Internal Opening Research Articles

Comparison of preoperative MRI and surgical findings in perianal fistulas and factors affecting recurrence

Aims: Anal fistula occurs most commonly when the anal glands become obstructed and infected in the intersphincteric plane. Although it has a high recurrence rates, its treatment is surgical. Magnetic resonance imaging (MRI) is the gold standard for accurate preoperative evaluation of the patient and detection of the relationship to the muscle groups that provide continence. The aim of this study was to evaluate the compatibility of MRI with surgery and to determine the parameters effective on recurrence.
 Methods: Primary perianal fistulas with MRI between 2016 and 2023 were retrospectively evaluated. Patient demographics were documented. Fistula classifications according to MRI findings, abscess locations, internal and external opening regions on MRI were compared with surgical findings. The surgical procedures performed were documented. Univariate and multivariate evaluations of recurrence performed by Cox regression analysis. Disease-free survival data were analyzed. 
 Results: A total of 180 cases with a mean age of 43.75±12.57 years were included in the study. At the end of MRI, there were 69 (38.3%) cases with an fistula external orifice > 3 cm. The largest group in Parks classification were intersphincteric patients with 127 (66.7%), 52 (28.9%) of the patients were in the complex group. The level of agreement between surgery and MRI internal opening was 13.4% and statistically significant (Kappa coefficient of agreement 0.134; p3 cm, transsphincteric, complex and patients requiring loose seton in surgery (p=0.001, p=0.001, p=0.001, p=0.001, p=0.007; p

Surgical treatment of anal fistula

A fistula of the anus is a chronic inflammatory process in the pararectal cell, intersphincter space and anal crypt with the presence of a formed fistula passage, where the affected anal crypt is the internal opening of the fistula. The urgency of surgical treatment of rectal fistulas is due to unsatisfactory results because of frequent anal incontinence and relapses of the disease. In this regard, most authors emphasize that the treatment of anal fistulas, as before, remains an urgent problem of colorectal surgery, and the search for new methods is a priority task of colorectal surgery. Literature analysis performed using the Elsevier, PubMed, eLIBRARY.RU, CyberLeninka, Google Scholar databases showed that the currently used technologies and methods of surgical treatment of anal fistulas do not allow us to determine their “gold standard”. In this regard, further analysis of the effectiveness and safety of their use, an assessment of the complications of surgical intervention and the frequency of relapses of the disease is necessary.

Analytical solution for the longitudinal seismic response of a shield tunnel with isolation layers under incident shear waves

The analysis of tunnel isolation has primarily focused on cross-sectional analysis, with little attention devoted to longitudinal analysis. The objective of this study was to develop a simplified analysis method for longitudinal isolation that can be efficiently applied in practical engineering. Therefore, a mechanical model of an isolated tunnel was established based on the Kelvin model, and an analytical solution for an isolated tunnel subjected to shear waves was derived. The numerical verification demonstrated the applicability and accuracy of our analytical solution, and an analysis was conducted to assess the effects of seismic motion amplitude and frequency, isolation layer, and soil on the isolation performance. The results indicate that the proposed mechanical model has good applicability and accuracy for analyzing the seismic and isolation performances of tunnels. The isolation effect is found to be insensitive to seismic motion amplitude, whereas the internal force response and joint opening of a tunnel increase at low frequencies and decrease at high frequencies. Additionally, the isolation effect is more prominent at low frequencies. Furthermore, the isolation effect increases with an augmented thickness of the isolation layer and a decreased elastic modulus of the isolation layer. As the foundation coefficient increases, the isolation effect of the isolation layer becomes more pronounced.

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism.

This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). Aretrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on avisual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes. Atotal of 60patients (49women and 11men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30patients. The comparisons of the groups at 1and 3months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6months after treatment (P > 0.05). Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as aprimary treatment option in patients with greater pain.

