Anorectal Disorders Research Articles

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure

In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.

Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery

Objective: To evaluate the clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Method: This was a retrospective study. A total of 120 patients with cervical cancer undergoing radical surgery at Tangshan People’s Hospital from June 2021 to June 2023 were randomly divided into two groups (n=60 cases each group). The control group received routine nursing intervention, while the study group was provided with comprehensive nursing intervention. Comparative analysis was conducted on clinical indicators, postoperative complications, bladder and pelvic floor function recovery, and patient satisfaction before and after intervention in both groups. Result: In the study group, ambulation time, gastrointestinal function recovery, duration of postoperative drainage tube placement, oral diet resumption time, duration of postoperative vaginal bleeding, and length of hospital stay were significantly shorter than in the control group (all p< 0.05). Bladder function recovery in the study group was superior to that in the control group (p< 0.05). The study group showed lower scores for anorectal disorders, urogenital disorders, and pelvic organ prolapse than the control group (p< 0.05, respectively). Patient satisfaction was 100% in the study group and 85% in the control group, suggesting a statistically significant difference between the two groups (p< 0.05). Conclusion: Comprehensive nursing intervention deserve to be promoted as it can accelerate postoperative clinical recovery, reduce the incidence of surgical complications, improve pelvic floor and bladder function post-cervical cancer surgery, and enhance patient satisfaction with care. doi: https://doi.org/10.12669/pjms.40.10.9271 How to cite this: Zhao Q. Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Pak J Med Sci. 2024;40(10):2287-2292. doi: https://doi.org/10.12669/pjms.40.10.9271 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Transrectal ultrasound (TRUS) as a diagnostic tool for abscesses and fistulas of the anus. Anatomy and methodology of the TRUS examination

Introduction Transrectal ultrasound (TRUS) is a valuable imaging technique used to diagnose abscesses and fistulas in the anorectal region. It provides detailed visualization of soft tissues and anatomical structures, making it a crucial tool for assessing conditions that are often challenging to diagnose with other methods. Our work explores the anatomy relevant to TRUS and outlines the methodology of the examination, emphasizing its importance in the accurate detection and treatment planning of anorectal disorders. Aim of the study To evaluate the effectiveness of transrectal ultrasound (TRUS) as a diagnostic tool for identifying and assessing abscesses and fistulas in the anorectal region. Methods and materials This review was conducted based on available data published in the PubMed database, using the following phrases: "TRUS”, „abscess", „diagnosis of fistulas”, and ”anorectal disorders”. Conclusion Transrectal ultrasound (TRUS) has proven to be a highly effective diagnostic tool for the detection and evaluation of abscesses and fistulas in the anorectal region. Its ability to provide clear visualization of soft tissues and complex anatomical structures enhances diagnostic accuracy, facilitating more precise treatment planning. By outlining the anatomical context and proper methodology for TRUS, this study highlights the technique’s value in improving clinical outcomes for patients with anorectal disorders. Further research and refinement of TRUS protocols may continue to optimize its diagnostic potential.

Gastrointestinal disorders in systemic sclerosis: cluster analysis and prognosis from a French prospective cohort.

The gastrointestinal tract (GIT) is frequently involved in systemic sclerosis (SSc) and is responsible for alteration of quality of life. Many complications can occur, including chronic intestinal pseudo-obstruction, digestive haemorrhage and small-intestinal bacterial overgrowth. Since early development of organ failure is associated with poor prognosis, we need to identify risk factors associated with severe GIT involvement to prevent severe forms of the disease. We conducted an observational prospective study, which included 90 SSc patients from December 2019 to September 2021. We collected questionnaires about digestive manifestations and quality of life, blood and stool samples, and performed imaging. At inclusion and throughout the study we assessed the occurrence of malnutrition and severe GIT disorders. We performed statistical analysis to highlight eventual risk factors associated with digestive manifestations, including hierarchical cluster analysis. A majority of our patients had gastro-oesophageal manifestations (93.3%), followed by intestinal manifestations (67.8%) and anorectal manifestations (18.9%). We found a correlation between anorectal disorders and cardiac disease, and between gastro-oesophageal involvement and impaired pulmonary function tests. Smoking was significantly associated with occurrence of severe GIT disorders. Malnutrition was frequent and associated with more cardiac and pulmonary disease. Cluster analysis identified three groups of patients, including one cluster with cardiac and digestive involvement. GIT manifestations are frequent and severe in SSc. Smoking appears to be associated with severe disease. Anorectal manifestations may be associated with cardiac disease, but we need more studies to validate these results.

