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Biomedical subjects

Pravin J Gupta

Publications and source records attributed to Pravin J Gupta.

At least 19 recordsLinked to original sources
PubMed2006

Combined Thiersch's procedure and subanodermal coagulation for complete rectal prolapse in the elderly.

BACKGROUND: The author describes a modification of Thiersch's procedure in patients with complete rectal prolapse by inducing fibrosis at the anal verge through circumferential subanodermal coagulation using a radiofrequency device. MATERIALS AND METHODS: An Ellman radiofrequency generator was used for coagulation. The postoperative events were recorded. The patients were followed over a period of 2 years to assess late outcome. RESULTS: Postoperative complications were observed in 2 patients. One of these developed suppuration in the tract of the encircling wire that needed removal, while the other had a recurrence due to loosening of the wire. At a 2-year follow-up, 3 patients developed recurrence while 1 had a persistent complaint of fecal incontinence. CONCLUSION: This study shows that a combined procedure of radiofrequency coagulation followed by Thiersch's circumanal wiring is quick and easy to perform with no formidable morbidity in elderly patients who are otherwise considered at high risk for definitive surgical procedures.

Aged↗
PubMed2006

Sphincterolysis: a novel approach towards chronic anal fissure.

BACKGROUND AND AIMS: The surgical approach in chronic anal fissure is often found associated with disturbed anal continence as well as recurrence. This report describes the author's approach of 'sphincterolysis' or fragmentation of the fibers of the internal sphincter on the left lateral anal wall. PATIENTS AND METHODS: 132 patients with chronic anal fissures were treated with this technique. Pre- and postoperative anal manometry was recorded. The postoperative course and early and 1-year follow-up results were recorded. RESULTS: Early complications included ecchymosis, hematoma, and pain. Fissure healing and relief of symptoms observed in 97% of patients. A transient, variable degree of incontinence occurred in 23 patients and persistent incontinence to flatus and soiling in 5. CONCLUSION: Internal anal sphincterolysis is a safe, effective procedure for the treatment of chronic anal fissure.

Adolescent↗
PubMed2006

Comparative study between radiofrequency sinus excision and open excision in sacro-coccygeal pilonidal sinus disease.

AIM: Evaluation of outcome of pilonidal sinus excision using a radiofrequency device and comparing its results with excision and open granulation procedure. METHODS: Patients with sacro-coccygeal pilonidal sinus disease (n=44) were randomly assigned to undergo either a wide excision and healing by open granulation procedure [WEG] (n=23) or a radiofrequency sinus excision [RSE] (n=21). An Ellman radiofrequency generator was used for RSE. Intra- and postoperative events and outcome data were evaluated and analyzed by Student's unpaired t test and chi(2) test. RESULTS: The significant differences in the two groups WEG and RSE were as follows: mean hospital stay (47 vs. 10 h, p< 0.05), period off work (29 vs. 8 days, p< 0.05), mean analgesic requirement (39 vs. 15 tablets, p< 0.05), time for complete wound healing (84 vs. 49 days, p< 0.05). At the mean follow-up of 30 months, 2 patients from the wide excision and open granulation group and one patient from the radiofrequency sinus excision group developed recurrence. CONCLUSION: These findings suggest that sinus excision with radiofrequency is a simple and swift procedure. It needs a short hospital stay and is associated with less postoperative pain and early resumption to work. As compared to excision and healing by granulation technique, the radiofrequency sinus excision procedure achieves faster wound healing and a better outcome.

Adult↗
PubMed2006

Randomized controlled study: radiofrequency coagulation and plication versus ligation and excision technique for rectal mucosal prolapse.

BACKGROUND: A novel technique of radiofrequency ablation and plication of the rectal mucosa (RAMP) as a treatment for rectal mucosal prolapse is reported. The results of this technique are compared with the conventional ligature and excision procedure (LEP). METHODS: Radiofrequency ablation was performed using an Ellman radiofrequency generator. Patients with rectal mucosal prolapse were randomized to undergo either LEP or RAMP. The intra- and postoperative outcomes and complications were recorded. RESULTS: RAMP on average resulted in reduced operation time, shorter hospitalization, and significantly less postoperative pain. Return to work was earlier and wound healing times were shorter than that of patients in the control group. The complication rates also were significantly shorter (9% in the RAMP group and 29% in the conventional LEP group). CONCLUSION: The procedure of radiofrequency ablation and plication of rectal mucosa is safe, effective, and swift. It can be proposed as an effective alternative to conventional surgical procedures.

