Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.252
Filtrar
1.
Neurol India ; 69(5): 1354-1355, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747811

RESUMO

The use of intraoperative neurophysiological monitoring is a helpful tool during surgeries of conus medullaris tumors and helps in reducing the risk of post-operative functional compromise like paraparesis, sensory deficits, or urological dysfunctions. External anal sphincter (EAS) motor evoked potential (MEP) monitoring is usually done for monitoring sacral nerve roots and to prevent post-operative neurological deficits. Here we describe a case where unilateral motor cortical stimulation aided us to differentiate the laterality of TcMEP responses in EAS.


Assuntos
Potencial Evocado Motor , Neoplasias da Medula Espinal , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Humanos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Raízes Nervosas Espinhais
2.
Eur J Oncol Nurs ; 55: 102059, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34757270

RESUMO

PURPOSE: Patients with mid-to low-rectal cancer can have various dysfunctions of defecation after sphincter-saving resection. Defecation dysfunction can manifest as incontinence, urgency, or frequent bowel movements, and is called low anterior resection syndrome (LARS). This study aimed to examine LARS score and objective anorectal function indices in Chinese patients receiving sphincter-saving surgery for mid-to low-rectal cancer. METHOD: This was a single-center cross-sectional study of patients undergoing sphincter-saving resection for low- or mid-rectal cancer and had restoration of trans-anal defecation for at least 1 month seen between January 2019 and June 2020. Patients completed a questionnaire regarding clinical characteristics, and Low Anterior Resection Syndrome (LARS) score and high-resolution anorectal manometry (HR-ARM) were used to assess defecation function. Multivariable analysis was used to identify variables significantly associated with defecation dysfunction. RESULTS: 146 patients completed and returned the questionnaires. 25 healthy adults also participated as control group for the anorectal manometry. Approximately 76% of patients developed LARS after surgery, of which 35.6% had major LARS. In these patients, anorectal manometry indices including initial rectal sensory capacity and rectal fecal sensory capacity, were significantly lower than normal. Logistic regression analysis showed that preoperative chemo-radiotherapy and the tumor inferior margins being close to the dentate line, especially 2-5 cm, were independent risk factors for defecation dysfunction after surgery. CONCLUSIONS: Defecation dysfunction is a frequent occurrence after sphincter-saving resection for mid- and low-rectal cancer. Preoperative chemo-radiotherapy and a shorter tumor inferior margins distance to the dentate line are independent factors for defecation dysfunction.


Assuntos
Incontinência Fecal , Neoplasias Retais , Adulto , Canal Anal/cirurgia , Estudos Transversais , Defecação , Incontinência Fecal/etiologia , Humanos , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Síndrome , Resultado do Tratamento
3.
Medicina (Kaunas) ; 57(11)2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34833422

RESUMO

Anal canal duplication (ACD) is a very rare condition, diagnosed and treated mostly in childhood. Less than 90 cases have been reported in the literature so far. We are presenting a case of a young woman who underwent surgical excision of the duplication when she was 27 years old. The patient was unaware of her condition and was referred from a gynaecological office to the surgical department with a history of perianal discomfort and mucus discharge. Local examination showed an external orifice posterior to the anal opening, on the median line, which had the macroscopic appearance of a secondary anal orifice. The opening was about 0.5 cm in diameter. Exploration of the tract revealed a length of about 4 cm. MRI described the aforementioned tract, parallel to the anal canal, with no other anomalies mentioned. Under spinal anesthesia, with the patient in jackknife position, the accessory anal canal was surgically excised. The pathology report showed the presence of smooth muscle fibers and typical anal glands in the specimen. After a five-year follow-up, the patient showed no recurrence or any other related local symptoms. Absence of perianal abscess from the patient history, along with the macroscopic aspect of the opening similar to a secondary anal orifice on the midline, should raise the suspicion of ACD. Due to the lack of bothersome symptomatology, the patient did not seek any special investigations for her condition until she was in her late twenties. ACD is a very rare condition in adults that might pass unnoticed, but a midline opening posterior to the anus should always raise the suspicion of a secondary anal canal. Surgery is the only cure for this condition with good results after a proper pre-operative workout to reveal others simultaneous malformations.