Review article: advances in the diagnosis and management of anorectal motility disorders.

Anorectal motility disorders such as dyssynergic defecation (DD), faecal incontinence (FI) and anorectal pain affect 40% of the population and are a frequent reason for gastroenterology consultation. They significantly affect the quality of life and lead to psychological distress. Lack of understanding of these problems compounded by a lack of availability and knowledge of diagnostic tools in most medical centres and/or trained physicians has significantly hampered this field. To discuss the latest advances in pathophysiology, diagnostic tests and therapeutic options for these disorders using an evidence-based approach. We reviewed the published literature over the past 20 years on DD, FI and anorectal pain and distilled these into a narrative review. A detailed history, prospective stool diary and digital rectal exam, together with diagnostic tests such as anorectal manometry, balloon expulsion test, translumbosacral anorectal magnetic stimulation test for assessing neuropathy, defecography and anal ultrasound, can provide detailed mechanistic and structural information. Such knowledge can pave the way for a meaningful and pathophysiologic-based management approach. This could include biofeedback therapy for DD or FI, sensory training for rectal hyposensitivity or sensory adaptation training for rectal hypersensitivity or sphincter bulking agents or neuromodulation therapies. These treatments are effective and safe. Anorectal motility disorders are common, but either less well recognized or poorly managed by most gastroenterologists. Equipped with the practical and up-to-date knowledge provided in this review, physicians could provide improved health care for these patients.

Impact of sacral neuromodulation on concomitant functional anorectal disorders in patients with fecal incontinence

Impact of sacral neuromodulation on concomitant functional anorectal disorders in patients with fecal incontinence

Natural Products with Potential Effects on Hemorrhoids: A Review.

Hemorrhoid disease is a common anorectal disorder affecting populations worldwide, with high prevalence, treatment difficulties, and considerable treatment costs. Compared to other treatment options, medical therapy for hemorrhoids offers minimal harm, more dignity to patients, and is more economical. Unfortunately, there are few chemical hemorrhoid medications available clinically, which makes the search for efficacious, cost-effective, and environmentally friendly new medication classes a focal point of research. In this context, searching for available natural products to improve hemorrhoids exhibits tremendous potential. These products are derived from nature, predominantly from plants, with a minor portion coming from animals, fungi, and algae. They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities. Therefore, we take the view that they are a class of potential hemorrhoid drugs, prevention products, and medication add-on ingredients. This article first reviews the factors contributing to the development of hemorrhoids, types, primary symptoms, and the mechanisms of natural products for hemorrhoids. Building on this foundation, we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types.

