Ultrasound-guided botulinum toxin for the treatment of chronic anal fissure: technical notes.

We are thrilled to present a new technique for treating chronic anal fissures using ultrasound-guided botulinum toxin injections. Our approach involves injecting botulinum toxin into the internal anal sphincter (IAS) guided by ultrasound for maximum effectiveness. We believe that our technique has significant potential to improve outcomes. We could not find any studies where ultrasound-guided TB puncture was used to treat chronic anal fissures.

Impacto de la utilización de stents colónicos como puente a la cirugía de neoplasias colorrectales oclusivas potencialmente curables sobre los resultados quirúrgicos y oncológicos / Impact on surgical and oncological results of the use of colonic stents as a bridge to surgery for potentially curable occlusive colorectal neoplasms

INTRODUCCIÓN: La seguridad y los resultados oncológicos de los pacientes tratados con stents cólicos como puente a la cirugía (PAC) son controvertidos. El objetivo de este estudio es evaluar los efectos sobre los resultados quirúrgicos y oncológicos de los stents como PAC de las neoplasias colorrectales oclusivas potencialmente resecables. MÉTODOS: Análisis retrospectivo de los pacientes intervenidos por neoplasia colorrectal oclusiva potencialmente resecable con o sin enfermedad a distancia entre septiembre de 2002 y octubre de 2015, comparando los pacientes tratados con stent como PAC (grupo Stent) con los intervenidos de forma urgente (grupo Cirugía). RESULTADOS: Veinte pacientes fueron intervenidos directamente, mientras que se intentó la colocación de un stent en 57 pacientes. En el grupo Stent hubo más intervenciones laparoscópicas (64,9 vs. 5%, p < 0,001), más anastomosis primarias (91,2 vs. 55%, p = 0,001), menos estomas (10,5 vs. 50%, p = 0,001) y una estancia postoperatoria más corta (7 vs. 12 días, p = 0,014). La morbilidad a los 30 días fue menor en el grupo Stent, pero no de forma significativa (29,8 vs. 50%, p = 0,104), aunque sí lo fue la mortalidad (1,8 vs. 20%, p = 0,015). Respecto a los resultados oncológicos, no se encontraron diferencias significativas al comparar la supervivencia global, el intervalo libre de enfermedad, la supervivencia libre de recidiva local o a distancia ni la supervivencia libre de progresión. CONCLUSIONES: La utilización de stents cólicos como PAC de las neoplasias colorrectales oclusivas potencialmente resecables parece proporcionar mejores resultados quirúrgicos y resultados oncológicos equiparables a los de los pacientes intervenidos directamente

INTRODUCTION: The outcomes of patients treated with colonic stents as a bridge to surgery (BTS) have recently been questioned in terms of safety and long-term oncologic outcomes. The aim of this study is to evaluate the effects on surgical and oncologic outcomes of colonic stents as a BTS for potentially resectable obstructive colorectal cancer. METHODS: We conducted a retrospective analysis of patients operated on for potentially resectable obstructive colorectal cancer with or without distant disease between September 2002 and October 2015, comparing the patients treated with a colonic stent as a BTS (Stent group) with those directly operated on (Surgery group). RESULTS: Twenty patients underwent urgent surgery, while stent placement as a BTS was attempted in 57 patients. The Stent group had more patients treated with a laparoscopic approach (64.9 vs. 5%, P < .001), higher primary anastomosis rate (91.2 vs. 55%, P = .001), less need for stomata (10.5 vs. 50%, P = .001) and shorter postoperative hospital stay (7 vs. 12 days, P = .014). Thirty-day morbidity was reduced in the Stent group, although not significantly (29.8 vs. 50%, P = .104). However, 30-day mortality was significantly lower (1.8 vs. 20%, P = .015). Regarding the long-term oncologic outcomes, no significant differences were found when comparing overall survival, disease-free survival, local recurrence-free survival, distant recurrence-free survival or progression-free survival. CONCLUSIONS: Colonic stenting as a BTS for potentially resectable obstructive colorectal cancer seems to offer better surgical and equal long-term oncologic outcomes when compared to those of patients directly operated on

Impact on surgical and oncological results of the use of colonic stents as a bridge to surgery for potentially curable occlusive colorectal neoplasms. / Impacto de la utilización de stents colónicos como puente a la cirugía de neoplasias colorrectales oclusivas potencialmente curables sobre los resultados quirúrgicos y oncológicos.

INTRODUCTION: The outcomes of patients treated with colonic stents as a bridge to surgery (BTS) have recently been questioned in terms of safety and long-term oncologic outcomes. The aim of this study is to evaluate the effects on surgical and oncologic outcomes of colonic stents as a BTS for potentially resectable obstructive colorectal cancer. METHODS: We conducted a retrospective analysis of patients operated on for potentially resectable obstructive colorectal cancer with or without distant disease between September 2002 and October 2015, comparing the patients treated with a colonic stent as a BTS (Stent group) with those directly operated on (Surgery group). RESULTS: Twenty patients underwent urgent surgery, while stent placement as a BTS was attempted in 57 patients. The Stent group had more patients treated with a laparoscopic approach (64.9 vs. 5%, P<.001), higher primary anastomosis rate (91.2 vs. 55%, P=.001), less need for stomata (10.5 vs. 50%, P=.001) and shorter postoperative hospital stay (7 vs. 12 days, P=.014). Thirty-day morbidity was reduced in the Stent group, although not significantly (29.8 vs. 50%, P=.104). However, 30-day mortality was significantly lower (1.8 vs. 20%, P=.015). Regarding the long-term oncologic outcomes, no significant differences were found when comparing overall survival, disease-free survival, local recurrence-free survival, distant recurrence-free survival or progression-free survival. CONCLUSIONS: Colonic stenting as a BTS for potentially resectable obstructive colorectal cancer seems to offer better surgical and equal long-term oncologic outcomes when compared to those of patients directly operated on.

Megarrecto condicionante de oclusión intestinal / Intestinal obstruction and megarectum

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Vasitis mimicking an Amyand's hernia: A case report.

INTRODUCTION: Amyand's hernia is an inguinal hernia containing the caecal appendix. It is usually an intraoperative finding, although it can be diagnosed preoperatively with radiologic examinations, which would show a tubular structure inside the inguinal canal. PRESENTATION OF CASE: A male patient presented to the emergency department complaining of abdominal pain in the right lower quadrant. He had been orchidectomized during his childhood due to cryptorchidism, and had been under antibiotic treatment a week before due to a suspected gonorrhoea. A small irreductible mass was found in the right groin. Blood tests showed leucocytosis and elevated CRP. A CT-scan was performed, reporting a tubular structure with a blind end entering the inguinal canal that seemed to be the appendix. Single-port laparoscopic exploration was indicated, and a right vasitis was found instead of an Amyand's hernia. After the operation, the patient explained that he had not taken the antibiotics for the gonorrhoea. DISCUSSION: Untreated gonorrhoea causes ascendant vasitis and orchyepididimitis. In the present case, since the patient did not have testicles, the inflamed vas deferens mimicked the Appendix inside the inguinal canal. If the patient had told the truth about the untreated gonorrhoea, maybe the condition would have been suspected and no radiological examinations would have been performed, which subsequently lead to an unnecessary operation. CONCLUSION: Presently, Amyand's hernia is more frequently diagnosed preoperatively than intraoperatively. However when an Amyand's hernia is preoperatively suspected, the possibility of a vasitis should always be ruled out in order to avoid unnecessary operations.