145 results on '"Anal stricture"'
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2. What Can an Aging Pouch Tell Us? Outcomes of Ileoanal Pouches Over 20 Years Old
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Ali A. Al Jabri, Patricia L. Roberts, David J. Schoetz, Angela H. Kuhnen, Elizabeth M. Breen, Peter W. Marcello, David A. Kleiman, Julia T. Saraidaridis, and Olga Beresneva
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Colonic Pouches ,Constriction, Pathologic ,Pouchitis ,Young Adult ,Postoperative Complications ,Crohn Disease ,Interquartile range ,Anal stenosis ,medicine ,Humans ,Retrospective Studies ,Proctocolectomy ,business.industry ,Gastroenterology ,General Medicine ,medicine.disease ,Ulcerative colitis ,Surgery ,Defecation ,Colitis, Ulcerative ,Pouch ,business ,Anal stricture - Abstract
Little is known about the long-term functional outcomes of restorative proctocolectomy.The aim of this study was to examine ileoanal pouch outcomes 20 and 30 years postoperatively.This is a retrospective case series.This study was conducted at a tertiary care referral center.Patients who underwent restorative proctocolectomy between 1980 and 1994 were identified. Those with ≥20 years of in-person follow-up were included.Pouch function, pouchitis, anal stricture, and pouch failure rates were analyzed.A total of 203 patients had ≥20 years of follow-up. Of those, 71 had ≥30 years of follow-up. Initial diagnoses included ulcerative colitis (83%), indeterminate colitis (9%), familial adenomatous polyposis (4%), and Crohn's disease (3%). Twenty-one percent of those with ulcerative or indeterminate colitis later transitioned to Crohn's disease. Mean daily stool frequency was 7 (IQR 6-8), 38% experienced seepage, 31% had anal stenosis, 47% experienced pouchitis, and 18% had pouch failure. Over time, stool frequency increased in 41% of patients, stayed the same in 43%, and decreased in 16%. Patients older than 50 years at the time of construction had more daily bowel movements (median 8 vs 6; p = 0.02) and more seepage (77% vs 35%; p = 0.005) than those younger than 50 years. Patients with Crohn's disease had higher stool frequency (median 8 vs 6; p0.001) and higher rates of anal stenosis (44% vs 26%; p = 0.02), pouchitis (70% vs 40%; p0.001), and pouch failure (38% vs 12%; p0.001) compared to non-Crohn's patients. Patients with ≥30 years of follow-up had similar function as those with 20-30 years of follow-up.This was a retrospective, single-institution study. Only 35% of pouches created during the study period had20 years of follow-up.Most patients maintain reasonably good function and retain their pouches after 20 years. Over time, stool frequency and seepage increase. Older age and Crohn's disease are associated with worse outcomes. See Video Abstract at http://links.lww.com/DCR/B801.ANTECEDENTES:se sabe poco sobre los resultados funcionales a largo plazo de la proctocolectomía restauradora.OBJETIVO:El objetivo de este estudio fue examinar los resultados del reservorio ileoanal 20 y 30 años después de la operación.DISEÑO:Serie de casos retrospectiva.ENTORNO CLÍNICO:Centro de referencia de atención terciariaPACIENTES:Se identificaron pacientes que se sometieron a proctocolectomía restauradora entre 1980 y 1994. Se incluyeron aquellos con ≥20 años de seguimiento en persona.PRINCIPALES MEDIDAS DE VALORACIÓN:Se analizaron la función, inflamación, tasas de falla del reservorio y estenosis anal.RESULTADOS:Un total de 203 pacientes tuvieron ≥20 años de seguimiento. De ellos, 71 tenían ≥30 años de seguimiento. Los diagnósticos iniciales incluyeron colitis ulcerosa (83%), colitis indeterminada (9%), poliposis adenomatosa familiar (4%) y enfermedad de Crohn (3%). El 21% de las personas con colitis ulcerosa o indeterminada pasaron posteriormente a la enfermedad de Crohn. La frecuencia promedio de las deposiciones diarias fue de 7 (rango intercuartil 6-8), el 38% experimentó filtración, el 31% tuvo estenosis anal, el 47% experimentó pouchitis y el 18% tuvo falla del reservorio. Con el tiempo, la frecuencia de las deposiciones aumentó en el 41% de los pacientes, se mantuvo igual en el 43% y disminuyó en el 16%. Los pacientes mayores de 50 años en el momento de la construcción tenían más evacuaciones intestinales diarias (media 8 vs 6, p = 0,02) y más filtraciones (77% vs 35%, p = 0,005) que los menores de 50 años. Los pacientes con enfermedad de Crohn tenían mayor frecuencia de deposiciones (media 8 vs 6, p0,001) y tasas más altas de estenosis anal (44% vs 26%, p = 0,02), inflamacion (70% vs 40%, p0,001) y falla del reservorio (38% frente a 12%, p0,001) en comparación con pacientes que tenian enfermedad de Crohn. Los pacientes con ≥30 años de seguimiento tuvieron una función similar a aquellos con 20-30 años de seguimiento.LIMITACIONES:Este fue un estudio retrospectivo de una sola institución. Solo el 35% de los reservorios creados durante el período de estudio tuvieron más de 20 años de seguimiento.CONCLUSIONES:La mayoría de los pacientes mantienen una función razonablemente buena y conservan el reservorio después de 20 años. Con el tiempo, la frecuencia de las deposiciones y la filtración aumentan. La vejez y la enfermedad de Crohn se asocian con peores resultados. Consulte Video Resumen en http://links.lww.com/DCR/B801. (Traducción - Dr. Ingrid Melo).
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- 2022
3. Outcome of Seton in the Management of Complex Fistula in Ano in a Tertiary Care Center in Bangladesh
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Armanul Islam, SM Quamrul Akther, Shakila Akhter, Asma Bint Anowar, Mozammel Hoque, Mustafizur Rahman, Syed Masud Reza, and Mahfuzur Rahman Khan
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Anal fistula ,medicine.medical_specialty ,business.industry ,Fistula ,Standard treatment ,Rectum ,medicine.disease ,Colorectal surgery ,Surgery ,medicine.anatomical_structure ,medicine ,Sitz bath ,Defecation ,business ,Anal stricture - Abstract
Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19
- Published
- 2021
4. Anterior sagittal anorectoplasty as a technique for the repair of female anorectal malformations: A twenty two-years-single-center experience
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Saber Waheeb, Ahmed Koraitim, and Ahmed Elrouby
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medicine.medical_specialty ,medicine.medical_treatment ,Fistula ,Anal Canal ,Rectum ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,030225 pediatrics ,Humans ,Rectal Fistula ,Medicine ,Retrospective Studies ,business.industry ,Rectovaginal Fistula ,Colostomy ,Infant ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Anus ,Anorectal Malformations ,Sagittal plane ,Surgery ,Rectal prolapse ,medicine.anatomical_structure ,Rectovaginal fistula ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,business ,Constipation ,Anal stricture - Abstract
Background Anorectal malformations (ARMs) are major congenital malformations occurring in female children in approximately 1 out of every 4000–5000 births. Posterior sagittal anorectoplasty (PSARP) was introduced for their treatment in early 1980s by Pena and Devries. However, anterior sagittal anorectoplasty (ASARP) was first introduced by Okada as a modification of the previous technique. Purpose The aim of this study was to report our experience and the long-term follow-up results of 594 female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. We chose this approach as the incision is smaller, with minimal cutting of the external sphincter and easier dissection of the vagina and rectum. The type of our study was retrospective study. Results The study included 594 patients; 342 of them were less than 1 year old. About 526 patients had rectovestibular fistula, anterior perineal anus in 55 patients, anocutaneous fistula in 6 patients and rectovaginal fistula in 7 patients. All of these patients had been subjected to ASARP technique which had been done in one stage without proceeding colostomy in about 470 cases and in staged fashion with a protective colostomy in 124 patients. Postoperative follow up revealed that four patients (0.7%) developed anal retraction, 30 patients (5%) developed anal stricture, 20 patients (3.4%) had rectal prolapse and 40 patients (6.7%) developed anterior anal migration. Constipation was observed in 161 patients (27%) by the end of 1st postoperative year reduced to 41 patients (7%) after one year. 474 patients were assessed for continence by Kelly's continence score and 453 patients showed good result, 16 patients showed fair result and about 5 patients had poor continence outcome. Conclusion Anterior sagittal anorectoplasty is a procedure with optimal functional outcome especially at if done at an early age in one stage without preliminary colostomy.
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- 2020
5. Laparoscopic surgical technique to enhance the management of anorectal malformations: 330 cases’ experience in a single center
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Long Li, Mei Diao, Yan Zhou, Rui Sun, Paul K.H. Tam, Wei Cheng, Xuelai Liu, Xianghai Ren, Hailin Sun, Xu Li, Anxiao Ming, Zhen Zhang, Qi Li, and Hang Xu
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Male ,medicine.medical_specialty ,Voiding cystourethrogram ,Adolescent ,Fistula ,Rectum ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Urethral diverticulum ,Humans ,Dysuria ,Postoperative Period ,Child ,Defecation ,Digestive System Surgical Procedures ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,medicine.disease ,Anorectal Malformations ,Surgery ,Rectal prolapse ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Anal stricture - Abstract
Laparoscopic-assisted anorectoplasty (LAARP) is considered to benefit the patients with vesico-prostatic fistula. The aim of this study is to present the details of our LAARP technique for improving the short- and long-term outcomes in the patients with high and intermediate types of anorectal malformations (ARMs). 330 patients with high-type (174 cases) and intermediate-type (156 cases) anorectal malformation (aged 8 days to 15 years) underwent LAARP from 2001 to 2019. LAARP was performed for full mobilization and resection of the dilated rectum, intra-rectal closure of the fistula, visualization, and enlargement of the center of the longitudinal muscle tube (LMT) from pelvic and perineal aspects. LAARP was performed in all patients and no patient was converted to open procedure. The urethral diverticulum was found in three patients (1.02%, 3/294) according to postoperative protocol voiding cystourethrogram but was not associated with any symptoms such as urinary tract infection and dysuria. Rectal prolapse requiring surgical intervention developed in 25 (7.6%) of 330 patients. Anal stricture occurred in three patients and re-do anoplasty was performed 5 months after LAARP. Anal retraction occurred in two patients and re-pull-through was conducted at 5 and 6 days, respectively, after LAARP. 228 patients who were older than 3 years were followed up. The median follow-up period was 5.8 years (range 3–15 years). 217 patients (95.2%) had voluntary bowel movements; 202 patients (88.6%) were free from soiling or with grade 1 soiling; 30 patients (13.6%) and 25 patients (11.3%) suffered from grade 1 and grade 2 constipation, respectively, while no patient had grade 3 constipation. Our experience demonstrates that the LAARP has advantages on rectal mobilization and resection, intra-rectal fistula closure and accurate tunnel formation in the LMT with minimal trauma. The improvement of the short-term and long-term outcomes after LAARP has been shown not only for high-type ARM but also for intermediate-type ARM.
