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1.
Khirurgiia (Mosk) ; (2): 48-52, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570354

RESUMO

OBJECTIVE: To improve treatment outcomes in patients with anorectal malformations via research of morphological criteria and differentiated approach to surgical correction. MATERIAL AND METHODS: There were 37 children with various types of anorectal malformations for the period 2000-2019. We analyzed morphological features of atretic rectum wall, fistula, anastomosis with adjacent organs and skin of the perineum. RESULTS: Morphological research of anorectal malformations made it possible to differentiate treatment strategy and explain the causes of unsatisfactory results after perineal and abdominal-perineal proctoplasty. Incidence and severity of complications, as well as early disability were reduced that significantly improved postoperative quality of life. CONCLUSION: According to the morphological criteria, deeper mobilization of atretic rectum within at least 2.5-3 cm of the rectal «cone¼ with intact muscular wall is necessary. This approach was valuable to ensure adequate closure function of the rectum, prevent anal incontinence and restore normal appearance of the perineum. These achievements contributed to decrease in the incidence of admissions, redo surgeries and improvement of social adaptation in children.


Assuntos
Malformações Anorretais , Incontinência Fecal , Procedimentos Cirúrgicos Reconstrutivos , Canal Anal/anormalidades , Canal Anal/cirurgia , Malformações Anorretais/patologia , Malformações Anorretais/cirurgia , Criança , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Incontinência Fecal/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/anormalidades , Reto/cirurgia
2.
Arq Bras Cir Dig ; 33(3): e1545, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470375

RESUMO

BACKGROUND: Oblique type of anastomosis. Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung's disease. AIM: To compare circular and oblique anastomoses following Soave's procedure for the treatment of Hirschsprung's disease. METHODS: Children who underwent Saove's pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. RESULTS: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). CONCLUSION: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave's procedure.


Assuntos
Anastomose Cirúrgica/métodos , Constipação Intestinal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Incontinência Fecal/etiologia , Doença de Hirschsprung/cirurgia , Proctocolectomia Restauradora/métodos , Criança , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Seguimentos , Doença de Hirschsprung/diagnóstico , Humanos , Lactente , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1123-1130, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353263

RESUMO

Anal fistula is one of the most common diseases in colorectal and anal surgery. Most of them are formed after the abscess of perianal space reptures. Due to the complexity and diversity of pathological changes, the clinical efficacy of some patients is not optimistic, and there may even be serious surgical complications, including delayed healing of anal fistula or varying degrees of fecal incontinence, which significantly affect the quality of life of patients and even lead to disability. The Working Committee of Clinical Guidelines of Anorectal Physicians Branch of Chinese Medical Association organized some domestic experts to discuss and prepare this expert consensus. It is suggested that comprehensive evaluation of anal fistula, including detailed medical history, physical examination and necessary auxiliary examination should be conducted before treatment. Auxiliary examinations include fistulography, ultrasound, CT or MRI. The purpose of the auxiliary examination is to accurately determine the position of the internal orifice of the anal fistula, the direction of the fistula and its relationship with the anal sphincter. Adenogenic anal fistula needs surgical treatment after diagnosis. The operation methods can be divided into two types: operations breaching sphincter and operations preserving sphincter function. The former includes anal fistulectomy, anal fistulotomy and seton placement; the latter includes ligation of intersphincteric fistula (LIFT), rectal mucosal muscle flap advancement repair, anal fistula laser closure, video-assisted anal fistula treatment, etc. It is suggested to select or combine the application according to the specific condition of patients. Bioabsorbable materials include anal fistula plug and fibrin glue. Due to the characteristics of retaining sphincter function and reusability, it is recommended to be used selectively by qualified and experienced doctors. Proper wound management after anal fistula surgery can reduce the pain of patients, promote healing and reduce the recurrence of anal fistula. Because there is a certain risk of recurrence and fecal incontinence after anal fistula surgery, for some patients with complex condition, repeated operations or impaired anal function, we must be careful when choosing reoperation, and weigh the benefits of patients and the risk of fecal incontinence.


