AIM: To evaluate the safety and efficacy of stapled transanal rectal resection (STARR), and to analyze the outcome of the patients 12-mo after the operation. METHODS: From May 2007 to October 2008, 50 female patients with rectocele and/or rectal intussusception underwent STARR. The preoperative status, perioperative and postoperative complications at ...

Aim  Optimal treatment of anal incontinence in a patients with a normal anal sphincter is controversial, as is the role of intra-anal rectal intussusception in anal incontinence. We evaluated the results of abdominal ventral rectopexy on anal continence in such patients. Method  Forty consecutive patients with incontinence and intra-anal rectal ...

Aim  Hailey-Hailey disease (HHD) is a genodermatosis characterized by recurrent chronic weeping plaques at intertriginous sites. In severe cases, topical and systemic treatments are often insufficient. Extensive excisions are traumatic for patients and have a high morbidity. Superficial ablative procedures such as dermabrasion have become established, but are difficult to ...

PURPOSE: Compared with total fistulotomy using a lay-open technique for treatment of deep horseshoe or deep posterior complex anal fistula, the seton drainage method has reduced damage of the external anal sphincter. However, conventional seton drainage is burdensome to patients, requiring frequent clinic visits for wound management during prolonged periods ...

BACKGROUND: Transanal endoscopic microsurgery (TEM) has been suggested as a minimally invasive procedure of low morbidity for rectal villous adenomas and early anorectal adenocarcinomas. It has been used clinically in many areas outside of China for more than 20 years, but it began in mainland China only about 2 years ...

PURPOSE: Anal stenosis represents a technical challenge for surgical management. We compared the effects of house flap, rhomboid flap, and Y-V anoplasty procedures in a randomized study in patients with anal stenosis. METHODS: Consecutive patients treated for anal stenosis at our institution were evaluated for inclusion. Participants were randomly allocated ...

PURPOSE: Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided transanal ligation of hemorrhoidal arteries. We analyzed results of experience at a single-institution with this transanal hemorrhoidal dearterialization device. METHODS: Overall, 170 patients were submitted to transanal hemorrhoidal dearterialization during the period ...

The total mesorectal excision (TME) for rectal tumours was introduced in 1982 by Heald et al. and has led both to a 5% de crease of local recurrences 5 and 10 years after the operation when compared with cases treated with conventional surgery, and to an increase of survival up ...

OBJECTIVE: To evaluate short term clinical outcome after stapled haemorrhoidectomy. METHODS: From May 2005 to Oct 2007, 55 patients with symptomatic late 2nd and 3rd degree haemorrhoids were admitted to Surgical Ward 2, Jinnah Postgraduate Medical Centre. All of them underwent stapled haemorrhoidectomy after routine preoperative preparation. Postoperatively, pain scores, ...

PURPOSE: The purpose of this study was to analyse preliminary experience and outcomes with the Cook Surgisis AFP anal fistula plug (Cook Medical, Bloomington, IN, USA) with respect to the treatment of complex anal fistulae in a specialist colorectal unit. METHODS: Data on all patients who were treated with the ...

A meta-analysis of published literature comparing J-pouch with side to end anastomosis after anterior resection (AR) for rectal cancer. Electronic databases were searched from January 1980 to March 2009. A systematic review was performed to obtain a summative outcome. Four randomized controlled trials involving 273 patients were analysed. One hundred ...

The aim of this study was to compare the complication rates of the single flap and double flaps versus flapless procedure in the tubularized incised plate urethroplasty. One hundred and seventy-two patients with any type of hypospadias underwent surgical repair by tubularized incised plate (TIP) urethroplasty between April 2002 and ...

BACKGROUND: The aim of this randomized controlled trial was to assess the possible benefit of using a new haemostatic agent (H?moionic) in the pelvic cavity in sphincter-saving surgery for rectal cancer. METHODS: Eighty-five patients undergoing elective sphincter-saving rectal resection for cancer were randomized into H?moionic (41 patients) and control (44) ...

Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for ...

OBJECTIVE: The present study was designed to evaluate functional outcome of perineal repair with and without levatorplasty versus transanal repair of rectocele in obstructed defecation. METHODS AND PATIENTS: A total of 48 multiparous women with obstructed defecation caused by a rectocele were randomly allocated to three groups: transperineal repair with ...

OBJECTIVES: The aim of this study was to evaluate prospectively the functional outcome of posterior sagittal rectopexy with prolene mesh for rectal prolapse in young adults. PATIENTS AND METHODS: The study was carried out on 32 patients, 21 were males (65.63%) presented with complete rectal prolapse with a mean age ...

BACKGROUND: The current literature does not provide unequivocal data on prognostic factors in conservative management of fecal incontinence. Moreover, the physiopathologic effects of pelvic floor rehabilitation on anorectal function are not well understood. Our aim is to identify some prognostic parameters and assess their effects on anorectal physiology of biofeedback ...

