaging Postoperative Hyperintensity Internal opening

Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

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World Journal of Clinical Cases 2022年第20期10卷 6845-6854页

作者： Pankaj Garg Vipul D Yagnik baljit kaur Geetha R Menon Sushil Dawka Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011India Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius

BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS *** Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the *** patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/*** were commenced on the 10^(th)postoperative day and continued for 1 *** was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of *** Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this *** were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to *** were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator *** were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid ***,regular KE led to a significa

关键词： Anal fistula Incontinence Urge Transanal opening of intersphincteric space Kegel exercises Manometry

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

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World Journal of Gastroenterology 2022年第16期28卷 1608-1624页

作者： Pankaj Garg Vipul D Yagnik Sushil Dawka baljit kaur Geetha R Menon Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011India Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India

Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to *** resonance imaging has brought more clarity to the pathophysiology of these *** with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been *** diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric *** is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of *** main reason for this is the paucity of literature about these *** common feature of all these fistulas is their complete involvement of the external anal ***,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be *** advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high *** have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

关键词： Anal fistula Supralevator Suprasphincteric Extrasphincteric Magnetic resonance imaging

Including video and novel parameter-height of penetration of external anal sphincter-in magnetic resonance imaging reporting of anal fistula

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 271-275页

作者： Pankaj Garg baljit kaur Vipul D Yagnik Sushil Dawka Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle Rive 744101Belle RiveMauritius

The main purpose of a radiologist’s expertise in evaluation of anal fistula magnetic resonance imaging(MRI)is to benefit patients by decreasing the incontinence rate and increasing the healing *** loss of vital information during the transfer of this data from the radiologist to the operating surgeon is unwarranted and is best *** this regard,two methods are ***,a short video to be attached with the standardized written report highlighting the vital parameters of the *** would ensure minimum loss of information when it is conveyed from the radiologist to the operating ***,inclusion of a new parameter,the amount of external sphincter involvement by the anal *** parameter is usually not included in the MRI *** can be evaluated as the height of penetration of the external anal sphincter(HOPE)by the *** external anal sphincter plays a pivotal role in maintaining *** parameter(HOPE)is distinct from the‘height of internal opening’and assumes immense importance as its knowledge is paramount to prevent damage to the external anal sphincter by the surgeon during surgery.

关键词： Magnetic resonance imaging Anal fistula External anal sphincter Video reporting Incontinence

Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review

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World Journal of Gastrointestinal Surgery 2021年第4期13卷 340-354页

作者： Pankaj Garg baljit kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of Pathology Gian Sagar Medical College and HospitalPatiala 140601PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius Department of Statistics Indian Council of Medical ResearchNew Delhi 110029New DelhiIndia

BACKGROUND A complex anal fistula is a challenging disease to *** To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula *** Anal fistulas operated on by a single surgeon over 14 years were *** magnetic resonance imaging was done in all *** procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula *** was initiated before *** per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex *** with associated abscesses were treated by definitive *** was evaluated objectively by Vaizey incontinence *** A total of 1351 anal fistula operations were performed in 1250 *** overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)*** did not change significantly after surgery in any *** per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS *** overall success rate was 93.5%in those *** a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,*** 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done *** sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex *** is the largest anal fistula series to date.

关键词： Anal fistula Fistulotomy Incontinence Surgery Recurrence

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婴儿眼底出血

国外医学（眼科学分册） 1993年第2期17卷 99-105页

作者： baljit kaur David Taylor 刘武

婴儿视网膜出血的位置和形态为眼底病的诊断提供重要线索。新生儿因产伤引起的视网膜出血常见,预后良好,为自限性。而婴儿的某些视网膜出血则可表明颅内动脉瘤、意外或非意外性损伤、和多种眼底病(如Coats病,残存性原始玻璃体增生症、... 详细信息

婴儿视网膜出血的位置和形态为眼底病的诊断提供重要线索。新生儿因产伤引起的视网膜出血常见,预后良好,为自限性。而婴儿的某些视网膜出血则可表明颅内动脉瘤、意外或非意外性损伤、和多种眼底病(如Coats病,残存性原始玻璃体增生症、早产儿视网膜病变、视网膜发育不良、高血压、近视)、或全身病(如血液病或心血管病变.感染、蛋白C缺乏)。本文根据视网膜出血的位置、形态和病因进行图解和分类。婴儿视网膜出血的及时诊断至为重要,因为通过治疗可预防早期剥夺性弱视和盲的发生。眼科体征亦为全身治疗提供有价值的评估。

关键词：视网膜出血诊断位置形态