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Technical Note
Anorectal benign disease
Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Ann Coloproctol. 2024;40(6):610-612.   Published online December 2, 2024
DOI: https://doi.org/10.3393/ac.2023.00696.0099
  • 683 View
  • 71 Download
PDFSupplementary Material
Review
Anorectal benign disease
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Ann Coloproctol. 2024;40(4):321-335.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00325.0046
  • 6,614 View
  • 565 Download
  • 1 Web of Science
  • 3 Citations
AbstractAbstract PDF
Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Citations

Citations to this article as recorded by  
  • Understanding the anatomical basis of anorectal fistulas and their surgical management: exploring different types for enhanced precision and safety
    Asim M. Almughamsi, Yasir Hassan Elhassan
    Surgery Today.2025;[Epub]     CrossRef
  • From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
    In Ja Park
    Annals of Coloproctology.2024; 40(4): 285.     CrossRef
  • Surgeon oriented reporting template for magnetic resonance imaging and endoanal ultrasound of anal fistulas enhances surgical decision-making
    Si-Ze Wu
    World Journal of Radiology.2024; 16(12): 712.     CrossRef
Letter to the Editor
Local plus oral antibiotics and strict avoidance of constipation is effective and helps prevents surgery in most cases of anal fissure
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Ann Coloproctol. 2023;39(2):188-189.   Published online November 29, 2022
DOI: https://doi.org/10.3393/ac.2022.00731.0104
  • 9,586 View
  • 162 Download
PDF
Original Article
Anorectal benign disease
Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study
Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg
Ann Coloproctol. 2024;40(5):490-497.   Published online October 11, 2022
DOI: https://doi.org/10.3393/ac.2022.00346.0049
  • 2,637 View
  • 107 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by  
  • Recent Advances in the Understanding and Management of Anal Fistula from India
    Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
    Indian Journal of Surgery.2024; 86(6): 1105.     CrossRef
  • Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
    Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
    Clinical and Experimental Gastroenterology.2024; Volume 17: 97.     CrossRef
  • Recent advances in the diagnosis and treatment of complex anal fistula
    Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
    Annals of Coloproctology.2024; 40(4): 321.     CrossRef
  • Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
    Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
    Health Science Reports.2023;[Epub]     CrossRef
  • Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
    David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
    Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16.     CrossRef
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