[Anal stricture treated by thread-typing method].

PURPOSE: A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by prolapsed hemorrhoids associated with rectal prolapse. METHODS: Sixty-eight patients were selected on the basis of validated constipation and continence scorings, clinical examination, colonoscopy, anorectal manometry, and defecography and randomized: 34 underwent a SA and 34 a STARR operation. The operated patients were followed-up with clinical examination, visual analog scale for postoperative pain, a satisfaction index, and defecography. RESULTS: At a mean follow-up of 8.1+/-2.0 and 7.9+/-1.8 months for the SA and STARR groups, respectively, the incidence of residual disease was significantly higher in the first group (29.4 vs 5.9 in the STARR group, p=0.007), while a significantly lower incidence of residual skin-tags was found after STARR (23.5% vs 58.8 after SA, p=0.03). All patients with residual disease showed prolapsed tissue over half the length of the anal dilator at the time of the operation. Operative time and incidence of transient fecal urgency were significantly higher in the STARR group (with p=0.001 and 0.08, respectively), while SA was followed by a significantly higher incidence of poor results at the overall patient satisfaction index (p=0.04). No significant differences were found in hospital stay, operative complications, postoperative pain, time to return to normal activity, continence, and constipation scores. All the defecographic parameters significantly improved after STARR, while SA was followed only by a trend to a reduction of rectal prolapse. CONCLUSIONS: STARR provides a more complete resection of the prolapsed tissue than SA in patients with association of prolapsed hemorrhoids and rectal prolapse with equal morbidity and significantly lower incidence of residual disease and skin-tags. The anal dilator can be used for selecting the surgical technique.

Anal Canal↗

PubMed2006

[Sexual abuse of prepubertal children].

BACKGROUND: During the last 15 years, a considerable change has taken place regarding the understanding of anatomical and microbiological anogenital findings in children. At the end of the 1980s, abnormal findings were described in more than 50 % of allegedly abused children. Today such findings are described in 5 %. An important consequence of this change is that absence of abnormal findings should never be used to exclude abuse, not even abuse with anogenital penetration. The main reason for this change is increased knowledge about normal variation and healing after injury, as well as an improvement in standardisation of terminology. MATERIAL AND METHODS: This paper is based on relevant literature published on this topic. RESULTS AND CONCLUSIONS: During this period, several findings have been reclassified from abnormal to normal or non-specific. Examples of such findings are anal dilatation, large and gaping hymenal opening and narrow hymenal brim. Some of the previously reported cases of anogenital scarring are probably mis-classified normal structures. Research-based international classification scales are now established in order to aid the physician in diagnosing sexual abuse, and these are revised on a regular basis. It is currently common to classify medical findings into three main categories; normal/unspecific findings, indeterminate findings and diagnostic findings.

Anal Canal↗