The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform

Richard L Nelson - One of the best experts on this subject based on the ideXlab platform.

  • dermal island flap Anoplasty for transsphincteric fistula in ano assessment of treatment failures
    Diseases of The Colon & Rectum, 2000
    Co-Authors: Richard L Nelson, Jose R Cintron, Herand Abcarian
    Abstract:

    PURPOSE: The aim of this study was to assess the treatment failures of island-flap Anoplasty for fistula-in-ano, a procedure designed to treat fistula without sphincter division. METHODS: Data concerning all patients having dermal island-flap Anoplasty for the treatment of transsphincteric fistula were reviewed. Variables assessed were age, gender, radial fistula location, cause, Crohn's disease, previous fistula operations, other complicating illnesses, internal sphincter closure, simultaneous use of fibrin adhesive injection, and use of combined dermal and rectal flap for large fistulas. Postoperative data collected included persistence of the distal tract, recurrence of the fistula, and treatment of the recurrence. Recurrence (or persistence) of the fistula was the dependant variable and each risk factor for recurrence was assessed using chi-squared analyses. RESULTS: Seventy-three flaps were performed in 65 individuals. Recurrence developed 17 times in 13 individuals. Recurrence was more likely to occur in males, patients who have had previous treatment of fistulas, patients with large fistulas requiring combined flaps, and patients who had simultaneous fibrin glue injection. Patients with Crohn's disease and individuals having internal sphincter closure had fewer recurrences. Factors reaching statistical significance included closure of the internal sphincter, the use of fibrin glue, and cause of the fistula. CONCLUSION: No specific anatomic or demographic characteristic is sufficiently associated with failure to exclude any patient from the operation. Closure of the internal sphincter should be done as part of the procedure and fibrin glue injection should not be done simultaneously.

  • island flap Anoplasty for treatment of transsphincteric fistula in ano
    Diseases of The Colon & Rectum, 1996
    Co-Authors: Alberto Del Pino, Russell K Pearl, Richard L Nelson, Herand Abcarian
    Abstract:

    BACKGROUND: Treatment of fistula-in-ano often replaces one problem, risk of persistent anal sepsis, with another, either incontinence after fistulotomy or mucosal ectropion after rectal flap advancement. A new technique for treatment of transsphincteric fistulas is described that could eliminate risk of both complications. TECHNIQUE: Island flap Anoplasty, previously used in management of anal strictures or ectropion, is modified to treat transsphincteric fistulas. RESULTS: The operation has been performed in 11 patients, 3 of whom had Crohn's disease. Follow-up varied from one to ten months. Early recurrences have occurred in three patients, two with Crohn's disease and one without. Remaining patients have done well. CONCLUSION: This procedure is technically easy to perform and appears to cure transsphincteric fistulas while preserving anal sphincter. In the event of persistence of fistula, other operative options are not eliminated by this procedure. We feel that further experience and longer follow-up is needed to define precise indications for this procedure and to determine if continence is improved more so than with standard fistulotomy.

  • island flap Anoplasty for the treatment of anal stricture and mucosal ectropion
    Diseases of The Colon & Rectum, 1990
    Co-Authors: Russell K Pearl, Vendie H Hooks, Herand Abcarian, Charles P Orsay, Richard L Nelson
    Abstract:

    Twenty patients with benign anal strictures and five patients with mucosal ectropion were treated with island flap Anoplasty. U-shaped or diamond-shaped islands of perianal skin were created, without undermining, and advanced into the anal canal to remedy the stricture or site of ectropion. Over a postoperative follow-up period that averaged 19 months, 16 patients judged their clinical results as excellent and 7 as good. There were two failures. In all patients the skin flaps survived, even in the elderly patients. Island flap Anoplasty is a simple, effective alternative to other forms of Anoplasty such as Y-V advancement or S-plasty.

Herand Abcarian - One of the best experts on this subject based on the ideXlab platform.

