Efficacy of surgical treatments for the management of solitary rectal ulcer syndrome: a network meta-analysis.

AIM: Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings. Several treatments have been reported in the literature with variable ulcer healing rates. This study aimed to evaluate the efficacy of different treatments for SRUS. MATERIALS AND METHODS: A systematic review and network meta-analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle-Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study's primary outcome was to estimate the rate of patients with ulcer healing. RESULTS: A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57-0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14). CONCLUSION: Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422).

Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse.

BACKGROUND: Different surgical techniques have been proposed for rectocele repair. However, controversial aspects exist on the best approach to use. The study aims to report the early and late outcomes of the sequential transfixed stich technique (STST) for the treatment of rectocele in the absence of mucosal prolapse. METHODS: One hundred patients presenting a symptomatic rectocele were treated with STST from January 2010 through August 2015. Patients with mucosal prolapse were not considered eligible for STST. After a period of 24 months from surgery, all the patients were clinically evaluated with the intent to investigate the risk of recurrence of the preoperative symptoms. RESULTS: All the patients were women (median age=54.7 years; ranges=37-75). Median discharge time was 1.5 days. One-month severe complications were: hemorrhoid thrombosis (6.0%), self-solved bleeding (6.0%), urinary retention (4.0%), anal secretion (4.0%) and urinary incontinence (1.0%). No post-operative cases of fecal incontinence were observed. Two years after surgery, 76.0% of patients reported a global improvement of the preoperative symptoms, with 73 and 35% of cases showing a reduced difficulty in the evacuation and need for digitation. Only 8.0% of patients showed a recurrence of the initial symptoms. CONCLUSIONS: The STST is a feasible, safe, and cost-effective technique for the treatment of the rectocele without rectal mucosal prolapse. The method does not increase the risk of postoperative anal incontinence and presents a short hospital stay. STST presents long-term results in line with other transvaginal and transanal approaches.

Role of magnified ileoscopy in the diagnosis of cases of coeliac disease with predominant abdominal symptoms.

OBJECTIVE: Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination. MATERIAL AND METHODS: All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy. RESULTS: Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) >25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn's disease, TI mucosal aftoid lesions were seen in two only in magnified view. CONCLUSIONS: Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn's disease.

The modern treatment of early gastric cancer: our experience in an Italian cohort.

BACKGROUND: Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors. However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort. METHODS: Forty-five patients for a total of 48 gastric lesions were enrolled in the study. Thirty-six EMR procedures were performed with the strip biopsy technique using a double-channel endoscope. En bloc resection refers to resection in one piece, while piecemeal refers to resections in which the lesion was removed in multiple fragments. A total of 12 ESD were performed and completed with IT knife. We define as curative treatment lateral and vertical margins of the resected specimens free of cancer and repeat endoscopic finding of no recurrent disease. RESULTS: Out of 36 EMR procedures, 10 were piecemeal resections (28%), while 26 were en bloc (72%). ESD led to en bloc resection in 11/12 cases (92%). Histological assessment of curability in the EMR group was achieved in 56% of the cases, and in 92% of the ESD group. Mean follow-up period was 31 months (range: 12-71 months). There was no local recurrence or distant metastasis in the curative group patients. CONCLUSIONS: These results seem to confirm the safety and the clinical efficacy of the ESD procedure in the Western world too.

[Use of an evaluation score for rectal mucosal prolapse]. / Utilità di uno score nel prolasso mucoso del retto.

Rectal mucosal prolapse is characterised by the protrusion of the mucosa alone in the rectal lumen. The authors, after an experience conducted in ambulatory patients, have produced a score to classify the extent of rectal mucosal prolapse based on evaluation of qualitative and quantitative factors that should help in the correct management of proctological patients. A total of 30 patients with proctological symptoms during outpatient visits were submitted to a minimally invasive test in comparison to the traditional ones, using a simple gauze plug connected to the end of a suture thread, inserted in the rectal lumen and removed via the anus. The score designed by the authors made it possible to classify 96.6% of patients accurately. In 4 patients the score was equal to zero. In 12 patients there was a mucosal prolapse of less than 25% with a reduction score equal to 2.4 and therefore these were treated with a single rubber ligature (7 patients with classes a and b) and 5 patients were treated with the transfixed stitch technique (TST) (class c). In 10 patients a 50% mucosal prolapse of the anal circumference and a mean reduction score of 5.6 were found. In 5 of these patients (classes a and b) it was possible to perform a multiple ligature while the other 5 (class c) were treated with TST. In 3 patients a prolapse ranging from 50 to 75% with a mean reduction index of 8.1 was found. The therapeutic procedure preferred for these patients was TST. In one patient a circumferential prolapse was diagnosed with a reduction score of 11 treated with Longo's surgical technique. The mucosal prolapse score seems to be useful to stratify patients more precisely in the choice of surgical intervention and during follow-up. The plug test is a minimally invasive test, useful for the application of the rectal mucosal prolapse score.

