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Pravin J Gupta

Publications and source records attributed to Pravin J Gupta.

35 records · Page 2Linked to original sources
PubMed2003

Randomized trial comparing in-situ radiofrequency ablation and Milligan-Morgan hemorrhoidectomy in prolapsing hemorrhoids.

The Milligan-Morgan (MM) operation is the most widely practiced procedure for prolapsed hemorrhoids. But it is also associated with a fair amount of postoperative pain, a long period of convalescence, and complications like bleeding and anal stenosis. The aim of this study was to evaluate the efficacy of in-situ radiofrequency ablation (RA) of hemorrhoids. During a 6-month period, 40 patients with grade 3 hemorrhoids were prospectively randomized for RA (21 patients) or MM hemorrhoidectomy (19 patients). Patients were evaluated for operative time, postoperative pain, time to return to work and occurrence of early and late complications. Duration of surgery was significantly higher in the MM group (p<0.0001). Postoperative hospitalization was longer in the MM group (p<0.001). The post defecation pain and pain at rest were much less in the RA group (p<0.001). Wound healing period (16.3 vs. 37.5 days) and time to return to work (7.3 vs. 18.3 days) were other significant findings. Early complications occurred more frequently in the MM group, but late complications like external skin tags [4 patients vs. 2 patients] and one asymptomatic recurrence was noted in the RA group. In-situ RA of prolapsing hemorrhoids is a quick and bloodless procedure. It is associated with significantly less postoperative pain, shorter hospital stay and early return to normal activity. It can be considered as an alternative to conventional hemorrhoidectomy.

Adult↗
PubMed2003

Radio frequency "sutureless" fistulotomy- a new way of treating fistula in anus.

AIM: To explore the effect of the classical lay open technique or fistulotomy with the radio frequency surgical device in the treatment of fistula in anus. METHODS: In our study, the conventional 'lay open' technique, or 'fistulotomy' was performed by employing the radio frequency surgical device as an alternative to the traditional knife and scissors. In a span of 18 months starting from July 1999 to December 2000, 210 cases with fistula in anus of varied types were operated in our nursing home exclusively applying the radio frequency device. RESULTS: The results of the study were not only encouraging but also were satisfactory. A follow up of the operated patients with radio frequency surgery over a period of 15 months, i.e. from December 2000 to March 2002 was summarized as below: (a) average time taken by the patient to resume routine - 7 days; (b) none of the patient had any interference with the continence; (c) the wounds were found healed within an average time of 47 days; (d) delayed wound healing was noticed only in 7 patients; (e) recurrence/ failure rate was reduced to as low as 1.5 percent. CONCLUSION: This technique has been found superior to the conventional fistulotomy in the sense that the time taken for the whole procedure is reduced to almost half, chances of bleeding are reduced to a minimum and the use of suture material is dispensed with. The procedure can safely be called a "Sutureless fistulotomy".

Adult↗
PubMed2003

Sphincterotomy with radio frequency surgery: a new treatment technique of fissure in ano and associated pathologies.

BACKGROUND: Anal fissures are dealt with using traditional approaches aiming at relieving the anal spasm and minimizing the anal sphincter pressure. Nevertheless, pathologies like sentinel tags, anal papillae, anal polyps, or small hemorrhoids which are often associated with chronic fissures are either considered innocuous, therefore left untreated, or are removed by conventional techniques. MATERIAL AND METHODS: In this retrospective, non-randomized study, we performed lateral internal sphincterotomy, which was followed by radio frequency surgical procedures to eliminate the associated pathologies mentioned above. RESULTS: In all, 283 patients were studied. All the patients treated by the method of lateral subcutaneous internal sphincterotomy followed by radio frequency surgical procedure for aforesaid associated pathologies were made comfortable on account of the reduction in pain and irritation during defecation, the pricking or foreign body sensation in the anus and pruritus or wetness around the anal verge. A follow up after 18 months showed that only 7 % of patients had recurrence of symptoms or local signs. CONCLUSION: This combined approach has been found to be an effective, easy and quick way of treating chronic fissure in ano with associated pathologies

Anal Canal↗
PubMed2003

Radiofrequency fistulotomy in anal fistula. An alternative to conventional surgical fistulotomy.