  • dermal island flap Anoplasty for transsphincteric fistula in ano assessment of treatment failures
    Diseases of The Colon & Rectum, 2000
    Co-Authors: Richard L Nelson, Jose R Cintron, Herand Abcarian
    Abstract:

    PURPOSE: The aim of this study was to assess the treatment failures of island-flap Anoplasty for fistula-in-ano, a procedure designed to treat fistula without sphincter division. METHODS: Data concerning all patients having dermal island-flap Anoplasty for the treatment of transsphincteric fistula were reviewed. Variables assessed were age, gender, radial fistula location, cause, Crohn's disease, previous fistula operations, other complicating illnesses, internal sphincter closure, simultaneous use of fibrin adhesive injection, and use of combined dermal and rectal flap for large fistulas. Postoperative data collected included persistence of the distal tract, recurrence of the fistula, and treatment of the recurrence. Recurrence (or persistence) of the fistula was the dependant variable and each risk factor for recurrence was assessed using chi-squared analyses. RESULTS: Seventy-three flaps were performed in 65 individuals. Recurrence developed 17 times in 13 individuals. Recurrence was more likely to occur in males, patients who have had previous treatment of fistulas, patients with large fistulas requiring combined flaps, and patients who had simultaneous fibrin glue injection. Patients with Crohn's disease and individuals having internal sphincter closure had fewer recurrences. Factors reaching statistical significance included closure of the internal sphincter, the use of fibrin glue, and cause of the fistula. CONCLUSION: No specific anatomic or demographic characteristic is sufficiently associated with failure to exclude any patient from the operation. Closure of the internal sphincter should be done as part of the procedure and fibrin glue injection should not be done simultaneously.

  • island flap Anoplasty for treatment of transsphincteric fistula in ano
    Diseases of The Colon & Rectum, 1996
    Co-Authors: Alberto Del Pino, Russell K Pearl, Richard L Nelson, Herand Abcarian
    Abstract:

    BACKGROUND: Treatment of fistula-in-ano often replaces one problem, risk of persistent anal sepsis, with another, either incontinence after fistulotomy or mucosal ectropion after rectal flap advancement. A new technique for treatment of transsphincteric fistulas is described that could eliminate risk of both complications. TECHNIQUE: Island flap Anoplasty, previously used in management of anal strictures or ectropion, is modified to treat transsphincteric fistulas. RESULTS: The operation has been performed in 11 patients, 3 of whom had Crohn's disease. Follow-up varied from one to ten months. Early recurrences have occurred in three patients, two with Crohn's disease and one without. Remaining patients have done well. CONCLUSION: This procedure is technically easy to perform and appears to cure transsphincteric fistulas while preserving anal sphincter. In the event of persistence of fistula, other operative options are not eliminated by this procedure. We feel that further experience and longer follow-up is needed to define precise indications for this procedure and to determine if continence is improved more so than with standard fistulotomy.

  • island flap Anoplasty for the treatment of anal stricture and mucosal ectropion
    Diseases of The Colon & Rectum, 1990
    Co-Authors: Russell K Pearl, Vendie H Hooks, Herand Abcarian, Charles P Orsay, Richard L Nelson
    Abstract:

    Twenty patients with benign anal strictures and five patients with mucosal ectropion were treated with island flap Anoplasty. U-shaped or diamond-shaped islands of perianal skin were created, without undermining, and advanced into the anal canal to remedy the stricture or site of ectropion. Over a postoperative follow-up period that averaged 19 months, 16 patients judged their clinical results as excellent and 7 as good. There were two failures. In all patients the skin flaps survived, even in the elderly patients. Island flap Anoplasty is a simple, effective alternative to other forms of Anoplasty such as Y-V advancement or S-plasty.

Russell K Pearl - One of the best experts on this subject based on the ideXlab platform.

  • island flap Anoplasty for treatment of transsphincteric fistula in ano
    Diseases of The Colon & Rectum, 1996
    Co-Authors: Alberto Del Pino, Russell K Pearl, Richard L Nelson, Herand Abcarian
    Abstract:

    BACKGROUND: Treatment of fistula-in-ano often replaces one problem, risk of persistent anal sepsis, with another, either incontinence after fistulotomy or mucosal ectropion after rectal flap advancement. A new technique for treatment of transsphincteric fistulas is described that could eliminate risk of both complications. TECHNIQUE: Island flap Anoplasty, previously used in management of anal strictures or ectropion, is modified to treat transsphincteric fistulas. RESULTS: The operation has been performed in 11 patients, 3 of whom had Crohn's disease. Follow-up varied from one to ten months. Early recurrences have occurred in three patients, two with Crohn's disease and one without. Remaining patients have done well. CONCLUSION: This procedure is technically easy to perform and appears to cure transsphincteric fistulas while preserving anal sphincter. In the event of persistence of fistula, other operative options are not eliminated by this procedure. We feel that further experience and longer follow-up is needed to define precise indications for this procedure and to determine if continence is improved more so than with standard fistulotomy.

