OBJECTIVE: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is well-established in the management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We review outcome of pouch surgery from a single centre, comparing non-South Asian and South Asian Caucasian populations. METHOD: Patients undergoing RPC for UC and FAP during ...

OBJECTIVE: The stapled transanal rectal resection (STARR) in patients with defecation disorders is limited by the shape and capacity of the circular stapler. A new device has been recently developed, the Contour Transtar stapler, in order to improve the safety and effectiveness of the STARR technique. The study has been ...

Background  Pre-pouch ileitis is a recently described condition which may occur following restorative proctocolectomy. Its aetiology remains unknown and only one study has reported the effect of treatment. We report a series of fourteen patients treated and followed up with repeat pouchoscopy. Aim  To study the effectiveness of antibiotics for ...

Report of a series of 12 cases of juvenile polyposis coli. The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken ...

BACKGROUND: Rectocele can be part of a more complex rectal prolapse syndrome including rectal intussusception and enterocele. This reflects insufficiency at different levels of support in the posterior pelvic compartment. A new technique involving reinforcement of the rectovaginal septum with mesh by a combined laparoscopic and perineal approach was evaluated. ...

BACKGROUND: Patients with primary rectal cancer undergoing low anterior resection are often reconstructed using a pouch procedure. The aim of this trial was to compare colon J pouch (CJP) with transverse coloplasty pouch (TCP) reconstruction with regard to functional results, perioperative mortality and morbidity. As there is considerable uncertainty over ...

The purpose of this study was to determine the long-term outcome of endorectal advancement flap (ERF) for complex anorectal fistulae. A total of 38 ERF were performed in 36 patients (2003-2007). Mean age was 45 years. The most common fistula type was transsphincteric. Eighty-one per cent of patients had prior ...

BACKGROUND: Chronic inflammation (CI) is commonly found in the anal transition zone (ATZ) after stapled ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Yet, its impact on defecatory function and the need for a complete mucosectomy has not been completely elucidated. This study aims to evaluate the long-term functional outcomes ...

BACKGROUND/PURPOSE: In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. METHODS: Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, ...

BACKGROUND: Three-dimensional anorectal ultrasound (3-DAUS) scanning provides accurate information on tumor size and its relation to the anal muscles. The purpose of this study was to evaluate the ability of 3-DAUS to assess response to radiochemotherapy (RCT) for rectal cancer by comparing 3-DAUS images to pathological findings. METHODS: Twenty-five patients ...

BACKGROUND DATA: Extracorporeal circular-stapled Billroth I (B-I) anastomosis is difficult in patients with obesity, a large body shape, or small remnant stomach, as it requires the duodenal stump to be lifted outside of the wound. The aim of this study was to evaluate the feasibility of circular-stapled B-I reconstruction for ...

BACKGROUND: Anastomotic leakage is the major complication after colorectal surgery. To date, animal experiments concerning colorectal anastomosis focus on anastomotic healing instead of anastomotic leakage. This study aims to develop a new experimental model for colorectal anastomotic leakage. METHODS: A control group, receiving an anastomosis with 12 interrupted sutures, was ...

INTRODUCTION: Stapled hemorrhoidectomy (SH) has routinely been performed using Procedure for Prolapse and Hemorrhoids Proximate Hemorrhoidal Circular Staplers (Ethicon Endo-surgery, Cincinnati, OH). Premium Plus CEEA 34 (Tyco Healthcare, New Haven, CT) has been recently introduced for SH. This study aims to review the effectiveness of CEEA 34 for SH. METHODS: ...

INTRODUCTION: Stapled haemorrhoidopexy (SH) is an attractive alternative to conventional haemorrhoidectomy (CH) because of reduced pain and earlier return to normal activities. However, complication rates are as high as 31%. Although some complications are similar to CH, most are specifically technique-related. In this prospective audit, we report our experience with ...

BACKGROUND: A new technique for performing laparoscopic anterior resection is described. Main differences from the standard technique are (1) pneumoperitoneum to improve exposure of the rectum, even in a narrow pelvis; (2) rectal division performed using a conventional linear stapler inserted via a 4.5 cm suprapubic incision; and (3) eversion ...

