Q: What is the contribution of Dr. Pankaj Garg in the field of anal fistulas? Has Dr. Garg done maximum work in the field of anal fistulas and is recognized as the topmost fistula expert in the world? If yes, why?

Dr. Garg Is Ranked Number -1 In the Field of Anal Fistulas in The World

Dr. Garg Is Ranked Number -1 In the Field of Anal Fistulas in The World

Dr. Garg is the topmost researcher as well as clinician in the field of Anal Fistulas

He has done maximum work in the field of anal fistula in the world (>60 publications) and is the undisputed number one fistula expert in the world. Anal fistula is a bad disease known for its recurrences (the disease keeps coming back again and again). In this field, Dr. Garg has the best possible success rate in the world, has done maximum innovations in the world, has the highest turnover of patients in the world, and treated patients from maximum countries. There would be very few doctors in the country who are number one in their field in the world!

The fascinating aspect is that Dr. Garg has become number one in the field of his work with zero research budget surpassing fellow experts from the USA, UK, Europe, and Australia who are better placed and equipped with several times more resources.

This figure was used by an expert recently who recommended Dr. Garg for a prestigious award

Dr. Garg for a prestigious award

A brief about the work of Dr Garg in the field of Anal fistulas is as follows: –

  1. Largest series of anal fistula in medical literature (1250 patients)[1]
  2. Largest series of exclusive complex high fistulas with long-term follow-up (408 patients)[1, 2]
  3. Largest series of Supralevator fistulas with long-term follow-up (129 patients)[1, 3]
  4. Largest series of Preoperative and Postoperative MRI in anal fistulas (2404 MRI)[4-6]
  5. Largest series of Anorectal Tuberculosis (776 patients, 1336 samples)[7-9]
  6. Largest series of fistulotomy to treat anal fistulas (611 patients)[1, 10, 11]
  7. New useful Classification of Anal Fistula (Garg classification)[12-14]
  8. Cardinal Principles to treat Complex Anal Fistula (Garg cardinal principles)[15-17]
  9. New Protocol to treat Anal fistula with No obvious internal opening (Garg protocol) [18, 19]
  10. Guidelines to interpret MRI in postoperative period after fistula surgery[4]
  11. A new anatomical space where fistula spreads (Outersphincteric of Garg space)[20, 21]
  12. A new type of highly complex fistula (RIFIL fistulas)[22]
  13. A new parameter-HOPE- as a parameter in MRI reporting of anal fistulas[23]
  14. Innovation of TROPIS Procedure- Highly effective to treat high complex and supralevator fistulas (healing rate>90% over long-term)[2, 24]
  15. Innovation of Tube in tract and PERFACT procedures for anal fistula[25-27]
  16. Management of circumrectal fistulas (completely encircling the anorectum)[28]
  17. Management of additional supralevator rectal opening in supralevator fistulas[29]
  18. First Proportional meta-analysis on VAAFT and anal fistula plug[30, 31]
  19. IRIP (inability to raise intraabdominal pressure) phenomenon as a cause of urinary retention after fistula surgery[32]
  20. First series of Anal Fistula and Pilonidal Sinus Disease coexisting simultaneously[33]
  21. First paper to objectively demonstrate role of MRI to confirm long-term healing in complex high cryptoglandular anal fistulas (151 cases)[34]
  22. First Guidelines on postoperative MRI in patients operated for cryptoglandular anal fistula (2404 MRI)[4]
  23. A new scoring system to accurately predict long-term healing in cyrptoglandular fistulas[35, 36]

EPONYMOUS INNOVATIONS NAMED AFTER DR GARG IN MEDICAL LITERATURE
Amongst the 29 innovations, many of them have been eponymously named after Dr Garg. All these have been published in prominent US & European journals and textbooks. It is a matter of great pride that so many innovations have been named after an Indian and are being followed all over the world.