Preoperative Assessment of Perianal Fistulas with Combined Magnetic Resonance and Tridimensional Endoanal Ultrasound: A Prospective Study.

we designed a prospective study of diagnostic accuracy that compared pelvic MRI and 3D-EAUS with pelvic MRI alone in the preoperative evaluation and postoperative outcomes of patients with perianal fistulas. the sample size was 72 patients and this was divided into two imaging groups. MRI alone was performed on the first group. Both MRI and 3D-EAUS were performed in parallel on the second group. Surgical exploration took place after two weeks and was the standard reference. Park's classification, the presence of a concomitant abscess or a secondary tract, and the location of the internal opening were recorded. All patients were re-evaluated for complete fistula healing and fecal incontinence six months postoperatively. All of the collected data were subjected to statistical analysis. the MRI group included 36 patients with 42 fistulas. The MRI + 3D-EAUS group included 36 patients with 46 fistulas. The adjusted sensitivity and negative predictive value were 1.00 for most fistula types in the group that underwent combined imaging. The adjusted specificity improved for intersphincteric fistulas in the same group. The adjusted balanced accuracy improved for all fistula types except rectovaginal. The combination of imaging methods showed improved diagnostic accuracy only in the detection of a secondary tract. The healing rate at six months was 100%. Fecal incontinence at six months did not present a statistically significant difference between the two groups (Fisher's exact test p-value > 0.9). Patients with complex perianal fistulas had a statistically significant higher probability of undergoing a second surgery (x2 test p-value = 0.019). the combination of pelvic MRI and 3D-EAUS showed improved metrics of diagnostic accuracy and should be used in the preoperative evaluation of all patients with perianal fistulas, especially those with complex types.

A review of pharyngocutaneous fistula management in head and neck malignancies.

Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols regarding the surgical timing and specific procedures could be found in the current literature. The authors aimed to review their clinical experience in surgical management and develop an algorithmic approach accordingly. A retrospective review of all hypopharyngeal cancer patients who developed pharyngocutaneous fistula during 2017 to 2021 at our hospital was conducted. Seventeen patients developed pharyngocutaneous fistula in all 321 pharyngeal cancer admissions during this period. Three patients received interventions at acute stage (?2 weeks), with two direct repairs Three patients received interventions at acute stage (?2 weeks), with two direct repairs and one regional flap coverage then negative pressure wound therapy. Nine received interventions at subacute stages (2 weeks to 3 months), with 4 resolved after debridement and direct repair yet another 4 underwent regional flap reconstruction and 1 free flap reconstruction. Five chronic fistula (>3 months) received secondary reconstructions utilizing a double-layered repair of local turn-over flaps for the internal mucosal opening and another flap harvest (four regional flaps and one free flap) to cover the outer skin defect. All patients after the palliative surgery achieved complete remission of fistula at follow follow-up. Different conservative and surgical approaches should be adopted according to the acute, subacute, and chronic stages of pharyngocutaneous fistula after palliative head and neck reconstructions.

Anatomic Study of Petrous Bone and Its Surrounding Structures in the Extended Anterior Transpetrosal Approach.

Extended anterior transpetrosal approach (ATPA) includes drilling the petrous bone to achieve maximal exposure of the petroclival region. Injuring of surrounding neurovascular structures, such as the internal carotid artery (ICA), during the procedure may result in severe complications. In this study, we aimed to use computer topographic images to provide comprehensive anatomic information on the petrous bone and surrounding structures to help surgeons during the extended ATPA. Computer topographic angiography images of 110 individuals were reviewed, and measurements were performed on coronal, sagittal, and axial planes following multiplanar reformation. The petrous apex and sagittal midline were used to locate the anterior, middle, and posterior parts of the petrous bone and petrosal segment of the ICA during the ATPA. The thicknesses of the petrous bone were 3.28±0.71, 3.53±0.88, and 7.02±1.11mm at the petrous apex, trigeminal impression, and internal opening of internal auditory canal (IAC) positions, respectively. The distances between the petrous apex to the trigeminal impression, internal opening of the IAC, auris interna, and labyrinth were 7.39±1.62, 15.95±2.48, 17.39±2.39, and 29.00±3.18mm, respectively. Furthermore, the petrosal segment of the ICA was located at the above landmarks on the petrous bone. Our findings provide anatomic information on the petrous bone and surrounding structures during the extended ATPA procedure based on fixed anatomic landmarks so as to achieve maximal exposure and reduce the number of complications.

