[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.

[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.