مینا الوندی پور

Postoperative pain is one of the most important complications of anorectal surgeries. Management of these pains would result in improved situations and more satisfaction in patients. The utilization of topical medications is a recommended approach and phenytoin is a preferred option for this method. Hence, this study aimed to invstigate the effects of topical ointment of phenytoin 1%, topical placebo on wound healing, and postoperative pain in patients with perianal fistula after fistulotomy.

This study is a double-blind randomized clinical trial, it was conducted by the 31 codes of research ethics of Iran. In this double-blind randomized clinical trial, 44 patients with anal fistula underwent fistulotomy at Imam Khomeini Hospital in Sari after obtaining informed consent and were randomly selected to receive topical 1% phenytoin ointment or topical placebo twice a day. Phenytoin 1% cream was prepared by Iran Daropaksh Company and the placebo was prepared from Vaseline ointment. The inclusion and exclusion criteria of the study were checked. Medicines were coded in opaque medicine cans and assigned to study groups using a limited randomization method. After that, up to 8 weeks after the operation, pain, recovery, pain caused by defecation, itching, and complications were determined and compared in the groups. Data analysis was done with SPSS software (version 13.0). Chi-Square, Independent-Sample-T test, and Repeated-Measure ANOVA tests were used to compare between 2 groups.

A total of 44 patients completed the study and a thorough analysis was carried out. The average age in the intervention group was 43.0±11.8 years and in the control group was 42.1±6.9 years (P>0.05). The patients in the two study groups did not differ in terms of the type of fistula (P>0.05). Postoperative pain from the first to the fifth visit was significantly lower in the phenytoin group compared to the placebo group (P<0.001). Also, the pain after defecation from the first to the fifth visit in the phenytoin group was significantly less than the placebo group (P<0.001). The percentage of recovery from the first to the fifth visit was significantly higher in the phenytoin group compared to the placebo group (P<0.001). There was no statistically significant difference between the intensity of itching among the groups (P>0.05). Wound secretion was observed in the phenytoin group and the control group, respectively, 63.6% and 68.2% (P>0.05). In the phenytoin group, 85.7% of serous and 14.3% of pus were observed, and in the control group, 53.3%, 33.3%, and 13.4% of serous, pus, and blood were observed, respectively (P>0.05). The only complication in the phenytoin group was bleeding, which was observed in 3 patients (13.6%).

In general, it can be concluded that 1% phenytoin ointment is effective in wound healing and reducing postoperative pain in patients with anal fistula undergoing fistulotomy. Therefore, the use of this topical medicine is recommended. However, studies with a larger sample size are needed to reach more definitive results.

Colorectal resection is used for various diseases and leakage in an anastomosis is one of its complications. Some studies confirmed the predictive effects of C-reactive protein (CRP) and procalcitonin markers leakage in anastomosis. This study aimed to investigate the prognostic value of CRP and procalcitonin in predicting anastomotic leakage in elective colorectal surgery in Mazandaran province, Iran.

This longitudinal study was performed in patients (n=72) undergoing intestinal anastomosis in Sari Imam Khomeini Hospital, Oct 2016-March 2017. White blood cells (WBC), temperature (T), CRP, and procalcitonin levels were measured at days 3 and 5 after the surgery. Data were analyzed using SPSS V21.

Anastomotic leakage occurred in two patients (2.8%). Procalcitonin levels (P= 0.000), CRP levels at days 3 (P= 0.000) and 5 (P= 0.000), WBC at day 5 (P = 0.041), and body temperature at days 3 (P= 0.014) and 5 (P= 0.004) after the surgery were associated with the incidence of anastomotic leakage.

Procalcitonin and CRP levels, WBC count, and body temperature were found to be correlated with anastomotic leakage, so they should be monitored at days 3 and 5 after the surgery to predict the incidence of complications.

There are several techniques for preserving the rectum in Low Anterior Resection (LAR) and preventing permanent ostomy. However, the superiority of these techniques is still under debate. The aim of this study was to compare the performance and clinical outcome of three methods of straight, side-to-end, and colonic J-pouch colorectal anastomosis in patients with rectal cancer referred to Imam Khomeini Hospital in Sari.

In this prospective single-blind clinical trial, all 75 patients with rectal cancer over the age of 18 years with primary rectal tumor with resection capability and position of the lower or middle rectum 4 to 12 cm from the anal canal, during the period of 2017 to 2018 referred to Imam Khomeini Hospital in Sari, were randomly divided into three groups of 25 people using block sampling: (the first group: low anterior resection with straight anastomosis, the second group: surgery with colonic J-pouch and the third group: side-to-end anastomosis). Functional outcomes (measured by Wexner criteria) and surgical complications were compared in the two groups, and patients were followed up to evaluate the functional features of the anastomosis.

60 patients including 29 women (48.33%) and 31 men were analyzed. The mean age of patients was 58.32±14.91 years. The mean length of surgery, median hospitalization and median bleeding in patients undergoing J-pouch anastomosis were 178.65±14.21 minutes, four days and 500 ml, respectively. No surgery-related complications were seen in the three groups. The Wexner criterion showed the superiority of patients who underwent J-pouch anastomosis surgery in the variables of daily defecation frequency, fecal incontinence and emergency defecation compared to the other two groups (p<0.001, p<0.005, p<0.022).

The results of this study showed that the performance indices of patients with rectal cancer in people undergoing J-pouch anastomosis are better compared to side-to-end and straight methods.

Fear of pain is one of the main reasons for refusing surgical hemorrhoidectomy among patients with hemorrhoids. This study investigated the effect of Diosmin on post-hemorrhoidectomy pain.

A single-blind randomized clinical trial was performed in 92 patients undergoing hemorrhoidectomy. They were randomly divided into two groups; the intervention group (n=46) received Diosmin 500 mg daily, and the placebo group (n=46) received a tablet daily. Both groups were examined after a week. Duration of hospitalization, return to work, and time of complete recovery and pain were also examined. Data analysis was done in SPSS V18.

The mean age of patients was 37.55±12.21 years. In both groups, distribution of population was completely homogeneous in terms of age (0.833), gender (1.00), degree of hemorrhoids (0.538), mucous secretion (0.514), duration of hospitalization (0.821), return to work (0.754), complete recovery (0.631), and postoperative bleeding (0.557) showing no significant relationship between the two groups (0.557). The mean pain intensity was 3.41±1.292 in intervention group and 4.65±1.370 in the placebo group which showed a significant difference between the two groups after the intervention (P=0.000).

Diosmin can be used as a safe drug with minimal side effects to control post-hemorrhoidectomy pain.
 
(Clinical Trials Registry Number: IRCT20180717040509N1)
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Background and

Todays one of the most common anorectal problems is hemorrhoid. Minor symptom of disease can be treated by medical treatment but at high grade disease we should consider surgery. Although conventional surgery is standard operation for hemorrhoid، it is associated with some complication. Many technique were designed to overcome these problems. One of these procedures is Ligasure hemorrhoidectomy that this study was done to compare it with conventional hemorrhoidectomy.

This was a randomized cilinical trial study of 60 patients with third-degree or four-degree hemorrhoid that was divided into two groups randomly. Operative time، bleeding، postoperative pain، rate of wound healing were recorded.

we randomized 60 patients، 30 to Ligasure and 30 to conventional. There were no difference in patients demographic datas. Operative time، bleeding، pain at second postoperative day in Ligasure group was less than the conventional. There was no difference in rate of healing، pain at first day postoperation and complications.

Ligasure hemorrhoidectomy is a safe and feasible procedure and in comparison with conventional hemorrhoidectomy cause more pain control and satisfaction.