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- 2020
6. Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line
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Ying Lv, Xiao Ping Zou, Ting Sheng Ling, Gui Fang Xu, Qi Sun, Huimin Guo, Ling Nie, Tian Yang, Xiaoqi Zhang, and Lei Wang
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Adult ,Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Perforation (oil well) ,Rectum ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pathological ,Aged ,Retrospective Studies ,Aged, 80 and over ,Proctectomy ,business.industry ,Gastroenterology ,En bloc resection ,Endoscopic submucosal dissection ,Middle Aged ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,Colorectal Neoplasms ,business ,Complication ,Anal stricture - Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) for laterally spreading tumors (LST) involving the dentate line (LST-DL) is challenging because of the specific anatomical features of the anorectum. This study aimed to evaluate the efficacy and safety of ESD for LST-DL. METHODS Consecutive patients with LST-DL who had undergone ESD at our hospital between January 2010 and December 2015 were retrospectively enrolled in this study. Rates of en bloc resection, R0 resection, and complications, pathological characteristics, and tumor recurrence were analyzed and compared with those of LST in the rectum not involving the dentate line (LST-NDL). RESULTS Altogether 49 patients with LST-DL (median age 63 years; 39 women; median lesion size 57 mm; median follow-up period of 24 months) and 96 patients with LST-NDL (median age 67 years; 31 women; median lesion size 47 mm; median follow-up period of 31 months) were enrolled. En bloc resection (93.9% [46/49] vs 94.8% [91/96]) and en bloc R0 resection rates (83.7% [41/49] vs 88.5% [85/96]), respectively, for LST-DL and LST-NDL, with no significant differences. However, ESD for LST-DL had a longer procedure time (77 min vs 54 min, P = 0.02), a greater postprocedural perianal pain rate (28.6% vs 0%, P
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- 2019
7. Assessment of the Heineke–Mikulicz anoplasty for skin level postoperative anal strictures and congenital anal stenosis
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Devin R. Halleran, Carlos A. Reck, Alessandra C. Gasior, Alejandra Vilanova Sanchez, Laura Weaver, Richard J. Wood, Marc A. Levitt, Rebecca M. Rentea, and Hira Ahmad
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Adult ,Male ,Posterior sagittal anorectoplasty ,medicine.medical_specialty ,Adolescent ,Outpatient procedure ,Anal Canal ,Constriction, Pathologic ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Anal stenosis ,030225 pediatrics ,Humans ,Medicine ,Child ,Digestive System Surgical Procedures ,Retrospective Studies ,business.industry ,Rectum ,Infant ,Level iv ,Mean age ,General Medicine ,Plastic Surgery Procedures ,Anorectal Malformations ,Surgery ,Treatment Outcome ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Older child ,Female ,Congenital anal stenosis ,business ,Anal stricture - Abstract
Introduction Acquired skin-level strictures following posterior sagittal anorectoplasty (PSARP) and some rare cases of congenital anal stenosis can be managed using a Heineke–Mikulicz like anoplasty (HMA). We hypothesized that this procedure was an effective, safe, and durable outpatient procedure in select patients. Methods We retrospectively reviewed all patients who underwent HMA for skin level strictures following PSARP or for certain congenital anal stenoses from 2014 to 2017. Results Twenty-eight patients (19 males, 9 females) with a mean age of 5.8 years (range 0.5–24.4) underwent HMA. Twenty-six had a prior PSARP, of which 18 were redo, and 8 were primary procedures. Two patients had congenital skin level anal stenosis. The mean follow up was 1.0 years (range 0.4–2.9). The average preprocedure anal size was Hegar 8, which after HMA increased 8 Hegar sizes to 16 (95% CI 7–9, p Conclusion HMA is a safe procedure for skin-level anal strictures following PSARP (primary and redo) and can also be used in some rare cases of congenital anal stenosis. Long-term follow up to determine the restricture rate is ongoing. A plan to do an HMA if a stricture develops may offer an alternative to routine anal dilations, particularly after a redo PSARP in an older child. Type of study Case series. Level of evidence Level IV.
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- 2019
8. Anus and Pain
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Ezio Falletto
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Proctalgia fugax ,Anal fissure ,medicine.medical_specialty ,business.industry ,Levator ani syndrome ,medicine.disease ,Anus ,Surgery ,Hemorrhoids ,medicine.anatomical_structure ,medicine ,Hypertonia ,medicine.symptom ,Abscess ,business ,Anal stricture - Abstract
Anal pain is a potentially highly debilitating symptom. It is frequently considered as an idiopathic problem but in some cases it could be due to nonfunctional or organic diseases. The manuscript analyzes the most common causes of nonfunctional and functional chronic anal pain, highlighting false beliefs and functional implications. Hemorrhoids rarely are painful unless they became complicated and develop thrombosis or necrosis. Instead, hemorrhoidectomy could develop easily persistent anal pain. The most common cause of anal pain is anal fissure. Also cryptoglandular anal abscess or anal stricture can lead to pain. Chronic anal pain is usually connected with an important anal resting and involuntary hypertonia and leads to a difficult evacuation. Other causes of chronic nonfunctional anal pain are considered and discussed.
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- 2020
9. Colonoscopic Results in Patients with Hartmann’s Colostomy
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Kyung Jong Kim and Young Hun Kim
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Crohn's disease ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Colostomy ,Anal canal ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Adalimumab ,medicine ,Methotrexate ,In patient ,Adalimumab Injection ,business ,Anal stricture ,medicine.drug - Published
- 2020
10. Quality outcomes for pediatric colorectal surgery treated during short-term international medical service trips at a dedicated site in Honduras
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Rebecca M. Rentea, Pastora X. Hernandez, Marc A. Levitt, Carlos A. Reck-Burneo, Juan Craniotis-Rios, Richard J. Wood, and Wilfried Krois
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medicine.medical_specialty ,Constipation ,Specialty ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Fecal continence ,Humans ,Child ,Retrospective Studies ,business.industry ,General surgery ,Level iv ,Retrospective cohort study ,General Medicine ,Evidence-based medicine ,Colorectal surgery ,Anorectal Malformations ,Treatment Outcome ,Honduras ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Surgery ,medicine.symptom ,business ,Colorectal Surgery ,Anal stricture - Abstract
Introduction Short-term international medical service trips (MSTs) provide specialized care in resource-constrained countries. There are limited data on immediate and long-term reported outcomes following specialty MST. We hypothesized that dedicated collaborative MST team and host institution produce outcomes and results comparable to those of high-income settings. Our primary aim was to analyze the long-term surgical and functional outcomes of our specialty-specific MSTs following five years of annual MST in Honduras. Methods We performed a single-institution retrospective analysis of 56 children who underwent colorectal and pelvic reconstructive operations between 2014 and 2018. Demographics, diagnosis, comorbidities, type of repair, long-term complications, and functional bowel and bladder results were recorded. Results We included a total of 56 children, 47 with ARM and 9 with HD, with a median age of 43.5 months (17–355) at the time of surgery. 25% (22) of the patients were lost to follow-up. Fecal continence was achieved by 23 (60%) patients 5 years (n = 11). Complications included constipation in 18 (42.9%) children with ARM and in 1 (12.5%) with HD. Eleven (19.6%) patients required revisional surgery for skin level anal stricture. Seventy-five percent of the patients with pediatric colorectal disorders attending the MST were compliant with continued long-term follow-up. Conclusion We were able to demonstrate that with organized, dedicated site and surgeon, results achieved can be comparable to those in the high-income countries (HICs). We conclude that this type of specialized care is feasible and beneficial for affected pediatric colorectal patients in resource-limited settings, when a strong partnership with a system of preoperative assessments and peri- and postoperative care can be established. Level of evidence Level IV (retrospective cohort study).
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- 2020
11. Anorectal Crohn’s Disease: Anal Stenosis and Anal Fissure
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Jeanette Zhang and Howard M. Ross
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medicine.medical_specialty ,Anal fissure ,Crohn's disease ,business.industry ,medicine.medical_treatment ,medicine.disease ,Surgery ,Natural history ,Anal stenosis ,Balloon dilation ,Initial treatment ,Medicine ,business ,Lateral internal sphincterotomy ,Anal stricture - Abstract
The treatment of anal stenosis and anal fissure in patients with anorectal Crohn’s disease requires knowledge of medical management, their natural history, and familiarity with the outcomes of various management modalities. The preservation of continence and functional outcome must be balanced with the potential for poor healing. Anal stricture dilation offers the best initial treatment for symptomatic anal stricture from Crohn’s disease. Operative approaches to anal stricture, including stricture division and sphincteroplasty, have resulted in improvement. Lateral internal sphincterotomy has resulted in the healing of anal fissure in patients with known anorectal Crohn’s disease.
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- 2020
12. Retained rectal foreign body in a child operated for high anorectal malformation
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Rajendra K Ghritlaharey
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medicine.medical_specialty ,medicine.diagnostic_test ,rectal foreign body ,business.industry ,Impaction ,foreign body ingestion ,lcsh:R ,Rectum ,lcsh:Medicine ,Physical examination ,General Medicine ,medicine.disease ,Anorectal malformation ,Surgery ,stomatognathic diseases ,medicine.anatomical_structure ,children ,Radiological weapon ,medicine ,Rectal foreign body ,otorhinolaryngologic diseases ,Foreign body ,business ,Foreign Body Ingestion ,Anal stricture - Abstract
Foreign body ingestion is not uncommon in pediatric age group. Foreign bodies including coin retention/impaction at the colorectal regions are less frequently reported in children and extremely rare in the operated cases of anorectal malformation (ARM). The present case is a 5.8-year-old boy who had retention of ingested foreign body (coin) in his rectum for 4 months. His history revealed that he was a case of high ARM which was managed with three-staged procedures. His clinical examination and radiological investigations revealed an anal stricture and a foreign body (coin) in his rectum. He was managed well with anal dilatation and removal of coin under general anesthesia. The intention for presenting the case is its rarity.
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- 2019
13. Surgical excision of extensive anal condylomata is a safe operation without risk of anal stenosis.
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Wroński, Konrad and Bocian, Roman
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GENITAL warts , *ANAL diseases , *PAPILLOMAVIRUSES , *SURGICAL complications , *FECAL incontinence , *DISEASE relapse , *SURGERY ,ANAL surgery - Abstract
Introduction: Anal condylomata acuminata was a well-known disease in ancient times but in recent years there has been a rapidly increasing number of people who suffer from this disease. The main cause of this disease is infection of human papilloma virus (HPV) which occurs through sexual contact. Currently there are three different ways to treat anal condylomata. Small changes of anal condylomata can be treated with local therapeutic agents, but the best results of treatment of extensive changes are obtained by surgical techniques. Material/Methods: The study group consisted of 30 patients with diagnosed extensive anal condylomata who underwent surgery in Mikolaj Pirogow High Specialized Hospital in Lodz. The survey was conducted from 2007 to 2011. Patients had been directed to the surgical ward by general surgeons and practitioners, proctologists and urologists. The diagnosis was made after proctological assessment in the knee-chest position. Results: All patients underwent surgery and had complete macroscopic electroexcision of anal condylomata. In the research group there was no mortality. Postoperative complications occurred in 4 (13.3%) patients - postoperative bleeding. Strong pain was present in 14 (46.7%) patients but only in the postoperative period. During postoperative follow-up there was no observed infection in the anal region or recurrence of disease. In the operated group there were no observed cosmetic deformations of the anus and/or the anal canal, narrow anal canal or functional fecal incontinence symptoms. Conclusions: Surgical treatment of anal condylomata is an effective and safe method for the patient. In our research there were no serious postoperative complications or recurrence of the disease during the follow-up period. [ABSTRACT FROM AUTHOR]
- Published
- 2012
14. Invasive urothelial carcinoma of urinary bladder presenting with annular constriction and mimicking proctitis observed by colonoscopy: A case report
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Ching-Heng Yen, Jung-Cheng Kang, Ta-Wei Pu, Yu-Hong Liu, Hsing-Wei Yu, and Chao-Yang Chen
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medicine.medical_specialty ,Invasive urothelial carcinoma ,Rectum ,Colonoscopy ,Case Report ,03 medical and health sciences ,0302 clinical medicine ,Carcinoembryonic antigen ,CA19-9, carbohydrate antigen 19-9 ,medicine ,Proctitis ,AFP, alpha-fetoprotein ,Bladder cancer ,Urinary bladder ,LDH, lactate dehydrogenase ,biology ,medicine.diagnostic_test ,business.industry ,medicine.disease ,CT, computed tomography ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,biology.protein ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,business ,MRI, magnetic resonance imaging ,Anal stricture ,CK, cytokeratin - Abstract
Highlights • The occurrence of rectal annular constriction due to infiltration by bladder cancer is relatively rare, and difficult diagnosis by colonoscopy. • The images including computed tomography, colonoscopy, and magnetic resonance imaging was fully recorded in our report. • The poor prognosis was noted from literature review with no record for survival >2 years after diagnosis of a rectal lesion., Introduction Bladder urothelial carcinoma rarely spreads to the gastrointestinal tract, and its presentation in the rectum varies. We report a case of a patient who presented with an annular constriction of the rectum. Presentation of case A 60-year-old man was referred to our hospital with chief complaints of anal stricture and partial obstruction for about 1 month. Computed tomography and magnetic resonance imaging revealed diffuse wall thickening of the rectum, possible high cellularity in the lower portion of urinary bladder, and lesions in the visible pelvic bony structure. A colonoscopy showed a contiguous annular constriction from 5 to 15 cm above the anal verge. Carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 39.75 ng/mL and 139.2 U/mL, respectively. A transurethral bladder biopsy revealed high-grade urothelial cell carcinoma, and anal biopsy showed a poorly differentiated carcinoma arranged in a small nested pattern within the subepithelial area of the anorectal tissue. A colostomy was performed, and the patient was transferred to another hospital for further treatment after series of survey with lung metastasis. Discussion Invasive bladder cancers rarely infiltrates into the rectum and is known with the difficulty diagnosis by colonoscopy. Furthermore, the secondary rectum tumor due to bladder cancer had poor record for survival in the literature review. Conclusion This case of bladder urothelial carcinoma penetrating to the rectum was interesting because it mimicked proctitis with diffuse annular swelling observed in the colonoscopy.
