Search results for "Anal Canal"
showing 10 items of 90 documents
Relaxation of the isolated human internal anal sphincter by sildenafil.
2007
Abstract Background Hypertonicity of the internal anal sphincter (IAS) appears to be involved in the pathogenesis of anal fissure. The relaxant effects of sildenafil, a selective phosphodiesterase 5 (PDE5) inhibitor, on isolated human IAS were investigated. Methods The efficacy (maximal effect, Emax) and potency (−log IC50, where IC50 is half-maximal inhibitory concentration) of the PDE5 inhibitors, sildenafil and zaprinast, and of nitric oxide donors, sodium nitroprusside and glyceryl trinitrate, as relaxants of histamine (0·1 mmol/l)-induced tone were examined in IAS strips under isometric contraction. The presence of PDE5 isoenzymes and changes in intracellular calcium and cyclic nucleot…
Chronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes.
2002
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results of the first patients treated with this novel approach applying two techniques of sacral spinal nerve stimulator implantation. METHODS: Six patients underwent either of two techniques for electrode placement: one “closed” (electrodes placed through the sacral foramen) and one “open” (cuff electrodes placed after sacral laminectomy). Follow-up evaluation of their continence status ranged from 5 to …
Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
2016
Abstract Background: Intraoperative identification of nerve fibers heading from the inferior rectal plexus (IRP) to the internal anal sphincter (IAS) is challenging. The transanal total mesorectal excision (TaTME) is said to better preserve pelvic autonomic nerves. The aim of this study was to investigate the nerve identification rates during TaTME by transanal visual and electrophysiological assessment. Material and methods: A total of 52 patients underwent TaTME for malignant conditions. The IRP with its posterior branches to the IAS and the pelvic splanchnic nerves (PSN) were visually assessed in 20 patients (v-TaTME). Electrophysiological nerve identification was performed in 32 patient…
Laparoscopic neuromapping in pelvic surgery: scopes of application.
2013
Background. New developments in intraoperative electrophysiological neuromonitoring for conventional surgery are providing further insights into functional neuroanatomy and nerve-sparing in the minor pelvis. The aim of this study was to open up potential scopes of application in laparoscopy. Methods. Ten patients with different indications for surgery (presacral tumor excision, n = 2; resection rectopexy. n = 2; low anterior rectal resection, n = 2; proctocolectomy. n = 2; abdomino-perineal excision of the rectum, n = 2) were investigated prospectively. The pelvic autonomic nerves were bilaterally mapped by laparoscopic electric stimulation under simultaneous electromyography of the intern…
Long term outcomes of fissurectomy and anoplasty for chronic anterior anal fissure without hypertonia: low recurrences and continence conservation
2021
Aetiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluatio…
Anal canal mixed adenoneuroendocrine carcinoma in a young patient misdiagnosed as anal abscess.
2021
Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) are rare tumours of gastrointestinal tract, extremely rare in anal canal. We report a case of misdiagnosed MiNEN in a 38-year-old woman initially conservatively treated for a supposed anal fistula. In a second proctological evaluation, biopsy of the anal neoformation was performed and the histological specimen diagnosed a MiNEN. The complete staging showed a disseminate disease and the patient started a chemotherapy schedule. After 6 months, stable disease was revealed at the last imaging performed and radical surgery was offered to the patient that is actually on oncological follow-up without recurrence at 1 year.
FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years
2021
Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003–2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the stu…
Diseases of the External Anal Area
1979
Diseases of the external anal area may be diagnosed during inspection using good lighting. Because of the variable responses to treatment, the individual diseases should be diagnostically distinguished from one another.
Anal Fistula in Crohn’s Disease
2015
Transmural bowel inflammation in Crohn’s disease (CD) is associated with the development of fistulas, which are tracts or communications that connect two epithelial-lined organs. Common sites for fistulas connect the intestine to bladder (enterovesical), to skin (enterocutaneous), to bowel (enteroenteric), and to the vagina (enterovaginal).
Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement
2015
Hemorrhoids are one of the most common medical and surgical diseases and the main reason for a visit to a coloproctologist. This consensus statement was drawn up by the Italian society of colorectal surgery in order to provide practice parameters for an accurate assessment of the disease and consequent appropriate treatment. The authors made a careful search in the main databases (MEDLINE, PubMed, Embase and Cochrane), and all results were classified on the basis of the grade of recommendation (A-C) of the American College of Chest Physicians.