AN OBSERVATIONAL STUDY ON THE ROLE OF DIETARY AND LIFESTYLE HABITS IN BHAGANDARA

Fistula in Ano is a chronic abnormal communication lined by granulation tissue which runs outwards from ano-rectal lumen to an external opening on perianal skin. In Ayurvedic classics, it was mentioned as Bhagandara, meaning ‘Darana’ around Bhaga, Guda and Basthi pradesha. Nowadays, everyone is bound by a busy and stressful schedule that leads to disruption of lifestyle, which harms the quality of life. Due to a lack of exercise and a sedentary life, most people suffer from various lifestyle diseases. The most common among them is ano-rectal diseases due to erect posture and habitat. Anorectal disorders are slowly progressing because of regular intake of junk food, low fibre diet and different lifestyle habits. Arshas (Piles), Bhagandara (Fistula in Ano) and Parikartika (Fissure in Ano) are the most common diseases among anorectal diseases. Among them, Bhaganda-ra is considered under Ashtamahagada (eight major diseases) by Acharya Sushruta due to its callous and chron-ic attitude. In Ayurveda, Ksharasutra ligation is the most effective treatment of Bhagandara; apart from that Acharyas also mentioned the concept of Pathya (wholesome foods and activities) and Apathya (unwholesome foods and activities) as a part of the treatment of this disease. Patients must have a diet that will keep their dhatus in good condition and not allow them to get vitiated. So, one should follow a healthy diet (Pathya) and lifestyle habits (vihara). Therefore, the retrospective cross-sectional observational study is reliable in finding the association between Fistula in Ano and dietary and lifestyle habits. Hence, looking forward to better manage-ment with harmony of food and lifestyle of a patient can prevent the incidence of Bhagandara without causing much effort to physician and inconvenience to patient. The study's objective was to find the prevalence of everyday dietary and lifestyle habits with Bhagandara, create awareness of the necessity to adopt healthy nutritional and lifestyle habits, and break the chain of causation of Bhagandara. Also, I want to find out whether dietary and lifestyle habits have any significant role in the causa-tion of the disease bhagandara. A detailed literature review was compiled from relevant modern medical books. Ayurvedic literature and the Internet on the disease, management, Nidanas, Pathyas and Apathyas. A retrospective cross-sectional observational study with 69 participants of the age group 18-80 years who had fistula in Ano from O.P, Department of Salyatantra, satisfying inclusion and exclusion criteria was carried out. The participants were selected based on a purposive sampling technique. Then they were provided with the questionnaire, which was framed incorporating common Ahara and Vihara, which have been mentioned under Nidana of Bhagandara. Selected subjects having Bhagandara were provided with the questionnaire, and data was collected on the basis of a retrospective cross-sectional observational study. The result was analysed based on the responses to questions framed based on Nidanas, Pathya Aahara, and Vi-hara. Since the data evaluated was based on the interpretation of the connection between two categorical varia-bles, such as the cause and the disease, the Chi-square test is an ideal choice for aiding in understanding and used to compare observed and expected results according to an assumed hypothesis. The present study noticed a significant relation of Bhagandara with Nidanas and Pathya Aahara Viharas. Dietary and lifestyle habits both have important roles in the causation of disease. Each subject in the whole sample fol-lowed more than half of the lifestyle regimens incorporated in the study compared to dietary regimens. Overall, both dietary and lifestyle habits have a significant role in the causation of Bhagandara, with a slight predominance of lifestyle regimen over dietary regimen in Bhagandara noted. Considering all observations, sta-tistical analysis was done, and conclusions were drawn. The study results assessed statistically reveals that the dietary and lifestyle habits already mentioned in Ayurvedic classics have a significant role in causation of the disease Bhagandara.

‘Queen of Poisons’ Aconitum with special reference to Indian Aconite - Vatsanabha

Aconitum, the "Queen of Poisons" commonly known as Monkshood or Wolf’s bane, is a genus of perennial plants belonging to the family Ranunculaceae. In Ayurveda also few species of Aconitum are used for its therapeutic actions and the most potent of them is Aconitum Ferox, also known as Indian aconite or Vatsanabha, and it has the ability to function as both the ultimate poison and an elixir. In Ayurveda, Vatsanabha is considered as Mahavisha included among Sthavara Visha by Acharya Charaka, and in Kanda Visha by Acharya Susrutha. Aconitum Ferox is a highly toxic with the estimated fatal dose of 1g of root powder with a fatal period of 6 hours which contains a potent cardiotoxin and neurotoxin known as Aconitine. Ingesting even a small amount of the plant can result in severe symptoms and even death. As a result of the high toxicity of Vatsanabha, prior to any therapeutic use, the roots should under gone proper Sodhana process. Rasayana (rejuvenating), Deepana (improves digestion), Balavardhana (improves strength) Agnimandyahara (relieves indigestion) Pleehodara (useful in splenomegaly), Vataraktahara (useful against gout) Shwasahara (useful respiratory diseases), Kasahara (relieves cough), Gudamayahara (useful in ano-rectal disorders) etc. are just a few of the therapeutic indications of Vatsanabha that have been used successfully to treat a range of medical conditions. Recent Researches have shown that Vatsanabha contains several biologically active compounds that may have numerous potential therapeutic properties. The pharmacological potential of Aconitum Ferox still justifies vast research possibilities.

Sexual Function After Surgical Treatment for Benign Anorectal Disorders.

Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10-25]) than that of preoperative patients (22, range [5-25]), p < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.

Prevalence and Burden of Disorders of Gut-Brain Interaction Among UK Medical Students

