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Objectives: To use three‐dimensional anorectal ultrasonography (3D‐US) to evaluate the outcome of ligation of the intersphincteric fistula tract (LIFT) in patients with crypto‐glandular transsphincteric fistula and describing the patterns of healing, failure, and recurrence rate. Methods: After classifying the fistula and determining the length of the sphincter muscle to be transected, the patients were submitted to LIFT. The accuracy of pre‐ and postoperative 3D‐US with 360° endoprobe (16 MHz) with automatic scanning and clinical findings was evaluated against surgical findings. Three outcomes were considered: healing, failure (persistent anal fistula through the original external opening or intersphincteric), and recurrence (reappearance of the anal fistula). Results: Sixty‐three patients of both sexes were evaluated. The 3D‐US assessment revealed primary healing in 50 (79.3%) patients, although in 6 (9.5%) cases healing was delayed and the cavity was without communication with the anal canal. The procedure failed in 9 (15.9%) and fistula recurred in 4 (6.3%), all of whom underwent a second surgery based on a new 3D‐US, resulting in a 92.3% (12/13) healing rate on 3D‐US. Conclusions: A 3D‐US was found to be useful in the preoperative assessment of fistulas by quantifying the percentage of muscle to be transected, and in the postoperative assessment by identifying healing, types of failure, and recurrence. The 3D‐US was accurate and consistent with surgical findings. [ABSTRACT FROM AUTHOR]

Background: Mucinous adenocarcinoma of anus is an uncommon neoplasm of the gastrointestinal tract. In most of the cases, early diagnosis of this disease is difficult since its symptoms frequently mimic benign inflammatory conditions. Methods: A systematic PubMed and Scopus search was conducted, a propos of a case report. Results: One hundred fifty patients from 93 case reports were included. The mean age of the patients was 60.5 years (range: 18–81). The majority of them were males (124 out of 150, 82.7%), while the main known risk factor was the history of chronic fistula (109 out of 150, 72.7%). Recurrent perianal sepsis and perianal pain were the principal symptoms at the time of presentation. No symptoms have been reported only in three patients (3 out of 150, 2%). Regarding the prior surgical history of the patients, multiple abscess drainage and perianal fistula’s related interventions were present in 62 (41.3%) and 19 (12.7%) patients, respectively. Neoadjuvant chemoradiotherapy was administered in 53 out of 150 patients (35.3%), while the majority of them have been treated with combined treatment of chemotherapy and radiotherapy. APR and its variations were the most applied surgical treatment (68%). Adjuvant chemoradiotherapy was administered almost up to one-third of the included patients (34%). Recurrence of the disease was reported in 41 out of 150 patients (27.3%). Death was reported in 44 out of 150 patients (29.3%). Conclusion: Review of the available published literature suggests that perianal mucinous adenocarcinoma is an extremely rare neoplasia. Τhere is no consensus as far as the diagnosis and the treatment strategies, due to the rarity of this neoplasm. High degree of clinical suspicion as well as histopathological confirmation is the principal requisites for the diagnosis of mucinous adenocarcinoma, especially in the ground of chronic ulcero-proliferative perianal lesions. [ABSTRACT FROM AUTHOR]

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative.

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative. [ABSTRACT FROM AUTHOR]

Aim: Identification of characteristic clinical findings for early diagnosis of carcinoma associated with anal fistula. Methods: From the perspective of early diagnosis, we compared the clinical characteristics of 13 cases of carcinoma associated with anal fistula with 5 clinical diagnostic criteria defined by Sumikoshi et al. Results: Pain and induration, absence of primary cancer at other sites, and presence of the fistula opening were observed in all cases, while mucinous secretion was observed in 8 cases and duration of anal fistula for more than 10 years in only 5 cases. Pain not relieved by drainage and marked induration without elasticity are differential points from abscesses. MRI showed hyperintense heterogeneous multifocal cystic lesions in 86% of cases, and endoanal ultrasonography (EAUS) showed lattice structures with septations of various sizes and isoechoic solid components in 83% of cases, all of which were useful for early diagnosis. Conclusions: The following four findings were useful for early diagnosis: 1) extensive severe induration, 2) pain not relieved by drainage, 3) mucinous secretion, and 4) characteristic MRI/EAUS findings. If even one of these is present, carcinoma associated with anal fistula should be strongly suspected and aggressive biopsy should be performed. [ABSTRACT FROM AUTHOR]

