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M Pescatori

Publications and source records attributed to M Pescatori.

At least 19 recordsLinked to original sources
PubMed2003

Rectocele: pathogenesis and surgical management.

BACKGROUND: Rectocele is a common finding in patients with intractable evacuatory disorders. Although much rectocele surgery is conducted by gynecologists en passant with other forms of vaginal surgery, many reports lack appreciation of the importance of coincident anorectal symptoms, and do not report functional and clinical outcome data. The pathogenesis of rectocele is still controversial, as is the embryological and anatomical importance of the rectovaginal septum as well as recognizable defects in its integrity and its relevance in formal repair when rectocele is operated upon as the principal condition in patients with intractable evacuatory difficulty. DISCUSSION: The investigation and surgical management of rectocele is controversial given the relatively small numbers of operated patients in any single specialist unit and the relative lack of prospective data concerning functional outcome in operated cases. The imaging of rectocele patients is currently in a state of change, and the newer diagnostic modalities including dynamic magnetic resonance imaging frequently display a multiplicity of pelvic floor disorders. When surgery is indicated, coloproctologists most commonly utilize an endorectal defect-specific repair, but there are few controlled randomized data regarding outcome and response criteria of specific symptoms with particular surgical approaches. A Medline-based literature search was conducted for this review to assess the clinical results of defect-specific rectocele repairs using the endorectal, transvaginal, transperineal, or combined approaches. Only the studies are included that report both pre- and postoperative symptoms including constipation, evacuatory difficulty, pelvic pain, the impression of a pelvic mass, fecal incontinence, dyspareunia or the need for assisted digitation to aid defecation. CONCLUSION: The history of rectocele repair, its clinical and diagnostic features and the advantages, disadvantages and indications for the different surgical techniques are presented in this review. Suggested diagnostic and surgical therapeutic algorithms for management have been included. It is recommended that a multicenter controlled randomized trial comparing surgical approaches for symptomatic evacuatory dysfunction where rectocele is the principal abnormality should be conducted.

Algorithms↗
PubMed2002

Two-quadrant semiclosed hemorrhoidectomy. A preliminary report.

Bleeding and delayed healing may affect the postoperative course following hemorrhoidectomy and cause discomfort to the patient. The present report deals with a modification of the Milligan-Morgan operation: the upper part of the surgical wound is covered with rectal mucosa and the distal edge is stitched with a running suture, with the aim of decreasing both the risk of bleeding and the healing time. The operation has been performed in 12 consecutive patients with two quadrant internal and external piles. The median operative time was 32 minutes (range, 21-30). The mean postoperative pain after 12 hours, measured from 1 to 10 on a visual analogue scale, was 4.4 (SEM, 1.4). All patients but three had their wounds healed within 3 weeks and none of them had postoperative bleeding requiring treatment. Acute urinary retention occurred in one case. All patients were discharged after 48 hours. None had anal incontinence or short-term recurrence. In conclusion, two-quadrant semiclosed hemorrhoidectomy provided good results in terms of both bleeding rate and healing process with an acceptable operative time and postoperative pain.

Adult↗
PubMed2001

Reconstructive perineoplasty in the management of non-healing wounds after anorectal surgery.

Non-healing wounds (NHW) following anorectal surgery cause great distress to the patient and may be followed by a retracting scar causing anal deformity and incontinence. The management of NHW is controversial. The aim of this study was to review our experience with reconstructive perineoplasty in the treatment of such condition. From January 1992 to June 2000, we treated 12 patients affected by NHW (4 men and 8 women, mean age 47 years), not responding to conservative treatment. None had Crohn's disease or HIV infection. Pre- and postoperative anal manometry and ultrasound were carried out in 8 patients. All had microspinal anesthesia, mechanical preparation of the intestine, and perineal wound cleansing. Reconstructive perineoplasty was performed by means of local flaps (i. e. cutaneous, fasciocutaneous, myocutaneous). Median follow-up was 13 months (range, 1 to 70). Postoperative complications were as follows: 5 perineal suture dehiscences (1 total, 4 partial), the flap being resutured in one case under local anesthesia; one patient required dilatations for mild anal stricture. No case of gross fecal incontinence, retracting scar or perineal ulcer was observed. Among those patients who had disordered anal continence prior to surgery, all but one improved continence score following perineoplasty from 2.8+/-2.2 to 1.8+/-1.2 (mean +/- sdm, not significant). Following reconstructive perineoplasty, no significant change was observed in functional and morphologic patterns of the anal sphincters either at manometry or by ultrasound. Reconstructive perineoplasty resulted in a good functional and clinical outcome in most cases and, therefore, may be considered an effective procedure in the management of NHW.

Adult↗
PubMed2001

Which surgical approach for rectocele? A multicentric report from Italian coloproctologists.

