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Anal sphincter repair

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https://www.readbyqxmd.com/read/28271331/five-years-of-experience-with-the-filac%C3%A2-laser-for-fistula-in-ano-management-long-term-follow-up-from-a-single-institution
#1
A Wilhelm, A Fiebig, M Krawczak
BACKGROUND: There are limited data available concerning endofistular therapies for fistula-in-ano, with our group reporting the first preliminary outcomes of the use of the radial fibre Fistula laser Closing (FiLaC ™) device. METHODS: The aim of this study was to assess a cohort of anal fistulae managed with laser ablation plus definitive flap closure of the internal fistula opening over a long-term follow-up. Factors governing primary healing success and secondary healing success (i...
March 7, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28251361/german-s3-guidelines-anal-abscess-and-fistula-second-revised-version
#2
Andreas Ommer, Alexander Herold, Eugen Berg, Alois Fürst, Stefan Post, Reinhard Ruppert, Thomas Schiedeck, Oliver Schwandner, Bernhard Strittmatter
BACKGROUND: The incidence of anal abscess and fistula is relatively high, and the condition is most common in young men. METHODS: This is a revised version of the German S3 guidelines first published in 2011. It is based on a systematic review of pertinent literature. RESULTS: Cryptoglandular abscesses and fistulas usually originate in the proctodeal glands of the intersphincteric space. Classification depends on their relation to the anal sphincter...
March 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28242026/surgical-approach-for-fecal-incontinence-with-a-patulous-anus-after-transanal-pull-through-for-hirschsprung-disease
#3
Yoshitomo Yasui, Syoichi Nishida, Tsubasa Shironomae, Miwa Satomi, Tsuyoshi Kuwahara, Miyuki Kohno
BACKGROUND: We have performed transanal pull-through (TAPT) for Hirschsprung disease since 1998. Some of our patients after TAPT showed a patulous anus and suffered from severe true fecal incontinence. We performed anal canal plasty for these patients and evaluated its efficacy in restoring anorectal function. METHODS: Thirty-one patients who were ≥5years old were previously operated on for Hirschsprung disease, and seven (22.5%) of these were indicated for this procedure...
February 12, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28222801/a-new-method-for-treating-fecal-incontinence-by-implanting-stem-cells-derived-from-human-adipose-tissue-preliminary-findings-of-a-randomized-double-blind-clinical-trial
#4
Arash Sarveazad, Graham L Newstead, Rezvan Mirzaei, Mohammad Taghi Joghataei, Mehrdad Bakhtiari, Asrin Babahajian, Bahar Mahjoubi
BACKGROUND: Anal sphincter defects are a major cause of fecal incontinence causing negative effects on daily life, social interactions, and mental health. Because human adipose-derived stromal/stem cells (hADSCs) are easier and safer to access, secrete high levels of growth factor, and have the potential to differentiate into muscle cells, we investigated the ability of hADSCs to improve anal sphincter incontinence. METHODS: The present randomized double-blind clinical trial was performed on patients with sphincter defects...
February 21, 2017: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/28178060/modified-beef-tongue-model-for-fourth-degree-laceration-repair-simulation
#5
Jana D Illston, Alicia C Ballard, David R Ellington, Holly E Richter
BACKGROUND: An existing model for fourth-degree laceration repair uses beef tongue with plastic or vinyl tubing. This modified model substitutes beef tripe for the anal mucosa and chicken leg muscles for the anal sphincter muscle analogs to create a realistic model. METHOD: Tripe is tunneled through the body of the trimmed beef tongue and sutured like an ostomy to simulate the anal canal. The tongue is incised toward the tripe "anal canal." Chicken leg muscles are tunneled from the incision out to the cut edges of the beef tongue to create anal sphincter muscle analogs...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28144213/abdominal-approaches-to-rectal-prolapse
#6
REVIEW
Kyla Joubert, Jonathan A Laryea
Rectal prolapse is a debilitating condition with a complex etiology. Symptoms are most commonly prolapse of the rectum and pain with bowel movements or straining, with worsening fecal incontinence over time due to progressive stretching of the anal sphincters. Physical findings are fairly consistent from patient to patient-most notably diastasis of the levator ani muscles, deep pouch of Douglas, redundant sigmoid colon, a mobile mesorectum, and occasionally a solitary rectal ulcer. Evaluation includes a physical exam or imaging demonstrating the prolapse, and evaluating for other causes of pelvic floor dysfunction...