A Comprehensive Case Study on the Successful Treatment of Perianal Fistula in a Four-Year-Old Male

This case study gives a thorough account of how a four-year-old boy who had been experiencing recurrent discomfort and perianal discharge for six months was diagnosed, treated, and then recovered. An MRI fistulogram revealed a transphincteric fistula with both the internal and exterior apertures placed at the 9 o'clock position, despite the absence of concomitant diseases and prior procedures. The treatment method used methylene blue infiltration to verify the internal aperture and then metal probe probing of the track. From the exterior to the internal opening, a partial fistulotomy was carried out, and the raw proximal track was treated with Kshara sutra. Surprisingly, the fistula was fully cured in just three months. This case study gives priceless information that could direct future treatments and serves as a testimonial to the efficiency of such a therapy method in controlling juvenile fistulas.

Investigating the Effects of Trigeminal Impression and Internal Acoustic Opening Morphology Differences for Possible Surgical Applications

The exhaustive information regarding the types of trigeminal pore (TP) or trigeminal impression (TI), internal acoustic opening (IAO), and related surgical approaches is lacking in the literature. Therefore, this study is performed to further elucidate the types of TP or TI, IAO, and the relationships with critical surgical landmarks in the skull base. Trigeminal impression (TI) and internal acoustic opening (IAO) found in 11 dry skulls, 24 right temporal bones, and 25 left temporal bones were examined on both sides to define their relationship to each other and nearby structures. The age and sex of these bones were not identified. Besides these, 77 skulls were examined by radiologic imaging methods. These skulls were identified by gender. According to test results, there was a significant difference between the left and right internal acoustic opening in the case of horizontal dimension (HD). The left HD-IAO is bigger than the right one. In addition, right HD-IAO, vertical dimension (VD) of right internal acoustic opening, left HD-IAO, and left VD-IAO values differed significantly in male and female patients. Investigating the relationship of TI and IAO with relevant structures suggests that surgical approaches involving the TP and IAO indicated that surgical approaches considering the TI and IAO variations may be used in the development of surgical processes and primary surgical interventions.

Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn's disease: A cohort study from northern India.

Fistulizing perianal Crohn's disease (CD) is a debilitating condition associated with significant morbidity and reduction in thequality of life. Magnetic resonance imaging (MRI) of the pelvis is the preferred imaging modality for thecomprehensive assessment of the perianal fistula. There is apaucity of data from India on the MRI spectrum of complex perianal fistula in CD. A single-centre cross-sectional analysis of patients with fistulizing perianal CD, who underwent pelvic MRI between January 2020 and December 2021, was performed. The clinical (age, sex, disease duration, disease location and behavior, disease activity [Perianal Disease Activity Index, PDAI] and treatment received) and radiological (number and location of fistulae, extensions, number and location of internal and external openings, fistula activity, presence or absence of perianal abscess and associated proctitis) characteristics of complex perianal fistula (defined according to the American Gastroenterological Association classification) were recorded. Of total 175 patients with CD who attended the gastroenterology clinic during the study period, 27 (15.42%) (mean age 42±15.5 years, 62.96% females and median disease duration four years) had complex perianal fistula and were included in the analysis. The mean PDAI was 5.48±2.53. The median Van Assche Index was 17 (interquartile range [IQR] 13-19). A majority (96.29%) of the fistulae were trans-sphincteric and four (14.81%) fistulae extended into the supralevator space. All fistulae were active on MRI. Concomitant perianal abscess and proctitis were seen in 59.26% (n=16) and 62.96% (n=17) of patients, respectively. Combination therapy with biologics and antibiotics/immune-suppressants were the most commonly prescribed medical therapy. Six (22.22%) patients underwent combined medical and surgical (non-cutting seton, fistulectomy, fecal diversion) treatment. The cumulative risk of thedevelopment of fistulizing perianal CD in a northern Indian cohort was similar to the western populations. Complex perianal fistulae were predominantly trans-sphincteric and commoner in females. MRI evaluation is pivotal forthe delineation of fistula anatomy, assessment of disease extent and activity and theevaluation of concomitant perianal abscess and other complications.

Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study.

Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients. We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non-stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity. Of the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2-34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration. Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor.