BACKGROUND: Loop ileostomies are often formed in order to defunction distal anastomoses. The aim of this study was to review the complications following closure of loop ileostomies. METHODS: This is a retrospective case note analysis of all loop ileostomy closures performed in the Northumbria Healthcare NHS Trust (population over 500,000) ...

Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the treatment of choice. There is scarce information regarding the prophylactic effects of oral metronidazole on postoperative complications of anal fissure. The objective of this study was to determine the effects of metronidazole ...

PURPOSE: Creation of subdartos pouch is an integral part of orchidopexy. The objective of this study was to describe and evaluate the results that can be achieved by using a new simplified technique (creation of subdartos pouch by balloon inflation of small sized Foley's or Fogarty catheter during orchiopexy). MATERIALS ...

Introduction Repair of high perianal fistulas presents a major surgical challenge. Transanal advancement flap repair (TAFR) provides a useful tool in the treatment of these fistulas. Initially promising results have been reported. More recent studies indicate that TAFR fails in one out of three patients. The aim of the present ...

BACKGROUND: Transanal advancement flap repair (TAFR) is useful in the treatment of high transsphincteric fistulas. Initially, promising results were reported. More recent studies have indicated that TAFR fails in one out of three patients. In almost all of our patients with a failure, we have observed healing of the flap ...

AIMS: To prospectively determine if rectal endoscopic ultrasound (EUS) can guide combination medical and surgical therapy and improve outcomes for patients with perianal fistulizing Crohn's disease. METHODS: Ten patients with perianal Crohn's disease were prospectively enrolled in a randomized prospective pilot study. The patients were randomized to either the EUS ...

OBJECTIVE: To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 years of a single surgeon's practice to determine the presence or absence of a learning curve after fellowship training. METHODS: From July 2002 to July 2005, an observational study of postoperative outcomes ...

BACKGROUND: 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 ...

Recurrent rectal prolapse, resistant to medical treatment, is an indication for surgical treatment. Patients with spinal dysraphia frequently have already been treated by sclerotherapy or other surgical techniques, but unsuccessfully. METHODS: We present 2 patients, who underwent laparoscopic rectopexy, with spinal dysraphia and complete rectal prolapse relapse after conservative treatment. ...

OBJECTIVE: To evaluate the relationship between extent of internal sphincter division following open and closed sphincterotomy, as assessed by anal endosonography, with fissure persistence/recurrence and faecal incontinence. METHOD: A total of 140 consecutive patients undergoing lateral internal sphincterotomy (LIS) for idiopathic chronic anal fissure were prospectively studied. Preoperative clinical assessment ...

INTRODUCTION: Doppler-guided hemorrhoidal artery ligation (DGHAL), as a method of treating hemorrhoidal disease, is currently used in many centers across Europe, Asia, and Australia. The aim of our study was to evaluate the clinical effectiveness and functional results of DGHAL as estimated by means of anorectal manometry. MATERIALS AND METHODS: ...

BACKGROUND: Considerable controversy exists regarding the optimum technique for gastroesophageal anastomosis. Double layer technique has long been considered important for safe healing but there is evidence that single layer technique is also safe and can be performed in much shorter time. The purpose of this study was to compare the ...

Outlet dysfunction is responsible for 25% of all cases of chronic constipation. The aim of this article was to report our outcomes and investigate the efficacy of the different treatments that we have adopted to solve it. One hundred and twenty-six patients were treated with either surgery and/or biofeedback therapy. ...

Familial adenomatous polyposis is a hereditary disease characterized by the presence of thousands of colonic adenomas, which, if untreated, invariably undergo malignant transformation. Because this disease manifests at a young age, the laparoscopic approach to perform surgery would be desirable due to its cosmetic benefits. We describe our experience with ...

Treatment for human papillomavirus (HPV)-associated anal canal disease has been unsatisfactory. The objective of our study was to determine the treatment outcome in our cohort with anal HPV disease. Overall, 181 patients were evaluated over a median period of 19.1 months (range = 2.8-125.5). Eighty-eight patients (48.6%) with high-grade anal ...

BACKGROUND: The aim was to evaluate outcomes in patients with ulcerative colitis complicated by primary sclerosing cholangitis (PSC) who required ileal pouch-anal anastomosis (IPAA) and orthotopic liver transplantation (OLT). METHODS: A retrospective analysis was performed of 32 patients undergoing both IPAA and OLT between 1980 and 2006. Data were collected ...

