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1.
Colorectal Dis ; 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31487087

RESUMO

Anastomotic leakage (AL) is one of the dire consequences of colorectal surgery and is associated with significant morbidity and mortality. The highest risk occurs in distal colorectal, coloanal, and ileoanal anastomoses. Therefore, every attempt should be made to decrease the incidence of, or ideally prevent, AL, particularly in these higher risk anastomoses. We describe our standard technique of quadruple assessment of colorectal and coloanal anastomoses. This article is protected by copyright. All rights reserved.

2.
Colorectal Dis ; 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31490019

RESUMO

Desmid tumours are myofibroblastic tumours that originate from the muscle aponeurosis and represent around 3% of all soft tissue neoplasms [1]. They commonly affect the extremities and to a lesser extent the abdominal wall and intestinal mesentery [2]. Although they do not have metastatic potential, desmoid tumours are known to be associated with aggressive local infiltration of the surrounding tissues.

4.
Dis Colon Rectum ; 62(8): 980-987, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162376

RESUMO

BACKGROUND: Complex anal fistula is one of the challenging anorectal conditions. Several treatments have been proposed for complex anal fistula, yet none proved to be ideal. OBJECTIVE: This randomized trial aimed to assess the efficacy of external anal sphincter-sparing seton in comparison with the conventional drainage seton in the treatment of complex anal fistula. DESIGN: This was a prospective, randomized, single-blind controlled study. SETTINGS: The study was conducted at the Colorectal Surgery Unit of Mansoura University Hospitals. PATIENTS: Adult patients of both sexes with complex anal fistula were recruited and evaluated with MRI before surgery. INTERVENTIONS: Patients were randomly divided into 2 groups; group 1 was treated with conventional drainage seton and group 2 was treated with external anal sphincter-sparing seton using a rerouting technique. MAIN OUTCOME MEASURES: The duration of healing, incidence of recurrence or persistence, postoperative pain, and complications including fecal incontinence were measured. RESULTS: Sixty patients (56 men) with a mean age of 43 years were included. Mean operation time in group 1 was significantly shorter than group 2 (29.8 ± 4.3 vs 43.8 ± 4.5 min; p < 0.0001). The mean pain score at 24 hours in group 1 was 8.1 ± 1.6 versus 5.3 ± 1.3 in group 2 (p < 0.0001). Five patients (17%) in group 1 experienced complications versus 2 (7%) in group 2. All of the patients in group 1 required a second-stage fistulotomy versus 2 patients (7%) in group 2 (p < 0.0001). Time to complete healing in group 1 was significantly (p < 0.0001) longer than group 2 (103 ± 47 vs 46 ± 18 d). Four patients (13%) in group 1 and 1 patient (3%) in group 2 experienced persistence or recurrence of anal fistula (p = 0.35). LIMITATIONS: This was a single-center study with relatively small numbers in each group. CONCLUSIONS: Patients treated with external anal sphincter-sparing seton after rerouting of the fistula tract achieved quicker healing and less postoperative pain than those with conventional drainage seton. Postoperative complication and recurrence rates were comparable in both groups. See Video Abstract at http://links.lww.com/DCR/A963. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03636997 (https://clinicaltrials.gov/ct2/show/NCT03636997).