Adult↗
PubMed2006

Radiofrequency surgery--novel techniques in the treatment of ano-rectal disease.

BACKGROUND: Radiofrequency surgery is a method of utilizing high frequency (3.8 to 4MHz) radio wave energy to incise, excise, or coagulate tissues. Radiofrequency (RF) is a relatively new modality that is being used for ano-rectal surgeries with increasing frequency. As the RF energy is applied, frictional heating of tissues results, with cell death occurring at temperatures between 60 and 100 degrees C. OBJECTIVE: This paper discusses author's clinical experience with radiofrequency for various ano-rectal pathologies namely hemorrhoids, anal fistula, anal polyps, sinuses and anal papillae. A Ellman dual frequency radiofrequency generator was used to carry out the procedures. This study is intended to be somewhat of a "how we do it" manual, explaining the principles of radiofrequency. CONCLUSION: Radiofrequency proctological procedures are simple to perform with many advantages over the more traditional techniques. The procedures take less operative time, the postoperative recovery is accelerated and the incidences of complications are negligible.

Anus Diseases↗
PubMed2006

Feasibility of day care surgery in proctology.

BACKGROUND: Proctological surgery is being carried out increasingly on an outpatient basis. The reasons for this are safe anesthetic procedures, short operation times and low complication rates. This study is a retrospective analysis of complication rates, symptom recurrence and long-term results according to outpatient proctologic surgery practiced in our hospital in the last 10 years. MATERIAL AND METHOD: A total of 2840 patients were operated and followed up. The procedures included hemorrhoidectomy, anal fistulotomy, sphincterotomy, and removal of rectal polyps, pilonidal sinotomy and anal stricturotomy. Procedures were performed either under short-term general anesthesia or regional block. RESULTS: Mean hospital stay was 7.3 hours (range 4-21 hours). The overall complication rate was 2.5%, which included bleeding, urinary retention, infection, continence disturbance and recurrence. CONCLUSION: Outpatient proctological surgery can be safely performed with a low recurrence and complication rate while offering a high level of patient acceptance and satisfaction. However, an appropriate diagnosis of the disease, proper selection of the patients with respect to their suitability for surgery and a round-the-clock availability of patient communication with the nursing staff are a must for the successful outcome of the procedure.

Adolescent↗
PubMed2005

Hemorrhoidal ablation and fixation: an alternative procedure for prolapsing hemorrhoids.

BACKGROUND: Many new techniques have been evolved to curb the problem of post-operative pain after hemorrhoidectomy. Stapler hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation are the two methods gaining popularity amongst proctologists. The author proposes another technique called radiofrequency ablation and fixation of hemorrhoids to add to this list. PATIENTS AND METHODS: The surgical technique and clinical follow-up of 410 patients operated by this technique are presented. An Ellman radiofrequency generator was used for hemorrhoidal ablation at the output power intensity of 80. Post-defecation pain and pain at rest were assessed using a visual analogue scale. Patient satisfaction score was calculated at the mean follow-up of 60 months (range 48-72). The results in terms of mean hospital stay, post-operative pain, post-operative complications, and period of incapacity for work were compared with the published data of results of stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation. RESULTS: Pain score at first evacuation was 6. The post-defecation pain score in the first week was 4 (range 3-6) and it was 3 (range 2-5) in the second week. The mean pain score at rest in the first week was 2 (range 1-4) and 1 (range 0-2) in the second post-operative week. In the long-term follow-up at a mean of 60 months, this procedure was found in most of the cases to control prolapse, discharge, and bleeding, with no stenosis or incontinence. The recurrence rate was less than 2%. The patient satisfaction score was high. CONCLUSION: The results of this technique of radiofrequency ablation and fixation of hemorrhoids hold positive promises in terms of less post-operative pain, early discharge from the hospital and faster return to work. The results are comparable to stapled hemorrhoidopexy and are better than Doppler-guided hemorrhoidal artery ligation in terms of effectiveness and symptomatic relief on a long-term basis.

Adult↗
PubMed2005

Radiofrequency ablation and plication: a non-resectional therapy for advanced hemorrhoids.

