ABSTRACT: : Ligation of intersphincteric fistula tract is a novel surgical technique in the treatment of transsphincteric fistula-in-ano that has been shown to be successful in the short term. Median follow-up in current literature ranges from 5 to 9 months. However, the long-term success rate is unknown.
: This study describes our long-term results in performing the ligation of intersphincteric fistula tract procedure.
: This study is a retrospective review.
: Thirty-eight patients from August 2008 to October 2011 were evaluated.
: All patients underwent the ligation of intersphincteric fistula tract for fistula-in-ano.
: Patient and fistula characteristics, primary healing rate, secondary healing rate, previous treatments, and failures were reviewed.
: The median follow-up was 26 months (range, 3-44 months), and 26 patients (68%) were followed for greater than 12 months. The overall primary healing rate was 61% (23 of 38), and it was 62% (16 of 26) in patients followed for over 12 months. Eighty percent (12/15) of the failures are early failures (persistent symptoms or failure at ≤6 months), and 20% are late failures (>6 months) with 1 failure occurring 12 months postprocedure. Increase in length of fistula tract was associated with decreased healing (OR 0.55, 95% CI 0.34-0.88, p = 0.01). There were no intraoperative complications and no reported incontinence.
: Our study demonstrates favorable long-term results for the ligation of intersphincteric fistula tract procedure. It appears that long tracts negatively affect healing, and late failures can occur up to 12 months postoperatively. Understanding the type of failure can help guide subsequent treatment to maximize healing success.
Diseases of the Colon & Rectum 03/2013; 56(3):343-7. · 3.13 Impact Factor
ABSTRACT: Preoperative serum albumin level is well recognized as a general predictor of adverse surgical outcomes in patients with gastrointestinal (GI) malignancy. Whether serum albumin or prealbumin levels can better predict postoperative surgical complications and death remains unknown. A retrospective review of 641 consecutive patients operated nonemergently for GI malignancies between January 1, 1997, and July 31, 2008, disclosed that 104 patients (16.2%) had complications and 23 (3.6%) subsequently died. All 641 patients had preoperative determination of serum albumin level (cost $0.13 per test), whereas 379 (59.1%) also had preoperative determination of serum prealbumin level (cost $2.27 per test). An albumin level below the discriminatory threshold of 3.2 g/dL was a significant predictor of overall postoperative morbidity, infectious and noninfectious complications, and mortality (all P < 0.001). In contrast, a prealbumin level below the discriminatory threshold of 18 mg/dL was a predictor of only overall morbidity (P = 0.014) and infectious complications (P = 0.024), but not of noninfectious complications or mortality (P = nonsignificant). We conclude that compared with the preoperative serum prealbumin level, the albumin level has superior predictive value for overall postoperative morbidity, both infectious and noninfectious complications, and mortality. The inclusion of serum prealbumin level in the routine preoperative testing of patients with GI malignancy for the purpose of predicting postoperative outcomes is neither clinically necessary nor cost-effective.
The American surgeon 10/2011; 77(10):1286-9. · 1.28 Impact Factor
ABSTRACT: Colorectal cancer (CRC) is third in mortality rate amongst Asian Americans. However, CRC characteristics in this patient population have been poorly defined. A retrospective review at an urban tertiary hospital located in an underserved region was performed to determine CRC characteristics for Asian Americans in comparison to other races. Four hundred fourteen patients were represented by Hispanics (n=161), African Americans (n=101), Asians (n=83), and Whites (n=69). The majority of Asian American patients (n=70, 84%) presented with a left-sided lesion. This proportion was higher than that seen in African Americans (59%, P < 0.0003), Hispanics (66%, P < 0.0033), and Whites (63%, P < 0.0036). Thirty-six Asian American patients presented with Stage III disease which was the most frequent presenting stage for this patient population and also statistically higher than all the other races. Furthermore, Asian Americans in this study still presented predominantly with left-sided lesions and in a more advanced stage. These findings suggest a potential benefit of initially offering flexible sigmoidoscopy given the decreased compliance among Asian Americans to obtain routine CRC screening. Ultimately, this modality may be more acceptable, leading to higher compliance for CRC screening in Asian Americans without likely degradation in cancer detection rates.
The American surgeon 10/2010; 76(10):1154-7. · 1.28 Impact Factor