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Biomedical subjects

P J Gupta

Publications and source records attributed to P J Gupta.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of rectal mucosal prolapse with radiofrequency coagulation and plication--a new surgical technique.

BACKGROUND: This study was designed to assess the outcome of using a new technique of mucosal ablation using a radiofrequency device followed by its plication for rectal mucosal prolapse and to compare the results with those under the conventional ligature and excision procedure. MATERIALS AND METHODS: The procedure of radiofrequency ablation and mucosal plication (RAMP) is described. A Ellman radiofrequency generator was used for the procedure. Out of the 46 patients with rectal mucosal prolapse, 24 patients were randomized to undergo ligature and excision procedure (LEP) and 22 were operated with RAMP. The operating time, amount of pain (VAS scale)[Primary end points], postoperative analgesic requirement, time to return to work, wound healing period and postoperative complications were documented. RESULTS: Radiofrequency ablation and mucosal plication procedure on an average resulted in shorter operation time (9 vs. 32 minutes, p < 0.0001), shorter hospitalization (16 vs. 42 hours, p < 0.0001) significantly lesser postoperative pain, fewer cumulative requests for analgesia by the patients (21 vs. 54 tablets, p < 0.0001), earlier return to work (7 vs. 18 days, p < 0.0001) and faster wound healing time (14 vs. 35 days, p < 0.0001). The complication rate was 9 % with RAMP group and 29 % with LEP group. CONCLUSION: The procedure of radiofrequency ablation and plication of mucosa shows promising results in patients with rectal mucosal prolapse. Being safe, effective, and a swift technique, it can be proposed as an improved alternative to conventional surgical procedure.

Adult↗
PubMed2006

Radioablation and suture fixation of advance grades of hemorrhoids. An effective alternative to staplers and Doppler guided ligation of hemorrhoids.

BACKGROUND: for advance grades of symptomatic hemorrhoids (grade III and IV) the author has innovated a procedure called radiofrequency ablation and fixation of hemorrhoids. The procedure is performed as a day care surgery. PATIENTS AND METHODS: the surgical technique and clinical follow-up of patients operated by this technique are presented. An Ellman dual frequency radiofrequency generator was used for ablation, which was followed by suture fixation of the hemorrhoids. Patient satisfaction score was assessed using a visual analogue scale. The results of this procedure are presented and are compared with the results of published data of stapled hemorrhoidopexy and Doppler guided hemorrhoidal artery ligation procedures. RESULTS: between 1998 and 2005, 2,376 patients were operated with this technique. Patient s mean age was 34 years and 1,438 patients were males. The postoperative complication rate was 3.5%, which included secondary bleeding, retention of urine and perianal thrombosis. The recurrence rate was less than 1.5%. The satisfaction score was 9.2 on VAS. CONCLUSIONS: radiofrequency ablation and fixation of hemorrhoids is a technique that results in less postoperative pain, shorter hospital stay, and early return to normal activity. It seems to be a better alternative to stapled hemorrhoidopexy or Doppler guided hemorrhoidal artery ligation with regard to effectiveness and symptomatic relief on long term.

Adult↗
PubMed2006

Radiofrequency coagulation: a new option for early grade bleeding hemorrhoids.

BACKGROUND: The treatment of hemorrhoids has undergone significant changes after introduction of new techniques during last years. Radiofrequency coagulation is a new approach for treating grade I and II hemorrhoids. In this procedure, the hemorrhoidal tissue is coagulated by a high frequency radio wave. The author describes his experience using this new technique. MATERIALS AND METHODS: The procedure was performed using an Ellman radiofrequency generator. Over a period of 18 months, patients with bleeding hemorrhoids were treated with this technique and a 16 months follow-up was carried out to assess a relief in bleeding episodes, complications, and recurrence rate. RESULTS: While 13% of patients experienced persistence or recurrence of bleeding, 2% of patients needed readmission for secondary hemorrhage. None has reported an infective complication. Overall ratio of comfort and patient contentment with pain and bleeding was satisfactory. CONCLUSION: The treatment of bleeding hemorrhoids using the radiofrequency coagulation is technically simple, therapeutically effective and virtually complication free. The equipment is portable, easy handling, long lasting, and needs only little maintenance. Long-term follow-up is necessary to justify reliability of this method (Ref. 49).

Adult↗
PubMed2006

A review of ano-rectal disorders and their treatment.

This article describes the techniques of diagnosis and office-based interventions. From this review one can presume that the primary care provider can effectively relieve most patients' symptoms and who also ensure that more significant bowel disease is not overlooked (Tab. 3, Ref. 17).