  1. Garg classification[12-14]
  2. Garg protocol[18, 19]
  3. Garg scoring system[35, 36]
  4. Garg space[20, 21]
  5. Garg cardinal principles[15-17]

References

1. Garg P, Kaur B, Goyal A, Yagnik VD, Dawka S, Menon GR. Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review. World J Gastrointest Surg 2021; 13(4): 340-354 ( Click here for PubMed, Click here for DOI )

2. Garg P, Kaur B, Menon GR. Transanal opening of the intersphincteric space: a novel sphincter-sparing procedure to treat 325 high complex anal fistulas with long-term follow-up. Colorectal Dis 2021; 23(5): 1213-1224 ( Click here for PubMed, Click here for DOI )

3. Garg P. Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature. Dis Colon Rectum 2018; 61(5): 612-621 ( Click here for PubMed, Click here for DOI )

4. Garg P, Kaur B, Yagnik VD, Dawka S, Menon GR. Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans. World J Gastroenterol 2021; 27(33): 5460-5473 [PMID: 34588745 PMCID: PMC8433608 DOI: 10.3748/wjg.v27.i33.5460] ( Click here for PubMed, Click here for DOI )

5. Garg P. Comparison of Preoperative and Postoperative MRI After Fistula-in-Ano Surgery: Lessons Learnt from An Audit of 1323 MRI At a Single Centre. World J Surg 2019; 43(6): 1612-1622 ( Click here for PubMed, Click here for DOI )

6. Garg P, Singh P, Kaur B. Magnetic Resonance Imaging (MRI): Operative Findings Correlation in 229 Fistula-in-Ano Patients. World J Surg 2017; 41(6): 1618-1624 ( Click here for PubMed, Click here for DOI )

7. Garg P, Goyal A, Yagnik VD, Dawka S, Menon GR. Diagnosis of anorectal tuberculosis by polymerase chain reaction, GeneXpert and histopathology in 1336 samples in 776 anal fistula patients. World J Gastrointest Surg 2021; 13(4): 355-365 ( Click here for PubMed, Click here for DOI )

8. Garg P, Garg M, Das BR, Khadapkar R, Menon GR. Perianal Tuberculosis: Lessons Learned in 57 Patients From 743 Samples of Histopathology and Polymerase Chain Reaction and a Systematic Review of Literature. Dis Colon Rectum 2019; 62(11): 1390-1400 ( Click here for PubMed, Click here for DOI )

9. Garg P. Comparison of histopathology and real-time polymerase chain reaction (RT-PCR) for detection of Mycobacterium tuberculosis in fistula-in-ano. Int J Colorectal Dis 2017; 32(7): 1033-1035 ( Click here for PubMed, Click here for DOI )

10. Garg P. Is fistulotomy still the gold standard in present era and is it highly underutilized?: An audit of 675 operated cases. Int J Surg 2018; 56: 26-30 ( Click here for PubMed, Click here for DOI )

11. Garg P. Standardizing the Steps of Fistulotomy to Maximize the Cure Rate and Minimize Incontinence Risk in Anal Fistula. Indian Journal of Surgery 2020; 82(6): 1325-1326 ( Click here for DOI )

12. Garg P. Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients – Cohort study. Ann Med Surg (Lond) 2020; 59: 122-126 ( Click here for PubMed, Click here for DOI )

13. Garg P. Garg Classification for Anal Fistulas: Is It Better than Existing Classifications?—a Review. Indian Journal of Surgery 2018; 80(6): 606-608 ( Click here for DOI )

14. Garg P. Comparing existing classifications of fistula-in-ano in 440 operated patients: Is it time for a new classification? A Retrospective Cohort Study. Int J Surg 2017; 42: 34-40 ( Click here for PubMed, Click here for DOI )

15.  Garg P. A new understanding of the principles in the management of complex anal fistula. Med Hypotheses 2019; 132: 109329 ( Click here for PubMed, Click here for DOI )

16. Garg P, Sodhi SS, Garg N. Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions. Clin Exp Gastroenterol 2020; 13: 555-567 ( Click here for PubMed, Click here for DOI )

17. Garg P. Intersphincteric Component in a Complex Fistula-in-Ano Is Like an Abscess and Should Be Treated Like One. Dis Colon Rectum 2018; 61(4): e26 ( Click here for PubMed, Click here for DOI )

18. Garg P, Kaur B, Singla K, Menon GR, Yagnik VD. A Simple Protocol to Effectively Manage Anal Fistulas with No Obvious Internal Opening. Clin Exp Gastroenterol 2021; 14: 33-44 ( Click here for PubMed, Click here for DOI )