- Published
- 2021
15. Surgical excision of extensive anal condylomata not associated with risk of anal stenosis.
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Klaristenfeld, Daniel, Israelit, Shlomi, Beart, Robert W., Ault, Glenn, and Kaiser, Andreas M.
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SURGICAL excision , *GENITAL warts , *REPORTING of diseases , *SURGICAL complications , *RISK assessment , *SURGERY - Abstract
Surgical treatment of extensive and confluent anal condylomata results in large open wounds, which in other contexts of anorectal surgery (e.g., hemorrhoidectomy), have been associated with a relevant risk of stricture formation. The aim of our study was therefore to revisit the issue and assess this risk and the general morbidity in patients undergoing extensive excision and fulguration of anal warts. Records of 41 consecutive patients undergoing with excision/fulguration of extensive, i.e., >50% confluent anal condylomata were retrospectively reviewed. Excluded were patients with a lesser degree of warts and patients lost to follow-up before complete wound healing. Data recorded included patient characteristics and evolution of the local area after the surgery. Forty-one patients (40 males and one female) underwent excision and fulguration of a large anal condyloma with an average follow-up of 6 months (range, 1–36 months). The majority of patients (97.6%) were HIV-positive with 80% taking antiretroviral medication. Half of the patients had not received any previous medical or surgical treatment, whereas one fourth had undergone surgical excisions or fulgurations before. Recurrent warts developed in 19 patients (46.3%). The surgical morbidity after the extensive excision consisted of bleeding (22%). However, none of the patients showed any evidence or complaints of postoperative stricturing and anal stenosis at follow-up. Excision of extensive anal condylomata has a known high probability of recurrences, but the risk of developing anal stenosis is low. Careful primary excision of even confluent warts can therefore be safely performed without major primary flap reconstructions. [ABSTRACT FROM AUTHOR]
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- 2008
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16. Post-operative strictures in anorectal malformation: trends over 15 years
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Charlotte Holbrook, Stewart Cleeve, Devesh Misra, and Indre Zaparackaite
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Male ,medicine.medical_specialty ,Adolescent ,Fistula ,medicine.medical_treatment ,Rectum ,Constriction, Pathologic ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,030225 pediatrics ,Laparotomy ,medicine ,Humans ,Child ,Retrospective Studies ,business.industry ,Infant ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Anus ,Anorectal Malformations ,Perineal fistula ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Sphincter ,Female ,Laparoscopy ,business ,Imperforate anus ,Anal stricture - Abstract
For decades, paediatric surgeons have employed the standard posterior sagittal anorectoplasty (PSARP) approach to deal with patients with anorectal malformations (ARM). In recent years, we noted an apparent increase in the incidence of anal stricture after surgical repair of ARM following the introduction of laparoscopic pull-through and techniques aiming to preserve the internal sphincter—the internal sphincter sparing approach (ISSA). We decided to analyse our data to find out if these new trends had added to the problem of post-operative strictures. All patients with ARM at our institution from January 2000 to December 2015 were identified. A retrospective case note review was carried out. Data collected included patient demographics, type of ARM, operative details, and post-operative outcomes. 114 patients were identified. Ten patients were excluded. Of the remaining 104 children, 48 (46%) were female. Median age was 8.3 (range 1.2–16.8) years. Types of ARM were as follows: perineal fistula (15 patients), anterior stenotic anus (12), imperforate anus without fistula (10), vestibular fistula (32), rectourethral (bulbar) fistula (11), rectourethral (prostatic) fistula (14), rectovesical fistula (7), and cloaca (3). Twenty-seven patients with a perineal fistula or anterior stenotic anus underwent perineal procedures that were variably described by the different operating surgeons. The majority (15 patients) had an anoplasty, 5 had anal transposition, 5 had limited PSARP, and 2 patients had ISSA. Two patients with a cloacal anomaly underwent open cloacal reconstruction. Of the remaining 75 patients, 45 had a PSARP approach, 6 had a laparoscopic-assisted pull-through, and 18 had ISSA. Four girls with vestibular fistula had anal transposition and two boys with imperforate anus without fistula had anoplasty. 15 (14%) children developed anal stricture. Stricture incidence differed according to operation type. PSARP was the most commonly performed procedure, with only 6% developing a stricture. In contrast, 30% of ISSA patients and 50% of children who had laparoscopic pull-through developed a stricture. Strictures also occurred in 11 and 12% of children having anal transposition and anoplasty, respectively. The laparoscopic-assisted pull-through involves tunnelling the sphincter muscle complex. We found that often the tunnels were not wide enough, resulting in narrowing not just at the ano-cutaneous junction but also at the deeper level. 50% developed strictures. We have modified our technique by ensuring that the tunnels are generous enough to allow the rectum to be pulled through without any resistance. ISSA unfortunately resulted in 30% of our patients developing strictures. This approach, started in 2004, was, therefore, abandoned in 2013. The standard Pena’s PSARP, with or without a laparotomy, has stood the test of time. Any modification of this approach must be carefully thought through and audited meticulously. Strictures can cause significant morbidity, which may need several revisions, and the resulting redo anoplasties run the risk of sphincter damage, ironically which the newer modifications of ISSA were trying to conserve.
- Published
- 2017
17. Error traps and culture of safety in anorectal malformations
- Author
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Alberto Peña, Duncan T. Wilcox, John F. Bealer, and Andrea Bischoff
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Foley catheter ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Digestive System Surgical Procedures ,Medical Errors ,business.industry ,Iatrogenic injury ,General surgery ,Colostomy ,Infant, Newborn ,Sigmoid colon ,medicine.disease ,Anorectal Malformations ,Hepatobiliary surgery ,medicine.anatomical_structure ,Rectal wall ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Surgery ,Patient Safety ,business ,Imperforate anus ,Anal stricture - Abstract
Introduction Attempting to decrease iatrogenic injuries and preventable harm, safety initiatives have become a priority in surgery. For adult hepatobiliary surgery, it has become common to study and consider “error traps” or common pitfalls that exist for laparoscopic cholecystectomy. 1 , 2 , 3 , 4 Extending this work to children, we have attempted to apply some of these initiatives by identifying error traps common to the care of patients born with anorectal malformations (ARM). Methods Five error traps were identified based on a retrospective analysis of operative records and radiographic studies from 398 re operative ARM cases performed by the authors. Once identified, the authors constructed a specific safety plan for each trap to promote a culture that will hopefully prevent ARM iatrogenic injuries. Results The identified error traps are: 1) creation of a colostomy too distal in the sigmoid colon, 2) inaccurate distal colostogram and definition of the patient's preoperative anatomy 3) absence of a Foley catheter during the repair of an ARM in males and the hazards of separating the anterior rectal wall from the genito-urinary (GU) tract 4) mismanagement of a post-operative anal stricture following an ARM reconstructive procedure 5) limited or unstructured follow up of these patients. For each of the five traps the authors present suggestions for their avoidance. Conclusion The repair on an anorectal malformation is an elective procedure and while not completely avoidable, there should be little tolerance for iatrogenic injury and preventable harm. A culture of safety should be followed, beginning with a recognition of the common error traps associated with ARM procedures.
- Published
- 2019
18. Endoscopic submucosal dissection involving the anal canal presents a risk factor for postoperative stricture
- Author
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Shinwa Tanaka, Hiroshi Takihara, Takashi Toyonaga, Shinichi Baba, Eiji Umegaki, Yoshiko Nakano, Yuzo Kodama, Toshitatsu Takao, Yoshinori Morita, and Tomoya Sako
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Colorectal cancer ,Rectum ,Anal Canal ,Constriction, Pathologic ,03 medical and health sciences ,Postoperative stricture ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Rectal Neoplasms ,Endoscopic submucosal dissection ,Anal canal ,Hepatology ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Anal stricture ,Abdominal surgery - Abstract
Although postoperative strictures after endoscopic submucosal dissection (ESD) in the rectum are relatively rare, some rectal lesions require resection involving the anal canal, which is a narrow tract comprising squamous epithelium. To the best of our knowledge, no studies have investigated narrow anal canals when evaluating post-ESD strictures. This study aimed to evaluate the impact of resections involving the anal canal on postoperative stricture development. Between April 2005 and October 2017, 707 rectal lesions were treated with ESD. We retrospectively investigated 102 lesions that required ≥ 75% circumferential resection. Risk factors for post-ESD stricture and, among patients with strictures, obstructive symptoms, and number of dilation therapies required were investigated. Post-ESD stricture occurred in 18 of 102 patients (17.6%). In the multivariate analysis, circumferential resection ≥ 90% and ESD involving the anal canal (ESD-IAC) were risk factors for postoperative strictures (P ≤ 0.0001 and 0.0115, respectively). Among the patients with strictures, obstructive symptoms were significantly related to anal strictures compared to rectal strictures (100% vs. 27.2%, P = 0.0041). Furthermore, the number of dilation therapies required was significantly greater among patients with anal strictures compared to those with rectal strictures (6.5 times vs. 2.7 times, P = 0.0263). Not only circumferential resection ≥ 90% but also ESD-IAC was a significant risk factor for the stricture after rectal ESD. Furthermore, anal strictures were associated with a significantly higher frequency of obstructive symptoms and larger number of required dilation therapies than were rectal strictures.
