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PubMed1993

[Value of abdominal rectopexy in obstructive disorders of defecation. A prospective study using a defecation index, manometry and radiology].

A prospective clinical, manometric, electromyographic and radiological study was conducted to judge the degree of success achieved with anterior-posterior rectopexy in 18 female patients suffering from obstructed defecation and varying degrees of incontinence. Prior to being operated on, 6 of the patients showed symptoms of intussusception, 4 an internal prolapse of the anterior rectum wall, and 5 a rectocele at least 2 cm in size; all of them had significant perianal descent. The main aim of this study was more precise definition of the pre- and postoperative bowel evacuation using a defecation index. This study shows that obstructed defecation is significantly associated with a lasting feeling of needing to defecate after evacuation, a sensation of incomplete evacuation, perianal pain and necessity for manual support during defecation. The patients had a mean age of 62 (range, 38-78) years. All underwent anterior-posterior rectopexy (Ivalon or Vicryl) with posterior pelvic repair of the puborectalis muscle. In 2 patients rectopexy was combined with sigmoidectomy, in 11 cases, with left hemicolectomy, and in 2, with subtotal colectomy. The median follow-up was 40.8 months (range, 6-66 months). Postoperatively anorectal manometry showed a significant increase in the resting anal pressure and the maximum voluntary pressure (P = 0.05). Continence was improved in 10 patients (55%), 7 (39%) of whom regained normal continence. No significant change in pelvic descent or anorectal angle was observed. Only 8 patients reported a complete evacuation of the rectum postoperatively.

Adult↗
PubMed2004

Clinical characteristics of colorectal polyp in Thai children: a retrospective study.

BACKGROUND: It was believed that more than 90 per cent of children with colorectal polyp had a single lesion, located in the rectosigmoid colon, therefore, sigmoidoscopy with polypectomy was the treatment of choice. After a wide use of pediatric colonoscopy, this concept has been changed. MATERIAL AND METHOD: This study was aimed to describe clinical characteristics of colorectal polyp in Thai children. Medical records of children with colorectal polyp were retrospectively reviewed. Comparison between polyposis coli and children with less than 5 polyps were also analyzed. RESULTS: There were 93 patients, 43 females and 50 males. The average age was 5.1 years. Lower GI bleeding and prolapse of rectal polyp comprised the two most common presentations, 93.5 and 39.8 per cent, respectively. The mean duration of symptoms was 5.6 months. Only 50.6 per cent had rectal polyp noted by digital examination. Investigations included sigmoidoscopy (n = 77), colonoscopy (n = 16), and barium enema (n = 16). Eight per cent of the cases had more than 5 polyps. Location of the polyps was noted in the rectosigmoid colon (88.2%), descending colon (4.3%), right-sided colon (4.3%), and pancolonic (3.2%). Of all the patients, 11.8 per cent had the polyp above the rectosigmoid region, whereas 50 per cent of those who underwent colonoscopy (n = 16) had the polyps noted proximal to this region. Older age, lower hematocrit, and more frequent right-sided polyps were significantly associated with polyposis coli (p < 0.05). Only 2 patients with polyposis coli were treated by colectomy. Histopathology included juvenile polyp (95%), inflammatory pseudopolyp (2.5%), and hyperplastic polyp (2.5%). CONCLUSION: Most of the children with colorectal polyp had juvenile polyp that is commonly found in the rectosigmoid colon. However, a significant number of patients had carrying polyps proximal to the rectosigmoid region, which would be easily missed by sigmoidoscopy. With the concern of malignancy change particularly in children with polyposis coli, routine colonoscopy should be considered as an initial investigation in children with colorectal polyp.

Adenomatous Polyposis Coli↗
PubMed1994

[Surgical treatment of genito-urinary prolapses by abdominal approach. Results in a continuous series of 203 operations].

