Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis.

The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of ulcerative colitis management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of ulcerative colitis. The committee was able to identify some points of major disagreement and suggested strategies to improve the quality of available data and acceptance of guidelines.

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn's disease.

The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a position statement of Italian colorectal surgeons to address the surgical aspects of Crohn's disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of Crohn's disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

Correction to: Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis.

The affiliation of the author Silvio Danese has been incorrectly published in the original publication.

Correction to: Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management.

The affiliation of the author Silvio Danese has been incorrectly published in the original publication. The complete correct affiliation should read as follows.

Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management.

The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of inflammatory bowel disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the general principles of surgical treatment of inflammatory bowel disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

Correction to: Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn's disease.

The affiliation of the author Silvio Danese has been incorrectly published in the original publication.

A think tank of the Italian society of colorectal surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: Crohn's disease.

The management of Crohn's disease (CD) requires extensive expertise. Many treatment options are available, and surgery still plays a crucial role. In recent years, many medical societies have provided surgeons and gastroenterologists dealing with CD with authoritative guidelines. However, a certain degree of variation can be observed in these papers, and application of guidelines in clinical practice should be improved. The Italian society of colorectal surgery (SICCR) promoted the project reported here, which consists of a think tank of Italian colorectal surgeons to address the surgical aspects of CD management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of CD. The management of CD is, by necessity, patient-tailored, and it is based on clinical data and surgeon's preference, but the committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

A think tank of the Italian Society of Colorectal Surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: ulcerative colitis.

The majority of patients suffering from ulcerative colitis (UC) are managed successfully with medical treatment, but a relevant number of them will still need surgery at some point in their life. Medical treatments and surgical techniques have changed dramatically in recent years, and available guidelines from relevant societies are rapidly evolving, providing UC experts with updated and valid practical recommendations. However, some aspects of the management of UC patients are still debated, and the application of guidelines in clinical practice may be suboptimal. The Italian Society of Colorectal Surgery (SICCR) sponsored the think tank in order to identify critical aspects of the surgical management of UC in Italy. The present paper reports the results of a think tank of Italian colorectal surgeons concerning surgery for UC and was not developed as an alternative to authoritative guidelines currently available. Members of the SICCR voted on several items proposed by the writing committee, based on evidence from the literature. The results are presented, focusing on points to be implemented. UC management relies on evaluations that need to be individualized, but points of major disagreement reported in this paper should be considered in order to develop strategies to improve the quality of the evidence and the application of guidelines in a clinical setting.

Azithromycin may reduce cholestasis in primary sclerosing cholangitis: a case report and serendipitous observation.

The newer macrolides have been shown to exert additional anti-inflammatory effects. We report the possible effect of azithromycin on primary sclerosing cholangitis in a patient treated with the drug for severe asthma. A 45-year-old woman with Crohn?s disease and primary sclerosing cholangitis, also suffering from severe asthma, was treated with azithromycin 500 mg OD for 3 consecutive days a week because of the clinical suspicion of bronchiectasis and the severity of her asthma. When the therapy was discontinued, her urine again became darker, pruritus reappeared with the usual severity and laboratory parameters, evaluated after 6 weeks without azithromycin, also worsened. For these reasons macrolide treatment was re-established. Cholestasis-related symptoms and the dark colour of the urine were again reduced 6 weeks later and laboratory parameters were again reversed. We are therefore tempted to speculate that azithromycin may have an effect on primary sclerosing cholangitis on the basis of its anti-inflammatory properties.

The vesicosigmoidal fistula: diagnosis and surgical treatment.

The authors report their experience in the diagnosis and treatment of 10 cases of vesicosigmoidal fistula. In accordance with the literature the most frequent presenting symptoms were of urinary origin. For the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed, or removed probable doubts about the nature of the intestinal pathology. Surgical treatment varied from one-stage to multi-stage procedures.

[The functional and manometric results of 2 surgical methods of posterior abdominal rectopexy]. / Risultati funzionali e manometrici di due metodi chirurgici di rettopessi addominale posteriore.

Functional changes after posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 31 patients with complete or internal rectal prolapse. We have observed an improvement of continence over 70% in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Maximal squeeze pressure was slightly increased after Ripstein's rectopexy, whereas no significant effects were found on anal pressures. Postoperatively the rectal capacity was reduced by Well's procedure (p < 0.05), while no significant changes were observed with Ripstein's operation. After the Wells procedure patients developed at the threshold for the relaxation of the internal sphincter progressively lower rectal volumes, reaching one year after rectopexy the statistical significance. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one hear postoperative control. In conclusion, when fecal incontinence appears associated to a rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seem to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems the the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.

[The long-term complications from ileostomy in patients with Crohn's disease and ulcerative colitis]. / Le complicanze a lungo termine dell'ileostomia in pazienti affetti da morbo di Crohn e colite ulcerativa.

In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileostomy (after colectomy) was mad in 203 patients affected by chronic inflammatory bowel disease. Patients were followed up prospectively to evaluate the frequency and severity of the complications. The cumulative rate of surgical reoperation was significantly higher in the group of patients with Crohn disease in comparison with those affected by ulcerative colitis. After 8 years it reached 75% in the first group and only 44% in the second. The most frequent indication for surgery reoperation were stenosis and retraction. 83% of the operations were only local not requiring laparotomy. No statistically significant correlation was found for the reoperation rate, the surgical technique, the length of the ileal resection and the post-operative weight gain. Only a systematic and accurate follow-up done by the surgeon and the enterostomist can detect an optimal functioning of the ileostomy. In case of complications which could be surgically corrected an early operation is needed. In most cases this can be simply made by local anesthesia.