Assuntos
Incontinência Fecal , Fístula Retal , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , China , Consenso , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Humanos , Qualidade de Vida , Fístula Retal/complicações , Fístula Retal/diagnóstico , Fístula Retal/cirurgia , Reoperação/efeitos adversos , Resultado do Tratamento
4.
Obstet Gynecol ; 136(5): 933-941, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030871

RESUMO

OBJECTIVE: To assess independent risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse surgery. METHODS: This secondary analysis includes OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) (n=374) and E-OPTIMAL (Extended) (n=285) trial participants. Surgical failure was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery or bothersome vaginal bulge. Worsening pelvic floor symptoms were defined as increases from baseline as large as the minimally important difference for subscale scores of the Pelvic Floor Distress Inventory: 11 for the Urinary Distress Inventory and Colorectal-Anal Distress Inventory and 34.3 for the Pelvic Organ Prolapse Distress Inventory. Outcomes were measured at 6 months then 1, 2, 3, 4, and 5 years. Chi-square and t test results from bivariate models and clinical relevance were used to inform final models. RESULTS: Baseline risk factors for surgical failure were Hispanic ethnicity (adjusted odds ratio [aOR] 1.92, 95% CI 1.17-3.15), perineal body (aOR 1.34, 95% CI 1.09-1.63), and pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 1.16, 95% CI 1.05-1.28). Risk factors for worsening of pelvic floor symptoms were pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 0.75, 95% CI 0.60-0.94) for worsening Pelvic Organ Prolapse Distress Inventory score, vaginal deliveries (aOR 1.26, 95% CI 1.10-1.44) and pretreatment Urinary Distress Inventory score (aOR 0.86, 95% CI 0.80-0.93) for worsening Urinary Distress Inventory score, and age (aOR 1.03, 95% CI 1.01-1.05) and pretreatment Colorectal-Anal Distress Inventory score (aOR 0.95, 95% CI 0.92-0.98) for worsening Colorectal-Anal Distress Inventory score. CONCLUSIONS: Hispanic ethnicity, larger preoperative perineal body, and higher pretreatment Pelvic Organ Prolapse Distress Inventory scores were risk factors for surgical failure up to 5 years after vaginal prolapse repair. Participants with higher baseline Pelvic Floor Distress Inventory scores were less likely to worsen. Risk factors for worsening Urinary Distress Inventory and Colorectal-Anal Distress Inventory scores included more vaginal deliveries and increased age, respectively. CLINICAL TRIAL REGISTRATION: NCT00597935, NCT01166373.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Vagina/cirurgia , Doenças Vaginais/cirurgia , Adulto , Idoso , Progressão da Doença , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Prolapso de Órgão Pélvico/complicações , Período Pós-Operatório , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Falha de Tratamento , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Doenças Vaginais/complicações
5.
Arch. argent. pediatr ; 118(5): 350-357, oct 2020. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122544

RESUMO

La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio


Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community


Assuntos
Humanos , Doença de Hirschsprung/cirurgia , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/terapia , Pediatria , Doença Crônica , Constipação Intestinal/dietoterapia , Constipação Intestinal/etiologia , Enterocolite/dietoterapia , Enterocolite/etiologia , Incontinência Fecal/dietoterapia , Incontinência Fecal/etiologia
6.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
7.
Obstet Gynecol ; 136(4): 811-822, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925633

RESUMO

Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician-gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.


Assuntos
Tratamento Conservador , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia/métodos , Qualidade de Vida , Idoso , Comorbidade , Tratamento Conservador/instrumentação , Tratamento Conservador/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Incontinência Fecal/psicologia , Incontinência Fecal/terapia , Feminino , Humanos , Anamnese/métodos , Administração dos Cuidados ao Paciente/métodos , Seleção de Pacientes
8.
Rehabilitación (Madr., Ed. impr.) ; 54(3): 215-220, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196738

RESUMO

Los quistes de Tarlov o quistes perineurales son lesiones de las raíces nerviosas localizadas fundamentalmente en el sacro. Su etiología es incierta. Generalmente constituyen hallazgos incidentales y, por lo general, son asintomáticos. Los quistes sintomáticos son infrecuentes; los síntomas habituales suelen ser el dolor, la radiculopatía y, más raramente, las disfunciones vesicales, intestinales y sexuales. Presentamos el caso clínico de una mujer de 70 años con un quiste de Tarlov que le producía incontinencia fecal y realizamos una revisión sobre la etiología, fisiopatología y el manejo en este caso en particular


Tarlov, or perineural cysts, are lesions of the nerve root usually located at the sacral level of the spine. Their cause is unclear. These cysts are generally identified as an incidental finding and are usually asymptomatic. Symptomatic cysts are infrequent, with symptoms usually consisting of pain, radiculopathy and, less frequently, bladder, bowel and sexual dysfunction. We report the case of a 70-year-old woman with Tarlov cyst, provoking faecal incontinence, and review the aetiology, pathophysiology and management of this particular case


