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| 1 | Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review显示文摘BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date. | Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 8 |
| 2 | Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula:Experience from 2404 scans显示文摘Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken.Incidentally,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period.In this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field. | Pankaj Garg Baljit Kaur Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastroenterology2021，27，33： | 6 |
| 3 | Diagnosis of anorectal tuberculosis by polymerase chain reaction,GeneXpert and histopathology in 1336 samples in 776 anal fistula patients显示文摘BACKGROUND The association of tuberculosis(TB)with anal fistulas can make its treatment quite difficult.The main challenge is timely detection of TB in anal fistulas and its proper management.There is little data available on diagnosis and management of TB in anal fistulas.AIM To detect TB in fistula-in-ano patients were analyzed in different methods utilized.METHODS A retrospective analysis of different methods,polymerase chain-reaction(PCR),GeneXpert and histopathology(HPE),utilized to detect tuberculosis in fistula-inano patients,treated between 2014-2020,was performed.The sampling was done for tissue(fistula tract lining)and pus(when available).The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were studied.RESULTS In 1336 samples(776 patients)tested,TB was detected in 133 samples(122 patients).TB was detected in 52/703(7.4%)samples tested by PCR-tissue,in 77/331(23.2%)samples tested by PCR-pus,3/197(1.5%)samples tested with HPE-tissue and 1/105(0.9%)samples tested by GeneXpert.To detect TB,PCRtissue was significantly better than HPE-tissue(52/703 vs 3/197 respectively)(P=0.0012,significant,Fisher’s exact test)and PCR-pus was significantly better than PCR-tissue(77/331 vs 52/703 respectively)(P<0.00001,significant,Fisher’s exact test).TB fistulas were more complex than non-tuberculous fistulas[78/113(69%)vs 278/727(44.3%)respectively](P<0.00001,significant,Fisher’s exact test)but the overall healing rate was similar in tuberculous and non-tuberculous fistula groups[90/102(88.2%)vs 518/556(93.2%)respectively](P=0.10,not significant,Fisher’s exact test).CONCLUSION This is the largest study of anorectal TB to be published.The detection of TB by polymerase chain-reaction was significantly higher than by histopathology and GeneXpert.Amongst polymerase chain-reaction,pus had a higher detection rate than tissue.TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups. | Pankaj Garg Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 3 |
| 4 | Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas显示文摘Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage.Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas.Along with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been described.The diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas.There is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of fistulas.The main reason for this is the paucity of literature about these fistulas.The common feature of all these fistulas is their complete involvement of the external anal sphincter.Therefore,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed.Recent advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high fistulas.These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper. | Pankaj Garg Vipul D Yagnik Sushil Dawka Baljit Kaur Geetha R Menon | 2022 | World Journal of Gastroenterology2022，28，16： | 2 |
| 5 | Isolation and separation of HMG proteins and histones H1 and H5 and core histones by column chromatography on phosphocellulose 显示文摘 | Garg C Reeck G R | 1998 | Protein Expres Purif1998，14，2： | 2 |
| 6 | Thermodynamic interdiffusion coefficient in binary systems with intermediate phases显示文摘 | Garg S P Kale G B Patil R V Kundu T | 1999 | Intermetallics1999，7，： | 2 |
| 7 | Stagnation point flow of a non-Newtonian fluid显示文摘 | Garg V K Rajagopal K R | 1990 | Mechanics Research Communication1990，17，： | 1 |
| 8 | School functioning of US children with asthma显示文摘 | FOWLER M G DAVENPORT M G GARG R | 1992 | Pediatrics1992，90，6： | 1 |
| 9 | Rivaroxaban versus warfarin in nonvalvular atrial fi- brillation显示文摘 | PATEL M R MAHAFFEY K W GARG J | 2011 | N Engl J Med2011，365，： | 1 |
| 10 | A parameter opti- mization approach to controller partitioning for integrated flight/propulsion control application显示文摘 | Schmidt P H Garg S Holowecky B R | 1993 | IEEE Transac- tions on Control Systems Technology1993，1，1： | 1 |
| 11 | Letter to theeditor regarding“Integrity of the lateral femoral wallin intertrochanteric hip fractures: An important pre-dictor of a reoperation,,显示文摘 | Garg B Malhotra R Jayaswal A | 2007 | J Bone Joint Surg(Am)2007，89，8： | 1 |
| 12 | Postural orthostatic tachycardia syndrome显示文摘 | Agarwal AK Garg R Ritch A | | 0，，981： | 1 |
| 13 | Tuberculosis vaccine: time to look into future 显示文摘 | CHAWLA S GARG D JAIN R B | 2014 | Hum Vaccin Im- munother2014，10，2： | 1 |
| 14 | Nuclear factor-kappa B sup- pressive and inhibitor-kappa B stimulatory effects of tmglitazone in obese patients with type 2 diabetes : evidence of an anti-inflammato- ry action显示文摘 | Aljada A Garg R Ghanim H | 2001 | J Clin Endocrinol Metab2001，86，7： | 1 |
| 15 | Performance analysis of a hybrid photovoltaic/thermal (PV/T) collector with integrated CPC troughs显示文摘 | Garg H P Adhikari R S | 1999 | International joumal of energy research1999，23，15： | 1 |
| 16 | Asoprisnil (J867):a selective progesterone receptor modulator for gynecological therapy显示文摘 | DeManno D Elger W Garg R | 2003 | Steroids2003，68，： | 1 |
| 17 | Theoretical and experimental studies on collector/storage type solar water heater显示文摘 | H P Garg R Usha | 1982 | International Journal of Solar Energy1982，29，： | 1 |
| 18 | Flow of a non-Newtonian fluid past a wedge显示文摘 | Garg V K Rajagopal K R | 1991 | Acta Mechanica1991，88，： | 1 |
| 19 | Beneficial effects of tumor necrosis factor - alpha inhibition by pentoxifylline on clinical, biochemical, and metabolic parameters of patients with nonalcoholic steatohepatitis显示文摘 | Satapathy SK Garg S Chauhan R | 2004 | Am J Gastroenterol2004，99，10： | 1 |
| 20 | Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebro- spinal fluid parameters? 显示文摘 | Garges HP Moody MA Cotten CM Smith PB Tiffany KF Len- festey R | 2006 | J Pediatr2006，117，4： | 1 |
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