Background: Implantation of Gatekeeper™ prostheses presents an option for the treatment of passive faecal incontinence (FI). Whilst preliminary results are encouraging, long-term data regarding its sustained benefit are limited. The aim of this study was to assess and evaluate the long-term clinical function and quality of life of patients with passive faecal incontinence who were treated with Gatekeeper™ prostheses. Methods: This was a single centre, single surgeon retrospective study of prospectively collected clinical data in patients with FI treated between June 2012 and May 2019. Patients with passive FI with symptoms refractory to conservative treatment and endoanal ultrasonography showing intact or disrupted internal anal sphincter were included. Formal clinical and quality of life assessments were carried out using the St. Mark's Incontinence Score (SMIS) and Faecal Incontinence Quality of Life (FIQoL) questionnaires at baseline, 3 months, 6 months, 12 months and then annually. Endoanal ultrasonography was performed both before and after surgery. Results: Forty patients (14 males, 26 females) with a median age of 62.5 (range 33–80) years were treated with the Gatekeeper™ implant. The majority of patients (87.5%) received six implants. There were no peri or post-operative complications. Prosthesis migration was observed in 12.5% patients. The median follow-up duration was 5 years (interquartile range (IQR) 3.25–6.00 years). A sustained improvement in median SMIS and FIQoL scores from baseline to follow-up was noted. Significant differences were observed between the median baseline SMIS score and last follow-up score of 16.00 (IQR 15.00–16.75) to 7.00 (IQR 5.00–8.00) respectively (p < 0.001), a 56.25% decrease. The overall median FIQoL score showed a significant improvement from 7.95 (IQR 7.13–9.48) to 13.15 (IQR 12.00–13.98) (p < 0.001) a 65.40% increase. Conclusions: Gatekeeper™ implantation is a safe approach to treating passive FI and is minimally invasive, reproducible and has minimal complications. Long-term sustained clinical improvement is achievable beyond 5 years. Careful patient selection is paramount, as is consistency of technique and follow-up protocol. [ABSTRACT FROM AUTHOR]