5.
Surg Endosc ; 33(8): 2444-2455, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31041515

RESUMO

BACKGROUND: Laparoscopic ventral mesh rectopexy (LVMR) has proved effective in the treatment of internal and external rectal prolapse. The present meta-analysis aimed to determine the predictive factors of recurrence of full-thickness external rectal prolapse after LVMR. METHODS: An organized, systematic search of electronic databases including PubMed/Medline, Embase, Scopus, and Cochran library was conducted in adherence to PRISMA guidelines. Studies that reported the outcome of LVMR in patients with full-thickness external rectal prolapse were included according to predefined criteria. A meta-regression analysis and sub-group meta-analyses were performed to recognize the patient and technical factors that were associated with higher recurrence rates. RESULTS: Seventeen studies comprising 1242 patients of a median age of 60 years were included. The median operation time was 122.3 min. Conversion to open surgery was required in 22 (1.8%) patients. The weighted mean complication rate across the studies was 12.4% (95% CI 8.4-16.4) and the weighted mean rate of recurrence of full-thickness external rectal prolapse was 2.8% (95% CI 1.4-4.3). The median follow-up duration was 23 months. Male gender (SE = 0.018, p = 0.008) and length of the mesh (SE = - 0.007, p = 0.025) were significantly associated with full-thickness recurrence of rectal prolapse. The weighted mean rates of improvement in fecal incontinence and constipation after LVMR were 79.3% and 71%, respectively. CONCLUSION: LVMR is an effective and safe option in treatment of full-thickness external rectal prolapse with low recurrence and complication rates. Male patients and length of the mesh may potentially have a significant impact on recurrence of rectal prolapse after LVMR.

7.
Int J Surg ; 66: 18-27, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30999055

RESUMO

BACKGROUND: We conducted a systematic review on the diagnostic accuracy of classical and newly reported hematological parameters which are easily available in a resource limited setting in making a diagnosis of Acute Mesenteric Ischemia (AMI). METHODS: We searched the PubMed, Scopus, and Cochrane library from January 1940 to April 2018. The search was limited to studies published in English and those involving human subjects only. The diagnostic accuracy of conveniently available parameters: Mean Platelet Volume (MPV), Neutrophil to Lymphocyte Ratio (NLR), Red Cell Distribution Width (RDW), lactate, D-dimer, alkaline aminotransferase, aspartate amino transferase, white blood cell count, lactate dehydrogenase, and amylase were assessed in this review. Studies were only included if they provided sufficient information allowing us to make a diagnostic accuracy contingency table and define a gold standard test. We excluded letters, editorials, and case reports. There were no restrictions to any particular study design. The QUADAS 2 protocol was used for quality appraisal. This study protocol was registered on Prospero with ID CRD42018088953. RESULTS: Of 560 articles which were initially retrieved, 20 studies, comprising of 2043 participants, were eligible for this review. AMI was diagnosed in 518 patients. D-dimer had the highest median sensitivity of 93% while the median specificity of lactate and NLR were 85.9 and 85.8, respectively. CONCLUSION: Observing the high heterogeneity among the studies, currently it is difficult to suggest any single marker for diagnosing AMI. Compared to the classical markers, RDW, NLR and MPV showed higher specificities. Using these new markers alongside with the classical markers in the context of a scoring system might help in making a diagnosis of AMI in emergency settings.


Assuntos
Biomarcadores/sangue , Isquemia Mesentérica/diagnóstico , Doença Aguda , Aspartato Aminotransferases/sangue , Índices de Eritrócitos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Contagem de Leucócitos , Linfócitos/patologia , Volume Plaquetário Médio , Neutrófilos/patologia , Sensibilidade e Especificidade
8.
World J Gastroenterol ; 25(13): 1560-1565, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30983816

RESUMO

Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer (CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells (MSCs) and bone marrow-mononuclear cells (BM-MNCs) therapy. These cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.


Assuntos
Neoplasias Colorretais/terapia , Transplante de Células-Tronco Mesenquimais , Monócitos/transplante , Complicações Pós-Operatórias/terapia , Cicatrização , Animais , Colectomia/efeitos adversos , Colo/patologia , Colo/cirurgia , Neoplasias Colorretais/patologia , Modelos Animais de Doenças , Progressão da Doença , Humanos , Complicações Pós-Operatórias/etiologia , Protectomia/efeitos adversos , Ratos , Reto/patologia , Reto/cirurgia , Resultado do Tratamento
10.
J. coloproctol. (Rio J., Impr.) ; 39(1): 81-89, Jan.-Mar. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-984639