[Sexual dysfunctions after conventional proctocolectomy]. / Le disfunzioni sessuali dopo proctocolectomia convenzionale.

Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. 49% (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 delivered by caesarean section. 57 men who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about the presence of sexual disturbances and their incidence was studied, 57% of elderly patients (above 40 years old) complained a reduced libido and sexual satisfaction. In younger patients (below 40 years old) 33% complained an impaired quality of sexual ife and 22% complained an impaired sexual satisfaction. However, despite some sexual dysfunction, 56% reported improved sexual life and 67% improved sexual satisfaction. This may be explained by improved general health and increased libido after removal of diseased bowel. The incidence of patients with ejaculatory disfunction (retention or retrograde ejaculation) is 9%. The increased awareness of uro-genital disfunction and therefore their prevention can contribute to the improvement of quality of life and to the rehabilitation of patients with benign diseases.

[Defecography in internal invagination of the rectum]. / La defecografia nell'invaginazione interna del retto.

Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). In the present study defecographies performed on 15 patients, with previous diagnosis of rectal invagination have been reviewed. Six patients had an intra-rectal (IR) invagination, three had an intra-anal (IA) invagination, while two patients did not show a typical rectal invagination. In the present series there is a suspected radiologic recurrence of the invagination. Three patients show a tendency to rectal stenosis. Anorectal angles at rest and under straining appears higher than the ones in normal subjects, after rectopexy, anorectal angles do not appear to be significantly changed and the pelvic floor is not significantly raising post-operatively. 7 out of 10 women had a rectocele preoperatively and 4 out 9 postoperatively. In 8 patients it was possible to compare a pre to a post-operative defecography. All patients but one displayed a reduction in the ability in emptying the rectum. The fact that rectal emptying is impaired may suggest that some autonomic denervation might occur following rectal mobilization.

[Carcinoma of the appendix. Presentation of one clinical case and review of the literature (author's transl)]. / Il carcinoma dell'appendice. Presentazione di un caso clinico e revisione della letteratura.

After presenting one case of carcinoma of the appendix of their own observation, the authors discuss several aspects of the anatomopathology, clinical course, and diagnosis of tumors of the appendix. From a review of existing literature it emerges that no case of carcinoma of the appendix was ever diagnosed preoperatively. The authors evaluate the difficulties inherent in such diagnosis and recommend some means of investigation that are currently applied to other organs.

[Occult rectal prolapse: functional results after rectopexy]. / Prolasso occulto del retto: risultati funzionali dopo rettopessia.

In the present work the Authors have studied 19 patients with occult rectal prolapse evaluating symptoms and functional results after posterior abdominal rectopexy. Symptoms of internal rectal procidentia appear as a definite syndrome. In our patients pain upon defecation, this being often localized to the perineal and sacral region, was observed in 14 on 19 cases, while fecal incontinence was present in 5 cases (29%) and rectal bleeding in 8 (44%). These compliances are relieved by the anatomical correction of the rectal intussusception, but the preexisting functional disorders in the mechanism of defecation appear to be unaffected by rectopexy. (Sensation of obstruction 11 cases (58%) preop. e 9 cases (53%) postop.).

[Medical therapy of chronic idiopathic constipation]. / Terapia medica della stipsi cronica idiopatica.

The medical care of the idiopathic constipation requires the correct patient identification based on precise classification items and on physiopathological considerations. The laxative abuse is often the most difficult problem to be solved and it has to be dealt with the consideration of different clinical aspects (wrong diet, psychological profile, concomitant diseases, drug therapy, etc.). The first step exactly consists in the identification and correction of the wrong convictions, of the behavioural attitudes and of the unbalanced dietary habits. Adding bran is the second widely accepted therapeutic step based on both physiopathological and epidemiological considerations. Even if the mechanism of action is still not completely understood, the fibre addition per se leads to an improvement of the constipation in quite a relevant percentage of patients, although it is often poorly tolerated. Nevertheless there are peculiar conditions not responsive to the bran addition such as the so-called "anismus". For these situations different therapeutic approaches have been proposed with variable results. Among these we can mention the re-educational programmes of the modalities of the defecation using biofeedback techniques. The chronic idiopathic constipation not respondent to the conventional medical therapy appears anyway a problematic and very difficult condition both from the investigational viewpoint and the therapeutic options. Finally it can be stated that the laxatives have a certain role in those clinical conditions most probably leading to the constipation. For each therapeutic drug class it is, of course, of great importance to know its mode of action as well as its adverse event profile.

[Angiomatosis of the colon; presentation of one case and review of the literature (author's transl)]. / Angiomatosi del colon. Presentazione di un caso e revisione della letteratura.

Following a brief introduction in which they outline the frequency of colonic angiomatosis and its characteristic symptom triad, the authors describe one case of this condition come to their observation and treated surgically. Next they discuss the classification, differential diagnosis versus other colonic diseases and disorders, available diagnostic aids, and therapeutic resources. They stress in particular the difficulty of diagnosing this condition correctly, to the point where definite recognition is often made only by exploratory laparotomy.

[Decompressive transversotomy. Technic of performance and closure]. / La trasversostomia decompressiva. Tecnica di esecuzione e di chiusura.

The routine technique used by the Authors for performance of decompressive transversotomy in operations on the left colon and the rectum is described. The technique for extraperitoneal closure of the stoma is described in detail: the method is easy to perform and does not involve any noteworthy postoperative complications. Long-term follow-ups demonstrate that there are no functional disorders connected with adhesion of the organ to the abdominal wall.