Background: Mucinous adenocarcinoma of anus is an uncommon neoplasm of the gastrointestinal tract. In most of the cases, early diagnosis of this disease is difficult since its symptoms frequently mimic benign inflammatory conditions., Methods: A systematic PubMed and Scopus search was conducted, a propos of a case report., Results: One hundred fifty patients from 93 case reports were included. The mean age of the patients was 60.5 years (range: 18-81). The majority of them were males (124 out of 150, 82.7%), while the main known risk factor was the history of chronic fistula (109 out of 150, 72.7%). Recurrent perianal sepsis and perianal pain were the principal symptoms at the time of presentation. No symptoms have been reported only in three patients (3 out of 150, 2%). Regarding the prior surgical history of the patients, multiple abscess drainage and perianal fistula's related interventions were present in 62 (41.3%) and 19 (12.7%) patients, respectively. Neoadjuvant chemoradiotherapy was administered in 53 out of 150 patients (35.3%), while the majority of them have been treated with combined treatment of chemotherapy and radiotherapy. APR and its variations were the most applied surgical treatment (68%). Adjuvant chemoradiotherapy was administered almost up to one-third of the included patients (34%). Recurrence of the disease was reported in 41 out of 150 patients (27.3%). Death was reported in 44 out of 150 patients (29.3%)., Conclusion: Review of the available published literature suggests that perianal mucinous adenocarcinoma is an extremely rare neoplasia. Τhere is no consensus as far as the diagnosis and the treatment strategies, due to the rarity of this neoplasm. High degree of clinical suspicion as well as histopathological confirmation is the principal requisites for the diagnosis of mucinous adenocarcinoma, especially in the ground of chronic ulcero-proliferative perianal lesions., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Evaluating anorectal function using real‐time tissue elastography (RTE) has not been reported. A previous study reported that in the internal anal sphincter (IAS) of surgical specimens of patients with rectal cancer who underwent abdominoperineal resection, there was an increased fibrosis trend in those who underwent pre‐operative chemoradiotherapy (CRT) compared with non‐CRT. We speculated that CRT might have induced sclerosis of the IAS because of fibrosis. Therefore, we aimed to establish a method of quantitating the degree of IAS hardness using RTE on endoanal ultrasonography. Methods: RTE was performed with freehand manual compression under a defined pressure at the middle anal canal. Using the most compressive point in the strain graph, we traced the region of interest in the IAS. The strain histogram showed a frequency distribution of colours according to the degree of strain (numeric scan ranging from 0 to 255; smaller number indicated harder tissue). We defined the mean of the strain histogram as 'elasticity'. Ten patients with locally advanced rectal cancer who underwent pre‐operative CRT were prospectively enrolled. We statistically evaluated the correlation between IAS elasticity and maximum resting pressure (MRP) values both at pre‐ and post‐CRT. MRP was examined concurrently with the examination of IAS elasticity. Results: Representativity of elasticity measurements was demonstrated. It revealed a trend: IAS elasticity had a moderate inverse correlation with MRP (r = 0.41, P = 0.07), regardless of whether measurements were made before or after CRT. Conclusion: We established a completely novel method for the assessment of elasticity of the IAS, using RTE on endoanal ultrasonography. [ABSTRACT FROM AUTHOR]

Anal fistula (AF) is a common referral to colorectal surgeons. Management remains challenging and sometimes controversial. Magnetic resonance imaging (MRI) is commonly performed in initial workup for AF. However, reports often lack key information for guiding treatment strategies. It has been shown that with structured radiology reports, there is less missing information. We present a structured MRI template report including 8 key descriptors of anal fistulas, whose effectiveness and acceptability are being assessed in a cross-sectional study (NCT04541238). [ABSTRACT FROM AUTHOR]

Anal canal duplication (ACD) is a rare congenital malformation, usually detected early in life. We report a case of a 67-year-old female with symptomatic ACD associated with a presacral cyst. Physical examination revealed an accessory opening located in the midline, posterior to the true anus. Imaging examinations, including fistulography, endoanal ultrasonography, and magnetic resonance imaging, revealed a blind-ending fistulous tract without connecting with the rectum and a presacral cyst posterior to the rectum. Complete surgical excision of the tract with cyst was performed through a posterior sagittal approach. Histologic examination revealed squamous epithelium lining and smooth muscle bundles, thereby confirming ACD. The postoperative course was uneventful, and the patient was doing well; no recurrence was observed 4 years after surgery. ACD can present for the first time in infants, children, and adults. Imaging examinations are useful for the diagnosis and preoperative assessment of ACD. Therefore, ACD should be considered in the differential diagnosis, even in adults, when a posterior perineal orifice is encountered, particularly in female patients. Once ACD is suspected, intense imaging inspection is recommended to visualize the ACD and associated anomalies, and surgical removal is warranted to prevent inflammatory complications or malignant changes.

