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PubMedDate not supplied

[Treatment of chronic anal fissure using closed internal and lateral sphincterotomy].

UNLABELLED: When the conservative treatment of the chronic anal fissure (nitrates, topical calcium channel blockers, topical nifedipine, lignocaine and cortisone compounds) proves to be inefficient, the surgery may be opted for. From among all surgical procedures (anal dilation, fissure excision, anal advancement flap) we have opted for closed internal and lateral sphincterotomy. During the period of 1990-2002, there have been performed by just one surgeon 47 sphincterotomies (15 men-32 women), average age 49 (23-76). RESULTS: There has not been any case of anal incontinence for gases or faeces, precocious or late; 1 para anal hematoma (2.12%) solved through puncture; 2 anal abscesses (4.25%), solved through incision and tegmen drainage. Control in 6 month's time and 1 year time: normal quality of life, without any subjective complaints; painless rectal touch, healing of the fissure, extensible anal sphincter, normal continence. The sphincterotomy was followed by the disappearance of the cleft syndrome with all patients. Although the literature contains citations of transitory and minimum incontinence in 2-4% of the cases, we have not noticed in any; no recurrences have been registered; morbidity is acceptable. The future will decide if, between sphincterotomy and the injection with the botulinum toxin, the latter one is to be preferred.

Adult↗
PubMed1992

Fast-growing cancer of the colon and rectum.

Recently, the existence of a flat, colorectal cancer has been proposed. This cancer is completely different in appearance from ordinary polyp cancer and is believed to invade deeply into the submucosa, even in its early stages. Its characteristics are quite different from cancers that follow the adenoma-cancer sequence, and it requires a greater search to detect. The authors observed four cases of fast-growing cancer that were relatively flat in appearance, contained no adenomatous component, and were invasive, even in their early stages.

Adult↗
PubMed2005

[Treatment of rectal tumors with transanal endoscopic microsurgery].

OBJECTIVE: The aim of this study was to assess one and a half years experience gained in Lithuania while treating rectal tumors with transanal endoscopic microsurgery in the Centre of Abdominal Surgery of Vilnius University Hospital "Santariskiu klinikos". MATERIALS AND METHODS: The patients who had rectal adenomas and low-risk T1 carcinomas of good or moderate differentiation, with no lymphatic and vascular invasion were selected for surgery. Tumor stage was determined by transanal endosonoscopy and rectoscopy with multiple macrobiopsies before surgery. RESULTS: A total of 47 patients were operated on. The average tumor size was 3.4+/-1.4 cm (ranged from 1 to 7 cm). Overall 25 (52.1%) carcinomas and 23 (47.9%) adenomas were removed. Pre-operative diagnoses did not correspond to the final clinical diagnoses in 14 (29.8%) cases. Forty-three (89.6%) radical operations (R0) and 5 (10.6%) doubtful complete operations (RX) were performed. One (2.1%) intra-operative complication and one (2.1%) post-operative complication were observed. After the removal of Ca T2 three patients underwent adjuvant radiotherapy. Twenty-six patients were followed up for 3-17 months after operation: 17 after removal of cancer and 9 after removal of adenoma. One (2.1%) recurrence of a tubulovillous adenoma was diagnosed. No other complications were reported. CONCLUSIONS: Initial results of transanal endoscopic microsurgery obtained while treating rectal adenomas and low-risk T1 cancers are promising. The low rate of complications and recurrences in this group offers many hopes. The experience of the treatment of T2 cancers with transanal endoscopic microsurgery and adjuvant radiotherapy is limited but the results are encouraging. It is obvious that the results of randomized and controlled trials need to be awaited before definite conclusions can be drawn.

Adenoma↗
PubMed2005

Transanal endoscopic microsurgery for rectal cancer.

BACKGROUND: Transanal endoscopic microsurgery has recently gained acceptance as an alternative minimally invasive surgical technique for the curative management of large rectal adenomas and selected early rectal carcinomas. OBJECTIVES: To analyze our 8 year experience using TEM for the management of rectal cancer. METHODS: Local resection by TEM was performed in patients with benign tumors and early rectal cancer. In addition, selected patients with T2 and T3 rectal cancers who were either medically unfit or unwilling to undergo radical surgery were also treated with this modality. Radical surgery was offered to all patients with incomplete tumor excision by TEM. RESULTS: Overall, 116 TEM operations for rectal tumors were carried out between 1995 and 2003, including 74 patients with rectal adenomas and 42 patients with rectal carcinomas. In 25 patients, TEM successfully removed all T1 tumors with clear tumor margins. Fourteen patients had T2 cancer and 3 of them (21%) required additional radical surgery due to incomplete excision. Local recurrence was observed in one patient with T2 cancer. There was no mortality. Major surgery or radiotherapy-related complications requiring additional surgical intervention was needed in five patients with T2 cancer. CONCLUSIONS: Local excision by TEM is a safe surgical procedure and should be offered to highly selected patients with early rectal cancer.

Adenoma↗
PubMed1992

Endoscopic diagnosis of anorectal melanoma.

Symptoms of anorectal melanoma commonly are attributed to hemorrhoids. The authors believe recognition of the sigmoidoscopic appearance will allow the physician to distinguish this condition from the more common anorectal disorders.

Aged↗
PubMedDate not supplied

[Development of forensic medical expertise of sexual conditions in men].

The necessity of new methodological approaches in forensic medical examination of sexual male conditions are discussed basing on the analysis of questionnaire surveys of isolated groups of men and forensic medical examinations of male victims accused of sexual crimes. How to update expertise of sexual male conditions including investigations of anorectal and erectile dysfunctions in shown.