RESUMO

ABSTRACT Background: Excisional hemorrhoidectomy is one of the most commonly performed anorectal procedures. Despite the satisfactory outcomes of excisional hemorrhoidectomy, the pain perceived by the patients following the procedure can be a distressing sequel. This review aimed to search the current literature for the existing evidence on how to avoid or minimize the severity of post-hemorrhoidectomy pain. Methods: An organized literature search was performed using electronic databases including PubMed/Medline and Google Scholar service for the articles that evaluated different methods for pain relief after excisional hemorrhoidectomy. Then, the studies were summarized in a narrative way illustrating the hypothesis and the outcomes of each study. The methods devised to reduce pain after excisional hemorrhoidectomy were classified into three main categories: technical tips; systemic and topical agents; and surgical methods. The efficacy of each method was highlighted along the level of evidence supporting it. Results: Stronger evidence (level Ia) supported LigaSure hemorrhoidectomy and the use of glyceryl trinitrate ointment to be associated with significant pain relief after excisional hemorrhoidectomy whereas the remaining methods were supported by lower level of evidence (level Ib). Conclusion: The use of LigaSure in performing excisional hemorrhoidectomy and the application of topical glyceryl trinitrate ointment contributed to remarkable relief of postoperative pain after excisional hemorrhoidectomy according to the highest level of evidence. Perhaps a multimodality strategy that combines systemic and topical agents can be the optimal method for control of pain after excisional hemorrhoidectomy, yet further prospective trials are required to draw such conclusion.


RESUMO Introdução: A hemorroidectomia excisional (HE) é um dos procedimentos anorretais mais comumente realizados. Apesar dos resultados satisfatórios da hemorroidectomia excisional, a dor percebida pelos pacientes após o procedimento pode ser uma sequela angustiante. Esta revisão teve como objetivo buscar na literatura atual as evidências existentes sobre como evitar ou minimizar a gravidade da dor pós-hemorroidectomia. Métodos: Uma busca organizada da literatura foi realizada usando bancos de dados eletrônicos, incluindo PubMed/Medline e Google Scholar, para os artigos que avaliaram diferentes métodos para o alívio da dor após hemorroidectomia excisional. Em seguida, os estudos foram resumidos de forma narrativa, ilustrando a hipótese e os resultados de cada estudo. Os métodos desenvolvidos para reduzir a dor após a hemorroidectomia excisional foram classificados em três categorias principais: dicas técnicas; agentes sísticos e ticos; e métodos cirúrgicos. A eficácia de cada método foi destacada ao longo do nível de evidência que a suporta. Resultados: Evidências mais fortes (nível Ia) apoiaram a hemorroidectomia de LigaSure e o uso de pomada de trinitrato de glicerila para ser associado com alívio significativo da dor após hemorroidectomia excisional, enquanto os métodos restantes foram apoiados por menor nível de evidência (nível Ib). Conclusão: O uso de LigaSure na realização de hemorroidectomia excisional e a aplicação de pomada tópica de gliceril trinitrato contribuíram para o notável alívio da dor pós-operatória após hemorroidectomia excisional, de acordo com o maior nível de evidência. Talvez uma estratégia multimodal que combine agentes sistêmicos e tópicos possa ser o método ideal para o controle da dor após hemorroidectomia excisional, mas ainda são necessários mais estudos prospectivos para chegar a essa conclusão.

11.
Obes Surg ; 29(5): 1534-1541, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30706309

RESUMO

BACKGROUND: Based on the promising results of transversus abdominis plane (TAP) block in various abdominal procedures, this study aimed to investigate its effect on postoperative pain and early outcome after laparoscopic bariatric procedures. METHODS: Patients with morbid obesity were randomly assigned to one of two equal groups; group I had US-guided TAP block upon completion of the bariatric procedure and before recovery from general anesthesia and group II did not have TAP block. All procedures were performed laparoscopically with a standardized five-trocar technique. RESULTS: Ninety-two patients of a mean age of 34.7 years and mean BMI of 49.5 kg/m2 were included. The mean pain score in group I was significantly lower than group II at 1 and 6 h postoperatively, whereas no significant differences in pains scores at 12 and 24 h between the two groups were observed. Eight patients in group I required rescue opioid analgesia within the first 24 h postoperatively, compared with 24 patients in group II (P < 0.0001). The postoperative nausea and vomiting (PONV) score at 24 h was significantly lower in group I than group II. Group I required a significantly shorter time to full ambulation and to pass flatus compared with group II. Hospital stay was similar in the two groups. CONCLUSION: Using US-guided TAP block in adjunct with laparoscopic bariatric surgery managed to achieve lower pain scores, lower opioid requirements, lower PONV scores, earlier ambulation, shorter time to pass flatus, and comparable hospital stay and complication rate to the control group.