Background: Obstetric anal sphincter injury is the most frequent cause of fecal incontinence (FI) in young women. However, the relationship between the extent of anal sphincter defects and the severity of long-term FI (at least 1 year after delivery) has been poorly studied. The aim of the present study was to determine if, in the long term, the extent of anal sphincter defects graded at anal endosonography was linked with the severity of FI. Methods: A retrospective study was conducted on women with a history of vaginal delivery, who presented with FI and had three-dimensional anorectal high-resolution manometry and endoanal ultrasound in our center from January 2015 to 2016. The detailed clinical history of each patient was obtained from the institutional database. The severity of FI was assessed with the Jorge and Wexner continence scale. Results: There were 250 women with a mean age of 60 ± 14 years. Seventy-six (30.4%) had an isolated defect of the internal anal sphincter, 21 (8.4%) had an isolated defect of the external anal sphincter, and 150 (60%) had both internal and external sphincter defects. The extent of IAS and EAS defects was proportionally correlated with the decrease in mean resting anal pressure (p < 0.01) and the decrease in mean squeeze pressure (p = 0.013) measured by 3DHRAM. No significant correlation was found between the extent and location of the defect (IAS, EAS or both) on endoanal ultrasound and the severity of FI. Menopause was the only independent factor significantly associated with the severity of FI. Conclusions: In our study, no significant correlation was observed between the extent of the anal sphincter defect and the severity of FI. Menopause was the only identified and independent risk factor for FI. These data confirm that, in the long-term, FI is often multifactorial. [ABSTRACT FROM AUTHOR]

Background: Tridimensional endoanal ultrasonography (3D-EAUS) has been used for the assessment of various anorectal lesions. Previous studies have reported good accuracy of 3D-EAUS in preoperative assessment of fistula-in-ano (FIA). This study aimed to assess the diagnostic utility of 3D-EAUS in preoperative evaluation of primary and recurrent FIA and its role in detection of associated anal sphincter (AS) defects.Patients and Methods: Prospectively collected data of patients with FIA who were investigated with 3D-EAUS were reviewed. The findings of EAUS were compared with the intraoperative findings, the reference standard, to find the degree of agreement regarding the position of the internal opening (IO) and primary tract (PT), and presence of secondary tracts using kappa (k) coefficient test. A subgroup analysis was performed to compare the accuracy and sensitivity of EAUS for primary and recurrent FIA.Results: Of the patients, 131 were included to the study. EAUS had an overall accuracy of 87, 88.5, and 89.5% in detection of IO, PT, and AS defects, respectively. There was very good concordance between the findings of EAUS and intraoperative findings for the investigated parameters (kappa = 0.748, 0.83, 0.935), respectively. Accuracy and sensitivity of EAUS in recurrent FIA were insignificantly lower than primary cases. EAUS detected occult AS defects in 5.3% of the patients studied.Conclusion: The diagnostic utility of 3D-EAUS was comparable in primary and recurrent FIA. 3D-EAUS was able to detect symptomatic and occult AS defects with higher accuracy than clinical examination. [ABSTRACT FROM AUTHOR]

Background: different studies have demonstrated the correlation between anorectal manometry and endoanal ultrasonography data in patients with fecal incontinence, but there is no almost interest describing the same in healthy subjects according to age. Aims: to study the possible correlation between anorectal manometry and endoanal ultrasonography data in a homogeneous group of healthy women, also according to age. Material and methods: prospective observational study of a healthy subjects cohort (n = 14). Homogeneous group of healthy volunteer women divided in 2 subgroups according to age. Results: there was no proved correlation between the internal anal sphincter's measurement and the resting pressure in the whole sample as well as the analysis according to age. Neither there was any proved statistically significant correlation between the external anal sphincter's thickness and the squeeze pressure, in the whole sample and by groups. Conclusions: it does not exist statistically significant correlation between the thickness of the sphincters and its function in a healthy subjects homogeneous group, neither in 2 groups according to age.Introducción: diferentes estudios han demostrado la correlación entre los datos de la manometría anorrectal y la ecografía endoanal en pacientes con incontinencia fecal, pero el interés ha sido escaso en describir lo mismo en sujetos sanos en relación a la edad. Objetivos: estudiar la posible correlación entre los datos de la manometría anorrectal y de la ecografía endoanal en un grupo homogéneo de mujeres sanas, también en función de la edad de las mismas. Material y métodos: estudio prospectivo observacional de una cohorte de sujetos sanos (n = 14). Grupo homogéneo de mujeres voluntarias sanas divididas en 2 subgrupos en función de la edad. Resultados: no se objetivó correlación entra la medida del esfínter anal interno y la presión basal de reposo, tanto en toda la muestra analizada como en el análisis detallado por grupos de edad. Tampoco se objetivó correlación estadísticamente significativa entre el grosor del esfínter anal externo y la presión de esfuerzo, en toda la muestra analizada y por grupos. Conclusiones: no existe correlación estadísticamente significativa entre el grosor de los esfínteres y su función en un grupo homogéneo de sujetos sanos, tampoco en función de 2 grupos de edad.