19. Garg P, Kaur B, Yagnik VD, Dawka S, Sohal A, Menon GR. Non-locatable internal opening in anal fistula associated with acute abscess and its management. World J Gastrointest Surg 2022; Accepted, under print

20. Garg P, Kaur B. The new pathways of spread of anal fistula and the pivotal role of MRI in discovering them. Abdom Radiol (NY) 2021; 46(8): 3810-3814 ( Click here for PubMed, Click here for DOI )

21. Garg P, Kaur B, Yagnik VD, Dawka S. A New Anatomical Pathway of Spread of Pus/Sepsis in Anal Fistulas Discovered on MRI and Its Clinical Implications. Clin Exp Gastroenterol 2021; 14: 397-404 ( Click here for PubMed, Click here for DOI )

22. Garg P, Dawka S, Yagnik VD, Kaur B, Menon GR. Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI. Abdom Radiol (NY) 2021; 46(12): 5550-5563 ( Click here for PubMed, Click here for DOI )

23. Garg P, Kaur B, Yagnik V, Dawka S. Inclusion of a video and a novel parameter-HOPE- in MRI reporting of Anal fistula. World J Gastrointest Surg 2022; (Accepted, under print)

24. Garg P. Transanal opening of intersphincteric space (TROPIS) – A new procedure to treat high complex anal fistula. Int J Surg 2017; 40: 130-134 ( Click here for PubMed, Click here for DOI )

25. Garg P. Tube in tract technique: a simple alternative to a loose draining seton in the management of complex fistula-in-ano–a video vignette. Colorectal Dis 2016; 18(1): 107 ( Click here for PubMed, Click here for DOI )

26. Garg P. PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure. World J Gastrointest Surg 2016; 8(4): 326-334 ( Click here for PubMed, Click here for DOI )

27. Garg P, Garg M. PERFACT procedure: a new concept to treat highly complex anal fistula. World J Gastroenterol 2015; 21(13): 4020-4029 ( Click here for PubMed, Click here for DOI )

28. Garg P, Kaur B, Yagnik VD, Menon GR. Extreme horseshoe and circumanal anal fistulas-challenges in diagnosis and management. Tzu Chi Med J 2021; 33(4): 374-379 ( Click here for PubMed, Click here for DOI )

29. Garg P, G RM, Kaur B. Comparison of different methods to manage supralevator rectal opening in anal fistulas: A retrospective cohort study. Cir Esp (Engl Ed) 2021; 16: S0009-0739X(0021)00114-00117 ( Click here for PubMed, Click here for DOI )

30. Garg P, Singh P. Video-Assisted Anal Fistula Treatment (VAAFT) in Cryptoglandular fistula-in-ano: A systematic review and proportional meta-analysis. Int J Surg 2017; 46: 85-91 ( Click here for PubMed, Click here for DOI )

31. Garg P, Song J, Bhatia A, Kalia H, Menon GR. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Dis 2010; 12(10): 965-970 ( Click here for PubMed, Click here for DOI )

32. Garg P. Inability to raise intraabdominal pressure (IRIP): a common missed cause of postoperative urinary retention after anorectal surgery. Tech Coloproctol 2020; 24(5): 499 ( Click here for PubMed, Click here for DOI )

33. Garg P. Anal fistula and pilonidal sinus disease coexisting simultaneously: An audit in a cohort of 1284 patients. Int Wound J 2019; 16(5): 1199-1205 ( Click here for PubMed, Click here for DOI )

34. Garg P, Yagnik VD, Kaur B, Menon GR, Dawka S. Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long-term follow-up of 151 cases. Colorectal Dis 2021; 23(9): 2447-2455 ( Click here for PubMed, Click here for DOI )

35. Garg P, Yagnik VD, Dawka S, Kaur B, Menon GR. A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas. Clin Exp Gastroenterol 2022; 15: 27-40 ( Click here for PubMed, Click here for DOI )

36 Garg P, Kumar P, Sasmal P, Sachdeva M, Jain M. A novel MRI-based scoring system to assess post-surgery healing and to predict long-term healing in cryptoglandular anal fistulas. Colorectal Disease 2022; 24(S1): 32, O054 (Oral Presentation) ( Click here for DOI )