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Anorectal fistula surgery is associated with risks of recurrence and/or faecal incontinence due to anal sphincter injuries. In order to minimise these complications, preoperative evaluation of the anatomy of the fistula tract and morphology of the anal sphincters is mandatory. Anal endosonography (AES) and Magnetic Resonance Imaging (MRI), due to high resolution of images and ability to identify a number of fistula elements which are important for surgeons in treatment planning, are the methods of choice in the diagnosis of anorectal fistulas.In this paper, a new template for endosonographic and MRI report, systematically describing all anorectal fistula's characteristics, is presented. This template provides practical information for the surgeon, useful in preoperative assessment and postoperative follow-up. [ABSTRACT FROM AUTHOR]

Malformations of the rectum and urinary tract frequently coexist, and the prevalence of urogenital defects in patients with a rectal defect ranges from 20 to 54%. In most patients, anorectal malformations are diagnosed and treated surgically in early childhood. In this report, we present a case of a 52-year-old male with a history of urological operations in infancy due to a congenital urethral malformation and multiple recurrent episodes of perineal abscesses with urinary retention. Anorectal endosonography and magnetic resonance imaging revealed the presence of a large cystic lesion adjacent to the rectal wall which became smaller at the level of the puborectalis. The walls of the lesion had a layered structure identical to the wall of the rectum. In addition, the examinations showed hypotrophy of the left lobe of the prostate and lack of left semnal vesicles. Thus, the lesion was diagnosed as duplication of the rectum or rectal diverticulum. Surgery was performed by an interdisciplinary team of colorectal surgeons and urologist. The lesion was removed laparoscopically. The pathological report revealed that the cystic wall was typical of the intestinal wall, consistent with a diagnosis of rectal duplication. [ABSTRACT FROM AUTHOR]

Introduction: The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment. We aim to determine the utility of transperineal ultrasound (TPUS) and anal ultrasound (AUS) in the diagnosis of HS and its differentiation from an anal fistula. Material/Methods: Retrospective analysis was performed on 51 patients (5 females, 46 males) aged 20-71 years (mean age 47.5), who were operated on in the years 2006-2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence. Results: In 66 out of 67 cases (98.5%), the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9%) AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9%) a skin malignancy coexisting with HS was found. Discussion: TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess. [ABSTRACT FROM AUTHOR]

In recent years there has been a significant progress in the diagnostics and therapy of diseases of anus and anal canal. The progress in diagnostics includes both advancement in imaging diagnostics, such as 2D and 3D ultrasonography or MRI, and improvement in functional examinations, such as non-invasive EMG. In the surgical treatment of proctological diseases, as in other fields of surgery, development of minimally invasive techniques is observed. On the other hand, however, many surgeons are going back to old treatment methods, changing only some technical details. It is not always possible to evaluate the efficacy of such methods explicitly, mainly because of a short period of observation and the fact that the groups of patients are not always homogeneous. This article discusses advancements in the treatment of such inflammatory diseases as anal fissure, haemorrhoids, abscesses, fistulas, condylomas and ano-rectal Crohn's disease. Major changes have been observed in the surgical treatment of anal fistules. Due to the large percentage of complications related to the surgical treatment of anal fistules, for a few years there have been attempts to use conservative methods of treatment of this disease. Such methods include tissue glue and so called "plugs", which are used to close the internal ostium of the fistula. Progress in the treatment of ano-rectal Crohn's disease mainly includes introduction of anti-inflammatory medicines of a newer generation, and the most recent novelty is biological treatment. In addition, current guidelines in the diagnostics and treatment of incontinence have been discussed, as well as contemporary trends in the management of patients with anal cancers. The article provides a review of the current literature on the treatment of proctological inflammatory diseases and anal cancers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate a frequency of obstetric anal sphincters defects in women after vaginal delivery. Methods: The study included 102 women, aged from 16 to 40 years (mean age 28.6 years). 28 women had perineal lacerations of 3rd and 4th degree. 22 women had instrumental delivery. Anal endosonography was performed on all participants using BK Medical scanner Pro focus with a 3D endoprobe during the first week after delivery. Starck''s classification was used to score sphincters defects. Results: The endosonographic images were abnormal in 8 out of 102 women (7.8%). Follow-up examinations after 6 weeks confirmed defects in 6 out of 102 women (5.8%). Five women had external anal sphincter torn, and 1 woman had both sphincters, internal and external, defected. Discordance between endosonographic diagnosis of defect and clinical assessment of sphincters continuity was demonstrated in 6 (5.9%) out of 8 initially found, including 2 (1.9%) false endosonographic results and 4 (3.9%) false clinical diagnosis (occult sphincter defects). The endosonography sensitivity and accuracy in sphincter defect diagnostic amounted to 100% and 98%, respectively. Conclusions: (1) Anal sphincters’ tears in symptomatic women are not as frequent as it was believed. (2) The defect diagnosis in the first week after delivery should be verified by a follow-up endosonography in 6 weeks, after regression of the edema and hematoma. [Copyright &y& Elsevier]