  • island flap Anoplasty for the treatment of anal stricture and mucosal ectropion
    Diseases of The Colon & Rectum, 1990
    Co-Authors: Russell K Pearl, Vendie H Hooks, Herand Abcarian, Charles P Orsay, Richard L Nelson
    Abstract:

    Twenty patients with benign anal strictures and five patients with mucosal ectropion were treated with island flap Anoplasty. U-shaped or diamond-shaped islands of perianal skin were created, without undermining, and advanced into the anal canal to remedy the stricture or site of ectropion. Over a postoperative follow-up period that averaged 19 months, 16 patients judged their clinical results as excellent and 7 as good. There were two failures. In all patients the skin flaps survived, even in the elderly patients. Island flap Anoplasty is a simple, effective alternative to other forms of Anoplasty such as Y-V advancement or S-plasty.

Mohamed Farid - One of the best experts on this subject based on the ideXlab platform.

Yikhong Ho - One of the best experts on this subject based on the ideXlab platform.

  • controlled randomized trial of island flap Anoplasty for treatment of trans sphincteric fistula in ano early results
    Techniques in Coloproctology, 2005
    Co-Authors: Kok Sun Ho, Yikhong Ho
    Abstract:

    Treatment of trans–sphincteric fistula is usually a compromise between recurrence and incontinence. Dermal island flap Anoplasty has been found to be useful in the treatment of these fistulas. We performed a randomized trial to compare dermal island flap Anoplasty with conventional treatment for trans–sphincteric fistula–in–ano. Seventy nine patients with fistula–in–ano were recruited; twenty patients with trans–sphincteric fistula confirmed by endoanal ultrasound were prospectively randomized to receive either dermal island flap Anoplasty (IFA) or conventional treatment (CVN) for trans–sphincteric fistula–inano. Conventional treatment consisted of lay open fistulotomy or seton insertion if deemed unsuitable for fistulotomy. Dermal island flap Anoplasty involved a cutaneous advancement flap into the rectum. Pain scores, fecal incontinence scores, operative complications, wound healing and recurrence rates were charted. Two patients in the CVN group required seton insertions, which were still intact at the 9–month follow–up. Two patients with similar high trans–sphincteric fistula in the IFA group avoided having a long–term seton. There were no differences in the postoperative pain score, incontinence score, complications, wound healing and recurrence rates between the two groups. IFA is a safe and useful method for treating transsphincteric fistula. It can be considered when a suprasphincteric extension is suspected, thus avoiding risk of incontinence or the discomfort of a long–term seton.

  • Controlled, randomized trial of island flap Anoplasty for treatment of trans–sphincteric fistula–in-ano: early results
    Techniques in Coloproctology, 2005
    Co-Authors: Kok Sun Ho, Yikhong Ho
    Abstract:

    Treatment of trans–sphincteric fistula is usually a compromise between recurrence and incontinence. Dermal island flap Anoplasty has been found to be useful in the treatment of these fistulas. We performed a randomized trial to compare dermal island flap Anoplasty with conventional treatment for trans–sphincteric fistula–in–ano. Seventy nine patients with fistula–in–ano were recruited; twenty patients with trans–sphincteric fistula confirmed by endoanal ultrasound were prospectively randomized to receive either dermal island flap Anoplasty (IFA) or conventional treatment (CVN) for trans–sphincteric fistula–inano. Conventional treatment consisted of lay open fistulotomy or seton insertion if deemed unsuitable for fistulotomy. Dermal island flap Anoplasty involved a cutaneous advancement flap into the rectum. Pain scores, fecal incontinence scores, operative complications, wound healing and recurrence rates were charted. Two patients in the CVN group required seton insertions, which were still intact at the 9–month follow–up. Two patients with similar high trans–sphincteric fistula in the IFA group avoided having a long–term seton. There were no differences in the postoperative pain score, incontinence score, complications, wound healing and recurrence rates between the two groups. IFA is a safe and useful method for treating transsphincteric fistula. It can be considered when a suprasphincteric extension is suspected, thus avoiding risk of incontinence or the discomfort of a long–term seton.