The most effective surgical technique for rectocele has not yet been clearly established. A retrospective multicentric study was carried out to compare the long-term results of 3 endorectal techniques (Block, Sarles and stapled) and the perineal levatorplasty, alone and in association, in a series of patients with symptomatic rectocele. From January 1992 to December 1999, 2212 patients with defecation disorders were referred to 5 Italian coloproctology units. An anterior rectocele was clinically diagnosed in 1045 patients and confirmed with defecography. On the basis of clinical and radiological parameters, 317 patients (312 women; mean age, 52.4+/-20.1 years) were selected for surgery. Group 1 consisted of 141 patients (136 women; mean age, 50.4+/-18.8 years) who were submitted to endorectal operations. Group 2 consisted of 126 women (mean age, 52.5+/-19.7 years) who received perineal levatorplasty. Finally, 50 women (mean age, 54.3+/-21.9 years) in Group 3 received endorectal operations associated with perineal levatorplasty. A total of 269 patients were followed postoperatively (mean period, 24.2+/-3.1 months, 27.5+/-5.4 months and, 22.8+/-2.8 months, respectively) with the same questionnaire and clinical examination. Three months after surgery, a defecography examination and anorectal manometry were performed in 136 and 132 patients, respectively. Operative time, hospital stay and time to return to work were significantly higher in Group 3 (p<0.001). There was one death in Group 3 due to severe sepsis. Main postoperative complications were: in Group 1, hemorrhage (7.8%, all Sarles), dehiscence of the endorectal suture (5.0%, all Block), distal rectal stenosis (2.1%, 1 stapled, 2 block), and rectovaginal fistula (1.4%, all Sarles); in Group 2, delayed healing of the perineal wound (16.4%); in Group 3 delayed healing of the perineal wound (22.0%), hemorrhage (6%, all Sarles), dehiscence (4.0%), stenosis (2.0%). 17.3% of patients of Group 2 and 22.5% of Group 3 complained of dyspareunia. Postoperative defecography showed a complete absence of the rectocele in 44.1% of patients and reduction of size in the others, without significant differences among the three groups. Manometric pattern was not significantly modified by surgery. Significant symptoms recurred in 5.9% of the patients in Group 1, 6.4% in Group 2, and 5.0% in Group 3. Perineal levatorplasty did not significantly improve obstructed defecation, as it did not allow to excise the rectal mucosal prolapse, and was followed by an high incidence of delayed healing of the perineal wound and dyspareunia. Sarles procedure achieved better control of mucosal prolapse but carried a higher complication rate compared to the others. The association of the perineal levatorplasty with an endorectal technique required significantly longer operative time, and led to a longer hospital stay and time to return to work. In conclusion, the investigated techniques showed different patterns of postoperative complications: bleeding after Sarles, dehiscence after Block, dyspareunia after perineoplasty and fatal gangrene after stapled, but non of them showed a clear superiority over the others in term of clinical or functional results 2 years after surgery.

Adult↗
PubMed2001

Sources of clinical referrals to an urban coloproctology unit in Italy.

Prompt and appropriate referrals to colorectal surgeons result in better clinical and more cost-effective outcome: the question that then arises is how patients with large bowel diseases get in contact with the specialist. The aim of the present research was to investigate the sources of clinical referrals of 1000 patients attending a dedicated coloproctology unit. One thousand consecutive new patients attending the private Coloproctology Unit of Rome were prospectively evaluated from May 1995 through December 1999. For each patient, the following data were collected: age, gender, source of referral, and disease classified as benign anal diseases, neoplasms, functional disorders or inflammatory bowel disease (IBD). There were 569 patients with benign anal disease, 334 with functional disorders, 57 with neoplasms, and 40 with IBD. Sources of referral were: surgeons (32.6%), previous patients (23.6%), other specialists (22.8%), general practitioners (11.8) and others (9.2%). Overall, referrals from non-medical sources were 32.8%, whereas 67.2% of the cases were referred by other colleagues. Most of the referring specialists were surgeons or gastroenterologists, who sent 304 patients, whereas 9.4% of the cases were referred by other colorectal surgeons. Previous patients who were satisfactorily cured sent 23.6% of the cases. Only 1.1% of patients were referred by health insurance companies and 0.2% found the Unit through Internet. Colleagues who referred patients to the coloproctologist sent mainly cases with benign anal diseases and functional disorders. Few patients were referred for colorectal cancer and IBD as these diseases are routinely treated by general surgeons and their management is expensive in a private hospital for patients without insurance coverage. In conclusion, GPs, media, health insurance and Internet may be the most valuable targets of an information campaign, as their role as sources of referral was lower than expected.

Adolescent↗
PubMed2000

Mucosal changes in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis.