Background: Disorders of Gut-Brain Interaction (DGBI) affect 40% of the general population and are associated with substantial health impairment. Medical students reportedly have among the highest rates of DGBI, although data is mainly from Asia and Africa. We addressed this issue within a UK-based university. Methods: An online survey was completed by 378 of 1621 medical students. Demographics, medical history, and gastrointestinal symptoms were collected, the latter using a modified Rome IV questionnaire to determine the presence of DGBI symptoms over the last 3 months. Additional validated questionnaires screened for somatization, psychological distress, eating disorders, quality of life, and burnout. Results: DGBI were present in 76% (n=289/378), of which two-of-three had multiple affected sites. The most frequent DGBI were gastroduodenal (57%), followed by bowel (49%), esophageal (29%), and anorectal (26%) disorders. Approximately 50% of students with DGBI experienced painful gastrointestinal symptoms at least one day/week. Students with DGBI, compared to those without, had significantly higher anxiety and depression scores, increased somatic symptom reporting, reduced mental and physical quality of life, poorer eating habits, and more frequent medication use (p-values, all&lt;0.05). They were also at significantly higher risk of burnout, through study exhaustion and disengagement. The greatest health impairment was seen in those with multiple, painful, DGBI. Only 23% and 5% of students with DGBI had consulted a primary care provider and gastroenterologist, respectively. Conclusion: Medical students commonly experience DGBI and associated health burden, yet infrequently seek help. Greater awareness may lead to increased support, improved health, and better study engagement.

An update on current diagnostic tools in Anorectal disorders

Anorectal emergencies comprise a wide variety of diseases that share common and overlapping symptoms, i.e., anorectal pain or bleeding , some of the them could be life-threatening and might require proper diagnosis and immediate management. It is well known that an incorrect diagnosis/delayed diagnosis is frequent for anorectal diseases leading to an impaired outcome. This article aims to improve the knowledge and the awareness on diagnostic tools , useful for every physician dealing with Anorectal emergencies.

London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders

Background/AimLondon Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM.MethodsFifty healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 104mmHg2.cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent).ResultsNo difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push).ConclusionsLP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons.Key points• London Protocol and Classification allied with the technological evolution of HRM (software and probes) has refined the diagnostic armamentarium in anorectal disorders.• Novel 3D and deepening the analysis of manometric parameters before the London Classification as a contributory diagnostic tool.• Comparison of healthy volunteers according to the London Protocol under a perfusional high-resolution system could establish equivalence points.

Partial Fistulotomy followed by Kshara application and Ksharasutra Ligation in Fistula-in-ano - Multiple approaches in a Single Case

Bhagandhara is one of the common ailments pertaining to Guda and it is mentioned under the heading of Ashtomahagada (eight major diseases). According to Acharya Susahruta, ‘Bhagandhara’ starts as deep-seated pidika (boil) surrounding Guda (anus) within two Angulas, producing fever and pain. In contemporary science it is compared to fistula-in-ano. Fistula-in-ano is a track lined by granulation tissue and communicating two epithelial lined surfaces which opens deeply in the anal canal or rectum and superficially on the skin around the anus. In modern medical science various treatment modalities has been explained but they are having its own merits and demerits. Ksharasutra is a medicated thread, indicated in ano-rectal disorders particularly in the management of Bhagandhara. In plane Kshrasutra the required time for cut through and healing of wound is more, so patients are mentally disturbed with this disease. Hence to minimize the required time, multiple interventions along with Ksharasutra is opted. In this case report, a patient of fistula- in-ano having 9cm at posterior aspect of anal canal was treated with multiple approaches which are partial fistulotomy, Kshara application and Ksharasutra ligation for remaining part of tract. Regular dressing was done with Jatyadi Ghrita for the partial fistulotomy wound and old Ksharasutra was changed with a new one by rail-road method on every week for the remaining part of fistulous tract. The unit cutting time (UCT) was measured and noted at every week. This case was cured completely within 7 weeks. Hence study concluded that the long fistula cases can be treated with multiple interventions along with Ksharasutra.

A CLINICAL STUDY ON VEDANASTHAPAN MAHAKASHAYA OINTMENT AND VEDANASTHAPAN GHANVATI IN THE MANAGEMENT OF PARIKARTIKA W.S.R. TO ACUTE FISSURE-IN-ANO

Parikartika (anorectal fissure) has become the most common and painful condition in anorectal disorders. Nowadays, people have faulty lifestyles and improper food habits, leading to the vitiation of doshas, particularly Apana vayu, which is a significant factor for deterioration in anal conditions leading to fissures in the ano with severe pain in the anal region. In Modern science, various treatment modalities, including antibiotics, laxatics, sphincterectomy, fissurectomy, etc., are expensive and require long hospitalisation with other unwanted complications. Hence, pain management is the first step by Vedanasthapan drugs, which results in pain-relieving and rapid healing of the fissure. The lack of analgesics in ayurvedic medicines is a disadvantage, and there is a constant quest for an ideal ayurvedic analgesic medicine like vedana-sthapana drugs. The properties of Vedanasthapanamahakashaya ointment and Vedanasthapana ghanvati are the group of drugs which subside pain and restore all vitiated doshas in the body to an equilibrium state. So, the Vedanasthapan Mahakashaya, on the basis of the chemical constituents of each drug, can be estimated that the part of drugs which is used to subside the pain in the body and these classes of drugs have the qualities of analgesic, anti-inflammatory and wound healing properties.