Feasibility of using transperineal ultrasound as a diagnostic test in perianal abscesses and fistulas under resource-limited setting: A retrospective study

Background: This study aimed to evaluate the feasibility of preoperative transperineal ultrasound (TPUS) in evaluating perianal abscesses and fistulas under a resource-limited setting and compared it with surgical findings as gold standards. Material and Methods: A retrospective study conducted between February 2017 and March 2020, involving 85 patients who were presented to the emergency department with suspected perianal suppurative conditions and underwent TPUS with a 4- to 7-MHz curved transducer, were enrolled. Perianal abscesses and fistulas were classified according to the American Gastroenterological Association criteria and Parks’ classification. Data on patients’ characteristics, TPUS findings, and operative findings were analyzed. The sensitivity and accuracy of preoperative TPUS in detecting lesions were assessed and compared with the surgical findings as gold standards. Result: The mean age of study participants was 32.12 ± 13.83 years and there were 69 (81.2%) men and 16 (18.8%) women. The TPUS findings were consistent with surgical results in 74 out of 85 patients. In 11 out of the 85 cases, preoperative TPUS missed the diagnosis, and in 5 (6.7%) out of 74 cases, TPUS showed other abnormalities. Perianal abscesses, fistula, and mixed abscesses (with fistula or sinus) were observed in 29 (39.2%), 34 (46%), and 6 (8.1%) cases, respectively. The sensitivity, specificity, and overall accuracy of TPUS in detecting perianal abscesses and fistulas were 86%, 100%, and 87%, respectively. TPUS correctly detected all perianal abscesses with their subtypes (sensitivity of 100%, excellent degree of correlation, k = 1). In the case of fistulas, the accuracy of TPUS in detecting subtype fistula was 87.5% (excellent degree of correlation, k = 0.81); however, it showed low sensitivity in identifying suprasphincteric fistula (5/10, 50%). Additionally, the accuracy of TPUS in detecting the number of external openings was 87.5%, with a reasonable degree of correlation (k = 0.78). However, the accuracy of TPUS in detecting the site of internal openings and tracts of the fistula was 82% and 95%, respectively. Within a mean follow-up of 6.571 ± 1.72 months, there was a recurrence in one fistula patient. Conclusion: Although the TPUS was not precise enough to diagnose suprasphincteric fistulas, it provides good diagnostic accuracy in identifying perianal abscesses and fistulas. Under resource-limited settings where MRI is unavailable or under emergencies, we recommend TPUS as the first diagnostic test for patients with perianal abscesses and fistulas.

Effect of Preloading with Consolidation on the Undrained Bearing Capacity of Ring Foundations

The undrained bearing capacity of ring foundations has received significant attention from researchers, but most of the reported studies do not reflect the effect of consolidation due to preloading. In this work, we investigated the postconsolidation undrained vertical capacity of ring foundations resting on nonhomogeneous clays using finite differential analyses and the modified Cam-clay constitutive model. The results are presented in nondimensional form and were compared with data available in the literature. The coupling influences of the internal opening of the foundation, the magnitude of the preloading, the duration of the consolidation, and the initial overconsolidation ratio of the clay were all considered. A methodology based on approximating expressions that captured the numerical results well is proposed as a way of predicting the undrained capacity gain of ring foundations for any degree of preloading and consolidation.

Endoscopic Suture With Chemocauterization: An Effective Treatment of Congenital Pyriform Sinus Fistula.

Endoscopic cauterization is an effective method for treating pyriform sinus fistula (PSF). However, these approaches sometimes result in a higher failure rate. We present an effective technique utilizing suture combined with chemocauterization as first-line treatment in patients with PSF and evaluate the safety and efficacy of its use in 126 patients. Retrospective study. Tertiary referral center. Retrospective case review of patients treated between March 2012 and June 2021 at our institution with descriptive statistical analysis. A total of 126 patients with PSF were included in this study with a mean age of 14.7 years. There was no sex predilection. The majority of patients presented with a left-sided neck lesion (89.7%). Ten patients presented following prior attempts at the surgery of the PSF at another institution; 8 via open surgery and 2 following endoscopic CO2 laser cauterization; other patients only had a history of repeat incision and drainageor antibiotic treatment. The success rate of obliteration of the internal opening was 96.83% after a single treatment without complications. Following reoperation, a successful outcome was achieved in the remaining 4 patients. Length of stay ranged from 10 to 14 days. No recurrences occurred within 12 to 120 months followed-up. Endoscopic suture combined with chemocauterization is a safe and effective treatment of PSF. Surgery can be performed during the acute cervical inflammatory period without increased risk of complication or recurrence, however, patients found to have acute changes affecting the pyriform sinus should be treated with a staged surgery strategy.