12.
Obes Surg ; 29(5): 1614-1623, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30734195

RESUMO

BACKGROUND: One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. METHODS: Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively. RESULTS: Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). CONCLUSION: Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate.

13.
Surg Endosc ; 33(5): 1368-1375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30675660

RESUMO

BACKGROUND: The transanal approach to pelvic dissection has gained considerable traction and utilization continues to expand, fueled by the transanal total mesorectal excision (TaTME) for rectal cancer. The same principles and benefits of transanal pelvic dissection may apply to the transanal restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA)-the TaPouch procedure. Our goal was to review the literature to date on the development and current state of the TaPouch. MATERIALS AND METHODS: We performed a PubMed database search for original articles on transanal pelvic dissections, IPAA, and the TaPouch procedure, with a manual search from relevant citations in the reference list. The main outcomes were the technical aspects of the TaPouch, clinical and functional outcomes, and potential advantages, drawbacks, and future direction for the procedure. RESULTS: The conduct of the procedure has been defined, with the safety and feasibility demonstrated in small series. The reported rates of conversion and anastomotic leakage are low. There are no randomized trials or large-scale comparative studies available for comparative effectiveness compared to the traditional IPAA. CONCLUSIONS: The transanal approach to ileal pouch-anal anastomosis is an exciting adaption of the transanal total mesorectal excision for refining the technical steps of a complex operation. Additional experience is needed for comparative outcomes and defining the ideal training and implementation pathways.

15.
Colorectal Dis ; 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30457180

RESUMO

BACKGROUND: Three-dimensional (3D) printing has been recognized as a revolutionary technological innovation that has benefitted numerous disciplines, including medicine. The present systematic review aimed to demonstrate the current applications of 3D printing in colorectal surgery along with the limitations and potential future applications of this innovation. METHODS: A PRISMA-compliant systematic literature search of studies that applied 3D printing in colorectal surgery in the period January 1990 through to July 2018 was conducted. Electronic databases including PubMed/Medline, Scopus, and Cochrane library were searched. All full-text original articles were eligible for inclusion. RESULTS: Nine studies including 58 patients of a median age of 60.7 years were reviewed. The studies assessed 3D printing in patients with planned stoma construction, colon cancer with liver metastasis, right colon cancer, rectal cancer, intractable constipation and anal fistula. The applications of 3D printing were classified into three categories: patient education, preoperative planning, and evaluation of response of colorectal liver metastasis to chemotherapy. 3D printed models aided in planning resection of colorectal liver metastasis, facilitating D3 lymphadenectomy in complete mesocolic excision, improving the understanding of pelvic anatomy in laparoscopic rectal cancer treatment, guiding electrode implantation in sacral neuromodulation for intractable constipation, and elucidating the morphology of anal fistula tract and anal sphincter muscles. CONCLUSION: Colorectal surgery may benefit from 3D printing in enhancing patient education before stoma construction, preoperative planning, and evaluation of response of liver metastasis to chemotherapy using 3D ultrasonography. This article is protected by copyright. All rights reserved.