February 2017: Clinics in Colon and Rectal Surgery
https://www.readbyqxmd.com/read/28027607/third-or-fourth-degree-intrapartum-anal-sphincter-tears-are-associated-with-levator-ani-avulsion-in-primiparas
#7
Dan V Valsky, Sarah M Cohen, Michal Lipschuetz, Drorith Hochner-Celnikier, Hagit Daum, Itai Yagel, Simcha Yagel
OBJECTIVES: We evaluated primiparous women with clinically diagnosed third- and fourth-degree and anal sphincter tears, to evaluate the rate of levator ani muscle injury compared to primiparous women without sphincter tears. METHODS: Primiparous women delivering in our maternity ward with intrapartum diagnoses of third- or fourth-degree anal sphincter tears, repaired by the overlapping technique, were recruited to undergo 3-dimensional transperineal sonography of the pelvic floor anatomy, including the anterior and posterior compartments...
April 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28000182/-current-situation-in-the-diagnosis-and-treatment-of-rectovaginal-fistula
#8
Hui Peng, Donglin Ren
The treatment of rectovaginal fistula is quite difficult. It is a formidable challenge for anorectal surgeons to successfully perform operations for rectovaginal fistulas, since both recurrence rate and incontinence rate are high. This commentary elucidates certain questions during the treatment course of rectovaginal fistula through reviewing relevant literature and our clinical practice, including the overall evaluation of the preoperative rectovaginal fistula, the choice of suitable operation timing, reasonable choice of operational procedure and standard perioperative management...
December 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/27986182/episiotomy-technique-and-management-of-anal-sphincter-tears-a-survey-of-clinical-practice-and-education
#9
Rebecca Menzies, Marian Leung, Nirmala Chandrasekaran, Andrea Lausman, Michael Geary
OBJECTIVE: To ascertain current techniques of episiotomy used by obstetrics and gynaecology faculty members and residents in an academic department and to determine the current management strategies for third and fourth degree tears. METHOD: A 14-question anonymous online survey was circulated to all faculty members and residents in the University of Toronto Department of Obstetrics and Gynaecology between October 2015 and March 2016. Results were analyzed descriptively or with Fisher exact test...
December 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27943520/evaluation-of-anatomical-and-functional-results-of-overlapping-anal-sphincter-repair-with-or-without-the-injection-of-bone-marrow-aspirate-concentrate-a-case-control-study
#10
W W Khafagy, M M El-Said, W M Thabet, S E-S Aref, W Omar, S H Emile, H Elfeki, M S El-Ghonemy, M T El-Shobaky
AIM: Overlapping anal sphincter repair (OASR) is used for treatment of faecal incontinence due to an external anal sphincter (EAS) defect; however, it is not the optimal treatment as its functional results tend to deteriorate significantly with time. The present study aimed to evaluate the effect of local injection of bone marrow aspirate concentrate (BMAC) on the outcome of OASR. METHOD: We compared a prospective group of 20 patients with EAS defect who were managed with OASR and BMAC injection (group I) with a historical control group of an equal number of patients managed with OASR alone (group II)...
January 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/27783118/evaluation-of-training-programme-uptake-in-an-attempt-to-reduce-obstetric-anal-sphincter-injuries-the-support-programme
#11
Nadia Rahman, Latha Vinayakarao, Sangeeta Pathak, Dawn Minden, Louise Melson, Ella Vitue, A Pradhan
INTRODUCTION AND HYPOTHESIS: The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). METHODS: Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies...
October 25, 2016: International Urogynecology Journal
https://www.readbyqxmd.com/read/27682743/can-anal-sphincter-defects-be-identified-by-palpation
#12
Ka Lai Shek, Ixora Kamisan Atan, Hans Peter Dietz
OBJECTIVES: The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. METHODS: This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/27643513/over-diagnosis-and-rising-rates-of-obstetric-anal-sphincter-injuries-oasis-time-for-reappraisal
#13
Dimos Sioutis, Ranee Thakar, Abdul H Sultan
OBJECTIVES: To identify the accuracy of clinically diagnosed OASIS using 3D endoanal ultrasound and compare symptoms and anal manometry measurements between those whose anal sphincters were adequately repaired to those who had persistent anal sphincter defects. METHODS: The endoanal scan images of women who sustained OASIS and attended the perineal clinic over a 10 year period (2003 - 2013) were re-analysed from data entered prospectively of women with clinically diagnosed and repaired OASIS...