Objective: endoanal ultrasonography can detect organic causes of anal pain without pathology on physical examination. The aim of this study is to evaluate the importance of endoanal ultrasonography in the diagnosis and therapeutic management of idiopathic and functional anal pain. Material and methods: retrospective study, between 15 March 2005 and 15 June 2008, of all patients with proctalgia and normal examination or with alterations not responsible for anal pain at proctologic exam that have undergone an endoanal ultrasonography. Results: a total of 90 patients were analyzed, with a mean age of 50.5 years, 58% were female. Twenty-three patients had functional anal pain clinic criteria. Endoanal ultrasonography revealed alterations in 49% of patients. The primary findings were changes in sphincters in 14 patients, followed by anal sepsis in 12 patients, anal fissure in 10 patients, perirectal lesions in 6 patients and ulcer of the anal canal in 2 patients. Of the patients with sphincter defects, 5 patients had criteria of chronic anal pain. In this group of patients, no differences were found in manometric and defecographic results between the different ultrasound abnormalities. Conclusions: the endoanal ultrasonography detected occult organic lesions to proctologic examination, in half the patients with anal pain. Ultrasound abnormalities were found in 22% of patients with functional anal pain. However, there was no correlation between ultrasound findings and physiological studies, and therefore could not find etiological or pathogenic factors of functional anal pain.Objetivo: la ecografía endoanal puede detectar causas orgánicas en el dolor anal sin patología en la exploración física. El objetivo de este estudio es evaluar la importancia de la ecografía endoanal en el diagnóstico y en el abordaje terapéutico del dolor anal idiopática y funcional. Material y métodos: estudio retrospectivo realizado entre el 15 de marzo de 2005 y el 15 de junio de 2008, en todos los pacientes referenciados para hacerse la ecografía endoanal, debido a dolor anal con exploración física normal o sin alteraciones que justifiquen el dolor anal. Resultados: analizamos 90 pacientes con edad media de 50,5 años, 58% mujeres. Veintitrés pacientes presentaban criterios de dolor anal funcional. La ecografía endoanal reveló alteraciones en el 49% de los casos. Las alteraciones más frecuentes fueron las alteraciones esfinterianas, en 14 pacientes, seguido de sepsis anal, en 12 pacientes, de fisura anal, en 10 pacientes, de las lesiones perirrectales, en 6 pacientes y de úlcera del canal anal, en 2 pacientes. De los pacientes con alteraciones esfinterianas, 5 pacientes tenían criterios de dolor crónico. En este grupo de pacientes, no se encuentran diferencias en los hallazgos manométricos y defecográficos entre las diferentes alteraciones ecográficas. Conclusiones: la ecografía endoanal detectó lesiones estructurales no sospechadas en el examen físico en la mitad de los enfermos con dolor anal. Se han encontrado alteraciones ecográficas en el 22% de los pacientes con dolor anal funcional. Sin embargo, no se encontró correlación entre los hallazgos ecográficos y los estudios fisiológicos, así que no fue posible encontrar factores etiológicos o patogénicos del dolor anal funcional.