Most of surgeons prefer fistulotomy by laying open technique in treating different types of anal fistula. We used the radiofrequency fistulotomy procedure in 136 cases of various types of low anal fistulae in a one-year period. The patients were followed for 18 months. The average time for complete wound healing was 37 days and additional follow-up was continued for 7 days. Delayed wound healing occurred in 7 patients. It failed completely in 2 patients and 3 were lost to follow up. No patient had interference with continence. Radiofrequency fistulotomy method was effective with easy tissue excision and minimum bleeding. It permitted use in deep and difficult areas like the adjoining tracts. The failure rate was 3.7%.

Catheter Ablation↗
PubMed2003

Anal fistulotomy with radiofrequency: a better option to a conventional procedure.

BACKGROUND: Even after the availability of many different surgical options, most surgeons still prefer the classical lay open technique (fistulotomy) as the gold standard for the treatment of anal fistula. This study analyzes the procedure and outcome of radiofrequency fistulotomy over the conventional scalpel method. MATERIAL AND METHODS: Fifty patients with low fistula in ano were analyzed in a prospective study. They were randomized into conventional and radiofrequency fistulotomy groups. Parameters measured included time taken for the procedure, amount of blood loss, postoperative pain, period taken for return to work and recurrence rate. The patients were followed over a period of 30 months. RESULTS: The average time for complete wound healing was 49 days. The patients took a mean period of 7 days to return to their routine. In 7 patients the wounds took more than 80 days to heal and were labeled as delay in wound healing. Two patients developed a recurrence. The comparative study between conventional and radiofrequency fistulotomy showed that procedure time was shorter (p= 0.001); intra operative bleeding was much less (p=0.0004), return to work was earlier (p= 0.029) and wound-healing time was shorter (p=0.0017) in radiofrequency procedure. CONCLUSION: In terms of parameters set for the study, the radiofrequency technique was found to have significant advantages over conventional fistulotomy procedure with regard to operation time, blood loss, return to normal activity and healing of the wounds.

Electrocoagulation↗
PubMed2003

Radiofrequency incision and lay open technique of pilonidal sinus (clinical practice paper on modified technique).

With the uncertainty as to the etiology and the complexities often encountered in its treatment, a pilonidal sinus has been considered as a tricky disease. Wide varieties of approaches are employed in dealing with this ailment ranging from a conservative treatment to an extensive surgical excision or repair. However, a method of simple lying open of pilonidal sinus is still considered as the favored one. We describe a modified approach to the procedure of incision and lying open the sinus tracts. This retrospective study describes 18 patients of chronic pilonidal sinus treated with a technique of radiofrequency surgery under local anesthesia. There were 12 males and 6 females within an age group ranging from 16 to 30. The patients were subjected to a follow-up for a period of 18 months. The patients were discharged on the same day of the procedure. Mean period off work was 7 days. The average healing time recorded was 67 days. Two wound complications in the form of premature closure of the skin edges were noted, requiring trimming of the edges. One of these two remained unhealed. At the last follow-up, no recurrence was found in the remaining 17 patients. In the era when the emphasis is on the criteria like minimum hospital stay, less postoperative pain, early resumption to work and a reduced recurrence rate, there is a future to the procedure of incision and lying open of the pilonidal sinuses by using the radiofrequency wave.

Adolescent↗
PubMed2002

Novel technique: radiofrequency coagulation--a treatment alternative for early-stage hemorrhoids.