Assuntos
Canal Anal , Imageamento por Ressonância Magnética , Abscesso , Adulto , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Feminino , Humanos , Períneo , Doenças Raras
4.
Ann Palliat Med ; 10(9): 10022-10030, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628926

RESUMO

BACKGROUND: Suprasphincteric anal fistula is a type of high anal fistula. The traditional method of cutting seton (CS) has a high recurrence rate and can cause severe damage to the anal sphincter and anal incontinence. The combination of loose and cutting seton is a novel method developed on the basis of the traditional cutting seton technique, and has already been adopted by some clinicians in China. This study will examine the effectiveness and safety of the loose combined cutting seton (LCCS) technique for the treatment of suprasphincteric anal fistulas. METHODS: This is a single-blinded randomized controlled trial conducted in the Anorectal Department of the China-Japan Friendship Hospital. A total of 76 patients diagnosed with suprasphincteric anal fistula will be randomly divided into two groups. One group will be treated with the LCCS method (the LCCS group; n=38) and the other group will be treated with the traditional CS method (the CS group; n=38). There will be 3 intervention periods, including the screening period, the surgical treatment period, and the postoperative follow-up period. Postoperative follow-up will be carried out on days 3, 5, 7, 14, 21, 28, 90, 180, and 365 after the operation. The main outcome measures are the complete cure rate of postoperative wounds and fistulas, the long-term recurrence rate, and evaluation of postoperative anal function (Wexner anal function assessment and anal function questionnaire). The secondary outcomes are the visual analogue scale (VAS) score for postoperative pain, pressure measurements of the anal canal and rectum before and after treatment, and the incidence of adverse events. All statistical results will be analyzed using the SPSS software 21.0 version. P values <0.05 will be considered statistically significant. DISCUSSION: This research introduces a novel method for the treatment of suprasphincteric anal fistulas. The LCCS method will be compared with the traditional CS method in terms of safety and efficacy. If the LCCS technique is a safe and effective treatment for suprasphincteric anal fistula, its clinical application should be promoted. TRIAL REGISTRATION: ClinicalTrials, Registration number: ChiCTR2100045450; pre-results. PROTOCOL VERSION: 2020-09-10 1.0 version.


Assuntos
Fístula Retal , Técnicas de Sutura , Canal Anal/cirurgia , Humanos , Recidiva Local de Neoplasia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fístula Retal/cirurgia , Resultado do Tratamento
5.
Arq Bras Cir Dig ; 34(2): e1594, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34669884

RESUMO

BACKGROUND: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. AIM: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. METHODS: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. RESULTS: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. CONCLUSIONS: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.


Assuntos
Hemorroidectomia , Hemorroidas , Canal Anal/cirurgia , Hemorroidas/cirurgia , Humanos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
6.
Prague Med Rep ; 122(3): 191-200, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606431

RESUMO

As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.


Assuntos
Malformações Anorretais , Diafragma da Pelve , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Criança , Humanos , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/cirurgia , Qualidade de Vida , Resultado do Tratamento
7.
Ann Palliat Med ; 10(8): 8718-8727, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488361