- Published
- 2019
19. Long-term outcomes of children with transanal endorectal pull-through and a review of the literature
- Author
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Feryal Gun Soysal, Erbug Keskin, Aladdin Celik, Tansu Salman, Basak Erginel, and Secil Yuksel
- Subjects
medicine.medical_specialty ,Time Factors ,Colon ,Anal Canal ,Descending colon ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Long term outcomes ,medicine ,Humans ,Hirschsprung Disease ,Child ,Surgical treatment ,Digestive System Surgical Procedures ,Enterocolitis ,business.industry ,Transverse colon ,General Medicine ,Surgery ,medicine.anatomical_structure ,Oral ingestion ,030220 oncology & carcinogenesis ,medicine.symptom ,business ,Hospital stay ,Anal stricture ,Follow-Up Studies - Abstract
The transanal endorectal pull-through (TERPT) procedure, the latest advancement in the surgical treatment of Hirschsprung's disease, has replaced most other surgical techniques in the last decade.Between October 2002 and March 2014, a total of 22 patients diagnosed with Hirschsprung's disease underwent a one-stage TERPT operation.Resected segments included the rectosigmoid (seven patients), the descending colon (10 patients), and the transverse colon (five patients). The minimum length of the resected segments was 15 cm and the maximum length was 65 cm. The mean length was 39.18 ± 12.05 cm. Following surgery, the start of oral ingestion was 1-8 days (mean 3 ± 1.69 days) and the hospital stay after the operation lasted 4-11 days (mean 7.04 ± 2.05 days). The mean follow-up period was 48 ± 6 months (range of 24-166 months). Out of 22 patients, three patients had an anal stricture, which responded to anal dilatations; three patients had an enterocolitis episode that required hospitalization; two patients experienced constipation; and two patients had incontinence/soiling.Our data suggest that the TERPT operation can be safely performed in terms of long-term complications.
- Published
- 2016
20. The effectiveness of digital anal dilatation in preventing anal strictures after anorectal malformation repair
- Author
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Swaleh Shahbal, Kihiko Kuria, Timothy Jumbi, and Francis Osawa
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Anal Canal ,Constriction, Pathologic ,Thumb ,Middle finger ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Small finger ,030225 pediatrics ,medicine ,Humans ,Child ,Digestive System Surgical Procedures ,Postoperative Care ,Anus Diseases ,Hegar dilators ,business.industry ,Infant ,General Medicine ,Index finger ,Dilatation ,Numerical digit ,Anorectal Malformations ,Surgery ,Exact test ,medicine.anatomical_structure ,Cross-Sectional Studies ,Treatment Outcome ,030220 oncology & carcinogenesis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Patient Compliance ,Female ,business ,Anal stricture - Abstract
Background Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar dilators. In our setup, few parents will acquire Hegar dilators for home based anal dilatation but majority will use fingers as an alternative. The basis of this study was to determine the effectiveness of digital anal dilatations in preventing anal strictures. Materials and methods This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited children post ARM repair undergoing digital anal dilatation. The diameters of the digits used for anal dilatation were assessed for adequacy using the desired anal size as a reference point. The main outcome variable was the presence of anal strictures. Data were entered in a data collection sheet and analyzed by use of SPSS (V.21.0 Chicago, Illinois). Chi-square test and Fisher's exact test were used to ascertain association among variables. A P-value of less than 0.05 was considered statistically significant. Results 50 patients with ARM post repair were recruited in the study. The rate of occurrence of anal stricture was 22%. Among the participants with anal strictures, only 27% were compliant to the dilatation regimen while 73% reported noncompliance. The mean diameter(mm) of the dilating digits at the level of the middle phalanx was Index finger (15.4 ± 0.58), middle finger (15.2 ± 0.61), ring finger (14.2 ± 0.71), small finger (12.5 ± 0.91) and thumb (17.6 ± 0.78). 46% of the participants were dilated with appropriately sized digits. The remainder had dilatations done with larger (22%) or smaller digits (32%). Notably, anal strictures occurred in participants who were dilated with inappropriately sized digits (P = 0.001). Conclusion Digital anal dilatation is safe and effective as a mode of anal dilation in the setting of compliance to a strict dilatation protocol, daily frequency of dilations and use of appropriately sized digits. Owing to the variability in the finger size, we recommend that digits be calibrated and education given to the caregivers on the use of the appropriately sized digit. Level of evidence Treatment study. Level III.
- Published
- 2018
21. 865 Endoscopic Stricturotomy in the Treatment of Anal Stricture in Patients With Fecal Diversion
- Author
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Nan Lan and Bo Shen
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,In patient ,business ,Anal stricture ,Feces ,Surgery - Published
- 2019
22. A novel four quadrant laser sphincterotomy for idiopathic severe anal stenosis
- Author
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Ashwin Porwal, Deepak Kulkarni, and Paresh Gandhi
- Subjects
Estritura anal ,medicine.medical_specialty ,Anal canal surgery ,Estenose anal ,Anal stenosis ,Anoderma ,RC799-869 ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Quadrant (abdomen) ,0302 clinical medicine ,Anoderm ,medicine ,Laser sphincterotomy ,Medical treatment ,business.industry ,Gastroenterology ,Esfincterotomia a laser ,030206 dentistry ,Anal canal ,Surgical procedures ,Diseases of the digestive system. Gastroenterology ,Anal stricture ,medicine.disease ,Surgery ,Cirurgia de canal anal ,Stenosis ,medicine.anatomical_structure ,Defecation ,Radiology ,business - Abstract
Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy. Resumo: A estritura ou estenose anal, embora incomum, é problema incapacitante. Essa condição afeta a qualidade de vida por causa da dor, do sangramento e da dificuldade de defecação, de incontinência ou aumento da frequência. A estenose anal ocorre quando o anoderma, normalmente flexível, foi substituído por tecido conjuntivo fibrótico, e o resultado é um canal anal anormalmente estenosado e inelástico. Na maioria dos casos, a estenose anal ocorre secundariamente a trauma, por causa iatrogênica, por doença inflamatória, radiação ou neoplasia. Em geral, se considera que o tratamento dessa condição é tarefa difícil, tendo sido sugeridos diversos métodos de tratamento. Com frequência a estenose anal não responde ao tratamento clínico conservador. Procedimentos cirúrgicos como as dilatações ou a anoplastia estão associados a complicações significativas, implicando difícil desafio terapêutico. Atualmente, o cirurgião conta com várias opções terapêuticas satisfatórias. No presente caso, relatamos e exploramos um novo tratamento clínico para estenoses anais, por meio da esfincterotomia a laser nos quatro quadrantes. Keywords: Anal stenosis, Anoderm, Laser sphincterotomy, Anal stricture, Anal canal surgery, Palavras-chave: Estenose anal, Anoderma, Esfincterotomia a laser, Estritura anal, Cirurgia de canal anal
- Published
- 2018
23. Management of Burn Injuries of the Perineum
- Author
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Ted Huang and Mohamed E. Ismail Aly
- Subjects
medicine.medical_specialty ,business.industry ,Anal orifice ,Perineum ,Surgery ,medicine.anatomical_structure ,Urethra ,medicine ,In patient ,business ,Anal stricture ,Lower trunk ,Penis ,Muscle contracture - Abstract
Burns involving the perineum are uncommon, but the area can be involved in extensive burns of the lower trunk and lower limbs. Burn injuries can involve the external urethra, penis, labial structures, anal orifice, and distal rectal mucosa. Management is generally conservative in the acute phase with some exceptions. Scar contraction with subsequent contractures formation is common and can cause distortion of the local anatomy and function. Delayed reconstructive techniques utilizing scar release, skin grafts, and/or local flaps are undertaken at a later stage in patient care. Complex penile reconstruction and correction of rectal mucosal prolapse and anal strictures might be required in cases with extensive perineal burn injuries.
- Published
- 2018
24. Clinical impact of ultrathin colonoscopy for Crohn's disease patients with strictures
- Author
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Yasuhiro Fujiwara, Mitsue Sogawa, Atsushi Noguchi, Toshio Watanabe, Kenichi Morimoto, Kazunari Tominaga, Tetsuya Tanigawa, Satoshi Sugimori, Yasuaki Nagami, Masatsugu Shiba, Kenji Watanabe, Takako Miyazaki, Hirokazu Yamagami, Tetsuo Arakawa, and Noriko Kamata
- Subjects
Crohn's disease ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,Endoscope ,business.industry ,Gastroenterology ,Colonoscopy ,medicine.disease ,Inflammatory bowel disease ,Endoscopy ,Surgery ,Intestinal mucosa ,Intestinal Stricture ,medicine ,business ,Anal stricture - Abstract
Background and Aim Mucosal healing is now the ideal treatment goal for patients with Crohn's disease (CD) and endoscopy is suitable for both visualizing the intestinal mucosa and optimizing treatment according to the objective endoscopic findings; however, passing through strictures with a conventional colonoscope is sometimes difficult. An ultrathin colonoscope (outer diameter 9.2 mm) has been developed for superior insertion performance. Methods CD patients with strictures that could not be passed with a conventional colonoscope were eligible for entry into the study. We investigated the rate of passage of the ultrathin colonoscope beyond strictures. We also investigated the clinical impact of optimizing the treatment strategy according to the endoscopic findings beyond the stricture. Results Of 49 patients, the ultrathin colonoscope could pass the stricture in 59.2% (29/49). The main reason for failure compared with the “pass” group was anal stricture (P = 0.005). When including finger bougie for severe anal stricture, passage of the stricture was achieved in 83.7% (41/49) of cases and the oral mucosa beyond the stricture was visualized. In these cases, 56.1% (23/41) had treatment efficacy confirmed and 43.9% (18/41) required a change of treatment. Importantly, half (9/18) of them were in clinical remission. There were no complications of the study. Conclusion The ultrathin colonoscope could provide optimized treatment based on objective findings of the activity of the oral-side mucosa in CD patients complicated with stricture. Selection of the appropriate endoscope to visualize the responsible lesion is essential to optimize the treatment strategy in each case of CD.
- Published
- 2015
25. The role of surgery for children with perianal Crohn’s disease
- Author
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Thomas D. Walters, Natashia M. Seemann, Abdul Elkadri, and Jacob C. Langer
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Disease ,Perineum ,Skin breakdown ,Ileostomy ,Crohn Disease ,Disease severity ,medicine ,Humans ,Rectal Fistula ,Child ,Abscess ,Colectomy ,Retrospective Studies ,Perianal Crohn's disease ,Anus Diseases ,Crohn's disease ,Tumor Necrosis Factor-alpha ,business.industry ,Infant ,General Medicine ,medicine.disease ,Combined Modality Therapy ,Surgery ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Anal stricture - Abstract
Purpose Children with perianal Crohn's disease (PCD) are a unique and diverse patient population. The purpose of this study was to describe the spectrum of disease and role of surgery. Methods A retrospective chart review of all children having at least one surgical intervention for PCD over 10years was performed. Results Fifty-seven patients (63% male) aged 0.5–17 (median 13) years were identified. Perianal disease consisted of skin tags (49%), superficial fistulae (49%), deep fistulae (37%), superficial abscesses (68%), deep abscesses (9%), skin breakdown (19%), and anal strictures (7%). 84% received anti-TNF therapy, with 27% treated with a second anti-TNF medication. Minor surgical procedures, commonly done during anti-TNF therapy, included abscess drainage (67%) and seton placement (33%). Major surgical procedures, done almost exclusively after anti-TNF failure, included defunctioning ileostomy (23%) and subtotal colectomy (9%). Follow-up ranged from 7 to 160 (median 54) months. Conclusions Pediatric PCD has a wide range of disease severity. Minor surgery provides adequate drainage before and during anti-TNF therapy, while major surgery plays a role in medically refractory disease. Appropriate surgical intervention remains an important part of the treatment paradigm.