Purpose The aim of this study was to assess the postoperative anorectal anatomy and function in children with congenital anorectal malformations (ARM) using endoanal ultrasonography (EUS) and anorectal manometry. Methods This study included 47 children who had undergone posterior sagittal anorectoplasty (PSARP) or transperineal anorectoplasty for the repair of an ARM. Children were grouped according to symptoms of defecation disorder, including normal defecation, fecal soiling, fecal incontinence, and constipation. Ten children with no history of anal or rectal diseases served as healthy controls. A well-established scoring system was used for the evaluation of anal function and defecation disorder. Results EUS showed significant differences in the thickness of the interior sphincter between the ARM patients and the healthy controls ( P < 0.05). However, no significant difference was found in the thickness of the interior sphincters between the PSARP group and transperineal anorectoplasty group ( P > 0.05). Anorectal manometry showed that the balloon volumes were significantly different between the surgical group and the control group ( P < 0.01), and between the low defect group and the intermediate-high defect group ( P = 0.022). Balloon volume was significantly correlated with anal function scores ( r = − 0.30, P < 0.05). Conclusions EUS and anorectal manometry can provide objective assessment of postoperative anorectal anatomy and function in children with ARM. [ABSTRACT FROM AUTHOR]

Introduction: transanal endoscopic microsurgey (TEM) was developed in 1983 by Büess as a minimally invasive technique to manage rectal villous adenomas and early rectal adenocarcinomas. Many studies have been published worldwide about its excellent results in morbidity and recidive rate, but there are few studies addressing functional results. The objective of this study is to analyze the effect of this technique in the anal anatomy and compare with the manometric results. Material and methods: we devised a prospective study of 40 patients. 39% female, 61% male. All of them filled an incontinence questionnaire (Pescatori scale) and endoanal ultrasonography and manometry was carried out preoperatively, third month postoperative and at sixth month only if incontinence appeared. Results: 32 patients (80%) had villous adenomas and 8 patients (20%) had adenocarcinomas (uT1). Three patients complained of flatus incontinence at 3rd postoperative month that disappeared with normal continence at 6th month. Anorectal manometric values: mean anal resting pressure (ARP) decreased at 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was for maximal squeeze pressure (MSP) from 152.5 mmHg preoperatively to 142.2 mmHg at 3rd month. Ultrasonography demonstrated internal anal sphincter (IAS) rupture in 3 patients, with a full integrity of the external anal sphincter in all patients. Conclusions: during TEM, a significant anal dilatation occurs, because of rectoscopy (40 mm wide), what can produce a rupture of IAS, with the consequent decreasing in ARP, and a dilatation without rupture of external sphincter what produces a decreasing of MSP. The fall of anal pressures had minima clinical repercussion when sphincter is intact, but when IAS is broken a temporal incontinence develops.Introducción: la microcirugía transanal endoscópica (TEM) fue desarrollada en 1983 por Büess como técnica mínimamente invasiva para el tratamiento de adenomas y adenocarcinomas en estadio precoz de recto. Son múltiples los estudios realizados en todo el mundo sobre sus resultados de morbimortalidad y tasa de recidiva, pero sin embargo son muy pocos los estudios publicados sobre los resultados funcionales. El objetivo de este estudio fue analizar el efecto que esta cirugía provoca en la anatomía del canal anal y compararlo con los resultados funcionales. Material y métodos: realizamos un estudio descriptivo prospectivo de 40 pacientes: 39% mujeres, 61% hombres. En todos ellos se cumplimentó una encuesta de función esfinteriana (test de Pescatori) y ecografía endoanal y manometría preoperatoria, al 3er mes postoperatorio, y al 6º sólo si apareció incontinencia Resultados: Treinta y dos pacientes (80%) fueron operados de adenomas y 8 pacientes (20%) de adenocarcinomas uT1. Tres pacientes presentaron incontinencia a gases al 3er mes postoperatorio que se normalizó al 6º mes. Valores de la manometría anorrectal: la presión media en reposo (PMR) había disminuido a los 3 meses con respecto al valor preoperatorio de 87,2 a 70,1 mmHg, al igual que la presión máxima de contracción (PMC) de 152,5 mmHg de forma preoperatoria a 142,2 mmHg. Ecográficamente se pudo demostrar rotura del esfínter anal interno en 3 pacientes, estando en todos los pacientes íntegro el esfínter externo. Conclusiones: durante el tiempo quirúrgico de la TEM y debido al diámetro del rectoscopio (40 mm), existe una dilatación mantenida del canal anal. Esto unido al hecho de que es frecuente que haya que modificar la posición del mismo, se traduce, en algunos casos, en un riesgo de rotura del EAI, con la consiguiente caída en la PMR. En definitiva la caída que se objetiva en las presiones endoanales tiene una mínima repercusión en la clínica a menos que exista una lesión esfinteriana lo que conlleva incontinencia, en cualquier caso siempre temporal.

