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| 1 | Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review显示文摘BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four 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 plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The 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)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 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 judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date. | Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 8 |
| 2 | Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula:Experience from 2404 scans显示文摘Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken.Incidentally,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period.In 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. | Pankaj Garg Baljit Kaur Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastroenterology2021，27，33： | 6 |
| 3 | Diagnosis of anorectal tuberculosis by polymerase chain reaction,GeneXpert and histopathology in 1336 samples in 776 anal fistula patients显示文摘BACKGROUND The association of tuberculosis(TB)with anal fistulas can make its treatment quite difficult.The main challenge is timely detection of TB in anal fistulas and its proper management.There is little data available on diagnosis and management of TB in anal fistulas.AIM To detect TB in fistula-in-ano patients were analyzed in different methods utilized.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 performed.The 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 studied.RESULTS 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 GeneXpert.To 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)(P<0.00001,significant,Fisher’s exact test).TB fistulas were more complex than non-tuberculous fistulas[78/113(69%)vs 278/727(44.3%)respectively](P<0.00001,significant,Fisher’s exact test)but the overall healing rate was similar in tuberculous and 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 published.The detection of TB by polymerase chain-reaction was significantly higher than by histopathology and GeneXpert.Amongst polymerase chain-reaction,pus had a higher detection rate than tissue.TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups. | Pankaj Garg Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 3 |
| 4 | Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas显示文摘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 manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along 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 described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper. | Pankaj Garg Vipul D Yagnik Sushil Dawka Baljit Kaur Geetha R Menon | 2022 | World Journal of Gastroenterology2022，28，16： | 2 |
| 5 | Development and optimization of modified release IPN macromolecules of oxcarbazepine using natural polymers显示文摘 | Vipul D Prajapati Abhishek K Gandhi Krishna K Patel | 2015 | International Journal of Biological Macromolecules2015，73，： | 1 |
| 6 | Chilaiditi syndrome with carcinoma rectum: rare entity 显示文摘 | Vipul D Yagnik | 2011 | Saudi J Gastroenterol2011，17，1： | 1 |
| 7 | Liquid crystalline, rheological and thermal properties of konjac glucomannan 显示文摘 | VIPUL D MIHIR S STEPHEN P | 1998 | Polymer1998，39，5： | 1 |
| 8 | Liquid crystalline,rheological and thermal properties of konjac glucomannan显示文摘 | VIPUL D MIHIR S STEPHEN P | 1998 | Polymer1998，39，5： | 1 |
| 9 | Carrageenan: A natural seaweed polysaccharide and its applications 显示文摘 | Vipul D Prajapati P M Maheriya G K | 2014 | So- lanki Carbohydrate Polymers2014，105，： | 1 |
| 10 | Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws显示文摘BACKGROUND Intertrochanteric(IT)fracture is one of the most common fractures seen in an orthopaedic practice.Proximal femoral nailing(PFN)is a common modality of fixing IT femur fracture.We 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 fractures.AIM To compare the outcomes of IT fractures(AO/OTA 31-A1 and 31-A2)treated by PFN with and without distal interlocking screws.METHODS 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 fractures.We 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 interlocking.Then,the results were compared.RESULTS 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 pattern.However,similar results were observed in both groups with the fracture pattern AO/OTA 31-A1.In 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 complications.The operative time,IITV radiation time and time to radiological union were reduced.These patients also had better rotational alignment of the proximal femur,and the anatomy of the proximal femur was well maintained.It 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 collapse and failure of bone-implant construct in 21.40%.CONCLUSION In fracture pattern AO/OTA 31-A2,PFN without distal interlocking had better results and less complications than PFN with distal interlocking. | Nadeem A Lil Vipul R Makwana Tirth D Patel Arjav R Patel | 2022 | World Journal of Orthopedics2022，13，3： | 1 |
| 11 | Liquid crystalline, rheological and thermal properties of konjac glucomannan显示文摘 | Vipul D Mihir S Stephen P | 1998 | Polymer1998，39，5： | 1 |
| 12 | Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery显示文摘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 division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence 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 KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There 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 follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All 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 incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients). | Pankaj Garg Vipul D Yagnik Baljit Kaur Geetha R Menon Sushil Dawka | 2022 | World Journal of Clinical Cases2022，10，20： | 1 |
| 13 | Combining in situ chemical oxidation, stabilization, and anaerobic bioremediation in a single application to reduce contaminant mass and leachability in soil 显示文摘 | DANIEL P C VIPUL J S FRANK J D | 2015 | Journal of Hazardous Materials2015，84，2： | 1 |
| 14 | Carrageenan : a natural seaweed polysaccharide and its applications 显示文摘 | VIPUL D P PANKA J M GIRISH K J | 2014 | Carbohydrate Polymers2014，105，5： | 1 |
| 15 | Biodegradable polymer blends of poly ( lactic acid ) and poly ( ethylene glycol ) 显示文摘 | Mihir S Ananda K R Vipul D | 1997 | Journal of Applied Polymer Science1997，66，8： | 1 |
| 16 | Biodegradable polymer blends of polylacticacid (PLA) and polyethyleneglycol (PEG) 显示文摘 | MIHIR S ANANDA K R VIPUL D | 1997 | J Appl PolymSci1997，66，8： | 1 |
| 17 | Fecal diversion in complex anal fistulas:Is there a way to avoid it?显示文摘Temporary fecal diversion by a diverting colostomy or ileostomy is occasionally performed for serious complex fistulas.The 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 fasciitis.The 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 tissues.Once the fistula has healed,the diverting stoma is closed.However,two questions are relevant.First,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. | Pankaj Garg Vipul D Yagnik Sushil Dawka | 2021 | World Journal of Clinical Cases2021，9，25： | 0 |
| 18 | Including video and novel parameter-height of penetration of external anal sphincter-in magnetic resonance imaging reporting of anal fistula显示文摘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 rate.Any loss of vital information during the transfer of this data from the radiologist to the operating surgeon is unwarranted and is best prevented.In this regard,two methods are suggested.First,a short video to be attached with the standardized written report highlighting the vital parameters of the fistula.This would ensure minimum loss of information when it is conveyed from the radiologist to the operating surgeon.Second,inclusion of a new parameter,the amount of external sphincter involvement by the anal fistula.This parameter is usually not included in the MRI report.This can be evaluated as the height of penetration of the external anal sphincter(HOPE)by the fistula.The external anal sphincter plays a pivotal role in maintaining continence.This 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. | Pankaj Garg Baljit Kaur Vipul D Yagnik Sushil Dawka | 2022 | World Journal of Gastrointestinal Surgery2022，14，4： | 0 |
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