Cadaveric Evaluation of the Canalicular-Lacrimal Sac-Mucosal Folds and Clinical Implications.

The purpose is to study the anatomical variations of the characteristic mucosal folds at the canalicular-lacrimal sac junction and their potential clinical implications. Twelve lacrimal drainage systems of six fresh frozen Caucasian cadavers were studied to assess the openings of the common canaliculus into the lacrimal sac. A standard endoscopic dacryocystorhinostomy was performed until complete lacrimal sac marsupialization and reflection of the flaps. All specimens were subjected to clinical assessment of lacrimal patency via irrigation. A high-definition nasal endoscopy assessed the internal common opening and the mucosal folds in its close vicinity. Probing at the internal common opening was performed to aid in the assessment of the folds. Videography and photo documentation was performed. All 12 specimens had a single common canalicular opening. Ten of the 12 specimens (83.3%) were noted to have canalicular/lacrimal sac-mucosal folds (CLS-MF). Anatomical variations were noted across these 10 specimens and included inferior 180° (n = 6), anterior 270° (n = 2), posterior 180° (n = 1), and 360° CLS-MF (n = 1). Cases were randomly chosen to demonstrate the clinical implications of misinterpreting them as canalicular obstructions or the potential to cause an inadvertent false passage. The inferior 180° was the most common CLS-MF noted in the cadaveric study. It is helpful for clinicians to recognize the prominent CLS-MF and their clinical implications intraoperatively. Further fundamental work is needed to characterize the anatomy and the possible physiological role of CLS-MFs.

Three-dimensional pelvic ultrasound is a practical tool for the assessment of anal fistula

ObjectiveThis study aims to investigate the diagnostic value of three-dimensional pelvic ultrasound in the preoperative assessment of anal fistula compared with findings of MRI and surgery.MethodsA total of 67 patients (62 males) with suspected anal fistula were analyzed retrospectively. Preoperative three-dimensional pelvic ultrasound and magnetic resonance imaging were performed in all patients. The number of internal openings and the type of fistula were recorded. The accuracy of three-dimensional pelvic ultrasound was determined by comparing these parameters with surgical outcomes.ResultsAt surgery, 5 (6%) were extrasphincteric, 10 (12%) were suprasphincteric, 11 (14%) were intersphincteric, and 55 (68%) were transsphincteric. There was no significant difference in the accuracy of pelvic 3D US and MRI, based on internal openings (97.92%, 94.79%), anal fistulas (97.01%, 94.03%), and those under Parks classification (97.53%, 93.83%).ConclusionThree-dimensional pelvic ultrasound is a reproducible and accurate method for determining the type of fistula and detecting internal openings and anal fistulas.

Thermal Analysis of an Ultrasonic Aspirator Micro Claw Tool Compared With Standard High-Speed Drilling During Internal Auditory Canal Opening in a Cadaveric Model.

The ultrasonic aspirator micro claw tool (UAmCT) can be used to remove the bone of the internal auditory canal (IAC) during vestibular schwannoma resection via the retrosigmoid approach (RSA) without the risk of a spinning drill shaft. However, the thermal profile of the UAmCT during IAC removal has not been reported. To compare the thermal profile of the UAmCT during access of the IAC to that of a conventional high-speed drill (HSD) and to present an illustrative case of this application. IAC opening via RSA was performed in 5 embalmed cadaveric specimens using the UAmCT with 3, 8, and 15 mL/min irrigation on the left and the HSD at 75 000 revolutions per minute and 0%, 14%, and 22% irrigation on the right. Peak bone surface temperatures were measured 4 times in 20-second intervals, and statistical analyses were performed using SPSS software. An illustrative case of a vestibular schwannoma resected via an RSA using the UAmCT to access the IAC is presented. The IAC was opened in all 5 specimens using both the UAmCT and HSD without complication. The mean peak bone surface temperatures were significantly lower with the UAmCT compared with the HSD ( P < .001). The UAmCT did not meaningfully prolong the operating time in the illustrative case, and the IAC was accessed without complication. The UAmCT may be a safe and effective alternative to HSD for IAC opening during vestibular schwannoma resection via the RSA. Larger studies under clinical conditions are required to further validate these findings.