Objective: to evaluate the effectiveness of endoanal ultrasound with hydrogen peroxide enhancement in the assessment of anal fistula (tract and internal opening), and to value the utility of this examination for anal or perianal suppuration when performed by a colorectal surgeon trained in this technique. Patients: endoanal ultrasound was performed in 103 patients with anal or perianal suppuration. Twenty patients were excluded: 9 had the external opening closed, and 11 had cryptoglandular abscesses. All ultrasound scans were performed by the same explorer using a B&K Diagnostic Ultrasound System with a 7 MHz endoprobe. The examination was based on the identification of the three anal planes, then hydrogen peroxide was infused and the procedure was repeated. Results: out of 83 patients included, 11 had a perianal sinus and 72 an anal fistula. In all fistulas the main tract was found: 24 were inter-sphinteric (33.33%), 33 trans-sphincteric (45.83%), 3 supra-sphincteric (4.17%), and 12 extra-sphincteric (16.67%). An internal opening was identified in 69 (95.83%). Conclusions: endoanal ultrasound with hydrogen peroxide enhancement is an effective examination to visualize fistulous tracts and internal openings. We think it is highly useful for anal or perianal suppuration to identify abscesses, to recognize a perianal sinus, to check the sphincteric condition, and to plan subsequent surgery.Objetivo: evaluar la efectividad de la ecografía endoanal contrastada con inyección de agua oxigenada para establecer la topografía fistulosa (trayecto y localización del orificio interno) y valorar la conveniencia de esta exploración en la supuración anal o perianal cuando es realizada por un cirujano general dedicado a coloproctología y entrenado en esta técnica. Pacientes: se hizo ecografía endoanal a 103 pacientes con supuración anal o perianal. Se excluyeron 20 pacientes del estudio: 9 tenían el orificio externo de la fístula cerrado y 11 presentaban abscesos de origen criptoglandular. Todas las ecografías fueron hechas por el mismo explorador utilizando un ecógrafo B&K con sonda rotatoria de 7 MHz. La exploración consistía en identificar los tres planos ecográficos del canal anal, inyectar agua oxigenada por el orificio externo y repetir el procedimiento. Resultados: de los 83 pacientes incluidos, 11 resultaron ser sinus y 72 fístulas perianales. De estas se localizó el trayecto principal en todas, identificándose 24 interesfinterianas (33,33%), 33 transesfinterianas (45,83%), 3 supraesfinterianas (4,17%) y 12 extraesfinterianas (16,67%). Se localizó el orificio interno en 69 (95,83%). Conclusiones: la ecografía endoanal realzada con agua oxigenada es un método efectivo para visualizar el trayecto y el orificio interno de las fístulas perianales. Creemos que resulta de gran utilidad en todos los casos de supuración anal o perianal para localizar colecciones, reconocer sinus perianales, conocer el estado de los esfínteres y planificar la cirugía.

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Medical Ultrasound.)