PURPOSE: Inflammation and dysplasia may affect the ileal pouch after restorative proctocolectomy and ileal pouch-anal anastomosis. The aim of this prospective study was to evaluate the morphologic changes and the risk of dysplasia within the pouch after ileal pouch-anal anastomosis. METHODS: Thirty-seven patients with ileal pouch-anal anastomosis underwent endoscopies and biopsies of the pouch: 21 patients were affected by ulcerative colitis and 16 by Crohn's colitis. The mucosal biopsy specimens were studied to investigate the degree of acute and chronic inflammation and the occurrence of dysplasia. A score system was calculated for each patient and correlated with the histologic diagnosis of ulcerative colitis or Crohn's colitis. RESULTS: After a median follow-up of 85 (range, 7-198) months, the inflammation histologic score evaluated was 3.8 (95 percent confidence interval, 2.4-5.1) and 3.5 (95 percent confidence interval, 2.6-4.3), respectively, in patients with Crohn's colitis and ulcerative colitis (mean and 95 percent confidence interval; P = 0.74, not significant), and no patient developed mucosal dysplasia. Fifteen patients (40.5 percent) developed clinical pouchitis that occurred in Crohn's colitis (9/16 patients or 56 percent) and in ulcerative colitis (6/21 patients or 28 percent; P not significant). The score was 4.1 (95 percent confidence interval, 3.2-5) in patients with pouchitis and 3.2 (95 percent confidence interval, 2.1-4.3) in patients without clinical pouchitis (P = 0.012) and was 4.1 (95 percent confidence interval, 2.6-5.5) and 4 (95 percent confidence interval, 2.9-5.3), respectively, in pouchitis patients with Crohn's colitis and ulcerative colitis. CONCLUSION: No difference in the inflammation histologic score was observed in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis. In our series, which includes those patients with longer follow-up (>5 years) or with chronic unremitting pouchitis, no case of dysplasia was found. The occurrence of pouchitis was higher in the case of ileal pouch-anal anastomosis for Crohn's disease than for ulcerative colitis, but no difference in the severity of the histologic score was noted.

Adult↗
PubMed2000

Glyceryl trinitrate for chronic anal fissure--healing or headache? Results of a multicenter, randomized, placebo-controled, double-blind trial.

PURPOSE: Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic anal fissure. METHODS: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients. RESULTS: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo (P = not significant). Pain score fell significantly in both groups, in addition to maximum anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate. CONCLUSION: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatment vs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic anal fissure.

Adult↗
PubMed2000

Psychologic aspects in proctalgia.

PURPOSE: One of the main problems in coloproctology is chronic idiopathic anal pain. The aim of this study was to investigate the psychosomatic components of proctalgia to identify which, if any, component is associated with this pain and to what extent. METHODS: Twenty patients with proctalgia were observed (mean age, 46 years). Psychologic consultations were required by the surgeons, because of persistent symptoms, to allow a better understanding of the problem and a more integrated therapy. The psychologic investigation consisted of three interviews and administration of the following tests: Institute for Personality and Ability Testing Anxiety Scale Questionnaire (1-10), Rorschach test (Klopfer and Davidson method), and Draw-A-Person test by Karen Machover. This sample was compared with a control group composed of 40 healthy subjects, homogeneous in age, social and working conditions, and investigation procedures. RESULTS: Patients showed depression and anxiety according to standard validated questions (Institute for Personality and Ability Testing Anxiety Scale Questionnaire) and personality disorders; they had a strong tendency to use primitive defense mechanisms and showed a lack of personality formation. CONCLUSIONS: Psychologic investigation allows a progressive clarification of all the components of anal pain. This might be useful not only for research purposes but also for a more effective approach to these patients.

Adult↗
PubMed2000

The use of relaxation techniques in the perioperative management of proctological patients: preliminary results.

Relaxation techniques positively affect the psychosomatic pattern of patients undergoing surgical treatment. Among these techniques guided imaging (GI) has been reported to improve outcome following colorectal surgery. This study assessed the effects of GI on the postoperative course in proctological patients. We carried out a prospective randomized trial in a group of patients operated on for anorectal diseases in our coloproctology unit. Patients were randomized into group 1 (n = 43) with standard care and group 2 (n = 43) with relaxation techniques; they listened to a GI tape with music and relaxing text before, during, and after surgery. The following parameters were evaluated by a questionnaire (a) postoperative pain measured by visual analogue score, (b) the quality of sleep measured by a similar score, and (c) the nature of first micturition, evaluated as normal or difficult. Groups were similar in age and sex distribution, type of disease, and operation performed. The pain score was 3.2 +/- 1.4 in GI patients and 4.1 +/- 2.1 in controls (P = 0.07). The quality of sleep score was 4.8 +/- 2.9 in GI patients and 6.4 +/- 2.7 in controls (P = 0.01). The first micturition was painful in 10.3% of GI patients and in 27.3% of controls (P = 0.09). Perioperative relaxation techniques thus showed a trend to reducing pain following anorectal surgery and significantly improving the quality of sleep; a decrease in anxiety and a consequent muscle relaxation may be involved. Therefore GI, a low cost and noninvasive procedure, can be recommended as an helpful tool in this type of surgery.

Adolescent↗