Turmocin Plus Suppresses Vascular Endothelial Growth Factor (VEGF) and Macrophage Infiltration in the Management of Perineal Wounds, Anal Fistula, Acute Anal Fissures and Haemorrhoids

Anorectal problems such as anal fistula, Crohn’s disease, haemorrhoids, and fissures are prevalent across the general population. Severe discomfort, inflammation, swelling, itching, and bleeding during defecation are common symptoms of anorectal disorders. Depending on the severity of the condition, several medical therapies or surgical procedures may be used to treat these diseases. Surgical treatments like fistulectomy and sphincterotomy or haemorrhoidectomy are highly intrusive and have a risk of recurrence. Furthermore, surgical procedures cause pain, inflammation, and perineal sores. These will lead to severe socio-economic ramifications in the patient’s life. Therefore, treatment options that aid in the reduction of inflammation, pain, and perineal wounds are critical for anorectal disease management. Herbal formulations that comprise turmeric (Curcuma longa) extract have anti-inflammatory, pain-relieving, and wound-healing properties. The purpose of the current study was to elucidate the effect of Turmocin Plus on the infiltration of inflammatory cells and the expression of pro-angiogenic factors in anorectal and lower gastrointestinal disorders. MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) and wound migration assays were performed to determine the results of Turmocin Plus on the viability and migration of inflammatory cells. The effect of Turmocin Plus on pro-angiogenic factors was determined using Western blot analysis and immunofluorescence. Further, we validate our in vitro findings in human fistula specimens using IHC. The investigation showed that Turmocin Plus inhibits immunological (RAW 264.7) cell migration while maintaining their viability. Inflammation and increased levels of Vascular Endothelial Growth Factor (VEGF) were observed in Inflammatory Bowel Disease (IBD), fistula, fissures, and higher-grade haemorrhoids. However, Turmocin Plus suppresses the VEGF expression in macrophages (RAW 264.7) cells. Furthermore, compared to untreated human fistula tissues, decreased expression of VEGF was observed in Turmocin Plus treated patient samples, validating the in vitro findings. Our study suggests that Turmocin Plus is a potent therapeutic formulation in treating fistula, perineal wounds, and Crohn’s disease.

Role of Adipose Tissue Hormones in Pathogenesis of Cryptoglandular Anal Fistula.

The cryptoglandular perianal fistula is a common benign anorectal disorder that is managed mainly with surgery and in some cases may be an extremely challenging condition. Perianal fistulas are often characterized by significantly decreased patient quality of life. Lack of fully recognized pathogenesis of this disease makes it difficult to treat it properly. Recently, adipose tissue hormones have been proposed to play a role in the genesis of cryptoglandular anal fistulas. The expression of adipose tissue hormones and epithelial-to-mesenchymal transition (EMT) factors were characterized based on 30 samples from simple fistulas and 30 samples from complex cryptoglandular perianal fistulas harvested during surgery. Tissue levels of leptin, resistin, MMP2, and MMP9 were significantly elevated in patients who underwent operations due to complex cryptoglandular perianal fistulas compared to patients with simple fistulas. Adiponectin and E-cadherin were significantly lowered in samples from complex perianal fistulas in comparison to simple fistulas. A negative correlation between leptin and E-cadherin levels was observed. Resistin and MMP2 levels, as well as adiponectin and E-cadherin levels, were positively correlated. Complex perianal cryptoglandular fistulas have a reduced level of the anti-inflammatory adipokine adiponectin and have an increase in the levels of proinflammatory resistin and leptin. Abnormal secretion of these adipokines may affect the integrity of the EMT in the fistula tract. E-cadherin, MMP2, and MMP9 expression levels were shifted in patients with more advanced and complex perianal fistulas. Our results supporting the idea of using mesenchymal stem cells in the treatment of cryptoglandular perianal fistulas seem reasonable, but further studies are warranted.

