118 research outputs found
LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE: 10-YEARS' EXPERIENCE IN A SPECIALIST COLORECTAL UNIT
No full textLATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE: 10-YEARS' EXPERIENCE IN A SPECIALIST COLORECTAL UNIT.
No full textPURPOSE: The aim of the study was to determinate the long-term outcome, recurrence rate and faecal incontinence after lateral internal sphincterotomy for chronic anal fissure (CAF) after failure of conservative treatment. METHODS:110 consecutive patients underwent surgery for a medically resistant CAF between 2002 and 2012. All data were prospectively collected and entered in a database including demographics, type of surgery, complications, healing time, incontinence (FISI score) and satisfaction with the operation (score 1-4). All patients were seen after surgery at 1 week, 1 month, six months and annualy threafter for 5 years. Patients were then contacted by phone. RESULTS: Median follow up was 3.5 years. 11 parients were lost at the follow-up. Overall complications rate was 5% ( 6 out of 110). Postoperative incontinence was 4.5% ( 5 out of 110). At the end of the follow.up 1 patient (1%) experienced significative incontnence (FISI score >5). Overall healing was achieved in 95% (94/99 patients), 91% of patients would have consented to the operation again if necessary. CONCLUSIONS: In our experience LIS remains the treatment ofchoice for medically resistant CAF, recurrence rate is low wiyh a minimal impact on continence
Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn's disease
No full textMesenteric closure following right colectomy remains controversial and, following the advent of laparoscopic surgery, many surgeons do not routinely close the mesentery after colorectal resection. Nevertheless, especially after the introduction of operations such as right colectomy with complete mesocolic excision and ileocolic resections with extensive mesentery removal for Crohn's disease, the wide mesenteric defect resulting from the dissections can certainly expose the patients to complications such as internal hernias or volvuli. In general, mesenteric closure requires intracorporeal suturing. We describe a simple technique for the closure of the mesentery after surgical resection using polymer-ligating clips. This novel technique seems to minimize the time, effort and risk inherent to the procedure, even after large mesenteric excisions
Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study
No full textAbdominal rectopexy for rectal prolapse. Meta-analysis of literature
No full textLaparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are little long-term
follow-up and functional outcome data available. Using meta-analytical techniques, this study was designed to evaluate long term results of
open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults. Methods: A literature review was performed using
the National Library of Medicine’s Pubmed Database; all articles reporting on abdominal rectopexy with a follow up longer than 16
months were considered. The primary end point was recurrence of rectal prolapse and the secondary end points were incontinence and constipation
improvement. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed.
Results: Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic) were included. Analysis of data suggested
that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy
and open abdominal rectopexy. Conclusions: Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare
equally with the open technique with regards to recurrence, incontinence and constipation. However large-scale randomized trials, with comparative,
strong methodology are still needed to find out outcome measures accurately
Captopril therapy in severe hypertension: effects of intravenous administration
No full textAbstract- In 10 severe hypertensives the effects of intravenous administration of scalar doses of captopril were evaluated. The behaviour of blood pressure, heart rate, electrocardiographic pattern and left ventricular (LV) diastolic function, in basal condition (T0) and after 60 min of captopril infusion (T60), were analysed. Diastolic performance was assessed by pulsed wave Doppler echocardiography, evaluating transmitral peak flow velocities in early diastole (PEDV), late diastole (PLDV) and the PEDV/PLDV ratio. All patients showed an increase in LV mass (assessed by M-mode echocardiography) and altered diastolic performance, documented by high PLDV and low PLDV/PEDV ratio values. Clinical, haematological, urinary and biochemical data were also assessed for possible side effects. Captopril significantly reduced BP in 7 out of the 10 patients. Supine BP decreased from 212 +/- 15.3/126 +/- 5.6 to 171 +/- 17.7/98 +/- 11.8 mmHg (T0 vs. T60 P less than 0.0001). No electrocardiographic abnormality was observed during the study. The goal of antihypertensive effect was reached at 40-50 min after the onset of captopril therapy. Heart rate showed a small but constant decrease (from 76 +/- 7.7 to 72.8 +/- 5.7 beats/min, T0 vs. T60, P less than 0.05). Side effects of intravenous captopril were always mild and transient; no severe hypotension as 'first dose effect' was observed in our study. The echocardiographic data showed a significant decrease in LV end-systolic dimension after captopril infusion, while left atrial, LV diastolic dimension and fractional shortening remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS
Transanal minimally invasive surgery for rectal lesions
No full textBackground and Objectives: Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery (TEM). The authors report their experience with TAMIS for the treatment of mid and high rectal tumors. Methods: From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed. Results: TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park's transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered. Conclusion: TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques
Small-Bowel obstruction secondary to adhesions after open or laparoscopic colorectal surgery
No full textBackground and Objectives: Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO. Method: This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems. Results: During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P =.16; hazards ratio (HR) 1.4 95% CI 0.82-2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P =.039; HR 2.82; 95% CI 0.78-8.51). Stoma formation was an independent risk factor for development of SBO (P =.049; HR, 0.63; 95% CI 0.39-1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P =.0003; HR, 2.85; 95% CI 1.44-5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P =.0001). Conclusion: The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention
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