[Usefulness of plug test for the intraoperative staging of rectal mucosal prolapse]. / Utilità del test della garza per la stadiazione intraoperatoria del prolasso mucoso del retto.

Rectal mucosal prolapse is characterised by protrusion of the rectal mucosa alone in the anal lumen. To correctly establish the intraoperative stage of rectal mucosal prolapse the authors performed a test based on the intrarectal introduction of a large-sized hydrophilic plug, to be extracted later from the anal canal. A total of 40 patients with proctological symptoms and with a diagnosis of rectal mucosal prolapse were submitted, in the outpatient setting, to a minimally invasive test with a small plug and later, in the preoperative stage, in patients under anaesthesia, using a plug entirely inserted into the rectal lumen and extracted via the anus. The same procedure was performed after surgery to verify the results of the excision. In all cases the plug test used in the preoperative stage permitted the perfect surgical evaluation of the extent of the prolapse. The plug test revealed a mucosal prolapse occupying 25% of the anal circumference in 10 patients, up to 50% in 20 patients and more than 50% in 10 patients. The first 30 patients were treated with the transfixed stitch technique, while for the others the Longo surgical technique was preferred. The plug test for the preoperative and postoperative evaluation of rectal mucosal prolapse is an effective tool for obtaining a more precise indication as to the optimal surgical intervention and for verifying the radicality of the surgical excision. The plug test, moreover, proved to be a minimally invasive and easily performed test for evaluating rectal mucosal prolapse.

[A new needle for colon-proctological surgery: personal experience]. / Un nuovo ago per la chirurgia colonproctologica: esperienza personale.

Rectocele and haemorrhoidal prolapse are two pathologies that in all cases entail partial excision of anorectal tissue possibly with less invasive surgical procedures. For these pathologies, the authors have recently improved their treatment procedures, introducing the sequential transfixed stitch technique (STST) for rectocele and the transfixed stitch technique (TST) for haemorrhoidal prolapse, and thereby obtaining a significant technical and clinical improvement in terms of both outcomes (complete correction of rectal prolapse and haemorrhoidal prolapse) and discomfort and quality of life in the postoperative period. Moreover, in the present study the authors propose a subsequent innovation of the technique developed recently for the treatment of rectocele and haemorrhoidal disease using a new curved siliconate needle, thinner than the traditional lanceolate needles, with a longer, more rigid needle-thread junction in order to achieve less invasiveness and mucosal trauma, enabling the surgeon to perform sutures in a simple, easy manner. Ten consecutive patients with a clinical and instrumental diagnosis of rectocele--6 type II and 4 type III--were treated with TSTS and 20 patients with third (12 patients) and fourth degree (8 patients) haemorrhoidal disease were treated with TST. The surgical procedures were the same for all patients, although patients were divided into two groups. To the first group (A) were allocated patients treated with traditional stitches with a cylindrical, half circle needle, (Hr 25.9 mm). To the second group (B) were allocated, for the same objective, patients treated with the new siliconate needle, with an ultrafine tip, manufactured by Assut Europe S.p.A. The mean duration of the TST surgical procedures was 16 minutes using the new siliconate needle, whereas the mean duration using the traditional lanceolate needle was 17 minutes (p = ns). The surgical team judged the TST performed with the siliconate needle to be easier in 90% of cases in comparison to 70% of cases treated with the traditional lanceolate needle (p < 0,05). In patients treated with TSTS using the traditional lanceolate needle the mean duration of the surgical procedures was 20 minutes as against 18 minutes in the cases treated with the siliconate needle (p = ns). The surgical team judged the TSTS performed with the siliconate needle to be easier in all cases, while in two cases treated with the traditional lanceolate needle there were technical difficulties related to the use of the needle. The use of the ultrafine siliconate siliconate needle is more effective for the treatment of rectocele with TSTS and for haemorrhoidectomy with TST, particularly with a view to improving the surgical procedures and limiting the extent of mucosal damage related to suture oedema.

[Proctological surgery: use of an absorbable haemostatic sponge]. / Chirurgia proctologica: uso di un tampone emostatico assorbibile.