BACKGROUND: The aim of this study was to review our experience with gracilis muscle interposition for complex perineal fistulas. MATERIAL AND METHODS: A retrospective review of all patients who underwent repair of perineal fistula using the gracilis muscle between 1995 and 2007 was undertaken. Patients were divided into 2 groups ...

OBJECTIVES: Anal fistulas are common in individuals with Crohn's disease (CD). We sought to evaluate the efficacy of oral spherical adsorptive carbon (AST-120) (Kremezin; Kureha Corporation, Tokyo, Japan) for the treatment of intractable anal fistulas in patients with CD. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, patients with CD ...

OBJECTIVE: Conventional Milligan-Morgan haemorrhoidectomy is associated with significant pain and potentially hazardous complications. Doppler-Guided Haemorrhoidal Artery Ligation (DGHAL) may offer a lower risk, pain-free alternative. We present our early and long-term outcome experience with DGHAL, combined with patient views and satisfaction with the procedure. METHOD: One hundred and thirteen DGHALs ...

PURPOSE: We sought to describe the types of colectomy, follow-up surgical/diagnostic procedures, and complications occurring within 180 days of colectomy in a population of privately insured individuals with ulcerative colitis (UC). METHODS: This was a retrospective analysis of claims data of privately insured patients (MarketScan) for the years 2001-2004. We ...

PURPOSE: After restorative proctocolectomy, 7 to 8 percent of patients may have a pouch leak. Concern exists that pouch leak may be associated with impaired functional outcome. We evaluated patients who underwent restorative proctocolectomy to determine whether pouch leak adversely affected long-term functional outcome and quality of life. METHODS: We ...

PURPOSE: To compare the effects of (three-dimensional) 3D vs. two-dimensional (2D) radiation therapy (RT) for carcinoma of the prostate on the prevalence and pathophysiology of anorectal dysfunction. METHODS AND MATERIALS: Anorectal symptoms, motility, sensory function, and anal sphincter morphology were evaluated before and up to 2 years after randomly assigned ...

BACKGROUND: Placement of expandable metallic stents (EMS) has been considered contraindicated for patients with malignant rectal obstruction within 5 cm of the anal verge because of the potential problems of anal pain. OBJECTIVE: Our purpose was to investigate the technical feasibility, clinical effectiveness, and safety of EMS placement in patients ...

This study was designed to review the results of circular stapled hemorrhoidopexy (CSH) in the management of second-, third-, and fourth-degree hemorrhoidal disease. The medical records of 483 patients who had undergone circular stapled hemorrhoidopexy for symptomatic hemorrhoidal disease from June 2001 to September 2006 were evaluated. Data regarding complications, ...

INTRODUCTION: 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 ...

PURPOSE: Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing on both past history, anal physiology, and imaging. METHODS: Eighty-eight consecutive patients who suffered from ...

PURPOSE: Anal fistulas that involve a significant amount of sphincter may be difficult to treat without compromising continence function. In this study, we evaluated our experience with the Surgisis anal fistula plug, which was recently reported to be successful in >80 percent of patients with complex fistulas. METHODS: We retrospectively ...

PURPOSE: A standardised protocol for performing a cutting seton has not been well described in the existing literature. The aim of this study was to examine our experience of treatment of complex anal fistulas by cutting seton over 15 years in our hospital, detailing surgical technique, results and complications. METHODS: ...

An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent ...

BACKGROUND: Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results. The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results. The aim of this study was ...

PURPOSE: Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications. METHODS: The outcome of patients who underwent treatment for anal fistula with the ...

BACKGROUND: The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). METHODS: Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 ...

PURPOSE: We performed a retrospective analysis of postoperative course and functional outcome after at least six months' follow-up in a series of 400 consecutive patients who underwent stapled anopexy. METHODS: All patients were evaluated at one week and one month after surgery and then according to symptoms. A clinical or ...

OBJECTIVE: The anal fistula has been a common surgical ailment reported since the time of Hippocrates but little systematic evidence exists on its management. We aimed to systematically review the available studies relating to the surgical management of anal fistulas. METHOD: Studies were identified from PubMED, EMBASE, Cochrane Controlled Trials ...

PURPOSE: This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. METHODS: From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were ...