September 19, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27624562/manometric-findings-in-relation-to-functional-outcomes-in-different-types-of-anorectal-malformations
#14
Kristiina Kyrklund, Mikko P Pakarinen, Risto J Rintala
AIMS: To compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. METHODS: A single-institution, cross-sectional study. After ethical approval, all patients ≥7years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM)...
September 2, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27613623/residual-defects-after-repair-of-obstetric-anal-sphincter-injuries-and-pelvic-floor-muscle-strength-are-related-to-anal-incontinence-symptoms
#15
Cristina Ros Cerro, Eva Martínez Franco, Giulio Aniello Santoro, Maria José Palau, Pawel Wieczorek, Montserrat Espuña-Pons
INTRODUCTION AND HYPOTHESIS: The aim was to analyze the correlation between residual anal sphincter (AS) defects and pelvic floor muscle (PFM) strength on anal incontinence (AI) in patients with a history of obstetric AS injuries (OASIS). METHODS: From September 2012 to February 2015, an observational study was conducted on a cohort of females who underwent repair of OASIS intrapartum. The degree of OASIS was scored intrapartum according to Sultan's classification...
September 9, 2016: International Urogynecology Journal
https://www.readbyqxmd.com/read/27554917/a-standardized-approach-for-the-assessment-and-treatment-of-internationally-adopted-children-with-a-previously-repaired-anorectal-malformation-arm
#16
Victoria A Lane, Clare Skerritt, Richard J Wood, Carlos Reck, Geri D Hewitt, Kate A McCracken, Venkata R Jayanthi, Daniel DaJusta, Christina Ching, Katherine J Deans, Peter C Minneci, Marc A Levitt
INTRODUCTION: A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population...
November 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27437391/usefulness-of-anorectal-manometry-for-diagnosing-continence-problems-after-a-low-anterior-resection
#17
Audrius Dulskas, Narimantas E Samalavicius
PURPOSE: For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer. METHODS: This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons...
June 2016: Annals of Coloproctology
https://www.readbyqxmd.com/read/27402195/pro-inflammatory-cytokines-in-cryptoglandular-anal-fistulas
#18
R S van Onkelen, M P Gosselink, M van Meurs, M J Melief, W R Schouten, J D Laman
BACKGROUND: Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α)...
September 2016: Techniques in Coloproctology
https://www.readbyqxmd.com/read/27392390/effect-of-age-patient-s-sex-and-type-of-trauma-on-the-correlation-between-size-of-sphincter-defect-and-anal-pressures-in-posttraumatic-fecal-incontinence
#19
Sameh Hany Emile, Mohamed Youssef, Hossam Elfeki, Waleed Thabet, Hesham Elgendy, Waleed Omar, Wael Khafagy, Mohamed Farid
BACKGROUND: The physiologic assessment of anal sphincters in cases of posttraumatic fecal incontinence is a fundamental step in planning operative treatment. In this study, we evaluate the correlation between size of anal sphincter defect, anal pressures, and clinical symptoms in patients with posttraumatic fecal incontinence. We also investigate the impact of patients' age, sex, and type of trauma on this correlation. METHODS: Records of 70 patients fitting the study's eligibility criteria were collected retrospectively from the archives of Mansoura University Hospitals' colorectal surgery unit...
July 5, 2016: Surgery
https://www.readbyqxmd.com/read/27355329/galectin-1-induced-skeletal-muscle-cell-differentiation-of-mesenchymal-stem-cells-seeded-on-an-acellular-dermal-matrix-improves-injured-anal-sphincter
#20
Zhao Ding, Xiangui Liu, Xianghai Ren, Qiulei Zhang, Tingtao Zhang, Qun Qian, Weicheng Liu, Congqing Jiang
According to recent studies, mesenchymal stromal cells (MSCs) transplanted via local or tail vein injection can improve healing after anal sphincter injury (ASI) in animal models. However, the transplanted MSCs do not generate skeletal muscle that completely resembles the natural anal sphincter structure. In the present study, we investigated whether bone marrow (BM)-derived MSCs could be induced by Galectin-1 (Gal-1) to differentiate into skeletal muscle and whether the recellularization of an acellular dermal matrix (ADM) with skeletal muscle-differentiated MSCs represents a promising approach to restore ASI in a rat model...
May 2016: Discovery Medicine
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