Assuntos
Humanos , Feminino , Idoso , Cistos de Tarlov/complicações , Incontinência Fecal/reabilitação , Raízes Nervosas Espinhais/lesões , Reflexo H , Incontinência Fecal/etiologia , Distúrbios do Assoalho Pélvico/reabilitação
9.
Chirurg ; 91(10): 870-877, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32474615

RESUMO

BACKGROUND: Traumatic anal sphincter muscle defects often occur after childbirth and surgery and can lead to fecal incontinence that requires further treatment. OBJECTIVE: The aim of this article is to illustrate the etiology of traumatic sphincter muscle defects, the treatment options of subsequent fecal incontinence and their evaluation on the basis of current studies. MATERIAL AND METHODS: Selected studies are presented. RESULTS: Fecal incontinence presenting with a traumatic sphincter muscle defect is often due to multiple factors especially in the aged and makes the use of extended diagnostic tools necessary; however, the subjective complaints do not always correlate with morphological or functional diagnostic findings. Besides reconstructive procedures, such as sphincteroplasty and graciloplasty, sphincter augmentation techniques and sacral nerve stimulation can also be applied in traumatic sphincter muscle defects that are often associated with a loss of efficacy in the long term or a high rate of adverse events. CONCLUSION: The fecal incontinence associated with traumatic sphincter insufficiency represents a diagnostic and therapeutic challenge due to the multifactorial origin. It is not uncommon that patients have to undergo several surgical and conservative interventions.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Canal Anal/cirurgia , Humanos , Músculo Liso
10.
BMC Womens Health ; 20(1): 131, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571291

RESUMO

BACKGROUND: Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed. METHODS: All women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark's incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography. RESULTS: In total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark's score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury. CONCLUSION: The prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark's incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.


Assuntos
Canal Anal/lesões , Parto Obstétrico/estatística & dados numéricos , Episiotomia/efeitos adversos , Incontinência Fecal/epidemiologia , Lacerações/epidemiologia , Períneo/lesões , Adulto , Canal Anal/fisiopatologia , Estudos Transversais , Parto Obstétrico/métodos , Episiotomia/estatística & dados numéricos , Incontinência Fecal/etiologia , Feminino , Humanos , Noruega/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Períneo/fisiopatologia , Gravidez , Prevalência , Qualidade de Vida
11.
PLoS One ; 15(5): e0232739, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437393

RESUMO

OBJECTIVES: Systemic sclerosis (SSc) is an auto-immune, multi organ disease marked by severe gastrointestinal (GI) involvement and gut dysbiosis. Here, we aimed to determine the safety and efficacy of fecal microbiota transplantation (FMT) using commercially-available anaerobic cultivated human intestinal microbiota (ACHIM) in SSc. METHODS: Ten patients with SSc were randomized to ACHIM (n = 5) or placebo (n = 5) in a double-blind, placebo-controlled 16-week pilot. All patients had mild to severe upper and lower GI symptoms including diarrhea, distention/bloating and/or fecal incontinence at baseline. Gastroduodenoscopy transfer of ACHIM or placebo was performed at weeks 0 and 2. Primary endpoints were safety and clinical efficacy on GI symptoms assessed at weeks 4 and 16. Secondary endpoints included changes in relative abundance of total, immunoglobulin (Ig) A- and IgM-coated fecal bacteria measured by 16s rRNA sequencing. RESULTS: ACHIM side effects were mild and transient. Two placebo controls experienced procedure-related serious adverse events; one developed laryngospasms at week 0 gastroduodenoscopy necessitating study exclusion whilst one encountered duodenal perforation during gastroduodenoscopy at the last study visit (week 16). Decreased bloating, diarrhea and/or fecal incontinence was observed in four of five patients in the FMT group (week 4 or/and 16) and in two of four in the placebo group (week 4 or 16). Relative abundance, richness and diversity of total and IgA-coated and IgM-coated bacteria fluctuated more after FMT, than after placebo. CONCLUSIONS: FMT of commercially-available ACHIM is associated with gastroduodenoscopy complications but reduces lower GI symptoms by possibly altering the gut microbiota in patients with SSc.


