Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study

ABSTRACT PURPOSE: To evaluate (i) acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation by the patients and (ii) accuracy of a set of clinical criteria for diagnosis of simple anal fistula. METHODS: A set of clinical criteria based on physical findings was u...

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Autores principales:	BHUPENDRA JAIN, HITESH GUPTA, MEDHA MOHTA, NAVEEN SHARMA, SANJAY GUPTA
Formato:	article
Lenguaje:	EN
Publicado:	Shiraz University of Medical Sciences 2021
Materias:	fistula in ano intersphincteric anal fistula transsphinteric anal fistula complex anal fistula magnetic resonance scan operative surgery Medicine R
Acceso en línea:	https://doaj.org/article/916d41394fdb46aba594e8b97e004bd1
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spelling	oai:doaj.org-article:916d41394fdb46aba594e8b97e004bd12021-11-14T06:50:29ZSimple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study2783-243010.30476/acrr.2021.90260.1085https://doaj.org/article/916d41394fdb46aba594e8b97e004bd12021-03-01T00:00:00Zhttps://colorectalresearch.sums.ac.ir/article_47426_70ace9c3042b6cd5f44a9aecd3a2bb3e.pdfhttps://doaj.org/toc/2783-2430ABSTRACT PURPOSE: To evaluate (i) acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation by the patients and (ii) accuracy of a set of clinical criteria for diagnosis of simple anal fistula. METHODS: A set of clinical criteria based on physical findings was used to diagnose patients with simple anal fistula. These patients were operated under local anesthesia with conscious sedation. Intravenous paracetamol, diclofenac sodium, and midazolam were administered as adjuvants. Fistulotomy with/without marsupialisation was performed in most patients. Clinical diagnosis was matched with operative findings. RESULTS: Among 193 patients presenting with anal fistula, 61 patients were diagnosed as simple anal fistula and were scheduled for surgery under local anesthesia with conscious sedation. One patient was found to have complex anal fistula during intraoperative assessment and surgery was deferred. Surgery could be completed under local anesthesia with conscious sedation for 58/60 (96.7%) patients. Acceptability of the procedure was assessed with two parameters: the patients’ satisfaction score on visual analogue scale and their willingness to undergo fistula surgery under local anesthesia again, if required. Median (interquartile range) visual analogue scale score for patients’ satisfaction was 10 (9-10). All the patients expressed their willingness to undergo fistula surgery under local anesthesia again, if required. The clinical criteria was successful in diagnosing simple anal fistula in 58/61 (95.1%) patients. The remaining three patients had high intersphincteric fistula (1) and blind sinus (2). CONCLUSIONS: Acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation was excellent. The proposed clinical criteria were highly accurate in diagnosing simple anal fistula.BHUPENDRA JAINHITESH GUPTAMEDHA MOHTANAVEEN SHARMASANJAY GUPTAShiraz University of Medical Sciencesarticlefistula in anointersphincteric anal fistulatranssphinteric anal fistulacomplex anal fistulamagnetic resonance scanoperative surgeryMedicineRENIranian Journal of Colorectal Research, Vol 9, Iss 1, Pp 24-31 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	fistula in ano intersphincteric anal fistula transsphinteric anal fistula complex anal fistula magnetic resonance scan operative surgery Medicine R
spellingShingle	fistula in ano intersphincteric anal fistula transsphinteric anal fistula complex anal fistula magnetic resonance scan operative surgery Medicine R BHUPENDRA JAIN HITESH GUPTA MEDHA MOHTA NAVEEN SHARMA SANJAY GUPTA Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
description	ABSTRACT PURPOSE: To evaluate (i) acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation by the patients and (ii) accuracy of a set of clinical criteria for diagnosis of simple anal fistula. METHODS: A set of clinical criteria based on physical findings was used to diagnose patients with simple anal fistula. These patients were operated under local anesthesia with conscious sedation. Intravenous paracetamol, diclofenac sodium, and midazolam were administered as adjuvants. Fistulotomy with/without marsupialisation was performed in most patients. Clinical diagnosis was matched with operative findings. RESULTS: Among 193 patients presenting with anal fistula, 61 patients were diagnosed as simple anal fistula and were scheduled for surgery under local anesthesia with conscious sedation. One patient was found to have complex anal fistula during intraoperative assessment and surgery was deferred. Surgery could be completed under local anesthesia with conscious sedation for 58/60 (96.7%) patients. Acceptability of the procedure was assessed with two parameters: the patients’ satisfaction score on visual analogue scale and their willingness to undergo fistula surgery under local anesthesia again, if required. Median (interquartile range) visual analogue scale score for patients’ satisfaction was 10 (9-10). All the patients expressed their willingness to undergo fistula surgery under local anesthesia again, if required. The clinical criteria was successful in diagnosing simple anal fistula in 58/61 (95.1%) patients. The remaining three patients had high intersphincteric fistula (1) and blind sinus (2). CONCLUSIONS: Acceptability of surgery for simple anal fistula under local anesthesia with conscious sedation was excellent. The proposed clinical criteria were highly accurate in diagnosing simple anal fistula.
format	article
author	BHUPENDRA JAIN HITESH GUPTA MEDHA MOHTA NAVEEN SHARMA SANJAY GUPTA
author_facet	BHUPENDRA JAIN HITESH GUPTA MEDHA MOHTA NAVEEN SHARMA SANJAY GUPTA
author_sort	BHUPENDRA JAIN
title	Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
title_short	Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
title_full	Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
title_fullStr	Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
title_full_unstemmed	Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study
title_sort	simple anal fistula: clinical criteria for diagnosis and local anesthesia with conscious sedation for surgery -an observational study
publisher	Shiraz University of Medical Sciences
publishDate	2021
url	https://doaj.org/article/916d41394fdb46aba594e8b97e004bd1
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Simple Anal Fistula: Clinical Criteria for Diagnosis and Local Anesthesia with Conscious Sedation for Surgery -an Observational Study

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