A Comparison of Laser and Fistulotomy Techniques in the Treatment of Fistula-in-Ano.

Background Anal fistulas are a common complication of perianal abscesses.The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The aim of this study was to evaluate the efficacy and cost-effectiveness of laser ablation compared to fistulotomy in the treatment of anal fistulas. Materials and methods The patients were examined for external and internal openings of the fistula, its number, length, type, relationship with the sphincters, and any previous history of abscess or proctological surgery. The surgical procedures, complications, incontinence, recurrence, and recovery time were evaluated and compared between the two groups. The laser ablation group received an intermittent laser application at a wavelength of 1470 nmand 10 watts for three seconds, while the fistulotomy group underwent cutting of the fistula tract with electrocautery while keeping a stylet in place. Results A total of 253 patients were included in this retrospective study, with 149 patients undergoing fistulotomy and 104 patients undergoing laser ablation. The patients were evaluated based on the type, number, and location of internal and external openings, and the length of the fistula tract according to the Parks classification. The mean follow-up period was 9.0±4.3 months. The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group. The recurrence rate was also found to be higher in patients with low transsphincteric fistulas and in patients with diabetes mellitus. Conclusion Our study findings indicate that while laser ablation may be associated with less pain and quicker recovery time, it may also have a higher recurrence rate compared to fistulotomy.We believe that laser ablation is a valuable option for surgeons to consider early on in the treatment process, especially in cases where fistulotomy is not suitable.

Clinicopathological features of corneal invasion by filtering bleb

PurposeTo describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery.MethodsWe reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered.ResultsThe mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients’ conditions.ConclusionFiltering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistula with Surgical Correlation

Objective: This study's goal was evaluate the part magnetic resonance imaging plays in the identification and classification in perianal fistulas to contrast those results with those from surgery. Study Design: Cross Sectional Place &amp; Duration: Study carried out between the periods of January 2022 to Aug 2022 Material &amp; methods: This study was tested on 50 patients in the hospital. Patients who had undergone MRI pelvis with or without contrast study were counted in the current study. Patients who undergone surgery prior or had recurrent perianal illness were not included in the study. Short T1 inversion recovery, T2 weighted (T2W) sagittal, axial, and coronal MRI sequences (STIR), T1W axial, and coronal sequences, and T1W post contrast axial &amp; coronal sequences were all evaluated. Results Reflected: while evaluation by MRI, among 50 patients, 45 which is 90% were man and 5 which is 10% were female gender. In 45 (90%) of the 50 patients overall, postoperative results confirmed perianal fistula. A total of 5(10%) patients had perianal sinus only. The primary tract was found to have a sensitivity and specificity of 97.73% and 83.33%, respectively, whereas the abscess had a sensitivity and specificity of 88.89% and 95.12%. High sensitivity was also acknowledged for accurately locating the internal opening (95.45%), detecting the horseshoeing (90.91%), correctly identifying the secondary ramification (92.86%) with specificity (94.44%). Conclusion: It is found that MRI demonstrated superior performance in evaluating perianal fistula with critical parameters (primary tract and its grading, internal opening, secondary ramification, abscess, horseshoeing). Pre-operative perianal fistula assessment should be correct to prevent problems and recurrence, which will decrease the need for additional surgeries. Practical Implication: As a result of this study, unnecessary radiation and diagnostic time could be avoided in the preoperative assessment of PAF in ano using MRI. It would also help decrease complications and unnecessary surgeries. Keywords: Magnetic Resonance Imaging and Perianal Fistula, perianal sinus, horseshoeing