- Published
- 2015
26. SECOND AND THIRD DEGREE HAEMORRHOIDS: MANAGEMENT WITH MINIMALLY INVASIVE PROCEDURE FOR HAEMORRHOID (MIPH) AND OUTCOME
- Author
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Rajesh Kumar Rathore and Kishna Ram Poonia
- Subjects
medicine.medical_specialty ,Constipation ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Rectum ,Rectal examination ,Surgery ,Proctoscopy ,medicine.anatomical_structure ,Ambulatory ,medicine ,Sclerotherapy ,medicine.symptom ,business ,Anal stricture - Abstract
The present study was carried out to study the management of second and third degree haemorrhoids with Minimally Invasive Procedure for Haemorrhoid (MIPH) and its outcome. Twenty five cases were included in the study. The major aims of the study were to evaluate the merits and demerits of Minimal Invasive Procedure for management of second and third degree haemorrhoids by using haemorrhoidal set and to study the efficacy of MIPH (Stapled haemorrhoidopexy) in terms of duration of surgery, early complications, time of ambulation, mean hospital stay, time of rejoin to work and late complications. The study was carried out in MB Government Hospital associated with R.N.T. Medical College, Udaipur. Patients admitted in different surgical wards were taken for study. Material and method used in this study include various laboratory investigations including CBC, BT, CT, Blood Sugar, S-urea, S-creatinine, HIV, HBsAg, Urine complete, X-Ray Chest and ECG. Special Investigation including Per rectal examination for anal sphincter tone, pain, any rectal growth, prolapse, bleeding, discharge and Proctoscopy to evaluate positions and grades of piles. Statistical analysis of various data done and maximum incidence thirty six percent of second and third degree haemorrhiods was found in 31-40 year age group. Males were predominantly affected as compared to females. Patients with second and third degree of haemorrhoids mostly visited hospital for bleeding per rectum and prolapse. Other symptoms about which patient were concerned were pain, itching and discharge and about half of the patients had associated history of constipation. Most of patients seek surgeons attention after a period of about one month. Twenty percent patients had positive family history of haemorrhoid. Eighty eight percent patients had taken some treatment in the form of laxative and ointment. Eight percent patients had undergone sclerotherapy and twelve percent patients had undergone ligation previously. Sixty eight percent patients had piles at three positions. Patients showd almost similar distribution of piles in relation to their positions at 3 O'Clock, 7 O'Clock & 11 O'Clock however secondary piles were found in eight percent patients. Forty percent patients were having second degree haemorrhoids and sixty percent patients had third degree haemorrhoids. Minimally Invasive Procedure for Haemorrhoid (MIPH) were performed in all 25 patients and fifty two percents were operated in 21-30 minutes. Twenty eight percent patients developed one or more early complication including bleeding, retention of urine, pain and prolapse.Seventy two percent patients became ambulatory within 6-12 hours after MIPH surgery. On first dressing no complaint was reported in ninty two percent patients. Eighty four percent patients were discharged on 2nd day after MIPH. Mean hospital stay was 2.4 day. Sixty percent patients joined their work on 4-5 days after operation. Anal Stricture in four percent patients, tenesmus in eight percent patients and recurrence in four percent patients were reported as late complications in follow up of patients in our study.
- Published
- 2014
27. Anal Sac Excision
- Author
-
Lynne A. Snow
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Fecal incontinence ,medicine.symptom ,business ,Anal stricture ,Surgery - Published
- 2017
28. Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene
- Author
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Alan Kawarai Lefor, Tadao Kubota, Kenji Okumura, Ken Mizokami, and Kazuhiro Nishida
- Subjects
Gangrene ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine.medical_treatment ,lcsh:Surgery ,Soft tissue ,Physical examination ,Case Report ,lcsh:RD1-811 ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Hemorrhoids ,Anal stenosis ,030220 oncology & carcinogenesis ,Medicine ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,Renal replacement therapy ,business ,Complication ,Anal stricture - Abstract
Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.
- Published
- 2017
29. LigasureTM hemorrhoidectomy: how we do
- Author
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Simona Grande, Giorgio Lisi, Giovanni Milito, Michele Grande, Elena Aronadio, Michela Campanelli, and Dario Venditti
- Subjects
Adult ,Hemorrhoidectomy ,Male ,030213 general clinical medicine ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Constriction, Pathologic ,Hemorrhoids ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Anal stenosis ,Internal Medicine ,medicine ,Humans ,Young adult ,Aged ,Aged, 80 and over ,Anus Diseases ,Anal fissure ,Urinary retention ,business.industry ,Gold standard ,Perianal Abscess ,Gastroenterology ,Middle Aged ,medicine.disease ,Surgery ,Settore MED/18 - Chirurgia Generale ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,business ,Anal stricture ,Follow-Up Studies - Abstract
Background Hemorrhoidectomy is considered the gold standard and the most effective and definitive treatment for grades 3 or 4 hemorrhoids, and Milligan-Morgan's and Ferguson's procedures are the most widely used techniques throughout the world. The aim of the study was to present our surgical technique using LigasureTM vessel sealing, focus on technical aspects and surgical tricks showing our results with a huge number of patients and a long-term follow-up. Methods Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, Italy, 1000 patients were selected to underwent LigasureTM hemorrhoidectomy for III and IV degree hemorrhoids. Age range 19-80 years, ASA I-II-III. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. Patients were followed-up at one week, one month, six, and twelve months after the operation and after 60 months they responded to the follow-up telephone interview and replied to the questionnaire. Results One-thousand patients were undergone LigasureTM hemorrhoidectomy. The mean follow-up was 7 years and 110 (11%) patients was lost from the follow-up after the first postoperative month. Among early postoperative complications, 21 patients (2.1%) has urinary retention treated with a urinary catheter and removed before the discharge. 3 (0.3%) patients had a minor bleeding that required a package of hemostatic absorbable sponge, as late complications, in 35 patients (4%) anal fissure due to hard stool, an incomplete healing was observed in 11 patients (1.1%) after the first month. Three transphincteric anal fistulas (0.3%) were collected and four perianal abscess (0.4%) were observed during the first month of the follow-up and they required a delayed surgical treatment. At the end of the seven years of follow-up 70 recurrences (7.8%) and 35 anal stenosis (4%) were detected. Conclusions If technical guidelines are respected rigorously and the device is applied correctly, feared late complications, such as impaired fecal continence, anal stricture and postoperative pain can be minimized.
- Published
- 2017
30. V-Y anoplasty for iatrogenic anal stenosis: our initial experience in BSMMU
- Author
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MM Matubber, Shahadot Hossain Sheikh, N Naznin, Asmm Rahman, Rahman, I Jahan, Abu Taher, and O Faruque
- Subjects
medicine.medical_specialty ,Patient satisfaction ,Anal stenosis ,business.industry ,medicine.medical_treatment ,medicine ,General Medicine ,V-Y anoplasty ,Lateral internal sphincterotomy ,business ,Anal stricture ,Colorectal surgery ,Surgery - Abstract
To date, ideal surgical management of anal stenosis has not been well defined. Different surgical options have been described in literature to treat anal stricture starting from partial lateral internal sphincterotomy to different flap anoplasties. For severe anal stenosis, advancement flaps are the only option and all the techniques show good result and patient satisfaction. We treated five cases of severe anal stenosis by V-Y anoplasty in Colorectal Surgery Unit of BSMMU. Here we have shown the clinical outcome of V- Y anoplas DOI: http://dx.doi.org/10.3329/bmj.v42i2.18986 Bangladesh Med J. 2013 May; 42 (2): 51-54
- Published
- 2014
31. A Case of Anal Canal Cancer Complicated with Anal Stricture of Chron's Disease
- Author
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Hiroyuki Yuzawa, Takayuki Yamamoto, Koichi Matsumoto, Tomonori Himan, Shigeki Nakayama, and Satoru Umegae
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Disease ,Anal Canal Cancer ,business ,Anal stricture ,Surgery - Published
- 2014
32. Resolution of constipation, anal stricture, and iron deficiency anemia after iron infusion: an analogy with Plummer Vinson syndrome
- Author
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Arjun Ohri, Shikha Singh, Vijaypal Arya, and Shashank Agarwal
- Subjects
medicine.medical_specialty ,Constipation ,Anemia ,Short Report ,Gastroenterology ,03 medical and health sciences ,Plummer–Vinson syndrome ,0302 clinical medicine ,Internal medicine ,medicine ,Plummer Vinson syndrome ,Anal fissure ,Chronic constipation ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,Rectal examination ,Anal stricture ,medicine.disease ,Surgery ,Iron-deficiency anemia ,Iron deficiency anemia ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Background Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus. Laboratory reports revealed microcytic hypochromic anemia with iron deficiency. A colonoscopy performed with a GIF XQ180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet, local anesthetics with a trial of mesalamine was initiated but the patient continued to have symptoms. He was referred to a hematologist for an evaluation of anemia and was started on intravenous (IV) iron infusion. Findings The patient’s symptoms of constipation, anal stricture and iron deficiency anemia resolved with iron infusion over 3 months. A repeat rectal exam was painless and confirmed resolution of anal stricture. Conclusion IV iron supplementation combined with conventional anal dilatation presents as a promising approach toward the treatment of anal strictures.
- Published
- 2016
33. The Tissue-selecting Technique
- Author
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Hong-Cheng Lin, Lei Lian, Hui Peng, Dong-lin Ren, Jian-Dong Tai, and Shang-Kui Xie
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Anesthesia, Epidural ,medicine.medical_specialty ,medicine.medical_treatment ,Rectal compliance ,Anesthesia, Spinal ,Hemorrhoids ,Patient Positioning ,Intestinal mucosa ,Surgical Stapling ,medicine ,Humans ,Intestinal Mucosa ,Anesthesia epidural ,business.industry ,Gastroenterology ,Rectal Prolapse ,General Medicine ,medicine.disease ,Surgery ,Endoscopes, Gastrointestinal ,Rectal prolapse ,Rectovaginal fistula ,Stapled hemorrhoidopexy ,business ,Anal stricture - Abstract
We describe a technique for the management of prolapsing hemorrhoids, with the aim to minimize the risk of anal stricture and rectovaginal fistula and to reduce the impact of the stapling technique on rectal compliance. This modified procedure was successfully applied in China, and preliminary data showed promising outcomes (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A117).
