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PubMedDate not supplied

Clinical applications of radiofrequency in proctology: a review.

The radiofrequency scalpel is an innovative instrument which allows to cut and coagulate tissues in an atraumatic manner, conversely to the electric scalpel. The authors describe the use of radiofrequencies in proctology by making a literature review for every major proctologic disease (hemorrhoids, anal fistulas, anal fissure, sinus pilonidalis, hypertrophied anal papillae). Many techniques have been developed with radiofrequencies in hemorrhoids treatment: coagulation, ablation with plication, Milligan Morgan and Parks hemorrhoidectomy. In the treatment of anal fissures, radiofrequency subcutaneous lateral internal sphincterotomy has been described. For anal fistulas, both radiofrequency fistulotomy and fistulectomy. Finally, radiofrequency sinotomy for sinus pilonidalis and coagulation for hypertrophied anal papillae are present in literature. The analysis of the results obtained with radiofrequency surgery compared with those of the "classic" surgery for proctologic disease shows that in most of them radiosurgery facilitates, accelerates and improves the surgical procedure.

Catheter Ablation↗
PubMed2006

Feasibility of day care surgery in proctology.

BACKGROUND: Proctological surgery is being carried out increasingly on an outpatient basis. The reasons for this are safe anesthetic procedures, short operation times and low complication rates. This study is a retrospective analysis of complication rates, symptom recurrence and long-term results according to outpatient proctologic surgery practiced in our hospital in the last 10 years. MATERIAL AND METHOD: A total of 2840 patients were operated and followed up. The procedures included hemorrhoidectomy, anal fistulotomy, sphincterotomy, and removal of rectal polyps, pilonidal sinotomy and anal stricturotomy. Procedures were performed either under short-term general anesthesia or regional block. RESULTS: Mean hospital stay was 7.3 hours (range 4-21 hours). The overall complication rate was 2.5%, which included bleeding, urinary retention, infection, continence disturbance and recurrence. CONCLUSION: Outpatient proctological surgery can be safely performed with a low recurrence and complication rate while offering a high level of patient acceptance and satisfaction. However, an appropriate diagnosis of the disease, proper selection of the patients with respect to their suitability for surgery and a round-the-clock availability of patient communication with the nursing staff are a must for the successful outcome of the procedure.

Adolescent↗
PubMed1994

[Caudal anesthesia in proctological surgery].

The technique and advantages of caudal peridural anesthesia for proctology surgery are reported. The scarce invasivity of this methodology, the scarce or lack of interference with respiratory and cardiocirculatory functionality, the good analgesic effect postoperatively in our patients operated for proctology pathology, established the reason why we consider caudal analgesia particularly indicated for proctology surgery.

Anesthesia, Caudal↗
PubMed1985

The mycotic flora in proctological patients with and without pruritus ani.

The perianal mycotic flora was studied in proctological patients with and without pruritus ani, as well as in control subjects. Four groups of patients underwent perianal mycoculture. In Group 1, 53 patients with anal pruritus were treated for benign anorectal disease. In Group 2, 24 patients with no underlying disease presented with anal pruritus. Both of these groups underwent concomitant chemical and parasitical examination of the faeces and an oral glucose tolerance test. In Group 3, 50 patients without pruritus ani at present or in the past were treated for benign anorectal diseases. In Group 4, 47 surgical patients without pruritus ani were treated for benign (9) and malignant (38) non-proctological diseases. In Group 1 the mycoculture was positive in 24/53 patients (Candida albicans 14, dermatophytes 10). In Group 2 fungal infections were seen in 16/24 patients (C. albicans 7, dermatophytes 9). No parasites or diabetes were found in either group. In Group 3 C. albicans was isolated in 14/50 patients. In Group 4 C. albicans was found in 11/47 cases (2 in benign, 9 in malignant diseases). Infection by C. albicans was observed in all groups studied, independent of the presence of disease or anal pruritus. The presence of dermatophytes was always associated with pruritus ani.

Adolescent↗
PubMed1992

Can proctological procedures resolve perianal pruritus and mycosis? A prospective study of 23 cases.

Twenty-three patients with pruritus ani associated with anal mycosis underwent primary treatment of a concurrent anal disorder. The anal disorders included haemorrhoids (n = 9), fissure (n = 8), anal spasm without fissure (n = 5), and occult mucosal prolapse (n = 1). Pretreatment investigation of faeces for parasites was negative. The glucosal tolerance test and white blood cell count were normal in all cases. Culture of skin smears from the perianal region was positive for Candida only in 16 patients, Dermatophytes only in 6 and a combination of both in 1 patient. Following the appropriate proctological procedure, pruritus resolved or markedly improved in 20 patients. The remaining three patients required antifungal treatment with econazole. Two of these, however, continued to complain of pruritus. It is suggested that in patients with pruritus ani associated with perianal mycosis, antimycotic therapy should be used only if fungal infection persists after treatment of the underlying proctological disease.

Adolescent↗
PubMed1999

[Experiences in surgery of proctologic diseases in patients with HIV infection].

