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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

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 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

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

diagnosis of anorectal tuberculosis by polymerase chain reaction,GeneXpert and histopathology in 1336 samples in 776 anal fistula patients

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World Journal of Gastrointestinal Surgery 2021年第4期13卷 355-365页

作者： Pankaj Garg Ankita Goyal vipul d yagnik Sushil dawka Geetha R Menon department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia department of Pathology Gian Sagar Medical College and HospitalPatiala 140506PunjabIndia department of Surgery Nishtha Surgical Hospital and Research CentrePatan 384265GujaratIndia department of Surgery SSR Medical CollegeBelle RiveMauritius department of Statistics Indian Council of Medical ResearchNew Delhi 110029India

BACKGROUNd The association of tuberculosis(TB)with anal fistulas can make its treatment quite *** main challenge is timely detection of TB in anal fistulas and its proper *** is little data available on diagnosis and management of TB in anal *** To detect TB in fistula-in-ano patients were analyzed in different methods *** A retrospective analysis of different methods,polymerase chain-reaction(PCR),GeneXpert and histopathology(HPE),utilized to detect tuberculosis in fistula-inano patients,treated between 2014-2020,was *** sampling was done for tissue(fistula tract lining)and pus(when available).The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were *** In 1336 samples(776 patients)tested,TB was detected in 133 samples(122 patients).TB was detected in 52/703(7.4%)samples tested by PCR-tissue,in 77/331(23.2%)samples tested by PCR-pus,3/197(1.5%)samples tested with HPE-tissue and 1/105(0.9%)samples tested by *** detect TB,PCRtissue was significantly better than HPE-tissue(52/703 vs 3/197 respectively)(P=0.0012,significant,Fisher’s exact test)and PCR-pus was significantly better than PCR-tissue(77/331 vs 52/703 respectively)(Pd non-tuberculous fistula groups[90/102(88.2%)vs 518/556(93.2%)respectively](P=0.10,not significant,Fisher’s exact test).CONCLUSION This is the largest study of anorectal TB to be *** detection of TB by polymerase chain-reaction was significantly higher than by histopathology and *** polymerase chain-reaction,pus had a higher detection rate than *** fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatm

关键词： Anal fistula Fistula-in-ano Tuberculosis,Histopathology,Polymerase chainreaction,GeneXpert

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

Some Characterizations of a Normal Subgroup of a Group and Isotopic Classes of Transversals

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Algebra Colloquium 2016年第3期23卷 409-422页

作者： vipul Kakkar R.P. Shukla department of Mathematics University of Allahabad Allahabad 211 002 India

Let G be a group and H be a subgroup of G which is either finite or of finite index in G. In this paper, we give some characterizations for the normality of H in G. As a consequence we get a very short and elementary proof of the main theorem of a paper of Lal and Shukla, which avoids the use of the classification of finite simple groups. Further, we study the isotopy between the transversals in some groups and determine the number of isotopy classes of transversals of a subgroup of order 2 in d2p, the dihedral group of order 2p, where p is an odd prime and the isotopism classes are formed with respect to induced right loop structures.

关键词： right loop normalized right transversal right inverse property isotopy

Stable fuzzy controllers via LMI approach for non-linear systems described by type-2 T-S fuzzy model

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International Journal of Intelligent Computing and Cybernetics 2021年第3期14卷 509-531页

作者： Himanshukumar R.Patel vipul A.Shah Instrumentation and Control Engineering department Faculty of TechnologyDharmsinh Desai UniversityNadiadIndia

Purpose-The purpose of this paper is to stabilize the type-2 Takagi-Sugeno(T-S)fuzzy systems with the sufficient and guaranteed stability *** given conditions efficaciously handle parameter uncertainties by the upper and lower membership functions of the type-2 fuzzy sets(FSs).design/methodology/approach-This paper reports on a relevant study of stable fuzzy controllers and type-2 T-S fuzzy systems and reported that the synthesis of controller for nonlinear systems described by the type-2 T-S fuzzy model is a key problem and it can be resolve to convex problems via linear matrix inequalities(LMIs).Findings-The multigain fuzzy controllers are established to improve the solvability of the stability conditions,and the authors design multigain fuzzy controllers which have extensive information of upper and lower membership ***,the authors derive the traditional stability condition in terms of *** simulation examples illustrate the effectiveness and robustness of the derived stabilization ***/value-The uncertain MIMO nonlinear system described by Type-2 Takagi-Sugeno(T-S)fuzzy model,and successively LMI approach used to determine the system stability *** proposed control approach will give superior fault-tolerant control permanence under the actuator fault[partial loss of effectiveness(LOE)].Also the controller robust against the unmeasurable process ***,the statistical z-test are carried out to validate the proposed control approach against the control approach proposed by Himanshukumar and vipul(2019a).

关键词： Takagi-Sugeno(T-S) Type-2 fuzzy logic system Linear matrix inequalities fuzzy control

Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws

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World Journal of Orthopedics 2022年第3期13卷 267-277页

作者： Nadeem A Lil vipul R Makwana Tirth d Patel Arjav R Patel department of Orthopaedics NHL Medical CollegeAhmedabad 380006GujaratIndia

BACKGROUNd Intertrochanteric(IT)fracture is one of the most common fractures seen in an orthopaedic *** femoral nailing(PFN)is a common modality of fixing IT femur *** retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association(AO/OTA)guidelines for IT femur *** To compare the outcomes of IT fractures(AO/OTA 31-A1 and 31-A2)treated by PFN with and without distal interlocking *** We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT *** divided the patients into two groups,in which one of the groups received distal interlocking screws(group 1)and the other group did not(group 2).The subjects were followed up for a mean period of 14 mo and assessed for radiological union time,fracture site collapse,mechanical stability of implant,and complications associated with the PFN with distal interlocking and without distal ***,the results were *** PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture ***,similar results were observed in both groups with the fracture pattern AO/OTA *** patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws,there were minimal proximal lockrelated complications and no risk of distal interlock-related *** operative time,IITV radiation time and time to radiological union were *** patients also had better rotational alignment of the proximal femur,and the anatomy of the proximal femur was well *** was also noted that in the cases where distal interlocking was performed,there was a gradual decrease in neck shaft angle,which led to varus

关键词： Intertrochanteric fracture Arbeitsgemeinschaft für Osteosynthesefra-gen/Orthopaedic Trauma Association 31-A1 and 31-A2 Proximal femoral nail distal interlocking screws Without distal interlocking screws Outcome