Anus Diseases↗
PubMed2005

A study of suppurative pathologies associated with chronic anal fissures.

BACKGROUND: Suppurative pathologies associated with chronic anal fissures are common but not well documented. Fissure abscess, post-fissure fistula, and post-fissure antibioma are but a few of them. These pathologies increase the complications and morbidity of the primary lesion and need a comprehensive approach. METHODS: From the hospital case record of 532 patients treated for chronic anal fissures, 88 patients (16.5%) were found to have one of these pathologies. This retrospective study describes such pathologies in terms of demographics, clinical presentation, pathological features, operative technique and outcome. RESULTS: Of the 88 patients who presented with pain and discharge per anus, 90% could resume their duties within a week of the surgical procedure. Wound healing took between 2 weeks and 2 months. At the last follow- up at 18 months, three patients had a recurrence (3.4%). CONCLUSIONS: Suppuration in chronic anal fissure seems to be more frequent than described. While dealing with the anal fissure, it is desirable to look for and attend to these associated pathologies, especially to avoid complications and morbidity of the primary disease.

Abscess↗
PubMed2005

Ano-perianal tuberculosis--solving a clinical dilemma.

BACKGROUND: Tuberculosis is one of the causes of granulomatous disease within the anorectal region. The clinical features, which include symptoms and signs of anal pain or discharge, multiple or recurrent fistula in ano and inguinal lymphadinopathy, are not characteristically distinct from other anal lesions. It is also difficult to distinguish it from other granulomatous diseases involving the same area. MATERIALS AND METHODS: A Medline database was used to perform a literature search for articles relating to the term 'anal', 'tuberculosis' and 'Koch's'. CONCLUSION: Analysis of the available literature shows that Koch's lesion in and around the anus is not uncommon. The presentation is varied in nature and tuberculosis should be suspected in lesions not responding to the conventional approaches. The treatment is two-fold: surgical for the suppuration and medical for the tuberculosis.

Anus Diseases↗
PubMed2005

A study of the symptomatology of hypertrophied anal papillae and fibrous anal polyps.

BACKGROUND: The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in proctology practice. But the experience is that they tend to produce minor but disturbing symptoms. This study is aimed to assay the impact and utility of attending these two conditions concurrently while dealing with cases of fissure in ano. PATIENTS AND METHODS: The study was carried out in 136 patients with chronic anal fissure having concomitant hypertrophied anal papillae or fibrous anal polyps. After relieving sphincter spasm by sphincterotomy, the polyps or papillae were destroyed using the radio frequency device. A comparison was made for the associated complaints like pruritus, pricking sensation, wetness, crawling sensation in the anus etc. before and after the removal of papillae or polyps by an independent observer blinded to the procedure. RESULTS: After one month of the procedure, the associated symptoms were reduced to a significant extent along with a nearly total decline in the primary complaints of pain and bleeding. There was significant reduction in pruritus (p=0.0003), discharge per anus (p=0.0006), crawling sensation in the anus (p=0.0004) and that of incomplete evacuation (p=0.001) At the follow up after 18 months, only 9 % of patients had recurrence of either anal fissure or symptoms like pruritus. CONCLUSION: This study establishes that removal of hypertrophied anal papillae and fibrous polyps should be carried on a routine basis during surgical treatment of anal fissure. This would add to the effectiveness and completeness of the procedure.

Anus Diseases↗
PubMed2005

Radio surgery in pilonidal sinus: a new approach for the old problem.

BACKGROUND: A wide variety of approaches are employed in dealing with sacro-coccygeal pilonidal sinus disease. They range from a conservative treatment to an extensive surgical excision. However, a method of lying open sinuses is still practiced in many parts of the world due to its simplicity and favourable outcome. MATERIAL AND METHODS: This study describes a modified approach to the above procedure where a radio surgical device has been used to carry out the complete process. Twenty-one patients with chronic pilonidal sinus were treated with this technique of radio surgery. There were 11 males and 10 females. RESULTS: The mean hospital stay was 8 hrs and mean time to return to work was 7 days. Mean healing time was recorded as 71 days. One patient had a delayed wound healing due to premature approximation of the external wound, needing refashioning of the edges. No recurrence was seen at a 2-year follow-up. CONCLUSION: An ideal surgical procedure for pilonidal sinus should be one, aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption and preventing recurrence. The technique of lying open of sinus tract using radio surgery technique resulted in achieving less tissue trauma, pain and inflammation. The patients returned to their routine within a short duration of time. The results do compare with the other extensive surgical procedures in vogue.