- Published
- 2013
34. Perianal Crohn’s disease and fistula-associated carcinoma: challenges in diagnosis
- Author
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Ettore Contessini-Avesani, Arianna Zefelippo, Stefano Costa, and Flavio Caprioli
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medicine.medical_specialty ,business.industry ,Abdominoperineal resection ,Proctocolectomy ,Anal Adenocarcinoma ,Fistula ,medicine.medical_treatment ,Gastroenterology ,medicine.disease ,Anus ,Surgery ,medicine.anatomical_structure ,Rectovaginal fistula ,Medicine ,business ,Anal stricture ,Chemoradiotherapy - Abstract
Dear Editor: Perianal manifestations are quite frequent in Crohn’s disease (CD): simple or complex fistulas, skin tags, haemorrhoids, ulcers, fissures and anal strictures may develop in association with active colorectal inflammation [1, 2]. Symptoms of perianal Crohn’s disease (PCD) vary in terms of severity but are usually recurrent and persistent; combined surgical and medical approach is the gold standard for therapy [1, 2]. Conversely, fistula-associated malignancies are very rare, but few cases among CD patients have been reported in literature; advanced stage at diagnosis and poor outcome are common features [3]. Detection of anorectal carcinoma arising on chronic complex PCD may be challenging, and delayed diagnosis could impair chances of radical treatment. Out of 344 CD-related operations conducted between January 2007 and June 2014 at a single tertiary referral institution, 83 procedures were performed for perianal disease on 60 patients. Four patients were found to have anorectal carcinoma associated with perianal fistula; clinical characteristics, diagnostic and treatment modalities for these patients are presented and discussed. Case 1 A 31-year-old female with a 13-year history of perianal CD and terminal ileitis underwent examination under anaesthesia (EUA) for transsphincteric fistula refractory to treatment. Multiple biopsies demonstrated mucinous anal adenocarcinoma. Abdominoperineal resection extended to the posterior vaginal wall, and coccyx, inguinal linfectomy and ileocecal resection were performed (p T4b N0). She received postoperative chemotherapy and steroids for recurrence of ileal CD. Four years after resection, a pelvic recurrence was detected and chemoradiotherapy started; the patient however died at 53 months from surgery due to disseminate disease. Case 2 A 45-year-old female was admitted for persistent rectovaginal fistula and active colitis. She was diagnosed with perianal CD 23 years before and had previous resection of terminal ileum and right colon. Sphincter-sparing proctocolectomy was performed. On histology, colloid adenocarcinoma of the anus associated with fistula was demonstrated (pT3 N0); she received chemoradiotherapy postoperatively. After 20 months, she developed a pelvic recurrence on the vaginal wall and underwent surgical excision; no signs of further recurrences were seen at 32month follow-up. Case 3 A 44-year-old male was diagnosed with perianal and ileocoecal CD at 21 and underwent ileocecal resection at that time. He was referred to our institution for recurrent abscesses and refractory perianal fistulas; although there was high suspicion for tumour degeneration on first clinical examination, office biopsies failed to demonstrate malignancy. EUAwith deeper biopsies showed mucinous adenocarcinoma of the Electronic supplementary material The online version of this article (doi:10.1007/s00384-015-2140-y) contains supplementary material, which is available to authorized users. A. Zefelippo (*) : S. Costa : E. Contessini-Avesani General and Emergency Surgery Unit, Ospedale Maggiore Policlinico, via F. Sforza 28, 20122 Milan, Italy e-mail: arianna.zefelippo@policlinico.mi.it
- Published
- 2015
35. Results of 666 consecutive patients treated with LigaSure hemorrhoidectomy for symptomatic prolapsed hemorrhoids with a minimum follow-up of 2 years
- Author
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Chung-Ming Chen, Yao-Jen Chang, Chieh-Wen Lai, Chuang-Wei Chen, and Koung-Hong Hsiao
- Subjects
Adult ,Hemorrhoidectomy ,Male ,Reoperation ,Anal fistula ,medicine.medical_specialty ,medicine.medical_treatment ,Postoperative Hemorrhage ,Hemorrhoids ,Urinary catheterization ,Prolapse ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Retrospective cohort study ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Rectal Diseases ,Treatment Outcome ,Prolapsed hemorrhoids ,Anesthesia ,Female ,business ,Anal stricture ,Follow-Up Studies - Abstract
Background Our aim is to report the outcomes of hemorrhoidectomy performed via LigaSure™ with a minimum follow-up of 2 years. Methods A total of 666 patients underwent hemorrhoidectomy for symptomatic prolapsed hemorrhoids (grade III and IV) via LigaSure between June 2006 and June 2008. Patient demographic and operative data were collected and analyzed. Results The mean patient age was 45.4 ± 11.1 years (x ± SD; range, 22–77), and approximately 72% had grade III hemorrhoids. All procedures were performed without complications. The operative time was 18.7 ± 4.1 minutes (range, 9–43), and hospital stay was 1.5 ± 0.6 days (range, 1–4). There was no immediate postoperative bleeding or other procedure-related complications. Twelve (1.8%) patients required urinary catheterization for a maximum of 1 day, and 21 (3.2%) patients had delayed postoperative bleeding. Most cases of bleeding resolved spontaneously; 3 patients (0.4%) required reoperation. A total of 645 patients (96.6%) responded to a follow-up telephone interview at a mean of 36 months (range, 24–49) after hemorrhoidectomy. After 1 year postoperatively, 2 patients received additional excisions for residual skin tags, 1 was treated for an anal stricture, 1 was treated for an anal fistula, and 3 were treated for anal fissures. Minor incontinence (flatus) was present in 11 (1.7%) patients, and 13 (2.0%) experienced mild bleeding caused by residual hemorrhoids; 1 patient underwent rubber-band ligation, and the others were successfully treated medically. No recurrent prolapse or persistent anal pain occurred during the follow-up period. The overall recurrence rate at 2-years follow-up was 3.1%. Conclusion The long-term recurrence rate after hemorrhoidectomy with LigaSure is low and comparable with conventional hemorrhoidectomy.
- Published
- 2013
36. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III-IV Prolapsing Hemorrhoids
- Author
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Hyeonseok Jeong, Hyun Tae Kim, Sunghwan Hwang, Hyoung Rae Kim, Hye Mi Yu, Ju Young Lee, Jiyong Lim, Young Gil Choi, Jihoon Yoon, and Kil O Ryu
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhoids ,Tissue selecting technique ,03 medical and health sciences ,0302 clinical medicine ,Anal stenosis ,medicine ,Tissue selecting therapy ,Abscess ,Circular stapled hemorrhoidopexy ,Urinary retention ,business.industry ,General surgery ,Gastroenterology ,medicine.disease ,Surgery ,Rectovaginal fistula ,030220 oncology & carcinogenesis ,Stapled hemorrhoidopexy ,Defecation ,Partial stapled hemorrhoidopexy ,030211 gastroenterology & hepatology ,Original Article ,medicine.symptom ,business ,Anal stricture - Abstract
Purpose Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III-IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. Methods We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. Results Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. Conclusion PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III-IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.
- Published
- 2016
37. The Comparison of Two Surgical Techniques In The Treatment Of The Anal Stricture Posthemorrhoidectomy Milligan-Morgan
- Author
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Dariel Tereska, Enton Bollano, Arben Gjata, and Krenar Lilaj
- Subjects
Abdominal discomfort ,medicine.medical_specialty ,Milligan morgan ,business.industry ,Skin flap ,Anal canal ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Defecation ,030211 gastroenterology & hepatology ,In patient ,030212 general & internal medicine ,business ,Lateral sphincterotomy ,Anal stricture - Abstract
Surgical treatment of anal stricture in open posthemorrhoidectomy brings various complications to the open hemorrhoidectomy in 5%-10% of the cases. In books it is widely known as "the fibrotic benign stricture" or as "iatrogenic stricture". Clinically, it is manifested with pain during defecation, minimal rectoragy and abdominal discomfort accompanied with a feeling of not having adequately emptied the bowels. Locally, it is manifested in the form of a rigid ring where even the small finger can hardly be penetrated. These symptoms can severely affect the quality of life in patients. Depending on the grade of the anal canal stricture, we can say that the anal stricture is found on three grades: light anal stricture, moderated anal stricture and expressed anal stricture. All our patients resulted in expressed anal stricture. In our research we have compared two operative techniques which were applied for the surgical treatment of the pathology. Partial posterior internal sphincterotomy technique with anoplastic in the open wound (SIPA) and the plastic with skin flap and closed internal lateral sphincterotomy, V-Y advancement flap (PLSL). Each technique aims at relaxing the anal canal with as less continence damage as possible and faster rehabilitation of the patient. The patients were divided into two groups: Group A of 15 patients treated with the SIPA technique and Group B of 14 patients treated with the PLSL technique. The study was conducted during February 2006 - March 2014. The results favored the PLSL technique.
- Published
- 2016
38. A standardized approach for the assessment and treatment of internationally adopted children with a previously repaired anorectal malformation (ARM)
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Victoria A. Lane, Venkata R. Jayanthi, Clare Skerritt, Christina B. Ching, Geri Hewitt, Kate McCracken, Daniel DaJusta, Katherine J. Deans, Carlos A. Reck, Richard J. Wood, Marc A. Levitt, and Peter C. Minneci
- Subjects
Diagnostic Imaging ,Male ,Reoperation ,medicine.medical_specialty ,Population ,Rectum ,Anal Canal ,Introitus ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Adoption ,Medicine ,Vaginal septum ,Humans ,Abnormalities, Multiple ,education ,Child ,Digestive System Surgical Procedures ,education.field_of_study ,business.industry ,Disease Management ,Infant ,General Medicine ,Anal canal ,medicine.disease ,Anus ,Anorectal Malformations ,Surgery ,Rectal prolapse ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Anal stricture - Abstract
Introduction A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population. Methods The results of investigations, indications, and rate of reoperation were assessed for adopted children with an ARM evaluated between 2014 and 2016. Results 56 patients (28 males) were identified. 76.8% required reoperative surgery. Mislocation of the anus outside the sphincter complex was seen in 50% of males and 39.3% of females. Anal stricture, rectal prolapse, retained vaginal septum, and a strictured vaginal introitus were also common. Conclusion The reoperative surgery rate in the internationally adopted child with an ARM is high. Complete, systematic evaluation of these children is required to identify complications following initial repair. Development of mechanisms to improve the primary surgical care these children receive is needed.
- Published
- 2016
39. Use of a Heineke-Mikulicz like stricturoplasty for intractable skin level anal strictures following anoplasty in children with anorectal malformations
- Author
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Taiwo A. Lawal, Marc A. Levitt, Carlos A. Reck, Victoria A. Lane, Richard J. Wood, and Alessandra C. Gasior
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Rectum ,Anal Canal ,03 medical and health sciences ,0302 clinical medicine ,Anal stenosis ,Medicine ,Humans ,Digestive System Surgical Procedures ,Retrospective Studies ,Hegar dilators ,business.industry ,Colostomy ,General Medicine ,Anal canal ,Plastic Surgery Procedures ,medicine.disease ,Anus ,Anorectal Malformations ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,030211 gastroenterology & hepatology ,business ,Imperforate anus ,Anal stricture - Abstract
Introduction We introduced a modification of the Heineke-Mikulicz technique to treat intractable skin level anal strictures post posterior sagittal anorectoplasty (PSARP). The aim of this article is to describe the technique and outcome in a series of patients. Methods This was a retrospective evaluation of patients who had Heineke-Mikulicz like stricturoplasty performed for a post PSARP skin level stricture over a one-year period. Results Five patients who were operated using the technique were reviewed. All had severe anal strictures that could admit Hegar dilator sizes 6 to 9 at 16months to 5years after PSARP. All underwent routine dilatations, which became increasingly painful. As an alternative to continued dilatations, an operative procedure was offered. The surgery was done as a day case and lasted 10 to 30min. The anus at the end of the procedure could comfortably accept a Hegar dilator size 14 to 17. None of the patients had a colostomy after the procedure and there were no complications. Conclusions The Heineke-Mikulicz like stricturoplasty is a simple surgical procedure that can be done in an ambulatory setting to treat children with intractable skin level anal stricture if this develops following definitive surgery for anorectal malformations.