The rectum, anal sphincter and puborectalis muscle show different contraction wave forms during prolonged measurement with a simulated feces

Contractile patterns in rectum, puborectalis muscle and anal sphincter must be studied to understand defecation. Six subjects had contractile waveforms studied with Fecobionics. Symptom questionnaires, balloon expulsion test and anorectal manometry were done for reference. The Fecobionics bag was filled in rectum to urge-to-defecate volume and measurements were done for 4 h before the subjects attempted to evacuate the device. Pressures and bend angle (BA) variations were analyzed with Fast Fourier Transformation. Four normal subjects exhibited low frequency waves (< 0.06 Hz) for pressures and BA. The waves were uncoordinated between recordings, except for rear and bag pressures. Peak wave amplitudes occurred at 0.02–0.04 Hz. Pressures and the BA differed for peak 1 (p < 0.001) and peak 2 amplitudes (p < 0.005). The front pressure amplitude was bigger than the others (rear and BA, p < 0.05; bag, p < 0.005) for peak 1, and bigger than bag pressure (p < 0.005) and BA (p < 0.05) for peak 2. One subject was considered constipated with lower front pressure amplitudes compared to normal subjects and increased amplitudes for other parameters. The sixth subject was hyperreactive and differed from the other subjects. In conclusion, the rectum, anal sphincter and puborectalis muscle showed different contraction waves during prolonged measurements. The data call for larger studies to better understand normal defecation, feces-withholding patterns, and the implications on anorectal disorders.

Current Status and Role of Artificial Intelligence in Anorectal Diseases and Pelvic Floor Disorders.

Anorectal diseases and pelvic floor disorders are prevalent among the general population. Patients may present with overlapping symptoms, delaying diagnosis, and lowering quality of life. Treating physicians encounter numerous challenges attributed to the complex nature of pelvic anatomy, limitations of diagnostic techniques, and lack of available resources. This article is an overview of the current state of artificial intelligence (AI) in tackling the difficulties of managing benign anorectal disorders and pelvic floor disorders. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed database to identify all potentially relevant studies published from January 2000 to August 2023. Search queries were built using the following terms: AI, machine learning, deep learning, benign anorectal disease, pelvic floor disorder, fecal incontinence, obstructive defecation, anal fistula, rectal prolapse, and anorectal manometry. Malignant anorectal articles and abstracts were excluded. Data from selected articles were analyzed. 139 articles were found, 15 of which met our inclusion and exclusion criteria. The most common AI module was convolutional neural network. researchers were able to develop AI modules to optimize imaging studies for pelvis, fistula, and abscess anatomy, facilitated anorectal manometry interpretation, and improved high-definition anoscope use. None of the modules were validated in an external cohort. There is potential for AI to enhance the management of pelvic floor and benign anorectal diseases. Ongoing research necessitates the use of multidisciplinary approaches and collaboration between physicians and AI programmers to tackle pressing challenges.

Laser Hemorrhoidoplasty for Treatment of the Hemorrhoids in Eastern Nepal

Background: Millions worldwide are affected by hemorrhoids (prevalence 2.9%-27.9%), causing symptoms in over 4% of individuals. These anorectal disorders result from enlarged anal hemorrhoidal cushions, often due to constipation. Internal or external, they're graded by prolapse severity, with common symptoms including painless rectal bleeding. Treatment options range from conservative to surgical, with the gold standard, Milligan-Morgan hemorrhoidectomy, associated with postoperative pain. Laser hemorrhoidoplasty, a minimally invasive diode laser approach, shows promise, offering less postoperative pain, shorter hospital stays, and fewer complications than traditional surgical methods.&#x0D; Materials and Methods: A prospective observational study of 40 adults undergoing laser hemorrhoidectomy for symptomatic Goligher’s grade II and III hemorrhoids at Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from June 2022 to June 2023. Outcomes included pain scores, bleeding, operative time, postoperative complications, hospital stay length, return-to-work time, and patient satisfaction measured by QOL SF36 scoring.&#x0D; Results: Among 40 patients, 16 were male and 24 females, averaging 42.32 ± 12.26 years. Grade III hemorrhoids were found in 31 patients, Grade II in 9. Operative time averaged 17.22 ± 2.14 minutes, with one case of managed intraoperative bleeding. Postoperative symptoms included pain, skin tags, and wound infection, but no reactive bleeding, urinary, or stool/flatus incontinence. Two cases experienced recurrence. Patient satisfaction in general health evaluation scored 65.11 ± 10.35.&#x0D; Conclusion: Laser hemorrhoidoplasty is associated with less complications, quicker operative time, quick recovery and similar patient satisfaction when compared to surgical methods of hemorrhoidectomy.