Adolescent↗
PubMed2005

Radiofrequency coagulation: a new option in early grades of bleeding hemorrhoids.

BACKGROUND: The treatment for hemorrhoids has undergone significant changes on introduction of new techniques in the last few years. Radiofrequency coagulation is a new approach for treating grades I and II of hemorrhoids. In this procedure, the hemorrhoidal tissue is coagulated by means of high-frequency radio wave. The author has described his own experience with this new technique. MATERIALS AND METHODS: The procedure was performed using an Ellman radiofrequency generator. Over a period of 18 months, patients with bleeding hemorrhoids were treated with this technique and a 16-month follow-up was carried out to assess relief in bleeding episodes, complications, and recurrence rate. RESULTS: While 13 % of patients had persistent or recurrent bleeding, 2 % of patients needed readmission for secondary hemorrhage. None had reported with any infective complication. The overall ratio of comfort, and patient's satisfaction due to relief of pain and bleeding were quite satisfactory. CONCLUSION: The treatment of bleeding hemorrhoids by using radiofrequency coagulation is technically simple, therapeutically effective and virtually complication-free. The equipment is portable, easy to handle, durable, and needs little maintenance. Long-term follow-up is necessary to justify the reliance on this method (Ref. 49).

Adult↗
PubMed2005

Ano-perianal tuberculosis.

A tuberculous origin must be considered when the cause of perianal lesion is unclear to avoid undesirable delay in the diagnosis and treatment. This brief treatise explores the different etiopathogenic, clinical, and diagnostic manifestations of ano-perianal tuberculosis (Tab. 4, Ref. 40).

Anus Diseases↗
PubMed2004

A comparative study between radiofrequency ablation with plication and Milligan-Morgan hemorrhoidectomy for grade III hemorrhoids.

BACKGROUND: Milligan-Morgan (MM) hemorrhoidectomy is the most favored treatment for prolapsed hemorrhoids. However, it may be associated with severe postoperative pain, long periods of convalescence and other complications. In alternative, I use a procedure of radiofrequency ablation and plication (RAP) of hemorrhoids. The present study compared the two procedures in terms of surgical parameters, postoperative pain and complications. PATIENTS AND METHODS: A total of 60 patients with grade III hemorrhoids were randomized to undergo radiofrequency ablation and plication (31 patients) or MM hemorrhoidectomy (29 patients). The patients were followed up to 2 years. RESULTS: Duration of surgery was significantly longer in the MM group as was postoperative hospitalization (p<0.05). Post-defecation pain and pain at rest were much less in the RAP group (p<0.05). Wound healing period (17 vs. 38 days) and time to return to work (7 vs. 17 days) were the other significant findings favoring RAP procedure. Early complications occurred more frequently in MM group, but late complications like external skin tags (4 vs. 2 patients) were more common in RAP group. One asymptomatic recurrence was noted in RAP group. CONCLUSIONS: Radiofrequency ablation and plication of hemorrhoids is associated with significantly less postoperative pain, shorter hospital stay and earlier return to normal activity. It can be considered as an alternative to the Milligan-Morgan hemorrhoidectomy.

Catheter Ablation↗
PubMed2004

Use of radiofrequency in the treatment of minor anal pathology.

BACKGROUND: Conventional approaches dealing with chronic anal fissures focus on relieving the anal spasm by manipulation of the internal sphincter. The concomitant pathologies like sentinel piles, anal papillae, or haemorrhoids, however, are often ignored for unknown reasons. MATERIAL AND METHODS: This study describes radiofrequency procedures to remove the above named associated pathologies after performing anal sphincterotomy. A separate, blinded and prospective study between conventional and radiofrequency excision of sentinel pile is described. The measured parameters included the procedure time, intraoperative blood loss, postoperative pain and wound healing time. RESULTS: This combined technique was found useful in treating anal fissures as well as the associated pathologies. The comparative study showed that the intraoperative bleeding was less (p < 0.0001) and wound healing was faster (p < 0.0001) in the radiofrequency group. CONCLUSION: Radiofrequency can be used as an alternative in treating pathologies like the sentinel tags, anal papillae, post fissure fistula or non prolapsing haemorrhoids found associated with anal fissures.

Anus Diseases↗
PubMed2004

Treatment trends in anal fissures.

