Comparison of botulinum toxin (BoNT) injection and lateral internal sphincterotomy (redo-LIS) for recurrent anal fissure treatment.

Objective: Today's gold standard for treating chronic anal fissure is the Lateral Internal Sphincterotomy (LIS). Botulinum Toxin (BoNT) injection is, on the other hand, an alternative treatment for patients who do not want to have surgical treatment, patients undergoing chemotherapy, patients of high risk for surgery, and those who have the risk of anal incontinence (e.g., elderly, past anorectal surgery, vaginal multiple births, etc.). The aim of this study is to compare the effectiveness of BoNT and redo-LIS for treatment of post-LIS recurrent chronic anal fissure, and reveal differences if any.This study aims to compare redo-LIS and BoNT injection for treating post-LIS recurrent anal fissure. Material and method: Nineteen patients who received LIS treatment and then redo-LIS or BoNT injection due to recurrence in the follow-up were included in this study. Group I (redo-LIS group) include 11 patients and group 2 (BoNT group) includes 8 patients. Their data on age, sex, anal incontinence scores and pain (VAS score) score as well. Results: During the 3-month post-surgery follow-up period, there was statistically significant difference (p < 0.01) between groups by pain. No deterioration in the incontinence scores of patients in the group during the 6-month post-surgery period. Conclusion: This study demonstrates that redo lateral internal sphincterotomy (LIS) is a reliable method for patients who received LIS but developed recurrent chronic anal fissure, and achieves successful results in terms of recurrence and relief of pain.

Gallbladder Polyp and Cancer Evaluation After Cholecystectomy: A Retrospective Observational Study.

Introduction Our aim in this study is to examine the clinical features of gallbladder polyps (GBPs) detected by preoperative ultrasonography (USG) or after cholecystectomy, especially benign and malignancy. Methods One thousand seven hundred patients between the ages of 18-80 who were operated on for cholecystectomy between January 1, 2015, and January 1, 2020, in Ankara Batikent Medicalpark hospital were evaluated in this study. Of these patients, 149 patients who were operated on due to polyp detected in USG, who were accompanied by polyp while being operated on for another reason, or who had a benign or malignant polypoid structure in postoperative pathology were examined. Mann-Whitney U test was used for continuous variables and the chi-square test was used for categorical variables. Results The mean age for patients with polyps was 44.6 years (range: 21-78). When the patient distribution was evaluated according to gender, although women were more, they were proportionally close to each other (female 77 (51.7%), male 72 (48.3%)). When the polyps were examined in pathology, 20 (13.4%) patients did not have polyps. Given the other patients, hyperplastic polyps were detected in 15 (10.1%), cholesterol polyps in 104 (69.8%), and adenocarcinomas in five (3.4%) of them. Of the patients with adenocarcinoma, two had T2 and three had T1 tumors. Two of the patients with gallbladder cancer had sessile polyps below 5 mm. Of the malignant cases, four were female and one was male. The median age in malignant cases was 55 years. All malignant cases had single polyps. Conclusion In conclusion, in our study, it was observed that most postoperative GBPs were benign - malignancy should come to mind at an advanced age - and was compatible with current malignant polyp risk factors. Contrary to the literature, female gender dominance was present in our malignant cases.

Skin-sparing approach in the management of Fournier's gangrene: the initial histological evidence and results of a tertiary health-care center.

BACKGROUND: To report the initial histological evidence on the feasibility of the skin-sparing approach in the treatment of Fournier's gangrene. METHODS: We retrospectively reviewed the clinical data and the tissue blocks obtained from patients who had undergone debridement in a tertiary healthcare center by a urologist and a general surgeon. RESULTS: The histological review revealed the prevalence of the intact epidermal layers in the debrided tissues involving necrosed subcutaneous parts. Clinical results of our cohort were compatible with the contemporary series. CONCLUSION: We can propose that the skin parts without macroscopic necrosis can be spared in the initial debridement in the treatment of Fournier's gangrene, at least in the first debridement. The skin-sparing approach may provide easier and primary closure of the wound without compromising surgical safety in Fournier's gangrene treatment.