BACKGROUND: Radio frequency ablation followed by plication of the hemorrhoidal mass for patients who would otherwise require hemorrhoidectomy is being practiced at our hospital since last 5 years. This procedure accomplishes hemorrhoidal symptom relief with far less post-operative pain and other complications as compared to various other types of hemorrhoidectomies. MATERIALS AND METHODS: A retrospective study of 1000 patients having grade III or grade IV hemorrhoids treated with the above technique over a period of 30 months is reported. A Ellman radiofrequency generator was used for ablation of the hemorrhoids. Follow-up record of these patients is presented. The post-operative outcome and procedure related complications are compared with conventional hemorrhoidectomy procedures. RESULTS: With this procedure, the post-defecation pain score reported was between 1 and 4 (VAS) in the first week, which subsided thereafter. There were 42% patients who had post-defecation bleeding in the first 10 days. There were 82% patients able to resume duties on the 6th post-operative day. Of these, 5% of the patients had post-operative urinary retention needing catheterization for a single time, and 18 patients required readmission for secondary bleeding. None of the patients complained of fecal incontinence, sepsis, or anal stenosis. In the subsequent follow-up at a mean of 19 months, 4% of the patients had residual skin tags, 3% of them had symptomatic anal papillae, and 2% developed recurrence of hemorrhoids. CONCLUSION: The combined procedure described above could be a feasible alternative for surgical treatment of hemorrhoids being quick and easy to perform. With this procedure, the hospital stay is short, post-operative pain is less, return to work is faster, and recurrence rate is low.

Adult↗
PubMed2005

Ambulatory hemorrhoid therapy with radiofrequency coagulation. Clinical practice paper.

BACKGROUND: Despite availability of numerous surgical and non-surgical options for the treatment of hemorrhoids like sclerotherapy, rubber band ligation, cryosurgery, infrared photocoagulation, bipolar diathermy, and electro coagulation, none of these therapies has been acclaimed as the ultimate. Coagulation of hemorrhoids using a radio-frequency device is a new therapy to be added to the list. PATIENTS AND METHODS: In the present retrospective study, the early and long -term effects of radiofrequency coagulation on patients presenting with hemorrhoids is described. An Ellman radiofrequency generator was used for this procedure. In a separate, randomized, and blinded study, a comparative evaluation was carried out between radiofrequency coagulation and rubber band ligation in terms of their effectiveness and patient comfort. RESULTS: Two hundred and forty patients with Grade I and II hemorrhoids were treated by radiofrequency coagulation technique and were followed up for a period of 16 months. While 33 patients reported persistence or recurrence of bleeding, only few complained of pain or discomfort. The comparative study showed that though rubber band ligation is an effective procedure, its pain quotient is greater than the radiofrequency coagulation. CONCLUSION: This study shows that radiofrequency coagulation is an easy and effective alternative to conventional techniques employed in the treatment of bleeding hemorrhoids. It is easy to perform, is less painful, and has a low rate of complications. However, further results based on a longer follow-up of larger number of patients and its comparison with other conventional treatment techniques are called for.

Adult↗
PubMed2005

Radiofrequency sinus excision: better alternative to marsupialization technique in sacrococcygeal pilonidal sinus disease.

BACKGROUND: A number of techniques have been described for treatment of patients with sacrococcygeal pilonidal sinus disease. The author reports his experience in the surgical management of pilonidal sinus using radiofrequency sinus excision technique. The results are compared with those obtained after excision and marsupialization procedure. MATERIALS AND METHODS: Seventeen patients were operated by radiofrequency sinus excision and 18 with excision and marsupialization. An Ellman radiofrequency device was used. The two groups were matched for age, gender and presentation symptoms. The median follow-up was two years. The patient's satisfaction on the outcome of the procedure was also evaluated. RESULTS: In the radiofrequency sinus excision group, we found on average a shorter operation time (10 vs. 36 minutes, p < 0.001), shorter hospitalization (nine vs. 30 hours, p < 0.001), significantly less postoperative pain, fewer cumulatve requests for analgesia by the patients (14 vs. 25 tablets, p < 0.001), and earlier return to work (six vs. 16 days, p < 0.001) The wounds with marsupialization did heal faster than those with sinus excision; however, the difference was not significant. At two year follow-up, one patient from each group had a recurrence. CONCLUSION: This pilot study shows that this new technique can be performed as a day care surgery. With reduced postoperative pain and early resumption to work, patient satisfaction is better in comparison to excision and marsupialization technique.