RESUMO

BACKGROUND: This study sought to investigate the effects of internal sphincterotomy of the anus in the treatment of defecation disorders in patients with outlet obstructive and mixed constipation. METHODS: This study included 250 patients, who met the Rome III criteria for functional defecation disorder-associated constipation and were admitted to the Proctology Department in the People's Hospital of Dazu District between July 2014 and June 2016. The patients were randomly divided into the traditional medical treatment group (n=125) and the surgical treatment group (n=125), and received traditional treatment and internal anal sphincterotomy, respectively. All patient clinical data were retrospectively analyzed. Indices relating to anorectal pressure, electromyographic indices of abdominal muscles, sleep quality, anxiety and depression, defecography and anal healing before and after treatment were measured, and the effects of the different treatment modalities on defecation disorders were analyzed. RESULTS: The total treatment effective rate was significantly higher in the surgical treatment group than in the traditional treatment group (P<0.05). The Constipation Scoring System scores at time points 1, 2 and 3 were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the Hospital Anxiety and Depression Scale and Pittsburg Sleep Quality Index scores were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the rectal resting pressure and 10SR were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). After treatment, the negative conversion rate of the balloon expulsion test was significantly higher in the surgical treatment group than in the traditional treatment group (P<0.05), while the rectocele, perineum descending distance, and anorectal angle of the efforts phase were significantly lower in the surgical treatment group than in the traditional treatment group (P<0.001). CONCLUSIONS: Internal anal sphincterotomy can significantly relieve defecation disorders and clinical symptoms, improve sleep quality, eliminate psychological disorders, and promote patient recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048818.


Assuntos
Esfincterotomia Lateral Interna , Canal Anal/cirurgia , Constipação Intestinal/etiologia , Defecação , Defecografia , Humanos , Estudos Retrospectivos
8.
BMC Surg ; 21(1): 350, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34560857

RESUMO

INTRODUCTION: Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. METHODS: We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient's complete healing, the evaluation of FI, recurrence rate and manometry parameters. RESULTS: All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 "de novo" temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. CONCLUSION: The fissurectomy and anoplasty with V-Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.


Assuntos
Incontinência Fecal , Fissura Anal , Canal Anal/cirurgia , Doença Crônica , Feminino , Fissura Anal/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
9.
Pol Przegl Chir ; 93(4): 41-45, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34515647

RESUMO

Ligation of the intersphincteric fistula tract (LIFT) is an established method for the treatment of high- and lowposition anal fistulas. Numerous meta-analyses confirm the high healing success rate with simultaneous low risk of sphincter damage. The aim of the study was to evaluate the results of the treatment of patients with high-position and complex transsphincteric fistulas using the LIFT procedure. Twelve patients (M - 9, F - 3) aged between 28 and 69 years (median age 50) undergoing surgery for complex and high-position transsphincteric anal fistulas, either primary or recurrent, in the period of 2016 to 2020, were included in the study. The inclusion criterion consisted in the presence of a fistula encompassing more than 30% of the anal sphincter volume as confirmed by transrectal ultrasound. All patients were subjected to surgical treatment by means of the LIFT procedure. The follow-up period was between 6 and 51 months (average of 16 months). Follow-up visits were held at 1 and 4 weeks as well as 6 months after surgery. During the postoperative period, data were collected on the curative effect or recurrence of transsphincteric fistulas (the primary endpoint) and on the presence of postoperative complications (the secondary endpoint). A total of 10 patients (83.3%) were healed, with 2 patients (16.7%) experiencing complications as manifested by recurring intersphincteric fistula. Full recurrence of the disease was observed in 2 patients (16.7%). Slight disturbances of continence were observed in 2 out of 12 patients (16.7%).


Assuntos
Fístula Retal , Adulto , Idoso , Canal Anal/cirurgia , Humanos , Ligadura , Pessoa de Meia-Idade , Fístula Retal/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
10.
Ugeskr Laeger ; 183(36)2021 09 06.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34498577

RESUMO

Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge of anal anatomy and imaging with MRI or endoanal sonography is crucial to classify AF as simple or complex depending on risk of anal incontinence after fistulotomy as summarised in this review. Fistulotomy has healing rates of > 90%, risks incontinence, and the procedure is reserved for simple fistulas. Complex AF are treated with a draining seton and then with sphincter-saving procedures which have long-term healing rates of about 50%.


