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Background Nucleic Acid Amplification Testing (NAT) assay is the new tool that may diagnose gonorrhoea and or chlamydia more sensitive and specific. The test, however, is not widely used in Indonesia, time consuming and expensive. Pooling of samples may significantly reduce the cost while maintaining the effectiveness of the test with high specificity and sensitivity rate for the detection of CT/NG infections. This study aimed to examine the effectiveness of 3-in-1 pooled samples from anal, rectal and throat of GenXpert CT/NG among MSM in Bali, Indonesia Methods A quantitative study was conducted between July 2017 and July 2018 in an MSM clinic in Bali. Xpert CT/NG samples were collected from throat, anal swab and first pass urine which then pooled into one cartridge. The pooled samples results were compared with each site results by CT/NG GeneXpert® assay. Results A total of 502 swabs were collected from 251 participants, comprises 251 pharyngeal and rectal swabs respectively, along with 251 First Pass Urine. Sensitivities and specificities of the GeneXpert® CT/NG assay was calculated using the pooled 3-in-1 sites compare to each site result as standard. 4/251 (1.5%) of rectal swab samples invalid and/or error by CT/NG GeneXpert® assay that most likely due to contamination with stools. The study shown the performance of 3-in-1 pooled samples (from anal, rectal and throat) of GeneXpert® CT/NG was highly effective due to the high rate of sensitivity and specificity, particularly from anal site as shown in table 1. Conclusion This is the first study ever conducted to report data on the performance of pooled samples of GeneXpert® CT/NG among MSM in Indonesia. Consistent with similar study in other countries using other NAT platform, this study found the high rate of sensitivity and specificity for CT/NG detection. To be concluded, pooled samples among MSM can be considered in the resource-constraint setting. Disclosure No significant relationships.

Increased defecation frequency and soiling are common complications of surgery for right-sided Hirschsprung's disease (HD). Though the laparoscopic Duhamel procedure is a favorable option in right-sided HD, the conventional laparoscopic technique is time consuming and has complications that are associated with the reservoir. In this study, we described a modified laparoscopic Duhamel technique with ex-anal rectal transection combined with the Deloyer's procedure for right-sided HD.Between March 2010 and January 2015, 18 right-sided HD underwent this modified laparoscopic Duhamel procedure (MLDP). The main modifications were to mobilize the colon and to dissect the retrorectal space under laparoscopy, pull out, and transect ex-anally by using a linear stapling device through a transverse incision on posterior wall of the rectum. Seven age-matched patients who underwent a conventional laparoscopic Duhamel procedure (CLDP) between March 2008 and December 2010 were included as the control group. Demographics, surgical procedures, operative data, postoperative complications, and clinical outcomes were compared between these two groups.Operative time was significantly shorter in the MLDP group (150 minutes versus 195 minutes; P = .03). There was no significant difference in mean timespan to obtain a normal defecation frequency (3.8 months versus 3.6 months), incidence of soiling (11.1% versus 14.3%; P = .34), and constipation (5.6% versus 14.3%; P = .69). Pouchitis were not found in the MLDP group, whereas 2 patients in the CLDP group (28.6%) presented with pouchitis and intractable diarrhea, requiring spur division. The incidence of postoperative enterocolitis was not significantly different in the two groups (11.1% in MLDP versus 14.3% in CLDP; P = .68). All 22 patients had a normal defecation over 4 years of age.Laparoscopic Duhamel with ex-anal rectal transection is a simple, easy-to-learn, and effective procedure for right-sided HD. It has low postoperative pouchitis because of a short pouch.

Longo's procedure of double stapled trans anal rectal resection (STARR) has been evocated as surgical treatment of the obstructed defecation syndrome (ODS) in patients with rectal mucosal prolapse. The aim of this study was to investigate the post-interventional findings of this technique, to help radiologist in knowledge of the changed morphology of the rectal lumen, also in attempt to recognize some potential related complications.

L’intervention de STARR permet de traiter les troubles de l’evacuation rectale en pratiquant une resection rectale par voie transanale. La correction d’une rectocele et/ou de la procidence interne du rectum permet ainsi de faciliter la vidange du rectum. Cette methode mini-invasive necessite de respecter, de facon rigoureuse, le protocole operatoire et de bien selectionner les patient(e)s pour pretendre a des resultats satisfaisants et durables.

Objectives To modify our technique of perianal anesthesia and use it in patients with painful conditions of the rectum and/or anus. Methods A total of 31 consecutive patients with anal-rectal problems underwent prostate needle biopsy. Of these, 17 were referred to our hospital after vain attempts to insert a transrectal ultrasound probe. Patients received a perianal-pericapsular injection of 1% lidocaine. Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score. Results Only in 1 patient were we unable to insert the transrectal ultrasound probe. The mean patient age was 65.28 ± 5.35 years. We performed a mean of 12.25 biopsies per case. At probe insertion, the mean pain score was 2.2 ± 0.83. During the biopsy punctures, the mean pain level was 2.53 ± 1.054. We did not find any increase in the complication rate related to the anesthesia method. Conclusions Modified perianal anesthesia can be used for transrectal ultrasound-guided biopsy of the prostate in patients with anal-rectal problems, because it provides significant pain relief.

T UMORS of the anus and rectum can be paIpated. The common mahgnant and benign neopIasms (adenocarcinema, polyps) of the anorectum are rarely confusing. However, there is a group of unusua1 tumors in this area which is often confused with carcinomas; the tumors are misdiagnosed because of their deviant pattern or are mistakenIy accepted as benign growths. This unusua1 group invoIves important diagnostic and therapeutic probIems. The foIIowing tumors were seen at our Institution from 1930 to 1947: maIignant meIanoma of the anorectum, hemangioma of the rectum, malignant Ieiomyoma of the rectum, Iymphosarcoma of the anorectum, synchronous carcinomas of anus and rectum, retrorecta1 or sacrococcygea1 teratoma and chordoma, sacra1 region.