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garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

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World Journal of Gastroenterology 2024年第3期30卷 204-210页

作者： Petr Tsarkov Inna Tulina Parvez Sheikh Darya D Shlyk pankaj garg Department of Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Oncologic Colorectal Surgery Sechenov First Moscow State Medical UniversityMoscow 119991Russia Department of Colorectal Surgery Saifee HospitalMumbai 400004MaharashtraIndia Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia

The main aim of this opinion review is to comment on the recent article published by garg et al in the World Journal of Gastroenterology 2023;29:4593–*** authors in the published article developed a new scoring system,garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the *** IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a *** associated social stigmatization often leads to significant under-reporting of the condition,which further impairs *** important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their *** to this,the management becomes even more *** issue is resolved up to a considerable extent by a scoring *** were several scoring systems in use for the last three *** prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,*** Hospital or Vaizey’s scores,and the FI severity ***,there were several shortcomings in these scoring *** the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring *** main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into *** GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring *** to this,GIS in

关键词： Fecal incontinence Scoring system Urge Stress Flatus

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Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template(SMART):An interdisciplinary Delphi consensus

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World Journal of Gastrointestinal Surgery 2024年第10期16卷 3288-3300页

作者： Iwona Sudoł-Szopińska pankaj garg Anders Mellgren Antonino Spinelli Stephanie Breukink Francesca Iacobellis Małgorzata Kołodziejczak Przemysław Ciesielski Christian Jenssen SMART Collaborative Group Giulio Aniello Santoro Department of Radiology National Institute of GeriatricsRheumatology and RehabilitationWarsaw 02-637Poland Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Surgical Oncology King Faisal Specialist Hospital&Research CenterRiyadh 11211Saudi Arabia Department of Biomedical Sciences Humanitas UniversityPieve Emanuele-MilanItaly IRCCS Humanitas Research Hospital Rozzano-MilanItaly Department of Surgery Maastricht and NUTRIM Institute of Nutrition and Translational Research in Metabolism GROW-Research Institute for Oncology and Reproductionthe Netherlands Department of General and Emergency Radiology A.Cardarelli HospitalNaples 80131CampaniaItaly Warsaw Proctology Center St.Elizabeth HospitalWarsaw 02-616Poland Department of Internal Medicine Hospital Märkisch OderlandStrausberg 15344BrandenburgGermany Brandenburg Institute for Clinical Ultrasound Neuruppin 16186BrandenburgGermany Third Referral Pelvic Floor Center Division of Surgery 2AULSS n.2 Marca TrevigianaDISCOG University of PaduaTrevisoItaly 不详

BACKGROUND There is still considerable heterogeneity regarding which features of cryptoglandular anal fistula on magnetic resonance imaging(MRI)and endoanal ultrasound(EAUS)are relevant to surgical *** a con-sequence,the quality and completeness of the report are highly dependent on the training and experience of the *** To develop a structured MRI and EAUS template(SMART)reporting the minimum dataset of information for the treatment of anal *** This modified Delphi survey based on the RAND-UCLA appropriateness for consensus-building was conducted between May and August *** hundred and fifty-one articles selected from a systematic review of the lite-rature formed the database to generate the evidence-based statements for the Delphi *** questions were anonymously voted by an interdisciplinary multidisciplinary group for a maximum of three iterative *** degree of agreement was scored on a numeric 0–10 *** consensus was defined as a score≥8 for≥80%of the *** Eleven scientific societies(3 radiological and 8 surgical)endorsed the *** three rounds of voting,the experts(69 colorectal surgeons,23 radiologists,2 anatomists,and 1 gastroenterologist)achieved consensus for 12 of 14 statements(85.7%).Based on the results of the Delphi process,the six following features of anal fistulas were included in the SMART:Primary tract,secondary extension,internal opening,presence of collection,coexisting le-sions,and sphincters *** A structured template,SMART,was developed to standardize imaging reporting of fistula-in-ano in a simple,systematic,time-efficient way,providing the minimum dataset of information and visual diagram useful to refer-ring physicians.

关键词： Anal fistulas Fistula-in-ano Template Reporting Magnetic resonance imaging Endoanal ultrasound

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Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 374-382页

作者： pankaj garg Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113India Department of Colorectal Surgery Indus International HospitalMohali 140507India

Complex anal fistulas are difficult to *** main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter *** to this,several sphincter-sparing procedures have been developed in the last two *** moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been *** two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success *** this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.