Assuntos
Transplante de Microbiota Fecal , Escleroderma Sistêmico/microbiologia , Escleroderma Sistêmico/terapia , Bactérias , Método Duplo-Cego , Ácidos Graxos/metabolismo , Incontinência Fecal/etiologia , Transplante de Microbiota Fecal/efeitos adversos , Fezes/química , Feminino , Humanos , Imunoglobulina A/metabolismo , Imunoglobulina M/metabolismo , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placebos , Resultado do Tratamento
12.
J Laparoendosc Adv Surg Tech A ; 30(6): 679-684, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32315564

RESUMO

Introduction: Rectal prolapse (RP) in pediatric patients may require surgical intervention. Varying surgical approaches and heterogenous patient populations have resulted in difficulty defining surgical outcomes and superiority of technique. We sought to review our surgical and self-reported outcomes of patients who underwent laparoscopic rectopexy for idiopathic RP. Methods: Records of children <18 years who underwent primary laparoscopic rectopexy between March 2009 and March 2019 were retrospectively reviewed. Patients with redo rectopexy were excluded. Demographics, pre- and postoperative treatment, and outcome data were collected and reported using descriptive statistics. Qualitative analysis of a quality of life (QoL) questionnaire administered to patients and parents 2-10 years postoperatively was performed. Results: Fifteen patients were included. Median age at surgery was 5 years (interquartile range [IQR] 3, 12.5); 60% were male and median weight was 22 kg (IQR 16.4, 39.2). Median length of stay was 6 hours (IQR 4, 22) with 9 (60%) discharged the same day. Perioperatively, 73% were on laxative for constipation, whereas only 33% were on laxative therapy at 6 months postrectopexy. Median follow-up was 19 months (IQR 8, 39). Three patients (20%) suffered recurrent RP (2 required redo rectopexy), and 2 patients self-limited urinary retention. Respondents to the QoL questionnaire indicated improvement in symptoms after surgery. No patient reported fecal incontinence, smearing, or leakage of stool. Conclusion: Laparoscopic rectopexy is a safe minimally invasive approach for children with idiopathic RP that offers high patient satisfaction with same-day discharge, early recovery, and low recurrence.


Assuntos
Constipação Intestinal/cirurgia , Incontinência Fecal/cirurgia , Previsões , Laparoscopia/métodos , Alta do Paciente/tendências , Qualidade de Vida , Prolapso Retal/cirurgia , Adolescente , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prolapso Retal/complicações , Recidiva , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
13.
BMC Surg ; 20(1): 68, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264858

RESUMO

BACKGROUND: Primary anorectal melanoma can be a rare differential diagnosis of anorectal mass. Due to the low case number reported in the literature, physicians are not aware of this aggressive disease. Although no consensus exists, wide local excision and abdominoperineal resection are considered the mainstay therapy. CASE PRESENTATION: An 85-year-old female patient presented with fecal incontinence 5 years after local resection of a primary anorectal melanoma. In the rectoscopy, a tumor proximal to the dentate line was identified and later confirmed as a recurrent primary anorectal melanoma. There were no signs of locoregional or distant metastasis on the MRI and PET/CT. She underwent another wide local excision and regained fecal continence postoperatively. CONCLUSIONS: Primary anorectal melanoma should belong to the differential diagnosis of anorectal mass. If technically feasible, wide local excision represents a less invasive treatment than abdominoperineal resection, retaining the anal sphincter and patient's quality of life. Even though wide local excision has a higher recurrence rate than abdominoperineal resection, there is no difference in survival between the two procedures. This is only under the premise that patients are followed-up regularly after wide local excision so that recurrence can be spotted early on and locally excised.


Assuntos
Neoplasias do Ânus/diagnóstico , Melanoma/diagnóstico , Neoplasias Retais/diagnóstico , Idoso de 80 Anos ou mais , Canal Anal/cirurgia , Neoplasias do Ânus/patologia , Incontinência Fecal/etiologia , Humanos , Masculino , Recidiva Local de Neoplasia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Período Pós-Operatório , Qualidade de Vida , Neoplasias Retais/cirurgia
14.
Sci Rep ; 10(1): 5553, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32221413

RESUMO

Most studies focusing on only one directional effect among cognitive health, physical function, and incontinence may miss potential paths. This study aimed to determine the pathway by analyzing the bidirectional effects of exposure (X) on outcome (Y) and explore the mediating effect (M) between X and Y. Secondary data analyses were performed in this study. The original data were collected from August to October 2013 in one VH in Tainan, Taiwan, and the final sample size was 144 older male veterans. Path analysis was performed to test the pathway sequence X → M → Y among the three outcome variables. Approximately 80% of the veterans were aged 81 or older, approximately 42% had a functional disability, 26% had cognitive impairment, and 20% had incontinence. The relationships between functional disability and incontinence and between functional disability and cognition impairment were bidirectional, and functional disability played a key mediating role in the relationship between cognitive impairment and incontinence. Physical more than cognitive training in order to improve or at least stabilize functional performance could be a way to prevent or reduce the process of developing incontinence.