The aim of this study was to demonstrate the advantages and efficacy of an absorbable haemostatic sponge for use in coloproctology during surgery for the most frequent pathologies of the anal canal and perineal region. The haemostatic sponge is made of absorbent gelatin that is insoluble in water and is endowed with haemostatic power. It can be produced in various sizes and forms adaptable to different uses and presents no toxic properties. The authors tested the haemostatic sponge in a series of consecutive patients referred to 5 coloproctological centres where they were submitted to surgery for pathologies of the anal canal and perineal region. A total of 100 consecutive patients, 50 with a clinico-instrumental diagnosis of grade III-IV haemorrhoids, 20 with a diagnosis of chronic anal fissure, 20 with symptomatic rectocele and 10 with simple fistulas, underwent surgery for their respective pathologies. In all patients treated, at the end of the procedures, the haemostatic sponge was used, achieving optimal haemostatic control of surgical wounds with no infectious complications. Use of the haemostatic sponge proved easy and satisfactory as regards stability in the anal canal and control of haemostasis after surgery for the most frequent proctological pathologies.

[Should surgical thread influence the outcome of haemorrhoidectomy with the transfixed stitch technique?]. / Il filo di sutura è in grado di influenzare gli esiti dell'emorroidectomia con tecnica dei punti transfissi (TPT)?

The technique of haemorrhoidectomy with the transfixed stitch technique (TST) is a surgical treatment modality for haemorrhoids that is available to the surgeon. The authors, through a personal interpretation of haemorrhoids based on the PATE 2006 classification, report the results of a comparative trial, using TST with two different surgical threads, Assufil and Monofil. The aim of this prospective randomised trial was to compare the results with the use of each surgical thread, analysing early postoperative side effects (bleeding, urinary retention, pain), late postoperative side effects (pain, bleeding, stricture, anal secretion, tenesmus and faecal incontinence), return to active life and quality of life. Patients with grade III-IV haemorrhoids were enrolled in our study and divided into two groups, one treated with TST using Assufil and the other treated with TST using Monofil. The main outcome measures such as analgesic intake during the first week, early and late side effects, return to active life and quality of life were evaluated. Patients were followed for six months after surgery. A total of 40 patients were enrolled, 20 per group. The pain score after surgery was significantly lower in all patients treated with TST. Thirty percent of TST patients treated with Monofil took analgesics in comparison to 35% of the Assufil group (p = ns). Postoperative pain after the start of bowel movements in TST patients was similar in the two groups. TST patients treated with Monofil showed a low incidence of discomfort and surgical oedema in comparison to the Assufil group. Side effects, surgical time and return to active life in patients treated with TST were similar in the two groups. TST haemorrhoidectomy is more advantageous utilising Monofil surgical thread because of its lower complication rate.

[New disposable exploratory vaginal valve: advantages and efficacy]. / Nuova valva vaginale esplorativa monouso: vantaggi ed efficacia.

In current clinical practice, proctological diseases are now classed more appropriately as pertaining to the area of pelvic floor dysfunction. For this reason all proctological examinations should be combined with a gynaecological assessment. The authors report the results of clinical experimentation with a new vaginal valve for use after surgery and in outpatient settings for exploratory purposes. The most important characteristics of the new valve are small size, simple shape and safe manoeuvrability in the vaginal canal, minimising vaginal injury. A total of 50 patients with symptomatic anal pathologies were submitted to surgery and subsequently followed-up with periodic outpatient examinations. The new disposable vaginal valve, used for exploratory purposes, permits complete, thorough exploration of the vagina, preserving the vaginal wall and avoiding misdiagnosis of possible associated pathologies or iatrogenic lesions related to surgery. The new vaginal valve was judged to be helpful in all treated cases, proving simple to use, and enabling vaginal exploration to be performed without traumatism during surgery. Moreover, the valve can be a useful accessory for the surgeon, to be used in everyday practice when vaginal exploration is necessary and particularly for the postoperative monitoring of transanal rectocele surgery.

[A new accessory for the isostatic anal retractor]. / Un nuovo accessorio per il divaricatore anale isostatico.