Assuntos
Incontinência Fecal , Fístula Retal , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Incontinência Fecal/etiologia , Humanos , Imageamento por Ressonância Magnética , Fístula Retal/diagnóstico por imagem , Fístula Retal/cirurgia , Resultado do Tratamento
12.
J Laparoendosc Adv Surg Tech A ; 31(10): 1200-1208, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34551270

RESUMO

Laparoscopy has a major role in the treatment of anorectal malformations (ARM) since Georgeson et al. introduced the laparoscopic assisted anorectoplasty in 2000. The majority of ARM can be repaired through a posterior sagittal incision without the need to enter the abdomen. Some ARM types require an abdominal approach to detach the rectum from the urinary tract in males or the vagina in females. Those malformations benefit from laparoscopy. In this article, we aimed to highlight the technical aspects relevant to the current laparoscopic repair of ARM.


Assuntos
Cavidade Abdominal , Malformações Anorretais , Laparoscopia , Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Feminino , Humanos , Lactente , Masculino , Reto/cirurgia , Vagina
13.
Langenbecks Arch Surg ; 406(7): 2497-2505, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34468863

RESUMO

BACKGROUND: The length of sphincter which can be divided during fistulotomy for perianal fistula is unclear. The aim was to quantify sphincter damage during fistulotomy and determine the relationship between such damage with symptoms and severity of faecal incontinence and long-term quality of life (QOL). METHODS: A prospective cohort study was performed over a 2-year period. Patients with intersphincteric and mid to low transsphincteric perianal fistulas without risk factors for faecal incontinence were scheduled for fistulotomy. All patients underwent 3D endoanal ultrasound (3D-EAUS) pre-operatively and 8 weeks postoperatively. Measurements were taken of pre- and postoperative anal sphincter involvement and division. Anal continence was assessed using the Jorge-Wexner scale and QOL scores pre, 6 and 12 months postoperatively. RESULTS: Forty-nine patients were selected. A strong correlation between pre- and postoperative measurements was found p < 0.001. A median length of 41% of the external anal sphincter and 32% of the internal anal sphincter was divided during fistulotomy. Significant differences in mild symptoms of anal continence were found with increasing length of external anal sphincter division. But there was no significant deterioration in continence, soiling, or quality of life scores at the 1-year follow-up. Division of over two-thirds of the external anal sphincter was associated with the highest incontinence rates. CONCLUSIONS: 3D-EAUS is a valuable tool for quantifying the extent of sphincter involvement pre- and postoperatively. Post-fistulotomy faecal incontinence is mild and increases with increasing length of sphincter division but does not affect long-term quality of life.


Assuntos
Incontinência Fecal , Fístula Retal , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Incontinência Fecal/etiologia , Humanos , Estudos Prospectivos , Qualidade de Vida , Fístula Retal/diagnóstico por imagem , Fístula Retal/etiologia , Fístula Retal/cirurgia
14.
Int J Colorectal Dis ; 36(12): 2775-2778, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34528117

RESUMO

PURPOSE: More long-term follow-up studies beyond 10 years after secondary sphincteroplasty for obstetric damage are warranted. This prospective study aimed to compare reported data on incontinence and satisfaction in a cohort of such patients examined at short-, long-, and very long-term follow-up. METHODS: Twenty out of 33 obstetric patients (61%) operated with secondary anterior overlapping sphincteroplasty during February 1996 to April 2004 were evaluated preoperatively and at short-, long-, and very long-term follow-up. Anal incontinence was scored by a combination of Wexner's and St. Mark's incontinence scores. The patients also reported degree of treatment satisfaction. RESULTS: Twenty patients were examined preoperatively and after a median (range) of 5 (2-62), 102 (64-162), and 220 (183-278) months. Corresponding incontinence scores were 11.5 (5-18), 5.5 (1-17) (p < 0.01), 10.0 (0-18) (p > 0.05), and 12.0. (1-18) (p > 0.05). With increasing follow-up times, patients reporting a better outcome were 75%, 65%, and 45%. At very long-term follow-up patients, reports were more dismal than expected in those also reporting improved incontinence cores. Incontinence scores did not improve in patients with neuropathy (n = 5) or patients (n = 5) with more than 10 years of symptoms. CONCLUSION: Initial improvement of anal incontinence attenuated with time, in particular from short- to long-term follow-up. Patients with neuropathy experienced no improvement of incontinence. Beyond stoma formation, in compliant patients, one should consider other treatment options like sacral nerve stimulation and neosphincter formation.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Incontinência Fecal , Canal Anal/cirurgia , Parto Obstétrico , Incontinência Fecal/etiologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Resultado do Tratamento
15.
Afr J Paediatr Surg ; 18(4): 210-214, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34341305