Full-thickness rectal prolapse (FTRP) is a multifactorial disease; the dominant cause is different in each case. The authors developed an original algorithm for qualifying patients for perineal or abdominal approach based on identification of dominant factor. The validity of the algorithm was assessed by treatment results. The study aimed to assess the results and patients' quality of life after FTRP surgery qualified for various procedures, based on a uniform algorithm. Consecutive 61 patients qualified for surgery due to FTRP from January 2012 and March 2019 were enrolled. The authors qualified for abdominal or perineal approach following a uniform algorithm. The following parameters were assessed before operation and each year after the surgery: constipation, incontinence, EuroQol 5 dimensions (EQ5D), and quality of life scale (QoL). Median follow-up period was 26 months. Investigators compared preoperative assessment and the last obtained follow-up assessment. Recurrence was observed in 5 patients (8.2%); constipation decreased from 41 patients (67.2%) before the surgery to 16 (26.2%) postoperatively. Incontinence score decreased by 51% in postoperative assessment. The Wexner score decreased from 11.7 points before to 6.3 after surgery (p < 0.001). No complications were observed. The QoL improved from 49.8 to 69.8 points after surgery (p < 0.001), and the EQ5D improved from 7.3 to 4 points (p < 0.001). The quality of patients' life, after full-thickness rectal prolapse procedures qualified for surgery according to the proposed algorithm, improved in terms of all measured parameters. The small group requires further studies to confirm the utility of the algorithm. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of the pilonidal sinus, due to various surgical methods, remains the current topic of discussion during surgeon meetings worldwide. The newest methods of treatment consist in the excision and simultaneous closure of the wound with cleft lift procedures. One of such methods is Bascom II procedure which has been widely used in the world but is less popular in Poland. Aim of the study: To evaluate the results of treatment of pilonidal cysts using Bascom II procedure performed by one operator. Material and method: 50 patients (40 men, 10 women), Avg. 30.6 years of age. All patients treated with Bascom II procedure in one surgical ward by one operator (resident during specialisation training) with the use of uniform surgical care for all operational protocols. The following were assessed: BMI, average hospitalisation time, pain, post-operative complications, wound healing time, patient's quality of life, and the recurrences rate after surgery. The follow-up period ranged from 12 to 52 months. Results: Average BMI 27.13 kg/m2. Avg. time of hospitalisation 2.95 days. Post-operative pain in the first 24 hours was on average 4.55 points. (+/- 2.24 points); on the 10th day on average 2.04 points (+/- 1.58 points); in the 30th day on average 0.76 points (+/- 1.1 points). Pain after healing 0.14 points (+/- 0.40 points). Post-operative complications occurred in 28.57% of patients [partial wound dehiscence (16.32%), serum leak (10.2%), hematoma (6.12%), total wound dehiscence (0%), wound infection (0%)]. The average time of full healing was 2.94 weeks. Recurrence occurred in one patient (2.04%). Conclusions: Bascom II procedure is characterised by a low recurrence rate and short wound healing time. It is a a safe, effective and patient-accepted method of treatment. Statistically, it significantly improves the patient's quality of life one year after surgery in terms of both physical and mental health. [ABSTRACT FROM AUTHOR]