Assuntos
Disfunção Cognitiva/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Incontinência Fecal/epidemiologia , Instituição de Longa Permanência para Idosos , Institucionalização/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Veteranos/estatística & dados numéricos , Atividades Cotidianas , Idoso , Causalidade , Comorbidade , Estudos Transversais , Pessoas com Deficiência/psicologia , Uso de Medicamentos/estatística & dados numéricos , Incontinência Fecal/etiologia , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Modelos Teóricos , Dinâmica Populacional , Qualidade de Vida , Fatores Socioeconômicos , Taiwan/epidemiologia , Incontinência Urinária/etiologia , Veteranos/psicologia
15.
Am J Surg ; 219(4): 592-597, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32209240

RESUMO

BACKGROUND: The aim of this study was to determine whether acute histologic inflammatory activity at the rectal margin predicts postoperative complications in children with ulcerative colitis following ileal pouch-anal anastomoses (IPAA). METHODS: Patients who underwent IPAA following previous total abdominal colectomy for ulcerative colitis between 2006 and 2014 were included. Data collected included demographics, operative and postoperative data, histologic grading of the rectal margin at time of IPAA, and stooling outcomes at one, six and 12 months following ileostomy closure. RESULTS: Twenty-seven patients were included. Acute inflammation scores ranged between 2 and 13. Unadjusted and adjusted models showed no statistically significant relationship between inflammation and presence of any postoperative complications, number of daily stools, nighttime stooling, soiling, or stool-altering medication usage. CONCLUSION: Acute histologic inflammatory activity at the rectal margin is not associated with increased rates of postoperative complications following IPAA creation in children, nor with poorer continence outcomes following ileostomy closure.


Assuntos
Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Mucosa Intestinal/patologia , Reto/patologia , Adolescente , Estudos de Coortes , Bolsas Cólicas , Eosinófilos/patologia , Incontinência Fecal/etiologia , Feminino , Humanos , Fístula Intestinal/etiologia , Mucosa Intestinal/cirurgia , Obstrução Intestinal/etiologia , Leucócitos Mononucleares/patologia , Masculino , Neutrófilos/patologia , Complicações Pós-Operatórias , Pouchite/etiologia , Proctocolectomia Restauradora , Reto/cirurgia , Estudos Retrospectivos
16.
World Neurosurg ; 136: 208-212, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917317

RESUMO

BACKGROUND: En-bloc sacrectomy is the treatment of choice for patients affected by sacral chordoma. It is a radical surgical procedure, which has to face the problem of handling fragile anatomic structures, such as the internal iliac vessels and the sacral nerve roots, with the risk of causing bowel, bladder, and sexual dysfunction. The combined anterior-posterior approach allows for a safer dissection of the tumor from the mesorectal fascia than the mere posterior approach, especially for tumors extending proximally to S3. Robotic surgery can improve the safety of the procedure. Sacral nerve stimulation is an accepted therapeutic option for fecal incontinence and may be used to treat postoperative incontinence. CASE PRESENTATION: We report on a patient affected by sacral chordoma with en-bloc sacrectomy preceded by a robotic-assisted dissection of the mesorectal fascia and on managing the postoperative fecal incontinence by implanting a sacral nerve stimulator on the first postoperative day. To our knowledge this is the first such procedure in the literature. CONCLUSIONS: From our experience, a robotic anterior approach increases safety for the organs in the pelvis when performing a sacrectomy. Moreover, a sacral nerve stimulator should be considered to manage neurologic complications following transection of nerve roots after sacrectomy.