关键词： Anal fistula Fistulotomy Incontinence Ligation of intersphincteric fistula tract Transanal opening of intersphincteric space Recurrence

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Fecal diversion in complex anal fistulas:Is there a way to avoid it?

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World Journal of Clinical Cases 2021年第25期9卷 7306-7310页

作者： pankaj garg Vipul D Yagnik Sushil Dawka Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Surgery SSR Medical CollegeBelle Rive 744101Mauritius

Temporary fecal diversion by a diverting colostomy or ileostomy is occasionally performed for serious complex *** main indications are highly complex and extensive cryptoglandular anal fistula,anal fistula associated with severe anorectal Crohn’s disease,recurrent rectovaginal fistula,radiation-induced fistula and anal fistula with associated necrotizing *** purpose of stoma formation is to divert the fecal stream away from the anorectum and the perianal region so as to control the infective process and prevent trauma to the operated repaired *** the fistula has healed,the diverting stoma is ***,two questions are ***,is it certain that the same disease would not relapse(or the fistula would not recur)once the colostomy is closed?Second,is there a non-surgical method which can obviate the need for a diverting colostomy?An attempt is made to answer both these questions in this review.

关键词： Anal fistula Fecal diversion Diverting stoma Colostomy Crohn’s disease Rectovaginal fistula

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Subcutaneous and breast metastasis from asymptomatic gallbladder carcinoma

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Hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 209-211页

作者： pankaj Kumar garg Nita Khurana Niladhar S Hadke Department of Surgery Maulana Azad Medical College and Lok Nayak Hospital Department of Pathology Maulana Azad Medical College and Lok Nayak Hospital

BACKGROUND:Though gallbladder carcinoma is asso- ciated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is *** carcinoma metastasizing to breast and subcutaneous tissue is not known. METHOD:This report describes an interesting and unusual case of asymptomatic gallbladder carcinoma presenting with subcutaneous and breast metastasis. RESULTS:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall,anterior chest wall,back and in bilateral *** needle aspiration cytology(FNAC)of these nodules revealed metastatic *** patient was investigated for a primary *** ultrasound of the abdomen followed by a contrast-enhanced CT scan showed a growth in gallbladder,infiltrating the liver with multiple hepatic ***-guided FNAC from the growth in the gallbladder revealed *** was diagnosed as a case of metastatic adenocarcinoma of the gallbladder and palliative combination chemotherapy with gemcitabine and carboplatin was *** she developed jaundice and deteriorated dramatically in a short span of *** specific therapy could be started and she was given supportive *** died within three weeks of diagnosis due to hepatic encephalopathy. CONCLUSIONS:This report highlights an unusual metastasis of gallbladder carcinoma to the breast and subcutaneous tissue presenting as multiple lesions,which has never been reported in the English *** were unknown sites of metastasis for carcinoma of the ***,bilateral multiple metastatic lesions to breast are also very rare.

关键词： gallbladder carcinoma breast metastasis subcutaneous metastasis

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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

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New objective scoring system to clinically assess fecal incontinence

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World Journal of Gastroenterology 2023年第29期29卷 4593-4603页

作者： pankaj garg Iwona Sudol-Szopinska Małgorzata Kolodziejczak Kaushik Bhattacharya Gurleen Kaur Colorectal Surgery Garg Fistula Research Institute(GFRI)Panchkula 134113HaryanaIndia Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department ofRadiology National Institute of GeriatricsRheumatology and RehabilitationWarsaw 02-637Poland Department of Proctology Proctologic CenterSt.Elizabeth HospitalWarsaw 02-616Poland Department of Surgery MGM Medical College and LSK HospitalKishanganj 855107BiharIndia Department of Pharmacology Adesh Medical College and HospitalShahbad 136143HaryanaIndia

BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring ***,there are significant lacunae in these scoring systems,due to which they are neither accurate nor *** To develop a new scoring system for FI that is accurate,comprehensive,and easy to *** A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and *** weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each *** average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI *** scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency *** score for each FI would be derived by multiplying the frequency score and the weight for that FI *** the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’*** Fifty patients and 50 laypersons participated in the *** weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was *** maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI *** A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomin

关键词： Feal incontinence Scoring system Urge Stress Flatus

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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

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Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula:Experience from 2404 scans

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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

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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

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