RESUMO

Context: Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is restored by a coloanal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull-through for HD as a new gold standard. Aim: The aim of the study was to evaluate the outcome of the laparoscopic-aided transanal pull-through procedure for the management of HD in children older than 3 years of age. Methods: This study was conducted on 15 consecutive patients presented to a university hospital, diagnosed as having HD relying on their clinical features, barium enema study and rectal biopsy. In all cases, laparoscopic-assisted transanal pull-through was attempted. The laparoscopic part included transition zone identification, seromuscular biopsy for fresh frozen histopathology and sigmoid and rectal mobilisation as much as possible down the peritoneal reflection. The transanal part included mobilisation of the rectal lower segment by 2-3 cm, resection till the ganglionic segment, and full-thickness two-layer coloanal anastomosis was done. Results: Early complications occurred in eight cases: enterocolitis in four cases and perianal excoriation occurred in four cases. There were no cases of anastomotic leak. Late complications occurred in seven patients: four cases developed stricture at the site of coloanal anastomosis and three cases experienced enterocolitis at 6 and 9 months postoperatively. Conclusion: Laparoscopic-aided transanal pull-through procedure is a safe, feasible modality for the management of HD in children more than 3 years.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doença de Hirschsprung , Laparoscopia , Canal Anal/cirurgia , Anastomose Cirúrgica , Criança , Pré-Escolar , Doença de Hirschsprung/cirurgia , Humanos , Lactente , Complicações Pós-Operatórias , Reto/cirurgia , Resultado do Tratamento
17.
Trop Doct ; 51(4): 573-577, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34334007

RESUMO

Rectocoele and faecal incontinence coexist in most patients. We determined an excellent one-year outcome of simultaneous repair of the former and correction of the latter can be achieved.


Assuntos
Incontinência Fecal , Retocele , Canal Anal/cirurgia , Incontinência Fecal/etiologia , Humanos , Resultado do Tratamento
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(7): 598-603, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34289544

RESUMO

Intersphincteric resection (ISR) involves the anatomy of hiatal ligament, internal and external sphincter and conjoined longitudinal muscle. The hiatal ligament is actually a branch of the longitudinal muscle of rectum, shown as an uneven ring attached to the levator ani muscle. The internal sphincter is the end of the circular muscle of rectum which begins at the level of hiatal ligament formation. The distance from the upper boundary of internal sphincter to dentate line is significantly different among individuals. Although there is adipose tissue in the space between the internal and external sphincters, no evidence of mesentery structure in the anal canal is found as in the rectum. The conjoined longitudinal muscle is the remaining branch of the longitudinal muscle, whose return passes through the external sphincter and ends at the anococcygeal ligament/coccyx after reaching the anal margin. The synergistic action of conjoined longitudinal muscle and the hiatal ligament participates in the defecation process. The individualized difference of ISR-related anatomy affects the operation, especially the anastomosis.