Assuntos
Cordoma/cirurgia , Terapia por Estimulação Elétrica , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Complicações Pós-Operatórias/terapia , Neoplasias da Coluna Vertebral/cirurgia , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/métodos , Sacro/inervação
17.
World J Surg Oncol ; 18(1): 12, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941505

RESUMO

BACKGROUND: Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer. This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals. METHODS: Fifty-two patients were included undergoing total mesorectal excision for rectal cancer, and 29 under control of pelvic intraoperative neuromonitoring. Fecal incontinence was assessed using the Wexner Score at 3 and 6 months after stoma closure (follow-ups 1 and 2) as well as 1 and 2 years after surgery (follow-ups 3 and 4). Risk factors were identified by means of logistic regression. RESULTS: New onset of fecal incontinence was significantly lower in the neuromonitoring group at each follow-up (follow-up 1: 2 of 29 patients (7%) vs. 8 of 23 (35%), (p = 0.014); follow-up 2: 3 of 29 (10%) vs. 9 of 23 (39%), (p = 0.017); follow-up 3: 5 of 29 (17%) vs. 11 of 23 (48%), p = 0.019; follow-up 4: 6 of 28 (21%) vs. 11 of 22 (50%), p = 0.035). Non-performance of neuromonitoring was found to be an independent predictor for fecal incontinence throughout the survey. Neoadjuvant chemoradiotherapy was an independent predictor in the further course 1 and 2 years after surgery. CONCLUSIONS: Performance of pelvic intraoperative neuromonitoring is associated with significantly lower rates of fecal incontinence. Neoadjuvant chemoradiotherapy was found to have negative late effects. This became evident 1 year after surgery.


Assuntos
Incontinência Fecal/etiologia , Síndromes Pós-Gastrectomia/etiologia , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Idoso , Quimiorradioterapia/efeitos adversos , Incontinência Fecal/epidemiologia , Incontinência Fecal/prevenção & controle , Feminino , Seguimentos , Humanos , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Pelve/inervação , Síndromes Pós-Gastrectomia/epidemiologia , Síndromes Pós-Gastrectomia/prevenção & controle , Estudos Prospectivos , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Fatores de Risco
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 71-75, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958934

RESUMO

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn's disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion: The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.


Assuntos
Canal Anal/cirurgia , Implantação de Prótese , Fístula Retal/cirurgia , Adolescente , Adulto , Bioprótese , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Cicatrização , Adulto Jovem
19.
Ann Vasc Surg ; 66: 670.e1-670.e4, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31978482

RESUMO

BACKGROUND: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS: Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS: The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS: Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.


Assuntos
Hematoma Subdural Espinal/etiologia , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Trombose Venosa/terapia , Terapia Combinada , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Hematoma Subdural Espinal/diagnóstico por imagem , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/terapia , Humanos , Pessoa de Meia-Idade , Paraplegia/etiologia , Paraplegia/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Trombose Venosa/diagnóstico por imagem
20.
Female Pelvic Med Reconstr Surg ; 26(2): 137-140, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990802

RESUMO

OBJECTIVE: The primary aim of this study was to determine if fecal incontinence (FI) is associated with self-reported fluid intake in women seeking care for pelvic floor disorders. The secondary aim was to determine the association between bowel symptoms and fluids associated with FI. METHODS: We conducted a retrospective cross-sectional study of women presenting for evaluation of pelvic floor disorders from 2009 to 2015. The presence of FI was defined as an affirmative response of any frequency to the question, "During the last 4 weeks, how often have you leaked or soiled yourself with stool?" Data on fluid intake and bowel symptoms were collected using the Questionnaire-based Voiding Diary and Colorectal-Anal Distress Inventory short form, respectively. The relationship between FI and quartiles of fluid intake, as well as the relationship between bowel symptoms and fluids associated with FI, was analyzed. RESULTS: Nine hundred twenty-four women were included: 379 (41%) with and 545 (59%) without FI. There was an association between FI and increasing total carbonated fluid intake (P = 0.009) and decreasing water intake (P = 0.009). The associations between FI and carbonated fluid intake and FI and water intake remained significant after controlling for patient characteristics (P < 0.05). There was a significant association between the symptom of straining to defecate and carbonated beverage intake (P = 0.046), which remained significant after controlling for patient characteristics (P < 0.001). CONCLUSIONS: Consumption of carbonated beverages is associated with FI in women. Intake of carbonated fluids is associated with bowel symptoms that may exacerbate FI symptoms.


Assuntos
Água Carbonatada/efeitos adversos , Ingestão de Líquidos/fisiologia , Incontinência Fecal , Intestino Grosso/fisiopatologia , Distúrbios do Assoalho Pélvico , Estudos Transversais , Incontinência Fecal/diagnóstico , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Motilidade Gastrointestinal , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/epidemiologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Pesquisa Qualitativa , Estudos Retrospectivos , Inquéritos e Questionários
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