Individuals who are seropositive for the human immunodeficiency virus (HIV) often suffer from disorders affecting the anorectum, but unfortunately the best kind of treatment frequently seems questionable. In a retrospective investigation we reviewed 29 HIV-positive patients with anorectal lesions who had experienced a proctologic operation. Our impression correlates with other findings according to which HIV-positive patients in advanced stages have a poorer post-operative outcome in terms of morbidity and survival than patients in an early CDC disease stage. This implies that the indication for a proctologic operation in an immunocompromised state has to be considered carefully.

AIDS-Related Opportunistic Infections↗
PubMed2004

[Outpatient surgery in proctology].

Proctological surgery can be carried out increasingly on an outpatient basis and thus more cost-effectively. The reasons for this are, in addition to modern anaesthetic procedures, short operation times and low complication rates in numerous proctological operations. Fissurectomies, individual haemorrhoidectomies, operations on uncomplicated fistulae and benign anal tumours only rarely need to be carried out nowadays under inpatient conditions. The conditions for successful outpatient surgery are: appropriate diagnosis of the indication, selection of the patients with respect to their suitability for surgery and standardised follow-up care.

Ambulatory Surgical Procedures↗
PubMed2006

[Approach to the present state of proctology in Andalusia (Spain): results of a community survey].

OBJECTIVE: Proctology has acquired such complexity that it requires a specific qualification, as well as the creation of specialized groups. In Andalusia there are proctologists throughout the public health system. Measurement of the quality of the distinct processes is essential. The aim of the present study was to determine the resources available, as well as to identify the management of these patients, with a view to identifying areas requiring improvement. MATERIALS AND METHOD: A descriptive, multicenter, cross sectional study of the current situation of proctology in general surgery services in 25 hospitals in Andalusia (20 public and 5 private) was performed. A survey was used to identify the general characteristics of the hospital, the tests available, and the treatments used. RESULTS: A total of 65.38% of the hospitals have a coloproctology unit, while a drop-in outpatient clinic is available in only 38.46%. Manometry and anal endosonography are available in 50% and 58%, respectively. Treatment of hemorrhoids is predominantly hemorrhoidectomy (92.30%). Medical treatment and sphincterotomy are the most widely used treatments for anal fissure, and anal dilation is still performed in 30.76%. Seton is used in 92.30%, as well as fistulotomy (88.46%), to treat fistula. The most frequent treatment of sinus is en-bloc resection and primary closure (54.16%). Between 30% and 44% report little experience of pelvic floor disorders. CONCLUSION: Although there is a willingness to achieve progress and reach an adequate scientific level, a multitude of obsolete practices should be corrected. Tools such as scientific evidence, information management and evaluation by means of comparison with standards should be diligently included in our clinical practice.

Colorectal Surgery↗
PubMed2004

The role of biofeedback therapy in functional proctologic disorders.

BACKGROUND AND AIMS: The question which patients with functional proctologic disorders truly benefit from the biofeedback has not been equivocally resolved. The aim of this study was to assess our results of biofeedback therapy in patients with anal incontinence or constipation. MATERIAL AND METHODS: Fifty-two consecutive patients who were treated with biofeedback therapy between January 1998 and March 2002 were studied. Data was collected from our proctologic database. RESULTS: Of the twenty-two patients with anal incontinence who underwent biofeedback therapy during the study period, twenty patients had incontinence affecting quality of life. Twelve patients (60 percent) benefited from biofeedback as judged by improvement of incontinence symptoms affecting quality of life; all four patients with partial sphincter defects, three out of four patients after secondary repair, three out of five patients with persistent incontinence after rectal prolapse surgery and two out of seven patients having idiopathic incontinence. Of the thirty patients who underwent biofeedback therapy for constipation, twenty-five had intractable symptoms of constipation. Constipation resolved in sixteen patients (64 percent); in thirteen out of nineteen (68 percent) of those with pelvic floor dysfunction (PFD) and in three out of six (50 percent) having combined PFD and slow transit constipation. In patients with PFD constipation was resolved in ten out of thirteen patients (77 percent) with anismus but in only three out of six (50 percent) having other causes. CONCLUSIONS: Biofeedback therapy improves incontinence after sphincter repairs and in patients with partial external sphincter defects, but does not improve idiopathic incontinence. Biofeedback is also effective in patients with constipation, especially when anismus is the only cause for symptoms of constipation and difficult evacuation.

Adult↗
PubMed2002

New approaches in ambulatory proctology.

Ambulatory proctology is till now very underestimated discipline, which is out of interest of big surgeons. But is is a very important field due to incidence of proctological affections and severe social consequences of their inappropriate diagnosis and treatment. We stress the conservative and semi-invasive treatment of hemorrhoids, anal thrombosis and anal fissures. We also mention the other anal pathologies.

Fissure in Ano↗
PubMed1976

[Multicenter clinical study of a novel steroid-free preparation in proctology].