Aim Anorectal manometry is the most common test used to explore anorectal disorders. The recent three-dimensional high-resolution anorectal manometry (3D-HRAM) technique appears to be able to provide new topographic information. Our objective was to develop an automated analysis of 3D-HRAM images to diagnose anal sphincter defects and compare the results with those of endoanal ultrasonography (EUS), which is considered to be the gold standard. Method All patients being tested in our department for faecal incontinence or dyschezia by 3D-HRAM and EUS were eligible for the study. 3D-HRAM was used to record resting and squeeze pressure, reflecting internal and external anal sphincter function, respectively. A software platform was designed to automatically analyse the 3D-HRAM images and calculate a diagnostic score for any anal sphincter defect compared with EUS. Results A total of 206 (91% female) patients of mean age of 54 years were included in the study. A sphincter defect was diagnosed by EUS in 130 (63%). The diagnostic scores from the 3D-HRAM automated analysis for an internal anal sphincter defect showed a sensitivity of 65% and a specificity of 65%. For an external anal sphincter defect, the sensitivity was 43% and the specificity 87%. Conclusion Our study developed a method based on 3D-HRAM to automatically diagnose sphincter defects, allowing a systematic and comprehensive analysis of the test recordings. Compared with EUS, the 3D-HRAM image analysis procedure revealed poor sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders. The aim was to develop a position paper on the diagnostic and therapeutic aspects of faecal incontinence, to provide practical recommendations for a cost-effective diagnostic work-up and a tailored treatment strategy. The recommendations were defined and graded on the basis of levels of evidence in accordance with the criteria of the Oxford Centre for Evidence-Based Medicine, and were based on currently published scientific evidence. Each statement was drafted through constant communication and evaluation conducted both online and during face-to-face working meetings. A brief recommendation at the end of each paragraph allows clinicians to find concise responses to each diagnostic and therapeutic issue. [ABSTRACT FROM AUTHOR]

Background: Although anal fistula are encountered commonly in surgical practice and have been studied extensively, some complex forms still continue to represent a difficult surgical challenge for many surgeons. The corner stone and the main aim of treatment for an anal fistula is to permanently eliminate abscess formation and achieve healing at the same time preserving anal function and continence. Therefore, precise preoperative assessment of perianal fistulae is crucial to achieving optimal surgical results. Patients and methods: In this prospective comparative study, 60 patients were enrolled during the period from December 2012 to June 2014. Endoanal ultrasonography (EAUS) (two-dimensional/threedimensional) with or without H2O2 enhancement was used for the preoperative assessment of perianal fistulae and abscesses, and the degree of accuracy and its agreement with the surgical findings were estimated. Primary fistulous tract and its relation to the sphincter complex, side tracts, internal opening, and any associated sepsis were determined by EAUS; the reviewers were blinded to the findings of the assessment. Results: In classification of the primary tract, there was agreement between EAUS and surgical findings in 47 of the 60 (78.3%) patients. In terms of the presence of an internal opening, the corresponding figures were 53 (88%) cases. In assessment of the secondary (side) tracts by EAUS, 55 (91.7%) patients were diagnosed accurately. In terms of the diagnosis of the presence or absence of abscess cavity or collection in the cases, EAUS diagnosed 53 (88.3%) patients accurately. Conclusion: EAUS with its recent innovations of three-dimensional technique and H2O2 enhancement is an excellent modality when planning for fistula surgery, especially with experienced and well-trained operators. [ABSTRACT FROM AUTHOR]

Background: Fecal incontinence is a frequent and debilitating condition that may result from a multitude of different causes. It is defined as the uncontrolled passage of faeces or gas over at least 1 month’s duration, in an individual of at least 4 years of age, who had previously achieved control. Aim of Work: to evaluate the outcome of overlap anal sphincter repair as regard the anal continence and postoperative complications. Patients and Methods: this is a prospective clinical trial was conducted on thirty (30) patients presented to Ain-Shams University hospitals with anal sphincter injury that were operated upon by a modified overlap repair done by the same surgical team. Endoanal ultrasonography was done and Wexner continence score was estimated for all cases preoperatively and postoperatively. All patients sharing in the study were fully informed about the procedure they had with a written informed consent. Results: In this study the mean preoperative Wexner score was 12.9 and the mean postoperative Wexner was 4.8; this reduction was found to be significant (p value=0.001). Also endoanal ultrasound showed that tear size significantly reduced among the studied cases(p value=0.001). Conclusion: from this study that overlapping sphincter repair is an effective method in the treatment of faecal incontinence in patients with repairable sphincter defects. However, long term follow up is required to confirm its efficacy. [ABSTRACT FROM AUTHOR]