BACKGROUND: For early-stage hemorrhoids, in which bleeding is the primary symptom, conventional approaches to management include injection of sclerosing solutions, band ligation, and infrared coagulation. In our study, we used the radiofrequency coagulation technique as an alternative strategy to treat early-stage hemorrhoids. MATERIALS AND METHODS: A total of 210 patients with bleeding hemorrhoids were treated with radiofrequency coagulation at the Gupta Nursing Home in Nagpur, India. RESULTS: Follow-up was at 2 weeks, 3 months, and 12 months after procedure. Results were recorded as follows: (1) Bleeding--Twenty-eight (13%) patients had recurrence of bleeding during the observation period. (2) Pain--Some degree of discomfort was reported by all patients within the first 48 hours. (3) Retention of urine--Only 1 patient had retention of urine; this patient was 74 years old and had an enlarged prostate. (4) Discharge--Thirty-four (16%) patients complained of discharge in the first 2 weeks after procedure. (5) Return to work--Seventy percent (n = 145) of patients resumed their duties after 48 hours; the remainder required 1 additional day. (6) Sepsis--There were no reports of postprocedure sepsis. (7) Sphincter function--None of the patients experienced problems with continence or stenosis. Overall patient satisfaction was 84% (n = 177). CONCLUSION: Although these initial results of coagulation of hemorrhoids by radiofrequency appear quite exciting and encouraging, long-term follow-up is needed to assess the duration of relief and potential side effects. Continued work in this area will likely provide promising new dimensions in the effective management of early-stage hemorrhoids in which bleeding is the main symptom. A separate, randomized trial was carried out to assess the difference in efficacy between infrared coagulation and radiofrequency coagulation in 100 patients with early-stage hemorrhoids. Radiofrequency coagulation was found to be more effective than infrared coagulation in terms of recurrence of bleeding, asymptomatic recurrences of hemorrhoids, and overall satisfaction of technique.

Adolescent↗
PubMed2002

Current trends of management for fissure in ano.

There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. About 10 different techniques are presented in brief with their efficacy and fallacy. A new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure. However, all the options should be presented to the patient with complete information about the method, cure rates, complications, and reversibility of the complications and the final choice should be left in his hands.

Anal Canal↗
PubMed2002

Use of enzyme and heparin paste in acute haemorrhoids.

BACKGROUND: While treating acutely inflammed piles, surgeons in general prefer to stick to the conservative method of treatment. This includes bed rest in a Trendelenburg's or jack-knife position, administration of liquid diet, stool softeners, antibiotics, and anti-inflammatory drugs along with warm Sitz baths and local application of glycerin and magnesium sulphate paste. We introduced an additional method in treating acutely inflammed piles. Ten tablets of trypsin and chymotrypsin (Chymoral forte, Elder Pharmaceuticals India) were powdered and were mixed with 30 grams of heparin (Thrombophobe, German Remedies Ltd, Germany) ointment. This paste was applied to the inflammed pile mass. In all, 67 received this in patient treatment with an average hospital stay of 2 days. The results were compared using chi2 test with similarly placed 22 patients who were treated with the conventional method only. RESULTS: In the patients receiving the application of the enzyme paste, local pain was reduced to a great extent, the defecation was comfortable, there was negligible local pruritus, and the routine body movements of the patient were painless. Local signs observed in the form of the size of the piles, perianal edema, and tenderness, were also found to be significantly reduced. CONCLUSION: The results of this study demonstrate that the additional use of a heparin-enzyme paste applied directly over the pile masses significantly improves the healing and resolution of acutely inflammed hemorrhoids. The effectiveness of the traditional conservative method of treatment could be gainfully supplemented by use of the pharmaceutical preparation suggested in this study.

Administration, Topical↗
PubMedDate not supplied

A randomized study between excision and marsupialization and radiofrequency sinus excision in sacro-coccygeal pilonidal disease.

BACKGROUND: The surgical approach to pilonidal sinus disease is open to debate. This prospective, randomized study was aimed to compare the outcome of the excision and marsupialization and the sinus excision technique by radiofrequency. MATERIALS AND METHODS: Thirty patients of chronic pilonidal sinus disease were randomly assigned to radiofrequency sinus excision (n = 15) and excision and marsupialization (n = 15). The parameters measured included intraoperative and postoperative data, wound-related complications, and recurrence. Patient satisfaction score was assessed at 1-year follow-up. RESULTS: The operation time, postoperative pain, hospital stay, and off work periods were significantly less (p < 0.05) in the technique employing radiofrequency surgery. At 1-year follow-up, there was 1 case of recurrence in each group. The patients from radiofrequency group expressed better satisfaction than the patients operated by marsupialization. CONCLUSION: Radiofrequency sinus excision technique needs a shorter hospital stay with reduced postoperative pain and early resumption to work in comparison with the sinus excision and marsupialization technique.