PURPOSE: A substantial body of recent evidence suggests that autologous adipose tissue transplant promotes healing in different lesions associated with local ischemia. We report the outcome of lipoaspirate transplant in hard-to-treat chronic anal fissures. METHODS: Eight patients were included in this pilot study, 5 with single and 3 with multiple ...

OBJECTIVE: To assess the effectiveness of an instructional DVD on the anatomy and repair of anal sphincter lacerations to improve postgraduate trainees' understanding. METHODS: A total of 71 obstetrics and gynecology trainees completed a pretest of third- and fourth-degree lacerations to assess baseline knowledge and perceptions. Question categories included anatomy, ...

INTRODUCTION: The aim of this prospective study was to assess the efficacy of different medical treatments and surgery in the treatment of chronic anal fissure (CAF). PATIENTS AND METHODS: From January 2004 to March 2009, 311 patients with typical CAF completed the study. All patients were initially treated with 0.2% ...

BACKGROUND: Rectal biopsy is considered the gold standard for the diagnosis of Hirschsprung's disease. The aim of this study was to evaluate the outcome of rectal biopsies performed in our institution, and to determine whether we are performing an adequate number of biopsies in patients presenting with features suggestive of ...

BACKGROUND/AIMS: There are few reports on defecography in male patients with defecation disorders (DD) such as morphological and functional abnormalities (MFA) in the anorectal region. To clarify the significance of defecography in male patients with DD, defecography was performed in the diagnosis and evaluation of DD. METHODOLOGY: The subjects of ...

Aim  This study quantified prospectively the amount of rectal wall removed during stapled haemorrhoidopexy and assessed its effect on ano-rectal function and health-related quality of life. Method  Thirty-three consecutive patients who underwent stapled haemorrhoidopexy for second- or third- degree haemorrhoids, or for failed medical treatment, in the Department of Surgery ...

INTRODUCTION: It was suggested that anal advancement flap be used to treat patients with chronic anal fissures that have failed medical management and have a low-pressure sphincter complex. We wished to assess anal advancement flap as a treatment for all chronic anal fissures. METHODS: All patients with chronic anal fissures ...

BACKGROUND & AIMS: Fibrin glue is a therapeutic for fistulas that activates thrombin to form a fibrin clot, which mechanically seals the fistula tract. We assessed the efficacy and safety of a heterologous fibrin glue that was injected into the fistula tracts of patients with Crohn's disease (ClinicalTrials.gov No. NCT00723047). ...

PURPOSE: This study evaluates the erectile function of male patients treated by preoperative radiotherapy followed by surgery and surgery alone for locally advanced rectal cancer. METHODS: A total of 112 men treated by total mesorectal excision with autonomic nerve preservation were included. Seventy-three patients were treated by preoperative radiotherapy followed ...

BACKGROUND: Up to 25% of inflammatory bowel disease (IBD) patients undergoing surgery with an ileal pouch-anal anastomosis (IPAA) will develop chronic pouchitis not responding to antibiotics. In case reports, thiopurine analogs and infliximab (IFX) have been proposed as effective therapy in this setting. We analyzed the long-term efficacy of IFX ...

The aim of this study was to assess the efficacy of fissurectomy with skin advancement flap in healing chronic anal fissures without hypertonia of the internal anal sphincter. Twenty-six consecutive patients who failed healing after well-practiced topical medical therapy were enrolled. Anorectal manometry was performed preoperative and 6 months postoperatively. ...

OBJECTIVES: To present our operative and postoperative functional outcomes of sutured compared with endovascular staple ligation of the dorsal venous complex (DVC) during robot-assisted laparoscopic radical prostatectomy (RALP). Ligation of the DVC during RALP with an endovascular stapler has purported advantages of decreased apical positive surgical margin (PSM) rate, blood ...

The objective of this prospective, randomized, controlled trial, conducted from May 2002 to December 2007, was to compare post-operative anastomotic leakage and stricture formation following layered manual versus stapler oesophagogastric anastomosis in patients who underwent resection of oesophageal or gastric cardia carcinoma. Patients (n = 516) were randomized to receive ...

PURPOSE:: This study was designed to determine the short-term results of transanal rectocele repair with use of a linear stapler and Bioabsorbable Seamguard. METHODS:: Ten women (median age, 56.1 y) with obstructed defecation syndrome were enrolled in the study. The preoperative study consisted of a medical history, physical examination, anoscopy, ...

AIM: To compare the results of subcutaneous internal lateral sphincterotomy under local anesthesia and nitroglycerin ointment treatments in acute and chronic anal fissures. METHODS: This was a comparative, prospective study of 340 patients of acute and chronic anal fissure. The patients voluntarily opted either for the surgical procedure under local ...

AIMS AND BACKGROUND: After sphincter-preserving surgery for rectal cancer and postoperative radiochemotherapy, many patients have unsatisfactory anorectal functional results which are not considered by the most common toxicity scales. The aim of the present study was to retrospectively assess the long-term incidence of impaired anorectal function in rectal cancer patients ...