A series of 203 abdominal operations for correction of genital prolapse performed between 1985 and 1992 is reviewed. We performed abdominal sacral colpopexy systematically associated with a Burch retropubic uretropexy. Resection of the peritoneum of the pouch of Douglas, and myorraphy of the levator ani were performed according to the findings of the clinical examination. 94 patients underwent a sacral colpopexy using a single suture of the cervix to the promontory, 41 had an anterior mesh, 33 had a suture associated with an anterior mesh, and 35 had 2 meshes (anterior and posterior). 96% of the patients were between 41 and 65 years old, and 90% were perimenopausal. 78.6% were multiparous and 32% had a neonate weighting 4kg or more. Urinary stress incontinence was isolated in 38%, and associated with another disorder in 57.8%. Urodynamic studies revealed detrusor instability in 12.3% of patients, and sphincter incompetence in 15.2%. Urinary tract insection was the most frequent postoperative complication (61.5%). One month post-surgical evaluation showed good anatomic results in 94.2 to 100% of cases, and good functional results in 56 to 70.5%. The longterm results were anatomically good in 86.7 to 100% of the patients, and functionally good in 53.3 to 80.5% (mean follow-up = 32.5 months). Results were not significantly different between the 4 surgical procedures.

Adult↗
PubMed2006

Perianal local block for stapled anopexy.

PURPOSE: This study was designed to demonstrate the usefulness of a method of regional anesthesia for circular stapler anopexy for prolapsing hemorrhoids. METHODS: Thirty-three patients consented to stapled anopexy under perianal local anesthesia. Eighteen patients with stapled anopexy under general anesthesia were controls. The perianal block was applied with 40 ml of ropivacaine, 4.75 mg/ml, injected immediately peripheral to the external sphincter. A submucosal block with 15 ml of ropivacaine, 2 mg/ml, was added after applying the pursestring suture. Postoperative pain was rated by the patient for 14 days by using a ten-point visual analogue scale. Patients also submitted a preoperative and postoperative (3-6 months) symptom questionnaire to rate anal symptoms. RESULTS: No operation was converted to general anesthesia. Operation time was similar in both groups. All patients in the local anesthesia group were pain free at discharge. The sums of pain scores during 14 days for daily average pain and peak pain were similar in both groups (average pain 23 (local anesthesia) vs. 35 (general anesthesia); peak pain 39 (local anesthesia) vs. 50 (general anesthesia); P>0.05). The preoperative symptom scores were 7.8 (local anesthesia) vs. 8.9 (general anesthesia) points, and the follow-up scores were 2.2 (local anesthesia) and 2.7 (general anesthesia), a significant improvement (P=0.001) in both groups but not different between groups. CONCLUSIONS: A perianal local block is easy to apply and has a high degree of acceptance among patients. The operation time, postoperative pain, and success rates of the operation equaled those of stapled anopexy performed under general anesthesia. The advantages are quicker turnover between cases and simpler management of pain-free postoperative patients in day surgery.

Adolescent↗
PubMed2004

Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model.

BACKGROUND: The procedure for prolapsing hemorrhoids (PPH) is a new surgical method for the treatment of symptomatic hemorrhoids. In cases of recurrent prolapse, the performance of a second PPH may result in a ring of mucosa and submucosa between the two circular staple lines. In this study, we used a porcine model to assess whether PPH can be safely performed twice. METHODS: Five adult pigs underwent two PPH procedures in one session, leaving a ring of approximately 1 cm of mucosa between the two staple lines. One month later, the pigs were examined under anesthesia. The anal canal was assessed using the following four methods: (a) clinical examination, (b) evaluation of mucosal blood perfusion at different levels of the anal canal via a laser Doppler flow detector, (c) measurement of concentrations of hydroxyproline and collagen to check for fibrosis, and (d) histopathological examination. RESULTS: At the completion of the study period, all five pigs showed no clinical evidence of anorectal dysfunction. On examination under anesthesia 1 month after surgery, there was no evidence of anal stenosis in any of the pigs. The mean mucosal blood flow between the two staple lines did not differ significantly from the flow measured proximally and distally (394 vs 363 and 339 flow units, respectively; p = NS). The collagen levels, based on hydroxyproline concentration, were 81 mcg/mg between the staple lines, compared to 82 and 79 proximally and distally, respectively ( p = NS). There was no significant difference in degree of fibrosis, as assessed histopathologically, between specimens taken from the ring between the staple lines and specimens taken from the area external to the staple lines. CONCLUSIONS: The results of this porcine model suggest that a second synchronous PPH is feasible. A controlled experience involving human subjects is required to determine the safety and usefulness of this technique in cases of metachronous application for recurrent or residual hemorrhoids.

