Operative results, sexual function and quality of life after gracilis muscle transposition in complex rectovaginal fistulas.

AIM: Successful treatment of complex rectovaginal fistulas (RVFs) continues to be a surgical challenge. Interposition of well-perfused tissue, such as gracilis muscle, is one treatment option. The aim of this study was to investigate the operative results, sexual function and quality of life after gracilis muscle transposition (GMT) in the authors' own group of patients. METHOD: The study included 19 women with RVF (mean age 48 years). The postoperative outcome was evaluated by a questionnaire and clinical examination. RESULTS: The postoperative follow-up period was 7 months to 3.5 years (mean 23 months). GMT led to primary healing of RVF in 10 (53%) patients. Recurrences were observed in nine (47%) patients with RVF, in four (44%) of whom healing was achieved as a result of further interventions. Following GMT, two complications (abscess formation) requiring revision occurred. Although 42% of the patients reported certain limitations following muscle removal, GMT is a procedure that has a positive influence on the healing rate (74%), quality of life, continence and patient satisfaction. CONCLUSION: GMT is a procedure that allows healing in the majority of patients with RVFs, and it should be considered especially in patients with recurrent fistulas, in whom a correlation between decreasing healing rates and the number of previous operations has been demonstrated.

[Alloplastic material in prolapse surgery : Indications and postoperative outcome of ventral rectopexy]. / Alloplastisches Material in der Prolapschirurgie : Indikation und postoperatives Outcome der ventralen Rektopexie.

BACKGROUND: In rectopexy the use of meshes provides stability by mechanical support as well as by the induction of scar formation; however, one of the problems of conventional methods of mesh rectopexy is that many patients postoperatively suffer from functional disorders, such as fecal incontinence and stool evacuation disorders. One reason is the damage of vegetative nerves following dorsal and lateral mobilization of the rectum, which is required for positioning of the mesh. In 2004 D'Hoore and Penninckx first described the method of ventral rectopexy, a new technique of mesh rectopexy which allows preservation of the autonomic nerves. OBJECTIVE: Does ventral rectopexy provide advantages regarding functional outcome, complications and recurrence rates? MATERIAL AND METHODS: A search was carried out in the databases PubMed and Medline for studies on ventral rectoplexy. Presentation and analysis of the current state of relevant studies relating to ventral rectopexy. RESULTS: Ventral rectopexy is characterized by a low complication rate and good functional results in terms of improvement of incontinence, constipation and stool evacuation disorders. The indications for ventral rectopexy are considered in patients with external prolapse of the rectum. Also in a well-selected patient population internal prolapse, rectocele as well as enterocele accompanied by obstructive defecation syndrome represent relative indications for ventral rectopexy. CONCLUSION: In order to obtain a valid assessment of the value of this procedure it is crucial to improve the current lack of evidence (level 3) by prospective randomized studies that compare ventral rectopexy with other surgical techniques and nonsurgical treatment options.

[Complication management following hemorrhoid operations]. / Komplikationsmanagement bei Hämorrhoidenoperationen.

BACKGROUND: Hemorrhoid operations are performed frequently in Germany. After the operation severe complications can occur that require appropriate management. OBJECTIVE: Presentation of current complications and suitable therapeutic options. MATERIAL AND METHODS: Data including operative procedures and complications that have been collected in an electronic online-based survey of all resident, affiliated and private practice German surgeons during the period from 1 December 2009 to 31 January 2010 are presented. A review of the current literature in a PubMed search is given. RESULTS: Stapled hemorrhoidopexy has several benefits during the early postoperative phase in comparison to conventional hemorrhoidectomy; however, patients should be informed about the possibility of postoperative defecation disorders, elevated recurrence and reoperation rates and rare life-threatening complications. CONCLUSION: The aim should be to keep risks at a low level by means of prevention, patient selection, careful analysis of indications and relevant expertise. In cases of complications early recognition and direct initiation of adequate treatment are crucial.

[Total mesorectal excison and colonic-J-pouch-anal anastomosis in the therapy of low rectal carcinoma--results in 116 patients]. / Totale mesorektale Exzision und Kolon-J-Pouch-anale Anastomose als Therapie des tiefsitzenden Rektumkarzinoms--Ergebnisse bei 116 Patienten.

BACKGROUND: Total mesorectal excision with coloanal anastomosis has been accepted as standard therapy of low rectal carcinoma. Interposition of colonic J-pouch improved the functional results and was associated with better postoperative quality of life. In this study our own results are evaluated. METHODS: Between 1. 7. 1999 and 30. 6. 2001 116 patients underwent total mesorectal excision with coloanal anastomosis and colonic J-pouch interposition. Thirty-eight patients (32.9 %) with uT3-carcinoma received preoperative adjuvant short-time irradiation with 5 x 5 Gy and seven patients (6.0 %) with local non resectable cancer conventional radiochemotherapy with 50.4 Gy. A protective stoma was constructed in 56 patients (48.3 %). Six patients (5.2 %) received secondary stoma due to anastomotic complications. RESULTS: A clinically relevant insufficiency of the anastomosis occurred in eight patients (6.9 %). Three patients needed a secondary laparotomy for local peritonitis. Fecal diversion was constructed secondarily in four patients due to pouchvaginal fistula and in one patient for ischiorectal abscess one year after the first operation. Six patients revealed small fistulas in the radiological examination without clinical consequences. Five patients with primary fecal diversion showed pouchvaginal fistulas. The over-all anastomotic complication rate was 16.4 %. The follow-up demonstrated already in the first year after surgery good functional results with satisfying anorectal continence. Only nine patients complained of intermittent incontinence for solid stool. No patient needed a definitive stoma due to anastomotic complications. One patient developed a small anastomotic tumor recurrence one year after surgery. He could be cured by abdomino-perineal excision. CONCLUSIONS: Our results confirm the importance of total mesorectal excision as standard therapy for low rectal carcinoma. Good functional results can be obtained already in the early postoperative period by colonic J-pouch interposition.

[Cutaneous lupus erythematosus and cardiolipin antibodies. Incidence and clinical significance]. / Kutaner Lupus erythematodes und Kardiolipin-Antikörper. Vorkommen und klinische Bedeutung.

In recent years, the importance of antiphospholipid antibodies in systemic lupus erythematosus and various other dermatological and internal diseases has been recognized. Characteristic symptoms associated with these antibodies are venous and arterial thrombosis, recurrent fetal loss, thrombocytopenia, and haemolytic anaemia. Two antiphospholipid antibody subgroups that are clinically relevant can be discerned: anticardiolipin antibodies and lupus coagulant. In this study, 51 clinically well-characterized patients with predominantly cutaneous lupus erythematosus were screened for the presence of anticardiolipin antibodies. Anticardiolipin antibodies could be detected in only three patients. These data suggest that, in patients with cutaneous lupus erythematosus, anticardiolipin antibodies should be measured only in the presence of symptoms associated with antiphospholipid antibodies.