BACKGROUND: Conservative treatment of anal fisures are reserved for acute forms. Many different treatments are available for chronic anal fissures, which offer different responses and risks for complications. MATERIALS AND METHODS: This study describes various surgical and non-surgical treatment modalities offered for chronic anal fissure with their advantages and complications. CONCLUSION: Considering the various pros and cons, we are of the opinion that treatment of chronic anal fissure must be individualized, depending on the clinical condition of patients. Explaining all the available options to the patient, the clinician should suggest a good and safe choice to achieve the optimum results for the particular patient. (Tab. 2, Ref. 26.)

Fissure in Ano↗
PubMed2004

Radio surgery: a new tool in proctology practice.

BACKGROUND: An apparatus that generates ultra-high frequency current waveform [radiofrequency] has emerged as a new tool to deal with many of the common ano rectal conditions. OBJECTIVE: The purpose of this paper is to enumerate the benefits of radiofrequency with emphasis on its advantages over conventional procedures. Based on extensive personal experience of using radiofrequency surgery in the performance of various anal pathologies, an attempt is made here to relay in narrative form the procedures from a "how-we-do-it" perspective. CONCLUSION: Our experience indicates that radiofrequency surgery not only facilitates but also improves the performance of surgical procedures in treating anal fistula, hemorrhoids, pilonidal sinus, anal papillae, anal polyps, anal warts, anal condylomas, anal antibiomas and papillomas. It significantly shortens operative time, causes negligible intra-operative bleeding, facilitates faster recovery by allowing rapid healing and minimizes the chances of postoperative complications. It permitted us to perform most of the above procedures as a day care surgery. Add to this, its cost-effectiveness coupled with better patient acceptance, radiofrequency surgery, applied judicially, could significantly improve the performance of a proctologist. The technique could be effectively applied in conjunction with conventional maneuvers to better the results of these procedures. Further studies, nonetheless, are called for to define long-term benefits of the treatment. (Tab. 4, Fig. 1, Ref: 36.)

Colorectal Surgery↗
PubMed2003

Infrared coagulation versus rubber band ligation in early stage hemorrhoids.

The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was rectal tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.

Adult↗
PubMed2003

Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery.

BACKGROUND: Hypertrophied anal papillae and fibrous anal polyps are frequently found in association with chronic fissure in ano. Usually, no specific attention is given to them and they are considered normal findings. The present prospective study was aimed at determining whether removal of hypertrophied anal papillae and fibrous anal polyps while dealing with chronic fissure in ano confers long-term benefit to patients. METHODS: Between July 1999 and December 2000, 140 patients undergoing anal sphincterotomy were randomized into two groups to have their fibrous polyps and hypertrophied anal papillae either removed by radiofrequency surgery or left intact. After two years, they underwent a detailed interview by an independent, masked investigator. RESULTS: Overall 84% of patients who had polyp and papilla removal rated the outcome of their surgery as excellent or good in comparison to 58% of controls. The mean satisfaction grading was 9.2 on a visual analogue scale in the treatment group compared to 8.1 in controls (p=0.004). CONCLUSION: Removal of hypertrophied anal papillae and fibrous anal polyps should be an essential part of treatment of chronic fissure in ano. Persistence of these structures leaves behind a sense of incomplete treatment, reducing the overall satisfaction on the part of the patient. Radiofrequency procedure is useful in eradication of these concomitant pathologies.

Adult↗
PubMed2003

Radiofrequency ablation and plication of hemorrhoids.

BACKGROUND: Radiofrequency ablation is emerging as a new therapeutic method in various fields of medicine. This study describes procedure of radiofrequency ablation followed by plication of hemorrhoidal mass in advanced grades of hemorrhoids. METHODS: This non-controlled, prospective study included 300 patients (211 men) treated at Fine Morning Hospital, Laxminagar, Nagpur, India, between July 1999 and December 2000. Patients were followed over a median period of 18 months (range, 15-20 months). RESULTS: The hospital stay was less than 24 hours for all patients. After 1 week, most of the patients had symptoms like bleeding and pain. At 4 weeks, 21% complained of pruritus, but none had prolapse, incontinence or anal stenosis. At the last follow-up, 96% had relief from bleeding, while 8% of patients had developed external skin tags and 6% had asymptomatic recurrence revealed by anoscopy. CONCLUSIONS: For advanced degree of piles with prolapse as the main symptom, plication of the pile mass along with radiofrequency ablation may be used as an alternative to the various types of hemorrhoidectomies. With this treatment, hospital stay is minimized, postoperative pain in low, recurrence is low and return to work is faster.

Adult↗