A rare case of a giant vulvar lipoma that developed in an adolescent is presented. A review of the world literature of 15 cases that occurred prior to adulthood confirmed that they tend to occur on the right side of the vulva. [ABSTRACT FROM AUTHOR]

The article discusses musculoskeletal extraintestinal manifestations during the course of non-specific bowel diseases. Suggestions concerning the diagnostics and treatment of non-specific inflammatory bowel diseases (IBD) did not include information on the probability of arthritis during the course of these diseases until 2005.

Introduction: Occurrence of giant inguinal hernias is not frequent because of growing medical awareness in the community as well as progress in surgical treatment in this field. Aim: To evaluate the effectiveness of repairs using the Lichtenstein technique in scheduled treatment of giant inguinal hernias Material and methods: Between 2006 and 2010 in the Department of Surgery with the Subdepartment of Proctology, Hospital at Solec in Warsaw, 909 repairs of inguinal hernia were performed, including 15 patients (1.65%) with the diagnosis of giant hernia. In 3 cases it was direct inguinal hernia and in 12 cases indirect inguinal hernia. All giant hernias occurred in male patients between 33 and 87 years of age (mean age 65 years old) and developed for many years, median of 14.2 years. All patients underwent scheduled repairs using the tension-free Lichtenstein technique. A non-absorbable polypropylene mesh was used for hernioplasty. Exact Fisher's test (p < 0.01) was used for statistical analysis. Results: In all cases contents of the hernial sac consisted of loops of small intestine, colon and omentum. Early complications occurred in 11 patients (73%) in the group of patients with giant hernias, whereas in the remaining group of patients early complications occurred in 53 patients (5.9%). The difference was statistically significant. In the group of patients with giant hernias no recurrence was observed over the observation period ranging from 6 months to 4.5 years. In the remaining group of patients recurrences occurred in 23 patients (2.6%). Conclusions: The Lichtenstein technique of repair is effective in management of giant inguinal hernias. A statistically significantly higher percentage of complications was observed in the group of patients with giant hernias as compared to the remaining group of patients with inguinal hernias. Patients with giant hernias require proper preparation for surgery, especially in relation to their respiratory efficiency. [ABSTRACT FROM AUTHOR]

The article presents a study on chronic venous disorders (CVD) among people working in static standing and prolonged sitting postures. The researchers observed 126 workers for the study, the inclusion criteria of which are age and posture at work. They assessed venous morphology in the lying position together with the presence of possible post-thrombotic changes and venous patency. They used venous segmental disease score (VSDS) to assess the anatomic distribution of CVD.

Background: This paper reports a case of an 87-year-old female patient who was admitted for an emergency operation due to massive hemorrhage of an ulceration localized on a huge neck tumor. Post-interventional diagnosis indicated hidradenocarcinoma. Hidradenocarcinoma is a rare skin neoplasm. It can coincide with adenoma, may develop through its malignant transformation or develop as a malignant tumor from the beginning. It may be found in all dermal localizations. It may develop metastases or appear in the diffuse form. Material and methods: Surgical excision of the tumor was performed obtaining a surgical margin, completed with excision of local lymph nodes and multiple layer suturing. Due to lack of the patient's consent, she has not been qualified for adjuvant therapy. Results : Control examination 6 and 12 months later showed no signs of local recurrence or lymph node metastasis. Conclusion: Surgical excision of apocrine hidradenocarcinoma with a surgical margin could present a good therapeutic effect in spite of lack of adjuvant therapy. [ABSTRACT FROM AUTHOR]