Child↗
PubMedDate not supplied

A review of conservative and surgical management of anal fissure.

BACKGROUND: Anal fissures are one of the common perianal conditions presenting with bleeding, itching, and pain of varying severity. The method of treating this pathology should preferably be the one that results in optimal clinical outcome, is less painful, and is patient friendly. Despite a plethora of techniques in vogue, an ideal management of this condition continues to be a subject of debate. MATERIALS AND METHODS: A Medline database was used to perform a literature search for articles relating to the term 'anal fissure'. CONCLUSION: Analysis of the available literature shows that by far, medical manipulation of the internal sphincter should be the first-line treatment in anal fissure. A surgical therapy is called for if the medical therapy fails or there is a recurrence.

Administration, Oral↗
PubMed2006

[The first case of management of the rectovaginal fistule using transanal endocsopic microsurgery].

The authors present an unusual and, according to the available literature data, so far unused method--management of the rectovaginal fistule, using a T.E.M. technique (transanal endoscopic microsurgery). In their case-review of a female patient, they present advantages of this technique in a case of a rare disorder - a benign rectovaginal fistule. All of the following employment of a harmonic scalpel in the T.E.M. method, as well as of a tissue adhesive Tissucol and of a surgical rectoscope in the vaginal phase of the procedure, deserve attention of surgeons and gynaecologists.

Female↗
PubMed2006

[Primary pelvic hydatid cyst: a case report].

The purpose of this report is to describe a case of primary pelvic hydatid cyst in a 30-year-old man who presented with abdominal symptoms related to compression of the rectum and urinary tract. This unusual location was initially considered as a tumour process. Proper diagnosis can sometimes be based on ultrasound and computerised tomography. However in some cases such as ours surgical exploration may be necessary for definitive diagnosis.

Adult↗
PubMed1990

Palliative endoscopic therapy for rectal cancer with neodymium:YAG laser.

Neodymium: YAG laser has become an alternative to conventional palliative therapy for rectal cancer. Between January 1986 and December 1989, 31 patients were treated with endoscopic laser evaporation for rectal cancers with obstruction (n = 17), bleeding (n = 3) and non-obstructive luminal narrowing (n = 11). Contraindications against surgery were multiple metastases (n = 16), poor general health (n = 7), refusal by patient (n = 5) and extensive local invasion (n = 3). Laser treatment was tolerated well with an initially good response in 29 patients. Palliation could be maintained in 20 patients with laser only; two patients had an unsatisfactory control of symptoms and in eight cases a diverting colostomy was eventually required, largely due to extramural tumor growth. Complications were limited to one stenotic scar. There were no laser-related deaths. Patients survived on average 10.8 (0.1-49) months, 2-year survival was 26%. We conclude that endoscopic neodymium: YAG laser therapy is an efficient and safe palliative method to control intraluminal, obstructing or bleeding rectal cancers.

Adult↗
PubMed2006

[Rectal stenosis following procedure for prolapse and hemorrhoids].

OBJECTIVE: To evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events. METHODS: A retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed. RESULTS: Only patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, P = 0.003). Other factors, such as gender (P = 0.32), prior surgery for hemorrhoids (P = 0.11), histological evidence of squamous skin (P = 0.77) or revision (P = 0.53) showed no significance. CONCLUSION: Rectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.

Adult↗
PubMedDate not supplied

[Laser treatment of rectosigmoidal tumors: long-term results].

Over a 10 year period, 530 patients were treated at the Lille Laser Center for a rectosigmoid tumour. Both argon and Nd:YAG lasers were used. Two hundred patients were treated for palliation of symptoms from a rectosigmoid cancer, 313 patients were treated for a rectosigmoid villous adenoma, and 17 patients with a familial polyposis were treated for the rectal polyposis remaining after total colectomy. The immediate success rate and complication rate were 88% and 2.7%, respectively, for patients with advanced cancer, 92% and 2% for those with a villous adenoma, and 100% and 0% for those with polyposis. Patients with an advanced cancer remained functionally improved during a 10.1 month average period after initial improvement. The recurrence rate after initial treatment for villous adenomas was 14% during a 3.1 year average follow-up. Immediate results were influenced by reason for treatment, initial symptoms and circumferential extension for patients with a cancer, and only by circumferential extension for patients with a villous adenoma. Long term results were influenced by reason for treatment and circumferential extension for patients with a cancer, and by reason for treatment, initial histology and localization for patients with a villous adenoma.

Adult↗
PubMed1991

[Relevance and therapeutic implications of dysplasia in the follow-up of ulcerative rectocolitis].

Long standing ulcerative colitis (UC) is a condition capable of malignant transformation. Even if the rate of occurrence of carcinoma differs considerably among the various series, there is general agreement that it can be detectable in advance through the finding of glandular dysplasia. The Authors examine such a problem in a series of 27 patients submitted to clinical and endoscopic follow-up from 1984 to 1989. During this study a total of 237 rectosigmoidoscopies, 83 colonoscopies and 71 histologic exams were performed. At the outset mild or moderate dysplasia was found in 5 cases (18%). However, in the follow-up no evidence of dysplasia was detectable in 4 of the 5 cases. In the remaining case dysplasia was present only in one control. It was not found in the subsequent two histologic examinations. In our limited experience the incidence of dysplasia was not significant enough to require a prophylactic proctocolectomy. Instead a frequent and thorough endoscopic follow-up is recommended.

Adolescent↗