The authors present the characteristics and the advantages deriving from the use of a new accessory to be fitted on the isostatic anal retractor in order to further improve visualisation of the operative field during the treatment of pelvic and anal pathologies. The isostatic anal retractor consists of a system of rotating rings and valves which are positioned with surgical stitches on the patient's buttocks. The new accessory is characterised by one or more elastic systems that can be fixed to the retractor metal ring and attached by means of curved needles to flaps of anal mucosa, affording enhanced visibility of the operative field. A total of 25 patients--15 with mucosal prolapse, 5 with haemorrhoids and 5 with anal fistulas--were treated surgically for their respective pathologies using the isostatic anal retractor and the new accessory. None of the patients observed complained of complications related to the use of the anal retractor or the accessory. In 95% of patients submitted to the procedures using the new accessory, visualisation of the operative field was improved as compared to the use of the anal retractor alone. In 5 patients it was possible to use the new accessory advantageously applied only to the external ring of the retractor. Our operative team judged the use of new accessory to be satisfactory in all cases in which greater visibility of the operative field is required. Use of the new accessory use in association with the isostatic anal retractor proved efficacious for achieving better therapeutic results with the treatments performed, permitting greater operator autonomy and enhancing visualisation of the operative field with respect for sphincter function.

[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy]. / Complicanze maggiori postoperatorie nella chirurgia colo-rettale per cancro. Incidenza in rapporto alla tecnica utilizzata: open versus laparoscopica.

In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer.

[New "PATE 2006" system for classifying hemorrhoidal disease: advantages resulting from revision of "PATE 2000 Sorrento"]. / Nuovo sistema di classificazione della malattia emorroidaria "PATE 2006": vantaggi della revisione della "PATE 2000 Sorrento".

In 2000 the Italian Society of Coloproctology introduced a novel system for classifying hemorrhoidal disease, PATE 2000 Sorrento, capable of assuring a better knowledge of such pathology. After several studies had established the efficacy of this classification system in comparison to anatomical criteria such as the size and dislocation of hemorrhoids in the anal canal, the need was felt to correct the limits of PATE 2000 Sorrento. Important parameters in assessing the severity of hemorrhoidal disease, such as numerical scores, symptom severity analysis and quality of life analyses, were introduced in PATE 2006 classification. The authors then tested the PATE 2006 on 500 patients with hemorrhoidal disease over a period of two years, referred to 4 different centres. The numerical scores of the PATE 2000 Sorrento factors, quality of life and the severity of symptoms introduced with this classification proved to be important parameters for evaluating hemorrhoids. In conclusions, PATE 2006 seems to be an improvement over the PATE 2000 Sorrento classification system in terms of its efficacy in establishing the more appropriate treatment for each patients with hemorrhoid disease.

[Scoring of postoperative complications in coloproctology]. / Uno "score" per le complicanze postchirurgiche in colonproctologia.

Surgical procedures for anorectal diseases are numerous, and the most important question is how to guarantee these patients an adequate follow-up in order to establish the real efficacy of the treatment and the effective incidence of side effects related to the procedures. The aim of this study was to assess the efficacy of a scoring system with analysis of the quality of life and measurement of the severity of short- and long-term complications which might be useful in the followup of patients surgically treated for anorectal diseases. The authors followed 200 patients and performed 90 hemorrhoidectomy, 50 surgical interventions for anal fissures, 30 fistulectomy and 30 surgical interventions for rectocele. After surgery, patients were followed up at 3, 6, and 12 months using a numerical questionnaire regarding short- and long-term complications and quality of life. During the follow-up after treatment 120 were regularly monitored while 80 were not. In the monitored cases it was observed that greater severity of short- and long-term complications was significantly associated with poor quality of life. The mean values of quality of life recorded at the various observation times up to the end of follow-up significantly differed in comparison to the mean values observed before surgery (5 vs. 8.5 vs. 9 vs. 8.9, p = 0.05). The quality of life after surgical treatment did not significantly improve, however, in the monitoring checks at 12 months as compared to those at 3 and 6 months (8.5 vs. 9 vs. 8.9, p = ns). The quality of life and the numerical value of severity of complications are useful follow-up indices of the principal surgically treated, proctological diseases.

[Sequential transfixed stitch technique (STST) in the treatment of rectocoele: advantages and efficiency in the first 20 cases treated]. / La tecnica del punto trasfisso sequenziale (TPTS) nel trattamento del rettocele. Vantaggi ed efficacia nei primi 20 casi trattati.