In a multicentre study 15 physicians investigated the therapeutic efficacy and tolerance of Faktu suppositories and ointment (containing the active principle of Albothyl, a condensation product of m-cresolsulfonic acid and formaldehyde) in 585 patients with proctological affections. Highly satisfactory results were achieved in 486 patients (83.1%). The following were found to be the main indications: -treatment of wounds after proctological operations, -fresh and fissures, -bleeding internal haemorrhoids, -anal eczema and anal pruritus, -rhagades and perforated or prolapsed external haemorrhoids (perianal thrombosis). None of the investigators reported any persisting adverse side-effects. 16% of the patients complained of local discomfort of varying intensity such as pruritus, burning or irritation. The symptoms mostly appeared on commencement of the treatment and necessitated discontinuation of therapy in 5.3% only. The extremely favourable effect of Albothyl - the active principle of Faktu - is due to its unique mechanism of action: the markedly acid milieu of the substance. Furthermore the Faktu preparations do not contain any steroids and consequently they can be used without any misgivings over prolonged periods.

Adolescent↗
PubMedDate not supplied

Ambulatory proctology surgery--an Indian experience.

OBJECTIVE: To evaluate the results of proctological surgeries carried out by us on an outpatient basis. DESIGN: Retrospective study. SUBJECT: 3256 patients with benign ano-rectal pathologies needing surgical intervention. MATERIALS AND METHODS: Patient demographics, type of anesthesia used, the type of operation and postoperative complications are described. Patient satisfaction was assessed independently after surgical procedure. RESULTS: Mean age of the patients was 37.5 years. 61% patients were male. There was no mortality. The mean duration of hospital stay was 8.4 hours (range 3-22 hours). Complication rate was 2.9%. 81.4% patients were highly satisfied with the procedure. CONCLUSION: Day care proctological procedures are a safe and effective way of reducing costs without increasing morbidity, mortality, and is acceptable to majority of patients.

Adolescent↗
PubMed1990

[The past and future of proctology].

Since antiquity, surgical treatments of anorectal lesions were performed by barbers and surgeons; proctology became with time a surgical speciality well defined and recognized todays. History of proctology is illustrated by some important figures and events: St. Fiacre, Felix the surgeon who operated on King Louis XIV's fistula and the acutely thrombosed hemorrhoidal prolapse of Napoleon.

Colorectal Surgery↗
PubMedDate not supplied

Treatment of haemorrhoids at the Moscow Research Institute of Proctology.

The article sums up experience acquired with the treatment of more than 4,000 patients with haemorrhoids at the Research Institute of Proctology (Moscow). The pattern that emerges is that only about 30% of patients with haemorrhoids should be subjected to radical haemorrhoidectomy. Others can be cured on conservative lines, including sclerosing injections. Two modifications of haemorrhoidectomy are described which have been developed at the Research Institute of Proctology (Moscow). Long-term results of haemorrhoidectomy have been examined in nearly 1,500 patients. In the post-operative period of five and more years, 3.78% of patients had recurrences.

Administration, Rectal↗
PubMedDate not supplied

[Proctological survey in a phlebology clinic].

At a phlebological centre, the writer was in a position to see proctological patients without its being possible to establish any particular connection between varicose veins and hemorrhoids. In this paper, he examines the prevalence of proctological symptoms and specifies which treatments are applied.

Adult↗
PubMed1988

Usefulness and limitations of colonoscopy in a proctological clinic.

Colonoscopy is a superior diagnostic tool for the detection of cancer of the colon. Its limitations include that it is not always available and there is a great deal of discomfort for the patient. It should therefore be used as effectively as possible. The goal of this retrolective cohort study was to analyze the usefulness of colonoscopy, especially by relating it to the subsequent therapeutic impact. Indication-related groups included "rectal bleeding," "other symptoms suggestive of malignancy," and "follow-up." In 714 patients selected as a result of admission to the proctological unit of our surgical clinic, a carcinoma was discovered in 9% and an adenoma in 13.4%. Patients with rectal bleeding were found to benefit most from colonoscopy since active therapeutic management followed in 56% of the cases. On comparison, there was a direct therapeutic impact in only 10% of the colonoscopies performed for follow-up. Identification of additional factors such as mucosal proliferation markers may help to improve the efficiency of endoscopy by more specifically designating the populations at risk for colonic neoplasia.

Adult↗
PubMed1990

Rhomboid flap in proctologic reconstruction.

The application of Limberg-type transposition flaps of rhomboid shape has been demonstrated to be one method of covering defects in the perianal area or the anal canal, after the extirpation of lesions that cannot be closed at first attempt because of defect size. This series includes five patients treated over a period of five years; a total of seven flaps were performed because there were contralateral lesions in two patients. The technique consists of extirpation of the lesion to create a rhomboid-shaped defect, which is then covered by a flap cut following the Limberg or Dufourmentel technique. Anoplasty techniques have been long established and advancement or rotation flaps are the most popular in proctologic surgery. Transposition flaps are useful because they are easy to remember and perform and have no serious postoperative complications.

Adult↗