Abstract

Introduction: In Colo-proctology, the high incidence of Ano-rectal diseases and the economic impact of various types of surgical treatments have motivated attempts to discover possibilities of Outpatient management of these Ailments. The advent of Minimally Invasive Procedures (MIP) and recent technological advances have made feasible the treatment of these conditions in the scope of day care Surgery.

Aims: In this study we evaluate our experience in an Outpatient unit solely dedicated to the Ambulatory treatment of Benign Anorectal disease by Minimally Invasive Procedures.

Material and Methods: It’s a retrospective study which includes 8420 patients who underwent various Day care Procedures at Treat Piles Clinic from 2012-2019.Patients who underwent LHP, DG HAL-RAR, lateral Internal Sphincterotomy, FiLAC and SiLaT for Grade 2-3 Hemorrhoids, Grade 4 Hemorrhoids, Anal Fistula and Pilonidal Sinus respectively were evaluated for the Outcome, Complications, Recurrence rate and the need for Readmission. Patient Groups: Group A: Patients with Hemorrhoidal Disease; Group B: Patients with Anal Fissure; Group C: Patients with Anal Fistula; Group D: Patients with Pilonidal Sinus.

Results: Group A: A total number of – patients were treated for Hemorrhoidal Disease by various Minimally invasive techniques and were followed up for a period of --months. 18% (631) of the patients were previously operated by conventional method. Gr1 Hemorrhoids: IRC was performed in 256 patients which showed complete resolution of symptoms in all the patients. There were no complications or Recurrence reported in this group. Grade 2 and 3: LHP alone was done in 1451 patients, in which complete resolution of symptoms was seen in 1296 patients within the 2nd postoperative week. Where as 126 patients complained of relapsing symptoms with relief after 4 postop weeks. Postoperative bleeding was reported in 12 patients on day 2-3; inflammatory edema was reported in 7 cases, while Rectal perforation was reported in 1 patient who was a known Alcoholic and Smoker with history of Cirrhosis. Recurrence was seen in 1% (29) of the cases. Readmission was required in 3 cases, for supportive treatment. DG HAL RAR alone was done in 1800 patients, out of which 1280 recovered completely by 1st postop week, while 484 patients had relapsing symptoms which subsided by 3rd postop week. Rectal tear was reported in 2 patients. Postop Recurrence was reported in 2%(36) patients. Group B: Chemical Sphincterotomy was performed in 260 patients and complete healing of Fissure was reported in –patients at day—and persistent symptoms were reported in 2% (5) patients. Percutaneous Minimally invasive laser Sphincterotomy was done in 2850 patients, with resolution of symptoms in all the cases by 3rd postop week. No recurrence was reported. Group C: 1420 patients underwent FiLAC procedure for Anal Fistula out of which 70% (994) patients had previously been operated for Anal Fistula at other Centers. The mean follow up time was 18 months. Primary healing of the Fistula Tract was observed in 1321 patients; while recurrence occurred in 99 cases (7%) after a mean period of 2 months. Group D: A total number of 383 patients with Pilonidal Sinus underwent Sinus Tract Ablation procedure, primary healing of the tract was reported in 368 patients while recurrence was seen in 15 cases (4%)

Conclusion: Ambulatory treatment of Anorectal diseases by Minimally invasive Procedures have good results with minimal complication rate, recurrence and hospitalization. The outcome of the procedures are only expected to be improved by the increasing experience.

Keywords: Minimally Invasive Procedures; Patients; Disease

References

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Citation

Citation: Sanjeev Singh Yadav., et al. "Outcome of Minimally Invasive Proctology (MIP) in a Daycare Unit".Acta Scientific Gastrointestinal Disorders 4.1 (2020): 14-17.

Copyright

Copyright: © 2020 Sanjeev Singh Yadav., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.