Animals↗
PubMed1980

Is continued anal dilatation necessary after a Lord's procedure for haemorrhoids?

Forty patients with symptomatic haemorrhoids had a Lord's procedure performed under general anaesthetic. Anal pressures were recorded before and after the dilatation. The patients were then randomly allocated to one of two regimens. Group 1 was given only a bulk laxative and group 2 was given a bulk laxative and a large anal dilator to use over the next few months according to Lord's regimen. When reviewed at 3 months and 12 months there was no difference in the results between the two groups. We conclude that the use of an anal dilator does not improve the result after a Lord's procedure.

Adult↗
PubMed1980

The anal reflex in idiopathic faecal incontinence: an electrophysiological study.

We have recorded the latency of the anal reflex, using a simple electrophysiological method, in 22 patients with anorectal incontinence and in 33 control subjects without anorectal disease. The mean latency in the control subjects was 8.3 ms (range 5-11.3 ms). In the patients with faecal incontinence the mean latency of the anal reflex was 13.0 ms (range 6.5-22.0 ms). The reflex latency was within the normal range in only three incontinent patients. These findings support our concept, based on histological examination of the external anal sphincter musculature, that a major cause of this syndrome is denervation of these muscles due to damage to the innervation of the external anal sphincter and puborectalis muscles.

Adolescent↗
PubMed1983

Differences in anorectal manometry between patients with haemorrhoids and patients with descending perineum syndrome: implications for management.

Anorectal manometry was carried out at rest, during balloon distension of the rectum and during rectal infusion of saline in 19 patients with haemorrhoids, 30 patients with descending perineum syndrome and 21 controls. Basal and squeeze pressures were significantly higher in patients with haemorrhoids than patients with the descending perineum syndrome. A lower rectal volume was required to inhibit internal sphincter tone in patients with descending perineum syndrome compared with control subjects or patients with haemorrhoids. During rectal infusion of saline basal and peak anal pressures in patients with the descending perineum syndrome were lower than in haemorrhoid patients. Peak rectal pressure was abnormally high in both groups. These differences in anorectal function suggest that despite a similar presentation, the two conditions have a different pathogenesis. Moreover, inappropriate anal sphincter stretch or mucosal excision in patients with descending perineum syndrome may lead to severe incontinence.

Anal Canal↗
PubMed1984

The balloon proctogram.

A balloon filled with barium has been used to simulate a soft stool for the radiological study of disorders of defaecation. Lateral radiographs demonstrate the level of the pelvic floor in relation to the pubococcygeal line, the change in the anorectal angle and the behaviour of the anal sphincters. In 12 patients with faecal incontinence, successfully treated surgically by postanal sphincter repair, the anorectal angle was reduced from 135 degrees +/- 4.4 degrees (s.e.m.) to 103 degrees +/- 4.1 degrees and the anorectal junction rose by 1.5 +/- 0.4 cm. In 10 patients with slow-transit constipation there was no pelvic descent and no change in the anorectal angle on straining. These patients were unable to expel the balloon and the results suggest that the pelvic floor does not relax normally.

Constipation↗
PubMed1989

Lateral internal sphincterotomy in the treatment of fourth degree haemorrhoids.

Between January 1984 and May 1988, 25 patients with fourth degree haemorrhoids were treated in the acute phase by lateral internal sphincterotomy under narcosis. Pain relief was immediate. The median hospital stay was 3 days. The median follow-up period was 26 months. For 20 patients a single lateral internal sphincterotomy alone was adequate treatment. If further therapy was required, simple band ligation was enough. There was one recurrence, which was treated with a further lateral internal sphincterotomy. In the long term, 18 patients had no complaints and seven had only minor complaints. Twenty-three patients were very satisfied and two were moderately satisfied. Nobody was dissatisfied. Lateral internal sphincterotomy is an attractive alternative in the treatment of fourth degree haemorrhoids, its major benefits being simplicity, efficiency and low morbidity.

Acute Disease↗