16.
Int J Colorectal Dis ; 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30421308

RESUMO

BACKGROUND: Although conventional hemorrhoidectomy proved effective in treatment of hemorrhoidal disease, postoperative pain remains a vexing problem. Alternatives to conventional hemorrhoidectomy as transanal hemorrhoidal dearterialization (THD) and stapled hemorrhoidopexy (SH) were described. The present meta-analysis aimed to review the randomized trials that compared THD and SH to determine which technique is superior in terms of recurrence of hemorrhoids, complications, and postoperative pain. METHODS: Electronic databases were searched for randomized trials that compared THD and SH for internal hemorrhoids. The PRISMA guidelines were followed when reporting this meta-analysis. The primary endpoint of the analysis was persistence or recurrence of hemorrhoidal disease. Secondary endpoints were postoperative pain, complications, readmission, return to work, and patients' satisfaction. RESULTS: Six randomized trials including 554 patients (THD = 280; SH = 274) were included. The mean postoperative pain score of THD was significantly lower than SH (2.9 ± 1.5 versus 3.3 ± 1.6). 13.2% of patients experienced persistent or recurrent hemorrhoids after THD versus 6.9% after SH (OR = 1.93, 95%CI = 1.07-3.51, p = 0.029). Complications were recorded in 17.1% of patients who underwent THD and 23.3% of patients who underwent SH (OR = 0.68, 95%CI 0.43-1.05, p = 0.08). The average duration to return to work after THD was 7.3 ± 5.2 versus 7.7 ± 4.8 days after SH (p = 0.34). Grade IV hemorrhoids was significantly associated with persistence or recurrence of hemorrhoidal disease after both procedures. CONCLUSION: THD had significantly higher persistence/recurrence rate compared to SH whereas complication and readmission rates, hospital stay, return to work, and patients' satisfaction were similar in both groups.

17.
J. coloproctol. (Rio J., Impr.) ; 38(3): 199-206, July-Sept. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-954603

RESUMO

ABSTRACT Background: Fistula-in-ano commonly affects males more than females. Some differences in the characteristics of fistula-in-ano between both genders have been recognized, yet the impact of these differences on the outcomes of surgery for fistula-in-ano is still unclear. The present study conducted a gender-specific analysis aiming to assess the characteristics and the outcomes of surgery of fistula-in-ano in each gender. Patients and methods: The records of patients with fistula-in-ano were retrospectively reviewed and the following variables were extracted: patients' demographics, type of fistula-in-ano, position of the external opening, operation performed, incidence of recurrence and complications, particularly fecal incontinence. Gender-based analysis of the characters and outcomes of surgery for fistula-in-ano was performed. Results: 565 (491 males) patients of a mean age of 41.7 years were included. Females had a significantly higher percentage of low fistula-in-ano than males (70.2% vs. 50.3%, p = 0.002). Males had a significantly higher percentage of high trans-sphincteric fistula-in-ano (48.5% vs. 29.7%; p = 0.003). Anterior fistula-in-ano was more common in female patients (69% vs. 16.3%; p < 0.0001). Recurrence of fistula-in-ano was detected in 42 (7.4%) patients. Males had higher recurrence rate than females (7.9% vs. 4%; p = 0.34). Fecal incontinence developed in 1.7% of patients with higher incidence observed in females (4% vs. 1.4%). Conclusion: The majority of fistula-in-ano in males were posterior and high trans-sphincteric whereas most fistula-in-ano in females were low and anteriorly based. Despite the different characteristics of fistula-in-ano; no significant differences in the rates of fistula recurrence and fecal incontinence between males and females could be recorded.


RESUMO Background: A fístula anal comumente acomete mais os homens que as mulheres. Algumas diferenças nas características da fístula anal entre ambos os sexos têm sido reconhecidas, embora o impacto dessas diferenças nos desfechos da cirurgia para fístula anal ainda seja incerto. O presente estudo realizou uma análise específica para sexo, com o objetivo de avaliar as características e os desfechos da cirurgia de fístula anal em cada sexo. Pacientes e métodos: Os prontuários de pacientes com fístula anal foram revisados retrospectivamente e as seguintes variáveis foram extraídas: dados demográficos dos pacientes, tipo de fístula anal, posição da abertura externa, cirurgia realizada, incidência de recidiva e complicações, particularmente incontinência fecal. Realizou-se uma análise baseada no sexo dos sujeitos e desfechos da cirurgia para fístula anal. Resultados: Foram incluídos 565 pacientes (491 do sexo masculino) com idade média de 41,7 anos. As mulheres apresentaram uma porcentagem significativamente mais alta de fístula anal baixa do que os homens (70,2% vs. 50,3%, p = 0,002). Os homens tiveram uma porcentagem significativamente maior de fístula anal transesfincteriana alta (48,5% vs. 29,7%; p = 0,003). A fístula anal anterior foi mais comum em pacientes do sexo feminino (69% vs. 16,3%; p < 0,0001). A recorrência de fístula anal foi detectada em 42 (7,4%) pacientes. Os homens apresentaram maior taxa de recorrência do que as mulheres (7,9% vs. 4%; p = 0,34). A incontinência fecal desenvolveu-se em 1,7% dos pacientes com maior incidência observada no sexo feminino (4% vs. 1,4%). Conclusão: A maioria das fístulas anais no sexo masculino foi posterior e transesfincteriana alta, enquanto a maioria das fístulas anais no sexo feminino foi baixa e anterior. Apesar das diferentes características da fístula anal, não foi possível registrar diferenças significativas nas taxas de recorrência de fístula e incontinência fecal entre homens e mulheres.