Adolescent↗
PubMedDate not supplied

Radiofrequency ablation and plication--a new technique for prolapsing hemorrhoidal disease.

BACKGROUND: The author describes a modified procedure of ablation with a radiofrequency device and plication of the hemorrhoidal mass for prolapsing hemorrhoids. The study is aimed at ascertaining if this procedure provides any advantages over the conventional hemorrhoid surgery. MATERIALS AND METHODS: Two different studies are included. The first study describes 600 serial patients with prolapsing hemorrhoids treated with this technique over a period of 18 months. An Ellman radiofrequency generator was used for the ablation of the hemorrhoids. The operative technique and postoperative outcome is reported. The second study compares this technique with standard Milligan-Morgan hemorrhoidectomy in a randomized trial of 100 patients. RESULTS: With this new procedure, the post-defecation pain and pain at rest were within tolerable limits (pain scores 1 to 4 on visual analog scale). Post-defecation bleeding was present in 60% of the patients. Pruritus and perianal thrombosis were complained by few others. No patient encountered any incontinence, prolapse, or stenosis. The comparative study showed definite advantages of this modified technique over Milligan-Morgan hemorrhoidectomy. CONCLUSION: The procedure of radiofrequency ablation and plication of hemorrhoids restricts the hospital stay to only a few hours and provides rapid physical recovery. It does seem to be a better alternative to the conventional surgical procedures in terms of postoperative pain, return to work, and complications.

Adult↗
PubMedDate not supplied

Radiofrequency coagulation with Thiersch's operation--a better palliative treatment in prolapse rectum.

PURPOSE: Thiersch operation is an age-old popular option for treatment of complete rectal prolapse (proctodentia) in elderly patients. This procedure is simple, easy to perform, and with very rare postoperative complications of any severe nature. This is especially suitable for those patients who are unfit for extensive abdominal surgical procedures in practice today. This procedure does help in mechanically supporting and containing the prolapse. Although the procedure is not curative, the confining of the prolapse in the anal canal does ensure a relief from symptoms generated by the prolapse. Nevertheless, withdrawal of the occlusive material used is inevitably followed by recurrence of the prolapse, making the procedure a failure in achieving a prolonged relief. METHODS: Looking at this drawback, we have made an addition to this conventional procedure by introducing circumferential coagulation of the subanodermal region through a radio frequency device. This results in inducing fibrosis and forming a zone of band. The added maneuver constricts the anal opening permanently and thus aids in reinforcement of the atonic sphincter. The study was carried out in 8 patients. Their average age was 57 years. All of them had complete prolapse of the rectum with associated features. Two of them were in early fifties, but they refused to undergo extensive procedures and opted for this method considered cheaper and quicker. RESULTS: A follow-up for a period ranging from 15 to 18 months was found satisfactory. None of the patients had any prolapse or its sequel. Not a single case was reported for any sinus or discharge from the site of incision. The incision site was well consolidated, and the knot or the thread could not be felt when seen after 12 months. CONCLUSIONS: The study shows that radio frequency coagulation followed by Theirsch operation for complete rectal prolapse in the elderly has been found to be relatively easy to perform. Except for the radio surgical unit, no special instrumentation is needed. The results of this procedure have been found to be gratifying in all the patients. It is felt that on appropriate selection of the patients and employing this new technique of operation would prove a boon in treatment of this problem. A further work in this direction and longer follow-up of the treated patients are bound to bring about exciting new dimensions in the field.

Journal Article↗
PubMedDate not supplied

Radio-ablation of advanced grades of hemorrhoids with radiofrequency.