OBJECTIVE: To treat anal incontinence due to obstetric external anal sphincter disruption via injection of autologous myoblast cells. DESIGN: Observational pilot study. SETTING: University hospital and district hospital PATIENTS: 10 women suffering from anal incontinence due to obstetric anal sphincter injury, refractory to conventional non-surgical therapy. INTERVENTIONS: Autologous myoblasts were ...

Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by the acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the RBCs. We present the case of a 59-year-old female who presented with a ...

OBJECTIVE: The aims of the present study were to evaluate the incidence offistula-in-ano following incision and drainage of acute perianal abscess and to determine factors influencing the fistula formation. MATERIAL AND METHOD: Patients with a first-time perianal abscess or intersphincteric abscess who underwent incision and drainage at Siriraj Hospital from ...

BACKGROUND/AIMS: Coloplasty has been reported as substitution to colonic J-pouch when it is difficult to fashion. However, previous studies showed conflicting results with reference to functional outcome. METHODOLOGY: Forty-seven patients with low rectal cancer were involved in this study from July 2000 to December 2006. Coloplasty was performed when colonic ...

Background: Previous studies have suggested that a lower lymphocyte ratio (Ly%) in the white blood cell (WBC) differential count is related to worse outcomes in patients with acute heart failure (AHF) and other cardiovascular disorders. Methods: In the Pre-RELAX-AHF study, 234 patients with AHF, systolic blood pressure >125 mm Hg ...

BACKGROUND/AIMS: Late efficacy of medical treatment of chronic anal fissure remains controversial due to high recurrence. This study aimed at analyzing safety and efficacy of topical diltiazem and bethanechol regarding healing and symptoms relief, safety, recurrence, and need for surgery. METHODOLOGY: This was a single-center nonrandomized trial. Outcomes of 30 ...

This study was carried out to test two different anastomotic techniques to identify advantages and disadvantages of each technique in goats. All animals were under local infiltration anaesthesia. A five-cm length of jejunum was resected from the first part of the jejunum and end to end anastomosis using 3-0 Polygalactin-910 ...

Manual dilatation of the anal sphincter and transanal introduction of the circular stapling device are required for intraluminal stapling anastomosis. This procedure has been regarded as one of the causes of postoperative evacuatory disorder in low anterior resection. However, there has been no evidence of this matter. Therefore, we conducted ...

INTRODUCTION: Surgical excision using Harmonic Scalpel is a modern technique used for ablation of symptomatic third degree and all fourth-degree hemorrhoids. Compared with electrocautery, Harmonic Scalpel causes minimal lateral thermal injury during tissue dissection. The resulting mucosal defect is then either left open or sutured (closed) depending on surgeon preference. ...

BACKGROUND: This study reviewed the impact of pre-operative chemoradiotherapy or post-operative chemotherapy and/or radiotherapy on total mesorectal excision (TME) for ultralow rectal cancers that required either low anterior resection with peranal coloanal anastomosis or abdomino-perineal resection (APR). We examined surgical complications, local recurrence and survival. METHODS: Of the 1270 patients ...

BACKGROUND: High transphincteric perianal fistula represents a technical challenge for surgical management. We compared the effects of partial rectal wall advancement flap versus the mucosal advancement flap in the treatment of high transphincteric perianal fistula in a randomized study in patients with anal fistula. PATIENTS AND METHOD: Consecutive patients treated ...

BACKGROUND: Crohn's disease is generally considered a relative contraindication for restorative proctocolectomy with ileal pouch anastomosis (IPAA). The natural history of IPAA in these patients has not well been defined. AIM: To evaluate the natural history of IPAA in patients with a well-defined preoperative Crohn's disease. METHODS: All patients from ...

BACKGROUND: Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard; W.L. Gore & Associates, Inc, ...

Failure rates of laparoscopic antireflux surgery (LARS) vary from 2-30%. A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this ...

OBJECTIVE: In a seven-year prospective cohort study, the authors assessed the longevity of defective resin-based composite (RBC) restorations that were not treated or were treated by means of repair, sealing, refinishing or total replacement. They also aimed to identify and quantify the main reasons clinicians diagnosed restorations as defective. METHODS: ...

PURPOSE: Haemorrhoidal disease is a frequently occurring entity in the western world. The Procedure for prolapse and haemorrhoids (PPH) and transanal haemorrhoidal dearterialisation (THD) are the most important surgical treatments that respect normal anal anatomy. This is the first randomized trial that compares both techniques in the treatment of grade ...

To compare the perioperative complications, analgesics requirement, and length of hospital stay between patients undergoing urgent closed hemorrhoidectomy for prolapsed thrombosed hemorrhoid and elective closed hemorrhoidectomy. Retrospective, comparative study. All records of the patients who underwent urgent and elective hemorrhoidectomy between January 2000 and December 2005 were reviewed. Perioperative complications ...