Rectocoele is defined as herniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of recto-vaginal septum. Transvaginal and transanal surgical approaches are currently used for the definitive treatment of symptomatic rectocoele, with conflicting results. The authors report the results of a new surgical technique defined as the sequential transfixed stitch technique (STST) using a new anal retractor of their own design. A total of 20 patients with symptomatic rectocoele (grade II in 11 and grade III in 9), assessed by proctological evaluation, digital examination of the anal canal, sphere test, defecography and total colonoscopy, were submitted to STST. Patients with previous colorectal or pelvic surgery were excluded from the study. Quality of life was assessed using a questionnaire before surgery and at 3 and 6 months of follow-up. Data were evaluated using the Agachan-Wexner score. STST was correctly performed in all cases without any early or late complications. The mean quality of life score before the intervention was 28.5, as against 16.4 after 3 months and 15.9 after 6 months (p < 0.05). The surgical procedure with the new retractor was judged satisfactory in 80% of cases. STST yielded optimal results for the surgical treatment of symptomatic rectocoele in our experience with a significant improvement in quality of life referred by the patients and the absence of postoperative sphincter damage.

[Design and use of a new disposable fenestrated anoscope in proctology]. / Ideazione di un anoscopio fenestrato monouso in proctologia.

Direct exploration of the anal mucosa always plays an essential role in the diagnosis and treatment of the main anal and perineal pathologies. The continuous need to improve coloproctological instruments, enhancing their efficacy and advantages for patients, prompted the authors to design and test a new anoscope for both diagnostic and operative purposes, suitable for simple, immediate use. This study was conducted to demonstrate the advantages and efficacy of a disposable "fenestrated" anoscope for band ligation of haemorrhoids and for performing biopsies on suspect areas of anal mucosa. The new disposable self-lit anoscope, made of inert, non-toxic plastic material tested by the authors, has been defined as "fenestrated" because it is characterised by the presence of a fenestration in the distal part of device, capable of improving visualisation of the anal canal and facilitating operative procedures. A total of 30 consecutive patients (25 with a clinico-instrumental diagnosis of grade II-III haemorrhoids and 5 with evidence of suspect lesions of the anal mucosa) were submitted to anoscopy using the new fenestrated anoscope. In the patients treated for haemorrhoids, ease of execution of band ligation was observed in all cases independently of the number and distribution of nodules. In the patients submitted to biopsy, the presence of condyloma was observed in 3 patients, and the presence of papillary hyperplasia in 2 patients. The new fenestrated anoscope proved to be a useful accessory both for diagnosis and for conservative treatment of haemorrhoids, permitting easy execution of ligation with no side effects. The anoscope was simple to use during diagnostic examinations and biopsies of suspect lesions of the anal canal, permitting accurate histological characterisation of the lesions in all cases.

[Efficacy of PTQ agent in the treatment of faecal incontinence]. / Efficacia dell'agente PTQ nel trattamento dell'incontinenza fecale.

Faecal incontinence caused by a weak or disrupted internal anal sphincter is common and the efficacy of current treatments for this condition is poor. This study evaluated the short- and long-term effects of injections of silicone biomaterials (PTQ) commonly used to increase anal internal sphincter resistance. A total of 16 patients with a mean age of 66 years affected by faecal incontinence with a low anal resistance to the pressure due to previous surgery of the pelvic region were submitted to intra-sphincteric PTQ injections. The effects of the treatment on the symptoms associated with faecal incontinence and on quality of life were evaluated with the American Medical System Score and with anal ultrasound at 3 months and one year after the procedures in comparison with the scores calculated at entry. At 3 months from the procedure, anal ultrasound confirmed that PTQ injections had been correctly performed without material migration to other regions. Faecal continence was significantly improved but more efficacy was found one year after the injections. The American Medical System Score calculated one year after the procedures was significantly improved in comparison with the scores calculated at entry. During the follow-up the Authors did not observe any significant complications. PTQ injections significantly improved faecal continence and consequently the quality of life of patients with sphincter dysfunctions.

[New anal retractor in pelviperineology: preliminary experience]. / Nuovo retrattore anale in pelviperineologia. Nostra esperienza preliminare.

The authors illustrate the technical characteristics and the clinical results of a new anal retractor in proctology and pelviperineology This new device, designed and produced by the authors, enables the surgeon to operate in a traditional or isostatic modality. The small external diameter and the original morphology seem to guarantee a less invasive introduction into the anal canal with minimal mechanical damage to the anal sphincter. The main indications for its use are pelvic floor surgery and patients with a diagnosis of anal incontinence or with suspected sphincter damage. Forty consecutive patients referred to our Coloproctological Unit have been operated on with the new anal retractor with no complications. The operative results obtained with the new device are defined as good in 75% and optimal in 10%. The anal retractor seems easy to use in all the surgical procedures with a much better safety profile with regard to anal sphincter.