- Published
- 2016
40. Comparison of morbidity between preventive and therapeutic ileostomy repair
- Author
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Donghyoun Lee, Woo Yong Lee, Kyung Uk Jung, Jung-A Yun, Ho-Kyung Chun, Seong Hyeon Yun, Yong Beom Cho, and Hee Cheol Kim
- Subjects
medicine.medical_specialty ,Ileus ,Colorectal cancer ,business.industry ,Mortality rate ,medicine.medical_treatment ,Anastomosis ,medicine.disease ,Surgery ,Ileostomy ,Colorectal cancer surgery ,medicine ,Complication ,business ,Anal stricture - Abstract
Backgrounds : The purpose of this study is to compare the complications after ileostomy take down between preventive and therapeutic ileostomy formation . Methods : From January 2006 through December 2010, 373 patients underwent closure of ileostomy. Inclusion criteria are as follows: 1) Patients undergoing an elective takedown of a temporary ileostomy in colorectal cancer; 2) age > 19. Excluded were patients with nonelective stoma take down and patients undertaken to treat anastomosis site stricture or anal stricture. 373 patients are included in the analysis: 280 Protective and 93 therapeutic. Results : The morbidity rate of protective ileostomy take down is 22.1% and therapeutic ileostomy take down is 30.3%. Ileus is the most common complication in both groups. Those who underwent therapeutic ileostomy have longer postoperative hospital stay (6.9 days vs 9.7 days)(p diet compared to preventive ileostomy group (3.9 days vs 6.8 days)(p complications after ileostomy take down in MultipleLogistic Regression Analysis analysis were therapeutic ileostomy take down(p Conclusion : In the colorectal cancer surgery, preventive ileostomy take down showed better outcomes than therapeutic ileostomy after take down. Thus, in the case whenanastomosis is unstable or low, it is important to consider inconvenience of patients, risk of re-surgery due to anastomosis site leakage and increase in complications after therapeutic ileostomy take down when we performing of preventive ileostomy formation.
- Published
- 2012
41. Photodynamic therapy with systemic meta-tetrahydroxyphenylchlorin in the treatment of anal intraepithelial neoplasia, grade 3
- Author
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Jan Bonne Aans, Eric M van der Snoek, Marchina E. van der Ende, Dominic J. Robinson, Jan C. den Hollander, Henricus J. C. M. Sterenborg, Dermatology, Pathology, Radiotherapy, and Internal Medicine
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Photodynamic therapy ,HIV Infections ,Dermatology ,Lesion ,SDG 3 - Good Health and Well-being ,medicine ,Anal cancer ,Humans ,Prospective Studies ,Pain Measurement ,Photosensitizing Agents ,business.industry ,Anal intraepithelial neoplasia ,Middle Aged ,medicine.disease ,Rectal discharge ,Anus Neoplasms ,Surgery ,Bloody ,Mesoporphyrins ,Photochemotherapy ,Dysplasia ,medicine.symptom ,Neoplasm Recurrence, Local ,business ,Anal stricture ,Carcinoma in Situ - Abstract
Background and Objective Anal cancer and preneoplastic anal lesions (anal intraepithelial neoplasia, AIN) rising especially in men having sex with men (MSM). There are no widely accepted treatment standards for AIN. Photodynamic therapy (PDT) using the systemic sensitizer meta-tetrahydroxyphenylchlorin (mTHPC) has the potential to treat the anal area even when the exact borders of the preneoplastic anal lesion cannot easily be visualized. Study Design/Materials and Methods In this prospective intervention study, 15 HIV-positive MSM with AIN 3 were treated in 25 PDT-sessions using mTHPC intravenously administered at drug doses of 0.075–0.15 mg ml−1 and illumination at 48 hours. The illumination was performed using a custom made applicator using either red light (652 nm) to a measured intended fluence of 10 and 20 J cm−2 and green light (532 nm) to a measured intended fluence of 105, 210, and 340 J cm−2. Red and green illuminations were performed at a (green) equivalent fluence rate of 105 mW cm−2. Results Initial complete response was seen in 7/25 (28%) of treatments and another 4/25 (16%) initial partial responses. After an average 8 months, recurrences were detected in 7/11 (64%) of sessions that initially showed response. A total 4/25 (16%) showed persistent complete response 6–15 months after green light illumination. Red light illuminations caused more significant side effects combined with no persistent complete response. Reported side effects were intense pain, bloody and purulent rectal discharge, and anal stricture formation, in one patient. Conclusion The results show that the use of systemic mTHPC is partially effective for the treatment of AIN 3. Lasers Surg. Med. 44: 637–644, 2012. © 2012 Wiley Periodicals, Inc.
- Published
- 2012
42. Results of 7302 stapled haemorrhoidectomy operations in a single centre: a seven-year review and follow-up questionnaire survey
- Author
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Kok-Sun Ho, Boon-Swee Ooi, Ming-Hian Kam, Choong-Leong Tang, Kong-Weng Eu, Jit-Fong Lim, and Kheng-Hong Ng
- Subjects
medicine.medical_specialty ,business.industry ,Questionnaire ,Retrospective cohort study ,General Medicine ,Dehiscence ,Surgery ,Single centre ,Patient satisfaction ,Medicine ,Young adult ,business ,Anal stricture ,Medical attention - Abstract
Background: This study aims to evaluate the results of all 7302 stapled haemorrhoidectomy operations performed in a single centre. Method: A retrospective review of all 7302 patients who underwent stapled haemorrhoidectomy at our department over seven years was conducted. The hospital database was reviewed for subsequent readmissions and re-operations. A questionnaire survey was also sent out to all the patients. Results: A total of 302 patients (4.1%) were admitted with post-operative bleeding and 281 stopped with conservative measures. Twenty one required surgical haemostasis. A total of 301 patients (4.1%) were admitted for an inability to void and 191 (2.6%) had true acute retention of urine, requiring catheterization. There were 124 patients (1.7%) admitted for pain, but all resolved with oral analgesia subsequently. Anal stricture requiring surgery occurred in only 86 patients (1.2%). Serious complications such as staple line dehiscence or anorectal sepsis occurred in seven patients. There were a total of 14 recurrences requiring readmission over this seven-year period, of which 12 were treated successfully with a second haemorrhoidectomy. A total of 1834 patients returned their questionnaire surveys and 95% of the patients reported complete resolution or improvement of their symptoms. Only 27 patients reported subsequent severe bleeding requiring medical attention. Conclusion: Stapled haemorrhoidectomy is safe, and most patients are satisfied with the long-term outcome.
- Published
- 2010
43. Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy
- Author
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Wei-Guo Wang, Ke-Qiang Yu, Wenzhu Lu, Chunmei Yang, and Hongbo He
- Subjects
Hemorrhoidectomy ,medicine.medical_specialty ,medicine.medical_treatment ,Anal Canal ,Postoperative Hemorrhage ,Cochrane Library ,Hemorrhoids ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,law ,Anal stenosis ,Humans ,Medicine ,Fecal incontinence ,Randomized Controlled Trials as Topic ,Pain, Postoperative ,business.industry ,Urinary retention ,General Medicine ,Length of Stay ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Lateral Internal Sphincterotomy ,medicine.symptom ,business ,Lateral internal sphincterotomy ,Anal stricture - Abstract
BACKGROUND Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy. METHODS A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain. RESULTS Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), -0.75; 95% confidence interval (CI), -1.14 to -0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), -17.19; 95% CI, -25.66 to -8.72; z = 3.98; P
- Published
- 2018
44. Nonfistulizing perianal Crohnʼs disease
- Author
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Guillaume Bouguen, Jean-François Bretagne, Laurent Peyrin-Biroulet, Laurent Siproudhis, and Marc-André Bigard
- Subjects
Anus Diseases ,medicine.medical_specialty ,Anal Carcinoma ,business.industry ,Fistula ,Gastroenterology ,medicine.disease ,Inflammatory bowel disease ,Surgery ,Crohn Disease ,Anal stenosis ,Epidemiology ,medicine ,Humans ,Rectal Fistula ,Immunology and Allergy ,Anal cancer ,Abscess ,business ,Anal stricture - Abstract
Nonfistulizing perianal lesions, including ulcerations, strictures, and anal carcinoma, are frequently observed in Crohn's disease. Their clinical course remains poorly known. The management of these lesions is difficult because none of the treatments used is evidence-based. Ulcerations may be symptomatic in up to 85% of patients. Most ulcerations heal spontaneously but may also progress to anal stenosis or fistula/abscess. Topical treatments only improve symptoms, while complete healing can occur in patients with perianal ulcerations receiving infliximab therapy. Half of all patients with anal strictures will require permanent fecal diversion. Dilatation for symptomatic strictures should be performed on a highly selective basis in the absence of active rectal disease in order to avoid infectious complications. Anorectal strictures associated with rectal lesions should first be managed with medical therapy. Skin tags are usually painless and may hide other perianal lesions. Anal cancer is uncommon. Its treatment is similar to that recommended for anal cancer occurring in non-Crohn's disease patients. After reviewing the classification, clinical features, and epidemiology of each type of nonfistulizing perianal lesion (ulceration, stricture, skin tags, and anal cancer), we discuss the efficacy of medical treatment and surgery. This review article may help physicians in decision-making when managing potentially disabling lesions.
- Published
- 2010
45. Anal stenosis: use of an algorithm to provide a tension-free anoplasty
- Author
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Kevin Hung, Zeev Duieb, Hung Nguyen, and Sree Appu
- Subjects
medicine.medical_specialty ,Constipation ,business.industry ,Follow up studies ,Retrospective cohort study ,General Medicine ,Surgical procedures ,medicine.disease ,Surgery ,Stenosis ,Anal stenosis ,medicine ,medicine.symptom ,Surgical Flaps ,business ,Algorithm ,Anal stricture - Abstract
Background: Anal stenosis is a debilitating condition that often is iatrogenic in cause. Various surgical procedures to manage this problem have been described. The present study evaluates the use of different anoplasty techniques in a series of 11 patients with anal stenosis. To the best of the authors' knowledge, this is the first study to provide a stepwise algorithm for the anoplasty techniques used. Methods: A series of 11 patients were evaluated for presenting symptoms, cause of anal stenosis, type of anoplasty used, complications and post-operative success in relieving symptoms. All operations were performed by one surgeon in three hospitals, and were followed up by the same surgeon and by a surgical registrar. Results: The most common presenting symptoms were constipation and decreasing calibre of stool. The main causes of anal stenosis were previous surgery, neoplasia and fissure. Transverse closure, Y-V and diamond advancement flaps were used in an escalating manner to deal with increasing severity of stenosis. All 11 patients had some level of improvement in symptoms post-operatively. There were no long-term complications. Conclusion: Anoplasty is a safe and successful option in the treatment of anal stenosis, and this stepwise algorithm takes the guesswork out of choosing the most appropriate procedure for each patient.