BACKGROUND: For advanced degree of hemorrhoids with prolapse of the rectal mucosa, the choice is hemorrhoidectomy, which could be open, close, diathermy, Laser, or stapled one. As an effective alternative to this, in situ radio-frequency ablation of the pile mass has been found to be quite efficacious with many added advantages over the conventional hemorrhoidectomy procedures in practice. MATERIALS AND METHODS: This study included 50 patients (34 males and 16 females) treated at Gupta Nursing Home, Laxminagar, Nagpur, India, with the above technique from April 2000 to March 2001 and each case followed up over a period of 12 months. RESULTS: In first 4 weeks of the procedure, 14% of patients complained of bleeding, whereas all of the patients had some amount of pain. Eleven (22%) patients had serosanguinous discharge, but in none of them was there any incontinence or prolapse. All of the patients resumed their routine within 1 week of the procedure. A subsequent follow-up of the patients at an interval of 12 weeks and 12 months showed significant relief in all of the above early postoperative symptoms. During follow-up at the end of 1 year, 7 patients were found to have skin tag formation. However, complications like anal stenosis or stricture or incontinence was not found in any of the patients. CONCLUSION: For advanced degree of piles with prolapse as the main symptom, in situ radio-frequency ablation can be a better choice to various types of hemorrhoidectomy in the sense that the hospital stay is minimized, recurrence is rare, and return to work is faster. The results are more assuring when compared with conventional hemorrhoidectomy. The technique fits into the parameters for being called the gold standard procedure. Except the radio-frequency unit, the procedure needs no specialized instrument. It can be performed in any routine surgical setup.

Catheter Ablation↗
PubMedDate not supplied

Radiosurgical fistulotomy; an alternative to conventional procedure in fistula in ano.

PURPOSE: Most surgeons continue to prefer the classic lay open technique [fistulotomy] as the gold standard of treatment in anal fistula. In this randomized study, a comparison is made between conventional fistulotomy and fistulotomy performed by a radio frequency device. MATERIALS AND METHODS: One hundred patients of low anal fistula posted for fistulotomy were randomized prospectively to either a conventional or radio frequency technique. Parameters measured included time taken for the procedure, amount of blood loss, postoperative pain, return to work, and recurrence rate. RESULTS: The patient demographic was comparable in 2 groups. The radio frequency fistulotomy was quicker as compared to a conventional one [22 versus 37 minutes, p = 0.001], amount of bleeding was significantly less [47 ml versus 134 ml, p = 0.002], and hospital stay was less when patient was operated by radio frequency method [37 hours versus 56 hours in conventional method, p = 0.001]. The postoperative pain in the first 24 hours was more in conventional group [2 to 5 versus 0 to 3 on visual analogue scale]. The patients from radio frequency group resumed their duties early with a reduced healing period of the wounds [47 versus 64 days, p = 0.01]. The recurrence or failure rates were comparable in the radio frequency and conventional groups [2% versus 6%]. CONCLUSIONS: Fistulotomy procedure using a radio frequency technique has significant advantages over a conventional procedure with regard to operation time, blood loss, return to normal activity, and healing time of the wound.

Adult↗
PubMedDate not supplied

Current treatment options for fissure-in-ano.

BACKGROUND: Fissure-in-ano is a painful condition that affects a sizable majority of the population. Selecting a method of treating the condition that could achieve optimal clinical results and the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This led to the innovation of a number of surgical and pharmacological methods that relax the anal muscle. While acute fissures could be managed with medical therapy alone, chronic fissures do need some form of manipulation to relieve internal sphincter spasm. MATERIALS AND METHODS: The present study discusses various techniques advocated for the treatment of acute and chronic fissure-in-ano. It also elaborates on the advantages and deficiencies of each. DISCUSSION: Despite the initial success with pharmacological agents in the treatment of patients with chronic anal fissures, a growing concern is developing about their use. Increasing incidence of adverse effects and decreasing long-term efficacy have been the major drawbacks. CONCLUSION: Surgery still remains the preferred option which should be offered to patients with relapse or therapeutic failure with prior pharmacological treatment. Nevertheless, the patient should be informed about the pros and cons of each mode of treatment with details of cure rates and possible complications.

Acute Disease↗