Assuntos
Neoplasias Retais , Canal Anal/cirurgia , Anastomose Cirúrgica , Humanos , Diafragma da Pelve , Reto/cirurgia
19.
Eur J Radiol ; 142: 109854, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303148

RESUMO

BACKGROUND: Anteriorly displaced anus (ADA) is defined as anterior displacement of the anus toward the perineum. Early radiologic characterization is a crucial step in guiding the first-line management. OBJECTIVE: The objective of this study was to assess the urethra-to-anus distance (UAD) on perineal ultrasound in female infants under the age of 3 months with anteriorly displaced anus and to retrospectively determine a cut-off to guide the indications for surgery. MATERIALS AND METHODS: Perineal ultrasound was performed prospectively in female infants under the age of 3 months with determination of the UAD, during screening for congenital hip dislocation. Determinations of the UAD on perineal ultrasound and pelvic MRI were performed for anteriorly displaced anus in girls between 2011 and 2018. RESULTS: 230 patients were included, of whom 173 were in the control group, with 52 examinations performed for anteriorly displaced anus and 5 examinations performed for vestibular anus. The mean UAD for infants under the age of 3 months was: 22.9 mm (±1.7) in healthy infants, 21.4 mm (±2.4) in infants with non-operated ADA, 17.5 mm (±1.8) in infants with operated ADA, and 10.8 mm (±1.3) in infants with anorectal malformation (ARM). A statistically significant difference was observed between the control group and the ARM group (p = 0.0001) and between the control group and the operated ADA group (p = 0.0001). The mean UAD for infants over the age of 3 months was: 25.5 mm (±4.1) in infants with non-operated ADA and 26 mm (±3) in infants with operated ADA. CONCLUSION: A urethra-to-anus distance of less than 17 mm appears to be a cut-off for anteriorly displaced anus in anorectal malformations.


Assuntos
Malformações Anorretais , Cirurgiões , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Malformações Anorretais/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Períneo/diagnóstico por imagem , Estudos Retrospectivos
20.
Tech Coloproctol ; 25(10): 1115-1121, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34318362

RESUMO

BACKGROUND: Therapeutic options for complex anal fistula (CAF) are limited. Video-assisted anal fistula treatment (VAAFT) allows examination of these anatomically complex fistulae from within. The aim of the present study was to evaluate outcomes of VAAFT for a series of CAF. METHODS: A retrospective study was conducted on consecutive patients at a single centre with complex anal cryptoglandular and Crohn's fistulae managed with VAAFT from June 2016 to June 2019. CAF was diagnosed as high intersphincteric/transsphincteric tract, multiple/secondary tracts, horseshoe or anovaginal fistulae. Patients were treated with 'therapeutic intent' if the internal opening was closed at the time of ablation and 'diagnostic/staged/palliative' VAAFT if there was no ablation/partial treatment/ablation-only, respectively. Symptom improvement was a reduction in reported pain, discharge, or pad use. RESULTS: Eighty-four patients (73 cryptoglandular, 11 Crohn's, M:F 2.5:1, median age 43 [22-77] years), underwent 105 VAAFT procedures. Twenty patients had > 1 VAAFT. Median follow-up was 8 (1-46) months. 40 (48%) had multiple or secondary tracts; an additional 16 (19%) had horseshoe and 3 (4%) anovaginal fistulae. Of the 84 patients, 19 [16/73 (22%) cryptoglandular and 3/11 (27%) Crohn's fistulae] healed. 34 (40%) unhealed reported improved symptoms; 23 (27%) no improvement; and 6 (7%) were worse. Sixteen (19%) had CAF > 5 years of whom none healed, albeit 50% reported symptom improvement. Five patients (6%) developed faecal incontinence: 2 temporary, 1 to flatus only and 1 to liquid and 1 to solid, all managed conservatively. CONCLUSIONS: VAAFT is a useful minimally invasive procedure for complex fistula with no other minimally invasive options. Complete healing is rare, and, although symptoms can be improved in a number of cases, there is a small risk of incontinence.


Assuntos
Fístula Retal , Cirurgia Vídeoassistida , Adulto , Canal Anal/cirurgia , Humanos , Fístula Retal/etiologia , Fístula Retal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...