- Published
- 2009
46. Como o coloproctologista brasileiro vê a doença hemorroidária: análise de dados colhidos de questionário dirigido aos especialistas filiados à sociedade brasileira de coloproctologia
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Daniel Martins Barbosa Medeiros Gomes, Rodrigo Guimarães Oliveira, Isabella Mendonça Alvarenga, Mônica Mourthé de Alvim Andrade, Flávia Fontes Faria, José Roberto Monteiro Constantino, and Geraldo Magela Gomes da Cruz
- Subjects
medicine.medical_specialty ,business.industry ,questionário sobre DH ,Coloproctologistas brasileiros ,medicine.medical_treatment ,Incidence (epidemiology) ,Gastroenterology ,medicine.disease ,Rubber band ligation ,Surgery ,Stenosis ,Anal stenosis ,Epidemiology ,medicine ,Health insurance ,Doença hemorroidária ,Complication ,business ,Anal stricture - Abstract
Analysis of a questionnaire with 52 questions about hemorrhoidal disease (HD) answered by 77 Brazilian specialists allowed the following conclusions: EPIDEMIOLOGY: The meantime of medical practice was 18.6 years; the 77 specialists attended ± 1,097.860 patients, HD being diagnosed in ± 393,763 (35.86%), and ± 102,400 patients (± 26%) undergoing surgical treatment. The approximate incidence by gender of HD was 42% in men and 58% in women, and the incidence of surgery 43% in males and 57% in females. The incidences of HD according to age were: 7% under 20 years, 40% between 21 and40 years, 40% between 41 and 60 years and 13% above 60 years of age. CLINICAL AND NON SURGICAL TREATMENT: clinical approach for HD was carried out in ± 291.363 patients. The non surgical treatment of choice was rubber band ligation (94,0% of the specialists), mainly for second grade internal hemorrhoids (85.2%), being the most common procedure the approach of a single ligation by each session (74.1%), without plicomectomy (67.1%). Satisfaction grade reached 91.0% (good and optimal). Rubber band ligation was used in ± 48,273 patients (12.50%), no complication being reported by most of the specialists (42 specialists, 53.95%), being hemorrhage the most common complication (69 cases, 0.142% of 48,273 ligations). HEMORRHOIDECTOMY: 102,400 hemorrhoidectomies were performed by the 77 specialists, being the intensity of anal symptoms the main indication for surgery despite of the grade of the HD (64.47%). Open hemorrhoidectomy (Milligan-Morgan) was the most used technique (65.79%) followed by closed hemorrhoidectomy (Ferguson) (21.05%). The most used anesthesia were spinal blocks, being 52.63% of raquianesthesia and 26.32% of peridural anesthesia. Knife position was the number one in preference (44.73%), followed by forced gynecologic position (22.37%) and regular gynecological position (21.05%). Most of the specialists preferred to perform hemorrhoidectomy in hospitalized patients (78.94%), being 55.26% as full day patients (55.26%) and 23.68% as day-patient. Antibiotic therapy was admitted by 77.0% of the specialists, being 47.0% in selected cases and 30.0% as routine; second generation cefalosporin was the most used antibiotic (13.0%) followed by the association of metronidazol and aminoglycoside (7.5%). POST OPERATORY: Among the analgesics used anti-inflammatory occupied the first place (29.0%), following paracetamol (21.5%), morphine (15.3%) and sodium diclophenate (13.0%). Routine rectal touch was carried out by 44 specialists (57.0%), being 34.5% with the aim of detection a possible anal stenosis and 25.5% to forbid the progress of an eventual stenosis. Among several post operatory complications called the attention the hemorrhage (admitted by 52.0% of the specialists) and anal stricture (9.0% of the specialists). 58 specialists (75.0%) ordered routine histopathology examination of the resected specimens. 55.52% of the specialists do not perform associated surgeries with HD. 57.89% of the specialists use clinical approach as far as hemorrhoid thrombosis is concerned. PPH (Procedure for Prolapsed Hemorrhoids): 35 specialists never tried PPH (45.0%) and 62% of them have never tried and do not feel like trying the technique. 38 specialists stated they tried this procedure (49.0%); 17 (22.0%) did not continue with PPH while 21 continued to use the technique. Of the 17 specialists 42.85% did not pursued using PPH because they did not like the results (not so good as the surgical techniques they use); 21.42% because the costs of the procedure are prohibitive; and 21.42% because the plans of health insurance companies they are affiliate do not authorize the technique. In the 487 cases of PPH carried out by the 12 specialists extra hand stitches were necessary in 55 patients (11.29%) and complications were confirmed in seven patients: four cases of anal stenosis (0.8%), two cases of hemorrhage (0.4%) and one case of unsatisfactory result with indication of conventional surgery (0.2%).
- Published
- 2009
47. The Use of Posterior Trans-Sphincteric Approach in Surgery of the Rectum: A Chinese 16-Year Experience
- Author
-
Huizhong Qiu, Bin Wu, Yi Xiao, and Guole Lin
- Subjects
Adult ,Male ,China ,medicine.medical_specialty ,Rectum ,Blood loss ,medicine ,Humans ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,Aged, 80 and over ,Rectal Villous Adenoma ,Rectal Neoplasms ,business.industry ,General surgery ,Middle Aged ,Vascular surgery ,Surgery ,Cardiac surgery ,Treatment Outcome ,medicine.anatomical_structure ,Cardiothoracic surgery ,Female ,business ,Anal stricture ,Abdominal surgery - Abstract
The posterior trans-sphincteric approach to treat different lesions of the rectum has been known since the last century. Although there are many advantages to this procedure, it has never been widely accepted because many surgeons fear its potential postoperative complications. The purpose of this study is to reevaluate the role of this conventional approach to surgery of the rectum from the authors’ 16 years experience. Data were collected retrospectively from clinical records of 102 patients with mid- to low-lying rectal neoplastic disease treated by a single surgeon using a posterior trans-sphincteric approach to the rectum at Peking Union Medical College Hospital, China, between August 1990 and August 2006. The Williams incontinence scale of every patient was assessed preoperatively and postoperatively and the results were analyzed. Forty men and 62 women with a median age of 55.5 years (range = 21–87 years) underwent this approach. Their preoperative anal continence was assessed as grade 1 in 98 and grade 2 in 4. Indications for surgery were rectal villous adenoma in 36, early rectal carcinoma in 43, advanced rectal carcinoma in 10, and rectal submucosal neoplastic disease in 13. The median operating time, blood loss, and postoperative hospital stay were 75 min (range = 40–180 min), 60 ml (range = 0–300 ml), and 8 days (range = 7–60 days), respectively. All 102 rectal neoplastic diseases achieved complete excision (partial rectectomy in 96, segmental rectectomy in 6), and the resection margins were all clear. Three patients (2.9%) developed postoperative wound infection, and 4 patients (3.9%) developed fecal fistula. Thirty-three patients (32.4%) developed postoperative initial incontinence to flatus (n = 26) or liquid stool (n = 7) within 1 week. Three months after the operation, 94 patients (92.2%) achieved grade 1 continence and only 8 patients (7.8%) had occasional episodes of flatus incontinence. No patient developed postoperative anal stricture. There was no operation-related mortality. Three patients (2.9%) developed local tumor recurrence during median follow-up of 76.8 months (range = 10–192 months). The posterior trans-sphincteric approach is suitable for mid- to low-lying rectal lesions amenable to treatment using local therapy.
- Published
- 2008
48. Complications of ileal pouch anal anastomosis
- Author
-
Frederick Alexander
- Subjects
Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Anal Canal ,Colonic Pouches ,Pouchitis ,Anastomosis ,Postoperative Complications ,Crohn Disease ,Risk Factors ,medicine ,Humans ,Child ,Contraindication ,Colectomy ,business.industry ,General surgery ,Anastomosis, Surgical ,medicine.disease ,Surgery ,Bowel obstruction ,Pediatrics, Perinatology and Child Health ,Colitis, Ulcerative ,Pouch ,business ,Anal stricture - Abstract
Ileal pouch anal anastomosis (IPAA) is associated with complications in a significant number of patients, including ileal-anal separation, anal stricture, pouchitis, pelvic sepsis, and small bowel obstruction. In most cases, these complications may be successfully treated using either medical or surgical therapy and do not result in long-term pouch dysfunction. Important preventative measures include accrual of experience or creation of a team with experienced surgical leadership and scrupulous selection of patients who have no features of Crohn's disease. Despite these precautions, 5% to 15% of patients will develop chronic pouch dysfunction and pouch failure requiring diversion with or without excision of the pouch. Medical measures, such as antibiotics, immunomodulators, and biologic agents, and surgical measures such as advancement flap anoplasty may be attempted to salvage pouch function and are successful in more than 50% of cases. Indeterminate colitis does not preclude IPAA; however, Crohn's colitis is absolute contraindication for same. Patients who require colectomy and are suspected for any reason to have CD may undergo ileorectal anastomosis with preservation of anorectal continence and excellent functional results.
- Published
- 2007
49. Long-term results of total colonic agangliosis patients treated by preservation of the aganglionic right hemicolon and the ileo-cecal valve
- Author
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Holger Till, Günter Fasching, Eva Amerstorfer, Michael E. Höllwarth, and Andrea Huber-Zeyringer
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Colon ,Gastroenterology ,Ileocecal valve ,Quality of life ,Internal medicine ,Surveys and Questionnaires ,Pediatric surgery ,Medicine ,Humans ,Hirschsprung Disease ,Total colonic aganglionosis ,Digestive System Surgical Procedures ,Retrospective Studies ,Enterocolitis ,Ileocecal Valve ,business.industry ,Infant ,Retrospective cohort study ,General Medicine ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Quality of Life ,Defecation ,Female ,medicine.symptom ,business ,Organ Sparing Treatments ,Anal stricture - Abstract
In 1989, Sauer introduced a technique to treat patients with total colonic aganglionosis (TCA) where he preserved the ileo-cecal valve and the right hemicolon to retain water and electrolyte absorption. This report examines the long-term outcome of patients who underwent this technique. All TCA patients treated between 1981 and 2005 according to Sauer were invited in 2013 to participate in a questionnaire survey to assess their long-term outcome focusing on bowel function and quality of life (QoL), using standardized scores. Of eight TCA patients (2 females, 6 males), seven participated in the follow-up survey (median follow-up time 13.5 years (range 8–31.6). Early postoperative complications involving bouts of enterocolitis in 3 and anal strictures in 5 patients ceased with age. Bowel movements ranged from median 3–4 times a day (range 1–8). Bowel-function score (BFS) was reduced in 6 patients (median 16 points, range 8–19, max 20), who also reported soiling incidences with the need for night-time protective aids in two. QoL assessment, however, documented a good outcome with a median score of 10 points (range 7–13, max 13). This long-term investigation of TCA patients treated according to Sauer’s technique documented a good QoL despite a reduced BFS.
- Published
- 2015
50. Anorectal malformations: definitive surgery during adulthood
- Author
-
H. J. Monroy, M. F. T. Roxas, V. I. Encila, S. G. Alamo, and Marc Paul J. Lopez
- Subjects
Enterocutaneous fistula ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urinary Fistula ,medicine.medical_treatment ,Fistula ,Philippines ,Anal Canal ,Rectourethral fistula ,Anus, Imperforate ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,030225 pediatrics ,Laparotomy ,Urethral Diseases ,medicine ,Humans ,Rectal Fistula ,Digestive System Surgical Procedures ,Retrospective Studies ,business.industry ,General surgery ,Gastroenterology ,Age Factors ,Rectum ,Plastic Surgery Procedures ,medicine.disease ,Colorectal surgery ,Anorectal Malformations ,Surgery ,Treatment Outcome ,030211 gastroenterology & hepatology ,Female ,business ,Imperforate anus ,Anal stricture ,Abdominal surgery - Abstract
Anorectal malformations (ARMs) are rarely seen in adults, since majority of cases are corrected in infancy or childhood. The aim of this study was to describe the profile of patients who underwent definitive surgery to correct their ARM in adulthood, and to discuss the outcomes of surgery (morbidity, mortality, and function). This retrospective study included patients 18 years old and above, managed surgically by the Division of Colorectal Surgery at the Philippine General Hospital, University of the Philippines, Manila, from January 1, 2004, to December 31, 2012. Data from the Integrated Surgical Information System and the patients’ hospital records were used to fill out a Data Collection Form. Frequencies and percentages were then computed. Eight patients were included in the study. The most common reason for consult was recurrent urinary tract infection (UTI, 25%). One patient had an imperforate anus (IA) without a fistula, and 1 patient had IA with rectal atresia, and the 6 had an IA with a fistula. All but one (87.5%) of the patients had undergone a prior diversion in infancy or childhood. Definitive surgical procedures included posterior sagittal anorectoplasty (PSARP) in 3 patients, anal transposition in 2 patients, laparotomy with colocutaneous anastomosis in two patients, and laparotomy and PSARP in 1 patient. There were 3 cases (37.5%) of postoperative complications. These complications included ureteral injury, enterocutaneous fistula, anal stricture, rectal stricture, rectovesical fistula, and recurrent rectourethral fistula. There was no reported mortality. Five patients already had their stomas reversed at the time of this writing. Our results showed that the rarity of the disease, limited surgical experience, and a technically challenging anatomy make the management of ARMs that persist into adulthood a formidable undertaking.
- Published
- 2015
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