O5 Dose mean opening pressure predominantly assess internal anal sphincter function

Introduction We have suggested that mean Opening Pressure (Op) recorded during Anal Acoustic Reflectometry (AAR) predominantly represents IAS function however, the extent remains unknown. The aim was to investigate this by excluding the external anal sphincter during general anaesthetic (GA) with confirmed neuromuscular blockade (NMB). Method Patients undergoing elective abdominal surgery requiring GA+NMB were approached. Patients had pre-operative (awake) and during GA + NMB (asleep) AAR measurements performed. The rectoanal inhibitory reflex (RAIR) was assessed permitting the Op value to also be recorded when the IAS was inhibited. Op was recorded at prerectal distension and then after 100 mls of air was inflated within a balloon in the rectum (post-rectal distension). Result 19 patients were included. The values of Op (cmH20) and the reductions observed during the RAIR when awake/asleep are as follows: Awake Op: prerectal distension (64.94) and post-rectal distension (35.35) therefore mean change 29.59 cmH2O i.e. 44.6% reduction Asleep Op: prerectal distension (37.64) and post-rectal distension (15.55) therefore mean change 22.1 i.e. 55.3% reduction The contribution of the IAS to Op is calculated as follows: (Mean change Op awake x 100)/% reduction in RAIR asleep = IAS contribution awake (29.59cmH20 x 100)/55.3 = 53.51cmH20 Total mean Op awake—IAS contribution awake = EAS contribution awake 64.94cmH20–53.51cmH20 (82.4%) = 11.43cmH20 (17.6%) Conclusion The IAS accounts for 82.4% of Op at rest and it remains our hypothesis that Op primarily represents IAS function. Take-home Message Opening pressure primarily represents internal anal sphincter function.

Rectoperineal Fistula Presented 5 Months After Repair of Severe Obstetric Perineal Laceration: A Case Report

Introduction: Obstetric severe perineal laceration can frequently occur as a surgical site infection (SSI), which sometimes leads to rectovaginal fistula after repair. We encountered a rare case of a rectoperineal fistula 5 months after repair of a severe perineal laceration.Case presentation: The patient was a 39-year-old woman who underwent repair of a fourth-degree perineal laceration after vaginal delivery. Five months after primary repair, she presented with perineal swelling and pain followed by uncontrollable flatulence or passage of feces at the perineum, which was finally diagnosed as a rectoperineal fistula. Transperineal repair with fistulous tract excision was performed for the rectoperineal fistula. Closure of the rectum, perineal body, and vagina was performed layer-by-layer constructing a thick perineum to prevent anal dysfunction. The fistula was successfully closed, and the patient did not show any symptoms of fecal incontinence 6 months after surgery.Discussion: As the rectoperineal fistula might have resulted in SSI at the primary repair of the obstetric injury, the delayed occurrence of the rectoperineal fistula was unusual. A perineal approach should be performed for complete fistulous tract excision, reconstruction of a robust perineal structure, and preservation of anal sphincter function.

Results of the use of intranodal laser coagulation in patients with chronic internal hemorrhoids stage III

Aim: to assess the efficacy of intranodal laser coagulation for hemorrhoids stage III.Patients and methods: the study included 62 patients with chronic internal hemorrhoids stage III without external hemorrhoids, who were informed of the INLC technology, its advantages and disadvantages. The selection for this procedure was done due to the high-resolution anoscopy, in the presence of type 1 and type 2 severity of inflammatory changes in the nodes.Results: on the 3rd day, no pain occurred in 52 (83.9%) patients. After 12 months, a complete disappearance of hemorrhoid symptoms was observed in 51 (82.3%) patients, while 7 (11.3%) patients had a recurrence. In 8 (12.9%) patients, symptoms of discomfort and itching were noted.Conclusions: intranodal laser coagulation allowed in 61 (98.4%) cases to perform this procedure on an outpatient basis, and did not affect the anal sphincter function. Good long-term results were obtained in 82.3% of cases. Intranodal laser coagulation is an effective method for chronic hemorrhoids.

Treatment of Complex Anal Fistula by Video-Assisted Anal Fistula Treatment Combined with Anal Fistula Plug: A Single-Center Study

Objective. The surgical treatment of complex anal fistulae is very challenging because of the incidence of incontinence after traditional approaches. There are no studies on the role of video-assisted anal fistula treatment (VAAFT) combined with anal fistula plug (AFP) in the complex anal fistulae. The aim of this study was to demonstrate the efficacy of treating complex anal fistulae using VAAFT combined with AFP. Method. This was a retrospective, nonrandomized observational study. 57 consecutive patients with complex anal fistulae who had undergone the VAAFT with AFP in our hospital between April 2016 and December 2019 were included. The primary outcomes were the cure rate, recurrence rate, and Wexner incontinence scores; the secondary outcomes were surgery time, blood loss, wound healing time postoperatively, pain, and patient satisfaction. Results. All 57 patients completed the surgery and follow-up, with an average follow-up time of 28 months; 6 patients suffered with recurrence (recurrence rate: 10.5%). The average surgery time was 57.9 minutes, and the average wound healing time was 46 days. There were no severe postoperative complications, and anal sphincter function was protected in all patients. Conclusions. The treatment of complex anal fistula by VAAFT combined with AFP is safe and effective, has a high healing rate and few postoperative complications, and is a promising surgery that can effectively protect the patient’s anal sphincter function.

Video-assisted anal fistula treatment combined with anal fistula plug for treatment of horseshoe anal fistula

Objective Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects. Methods We retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications. Results The surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function. Conclusion Although randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.

CASE REPORT: RARE FORM OF HIRSCHPRUNG’S DISEASE

Hirschsprung disease (HD) is a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. Incidence of total colonic aganglionosis (TCA) is 1 in 500 000 and it accounts for 5-10% of all cases of HD. HD should be suspected in patients with typical clinical symptoms and a high index of suspicion is appropriate for infants with a predisposing condition such as Down Syndrome (DS), or for those with a family history of HD. The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function. We present a clinical case report of TCA in a child with Down syndrome (DS) and review of literature.

A case of recto-vaginal obstetrical fistula treated by the Martius lamp, seen at Befelatanana Madagascar

The rectovaginal fistulas are a pathological epithelialized communication between the vagina and the rectum, its frequency is 10 to 30%, and it is a disabling pathology because of the social repercussion. Many flap techniques have been described but the aim is to present a simple procedure according to a particular technique called Martius. This is a case of woman presenting a low rectovaginal fistula on obstetrical trauma. The surgical technique consists of a repair according to the technique of Martius. The operative follow-up was simple and the patient was able to resume sexual activity and normal anal sphincter function. It is a simple technique, easy to achieve for the technical platform in Madagascar whose evaluation of the results for a larger population should be considered. This technique therefore deserves to be known and widely used.