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The American Journal of Gastroenterology Oct 2022
Topics: Anus Diseases; Constipation; Female; Hemorrhoids; Humans; Pregnancy; Pregnancy Complications
PubMed: 36194029
DOI: 10.14309/ajg.0000000000001962 -
Diseases of the Colon and Rectum Aug 2022
Topics: Abscess; Anus Diseases; Colon; Female; Humans; Rectal Fistula; Rectovaginal Fistula; Surgeons
PubMed: 35732009
DOI: 10.1097/DCR.0000000000002473 -
Deutsche Medizinische Wochenschrift... Apr 2023This article provides a practice-oriented overview of the most common proctological diseases: Anal eczema, hemorrhoidal disease, anal thrombosis, marisca, anal abscess... (Review)
Review
This article provides a practice-oriented overview of the most common proctological diseases: Anal eczema, hemorrhoidal disease, anal thrombosis, marisca, anal abscess and fistula, and anal fissure. Definitions and etiopathogenesis, clinic and diagnostics, and current therapy are presented.
Topics: Humans; Anus Diseases; Colorectal Surgery; Fissure in Ano; Hemorrhoids; Rectum
PubMed: 36990121
DOI: 10.1055/a-1932-7667 -
The British Journal of Surgery Sep 2022Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.
METHODS
The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).
RESULTS
Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20).
CONCLUSION
Avoiding abscess cavity packing is less painful without a negative morbidity risk.
REGISTRATION NUMBER
ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484).
REGISTRATION NUMBER
NCT03315169 (http://clinicaltrials.gov).
Topics: Abscess; Adult; Anus Diseases; Bandages; Drainage; Humans; Pain; Rectal Fistula; Treatment Outcome
PubMed: 35929816
DOI: 10.1093/bjs/znac225 -
Annales de Dermatologie Et de... Dec 2021
Topics: Anus Diseases; Female; Humans; Vulva
PubMed: 34756608
DOI: 10.1016/j.annder.2021.08.001 -
Techniques in Coloproctology Feb 2020Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular...
Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. Surgery is the main treatment and several procedures have been developed, but the risks of recurrence and of impairment of continence still seem to be an unresolved issue. This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.
Topics: Abscess; Anus Diseases; Humans; Rectal Fistula; Sepsis; Skin Diseases; Treatment Outcome
PubMed: 31974827
DOI: 10.1007/s10151-019-02144-1 -
Journal of Gastrointestinal Surgery :... Jul 2021
Topics: Anus Diseases; Humans; Perineum; Tuberculosis
PubMed: 33515174
DOI: 10.1007/s11605-021-04907-4 -
CMAJ : Canadian Medical Association... Jul 2019
Review
Topics: Administration, Topical; Calcium Channel Blockers; Conservative Treatment; Fissure in Ano; Humans
PubMed: 31266788
DOI: 10.1503/cmaj.190074 -
Journal of Clinical Gastroenterology Aug 2020Anorectal disorders encompass structural, neuromuscular, and functional disorders. They are common, often distressing, and in some cases debilitating, and significantly... (Review)
Review
Anorectal disorders encompass structural, neuromuscular, and functional disorders. They are common, often distressing, and in some cases debilitating, and significantly add to the health care burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathology and can pose significant diagnostic and management dilemmas. A meticulous history and comprehensive digital rectal examination can provide clarity on the diagnosis, appropriate testing, and management of these conditions. Today, with the development of sophisticated diagnostic tools such as high-resolution and high-definition (3-D) anorectal manometry, 3-D anal ultrasonography, magnetic resonance defecography and imaging, and neurophysiological tests such as translumbosacral anorectal magnetic stimulation, it is possible to more accurately define and characterize the underlying structural and functional abnormalities. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of anal fissure, hemorrhoids, rectal prolapse, intussusception, rectocele, solitary rectal ulcer syndrome, levator ani syndrome, dyssynergic defecation and fecal incontinence.
Topics: Anal Canal; Anus Diseases; Constipation; Defecation; Defecography; Fecal Incontinence; Humans; Manometry; Rectal Diseases; Rectum
PubMed: 32692116
DOI: 10.1097/MCG.0000000000001348 -
The Surgical Clinics of North America Jun 2024Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is... (Review)
Review
Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures.
Topics: Hemorrhoids; Humans; Fissure in Ano; Hemorrhoidectomy
PubMed: 38677814
DOI: 10.1016/j.suc.2023.11.001