Adolescent↗
PubMed2005

Novel approach to advanced hemorrhoidal disease.

BACKGROUND: There have been many attempts to find a less painful surgical method of treating hemorrhoids as against those available in standard surgical procedures. A novel technique of hemorrhoidal ablation by radiofrequency is described, which is followed by suture fixation of the hemorrhoidal mass. MATERIAL AND METHODS: This non-randomized, retrospective study describes the clinical outcome of the procedure performed in 1650 patients over a period of 5 years. An Ellman dual frequency radiofrequency generator was used for ablation of hemorrhoids. RESULTS: The operation time ranged between 6 to 8 minutes. Mean hospital stay was 9 hours. The immediate postoperative complication included retention of urine, wound infection and perianal thrombosis. The mean period of incapacity for work was 10 days. Late complications included development of anal tags, anal papillae and recurrence in 2% patients. There was no incidence of anal stricture or continence disorder. CONCLUSION: The procedure advocated by the author can be opted as an alternative to conventional surgical procedures. This day care procedure is simple to perform, allows the patients to return to normal activities in a short span of time with lesser pain and has fewer postoperative complications.

Adolescent↗
PubMed2004

Radiofrequency coagulation versus rubber band ligation in early hemorrhoids: pain versus gain.

OBJECTIVE: Band ligation of internal hemorrhoids is a well-established and accepted office procedure. However, there are several reports focusing on problems associated with this technique, which is perceived by many to be risk-free. This randomized study is aimed to compare radiofrequency coagulation and rubber band ligation of hemorrhoids on the parameters of effectiveness and comfort. MATERIAL AND METHODS: Eighty patients of 2nd degree bleeding piles were randomized prospectively for band ligation (44 patients) or radiofrequency coagulation (36 patients) technique. Parameters measured included postoperative discomfort and pain, time taken to return to work, complications accompanying the procedure and recurrence rate. RESULTS: The post defecation pain was more severe with band ligation (p=0.01) and so was rectal tenesmus (p=0.01). The patients from radiofrequency coagulation group resumed their duties early (2 versus 5 days, p=0.05). Recurrence rate was higher in radiofrequency coagulation group. CONCLUSION: Rubber band ligation is associated with significantly higher post treatment pain and discomfort. As against this, radiofrequency coagulation results in significantly less pain and post defecation discomfort. However, chances of recurrence of bleeding and prolapse of hemorrhoids are comparatively higher using radiofrequency coagulation of hemorrhoids.

Adolescent↗
PubMed2004

A study of hypertrophied anal papillae and fibrous polyps associated with chronic anal fissures.

BACKGROUND: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. However, they do cause a few disturbing symptoms. This study describes the advantages of the removal of such pathologies associated with chronic anal fissure. PATIENTS AND METHODS: Following lateral anal sphincterotomy, the polyps or papillae were removed using a radio frequency device. A comparison before and after removal of the papillae or polyps was carried out for the associated complaints such as like pruritus, pricking sensation, wetness, crawling in the anus etc. In a separated randomized and prospective study, 80 patients were divided into two groups. 40 patients underwent only sphincterotomy, while in the remaining 40 patients, the papillae or polyps were removed after sphincterotomy. Symptom comparison was made before and after the procedure at 6- month follow-up. RESULTS: After one month of the procedure, the associated symptoms were significantly reduced, with a near total decline in the primary complaints of pain and bleeding. There was significant reduction in conditions like pruritus (p=0.0001), discharge per anus (p=0.0001), crawling sensation in the anus (p= 0.0006) and sense of incomplete evacuation (p= 0.0001). The prospective study confirmed the above findings. CONCLUSION: The above study establishes that removal of hypertrophied anal papillae and fibrous polyps should be routinely carried out during surgical treatment of anal fissure to add to effectiveness and completeness of the procedure.

Anal Canal↗
PubMed2003

Pilonidal sinotomy with radiofrequency.

Pilonidal disease is most conveniently treated with sinotomy. A modified approach to the procedure, using radiofrequency technique, is described. The modification resulted in reduced hospital stay, less postoperative pain, early resumption to work and a reduced recurrence rate. The technique and results are described and discussed.

Catheter Ablation↗