An 'easy' method to understand perianal sepsis - a video vignette.

Impact of surgeon organization and specialization in rectal cancer outcome.

Purpose The present study was designed to assess the differences in the outcome of patients with rectal cancer treated by a group of surgeons before and after being organized as a Coloproctology Unit at the same University Department of Surgery. Methods Comparison of two periods of rectal cancer surgery: I (1986–91) and II (1992–95). Period I: 94 patients were operated on by 14 general surgeons. Period II: 108 patients were operated on by only 4 surgeons of the same group organized as a Colorectal Surgery Unit after visiting referral centres abroad, adopting techniques such as total mesorectal excision (TME) for middle and low rectal cancer and washout of rectal stump. Mean follow-up during…

A Prospective Audit of the Complications of Loop Ileostomy Construction and Takedown

<i>Aim:</i> A prospective review of the complications of ileostomy construction and takedown. <i>Materials and Methods:</i> One hundred twenty-seven consecutive patients undergoing construction of a loop ileostomy were included in a prospective nonrandomized computer database. Complications of the loop ileostomy were assessed prior to and after closure. Three closure techniques were performed [enterotomy suture (25.7%), resection and hand sewn (31.2%) or stapled anastomosis (43.1%)] and compared. <i>Results:</i> One hundred twenty-seven (73 male, 54 female) patients, mean age 54 years were included from 1992 to 2002. Seventy-two patients underwent anterio…

Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy

PURPOSE: The present study was undertaken to evaluate anal endosonographic results of the transverse and longitudinal extent of internal anal sphincter division after closed lateral subcutaneous sphincterotomy and its relationship to outcome with respect to anal fissure recurrence and postoperative anal incontinence. METHODS: Ten patients selected for symptomatic anal fissure recurrence (mean follow-up, 10.9 months) and 41 asymptomatic control patients (mean follow-up, 15.5 months) were reviewed by anal endosonography after closed lateral subcutaneous sphincterotomy. Clinical evaluation was focused on anal fissure recurrence and postoperative anal incontinence. The anal endosonographic stud…

Review of the anatomic concepts in relation to the retrorectal space and endopelvic fascia: Waldeyer’s fascia and the rectosacral fascia

Objective  A precise anatomical study of the fascias within the retrorectal space is reported, analyzing and clarifying the anatomical concepts previously employed to describe Waldeyer’s and the rectosacral fascia. Method  The pelvis was dissected in 15 cadavers (10 males and five females). All specimens were divided in the median sagittal plane including the middle axis of the anal canal, to allow a correct visualization of and access to the retrorectal space. Results  The retrorectal space was limited anteriorly by the rectum and posterior mesorectum covered by a fine visceral fascia, and posteriorly by the sacrum covered by the parietal presacral fascia. The rectosacral fascia divided th…

Tratamiento quirúrgico y resultados del cáncer de recto

Resumen Las experiencias acumuladas en los ultimos anos han modificado la tactica y la tecnica quirurgicas en el tratamiento del cancer de recto, existiendo una evidencia cientifica en la mejoria de los resultados en grupos especializados. El objetivo del presente trabajo es describir las distintas opciones tecnicas, indicaciones y los resultados del tratamiento quirurgico actual del cancer de recto. El cancer de recto puede tratarse con intencion curativa con cualquiera de las siguientes opciones quirurgicas: reseccion local, reseccion anterior con sus distintas variantes y amputacion abdominoperineal. Se deben mantener unos criterios de seleccion correctos, fundamentalmente en relacion co…

Estomas de protección en cirugía colorrectal. ¿Cuándo y cómo realizarlos?

Resumen En los ultimos anos, el empleo de estomas de proteccion en cirugia colorrectal se ha incrementado, y tiene fundamentalmente tres grandes indicaciones: 1) traumatismos ano-recto-colicos graves; 2) enfermedad de Crohn con importante afectacion anorrectal y perineal, y 3) prevencion de complicaciones derivadas del fracaso anastomotico, fundamentalmente tras reseccion anterior baja por neoplasia de recto y tras proctocolectomia restauradora por colitis ulcerosa o poliposis colica familiar. En cuanto al tipo de estoma a realizar, en los casos de enfermedad o traumatismo anorrectal, lo habitual sera realizar una sigmoidostomia en asa, por lo que la derivacion se situa inmediatamente proxi…

Simple technique for the intraoperative detection of Crohn's strictures with a calibration sphere.

Several methods have been used to detect and evaluate small-bowel strictures in Crohn's disease. We describe a simple technique for the calibration of strictures using a 2.5-cm medical plastic sphere. This method provides an aseptic, safe, and effective calibration of the entire small bowel.

Prospective study of morphologic and functional changes with time in the mucosa of the ileoanal pouch: functional appraisal using transmucosal potential differences.

PURPOSE: This study was undertaken to investigate the morphologic and functional changes with time in the mucosa of the ileoanal pouch. METHODS: A morphologic study by histopathologic analysis, mucosal morphometry, and mucin histochemistry and a functional study by analysis of transmucosal potential difference were performed in 27 patients with an ileoanal J-pouch after restorative proctocolectomy for ulcerative colitis. In 19 patients with a normal ileoanal pouch, two prospective follow-up analyses were performed after median functional pouch times of 14 and 39 months. We also evaluated eight patients with the diagnosis of pouchitis (median follow-up, 52.5 months). RESULTS: In the normal i…

Risk factors for recurrence and incontinence after anal fistula surgery

Objective: Fistula-in-ano continues to raise problems that require important therapeutic decisions. Our aim was to evaluate its recurrence and incontinence risk factors. Method: We analysed a series of 279 patients who had undergone anal fistula surgery with long-term follow-up. Results: 42.7% of the fistulae were considered complex and 46% had been referred from other institutions. There was delayed healing or recurrence in 7.2% patients, which appeared at a median of 4 months. The factors associated with recurrence were the type of fistula (extrasphincteric/suprasphincteric), nonidentification of internal opening (IO), recurrent or complex fistulae (CF), and associated chronic abscess. On…

Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas

Objective  Complex anal fistulas (CFs) are difficult to treat. Endoanal advancement flap (EAF) is one of the standard treatment options for such clinical conditions. Immediate sphincter repair after fistulectomy (ISR) is not commonly performed because of the fear of causing postoperative incontinence. The objective of this study was to compare the results of both techniques. Method  We retrospectively analysed a prospectively entered database composed of 146 patients (112 M; 34 F), undergoing operations for CF of cryptoglandular origin. The patients were divided in two groups: Group A: (EAF); n = 71 patients; Group B: (ISR); n = 75 patients. Results  Forty-two fistulas (28.7%) were recurren…

Surgical Anatomy of the Rectovaginal Space: Does a Standalone Rectovaginal Septum or Denonvilliers Fascia Exist in Women?

Background Below the anterior peritoneal reflection, the anterior rectal wall and mesorectum are separated from the posterior vaginal wall by a virtual rectovaginal space. In this space, the description of a specific and independent rectovaginal septum as a female counterpart of Denonvilliers fascia has been the subject of debate over the years. Objective The aim of this study is to perform an accurate anatomical study of the rectovaginal area in a cadaveric simulation model of total mesorectal excision to evaluate the possible structures and the dissection planes contained within the rectovaginal space. Design and setting This is a cadaveric study performed at the University of Valencia. P…