19.
J Surg Res ; 227: 95-100, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29804869

RESUMO

BACKGROUND: Electrogastrography (EGG) is a noninvasive technique for recording gastric myoelectric activity. The aim of this study was to measure and record gastric myoelectric activity in patients with obstructed defecation syndrome (ODS) and to compare their results with those of normal individuals. METHODS: Forty-two patients (22 male) with ODS and a mean age of 41.02 y were enrolled in this prospective study after thorough clinical and physiologic assessment. Eleven normal subjects (six female) with a mean age of 39.2 ± 8.4 y were assigned to the control group. Both patients and controls were subjected to surface EGG in fasting and postprandial states. Data were recorded and analyzed via a computer system to reveal the EGG pattern in both groups. RESULTS: Abnormalities in the EGG were found in 24 (57.1%) of the 42 patients with ODS. EGG in ODS patients showed alterations in the fasting state in the form of a significant decrease of the normal gastric slow wave (P = 0.03) and a nonsignificant increase in gastric dysrhythmias. The EGG alterations of ODS patients were significantly improved in the postprandial state as the normal gastric slow waves significantly (P = 0.006) increased and the gastric bradycardia declined significantly (P = 0.02). No significant differences were observed in the power distribution between the ODS patients and the healthy controls. CONCLUSIONS: Patients with ODS showed an altered EGG pattern compared with that of healthy control subjects. The alterations in ODS patients were more clearly observed during the fasting state and improved significantly after eating.

20.
Int J Colorectal Dis ; 33(10): 1461-1467, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29779044

RESUMO

BACKGROUND: Lateral internal anal sphincterotomy (LIS) is considered the treatment of choice for chronic anal fissure. This study aimed to compare the outcome of standard LIS and posterolateral internal sphincterotomy (PLIS) at 5 o'clock position as regards healing of anal fissure, improvement in symptoms, and complications. METHODS: Patients with chronic anal fissure were randomly allocated to one of two groups; group I underwent PLIS and group II underwent LIS. Patients were compared regarding the duration of healing of anal fissure, improvement in anal pain as recorded by visual analogue scale (VAS), complications, particularly fecal incontinence (FI) and changes in the anal pressures. RESULTS: Eighty (49 females) patients were included to this trial. The mean age of patients was 35.5 years. The duration of healing was significantly shorter in group I than in group II (4.1 ± 1.7 vs 5.8 ± 1.4 weeks; p < 0.0001). Group I achieved significantly lower pain score at 1 month postoperatively than group II (1.1 ± 0.9 vs 1.7 ± 0.98; p = 0.005). Two (2.5%) of group I patients and six (10%) of group II patients experienced minor FI postoperatively. The postoperative reduction in the mean resting anal pressure in group I was significantly higher than that in group II. CONCLUSION: Time to complete healing was significantly shorter and pain score was significantly lower after PLIS than after LIS which can be due to more reduction in the resting anal pressure after PLIS. Continence disturbances occurred after PLIS less frequently than after LIS; however, no significant differences between the two techniques were noted. TRIAL REGISTRATION: www.clinicaltrials.gov NCT03426449.

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