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The New Zealand Medical Journal Aug 2020Fistula-in-ano is a very common surgical condition, caused by anal cryptoglandular inflammation. Most cases are idiopathic. Other causes such as Crohn's disease, trauma...
Fistula-in-ano is a very common surgical condition, caused by anal cryptoglandular inflammation. Most cases are idiopathic. Other causes such as Crohn's disease, trauma and malignancy are well known. Management of fistula-in-ano is largely surgical, especially if the patient is symptomatic. The goal of surgical therapy is sepsis drainage, delineate anatomy and eradicate the fistula while preserving faecal continence. Establishing the aetiology is also crucial as often a combination of specialist medical therapy is required, for example, in Crohn's disease. We report an extremely unusual case of fistula-in-ano on an elderly man with chronic lymphocytic leukaemia (CLL). Histology from the fistula track demonstrated CLL infiltration. This case, not previously reported on PubMed search, illustrates a good example of joint specialist medical (a haematologist) and surgical effort in successfully treating this symptomatic fistula-in-ano.
Topics: Abscess; Aged; Drainage; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Magnetic Resonance Imaging; Male; Perineum; Rectal Fistula; Watchful Waiting
PubMed: 32994604
DOI: No ID Found -
Neurourology and Urodynamics Aug 2022The vaginal introitus is the entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum. The surgical anatomy of the vaginal introitus,... (Review)
Review
AIM
The vaginal introitus is the entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum. The surgical anatomy of the vaginal introitus, the lowest level of the vagina, has not been subject to a recent comprehensive examination and description. Vaginal introital surgery (perineorrhaphy) should be a key part of surgery for a majority of pelvic organ prolapse.
METHODS
Cadaver studies were performed on the anterior and posterior vestibules and the perineum. Histological studies were performed on the excised perineal specimens of a cohort of 50 women undergoing perineorrhaphy. Included are pre- and postoperative studies which were performed on 50 women to determine the anatomical and histological changes achieved with a simple (anterior) perineorrhaphy.
RESULTS
The vaginal introitus is equivalent to the Level III section of the vagina, measured posteriorly from the clitoris to the anterior perineum then down the perineum to the anal verge. The anterior and posterior vestibules, with nonkeratinizing epithelium, extend laterally to the keratinized epithelium of the labia minora (Hart's line). The anterior vestibule has six anatomical layers while the posterior vestibule has three. The perineum has an inverse trapezoid shape. Perineorrhaphy specimens were a mean 2.9 cm wide and 1.6 cm deep. They show squamous epithelium with loose underlying connective tissue. There were no important structures seen histologically, for example, ligaments or muscles. Microscopically, only 6 (12%) were completely normal with 44 (88%) showing minor changes including inflammation and scarring. Considerable anatomical benefits were achieved with such a perineorrhaphy including a 27.6% increase in the perineal length and a 30.8% reduction in the genital hiatus.
CONCLUSION
An understanding of the anatomy and histology of the vaginal introitus can assist with performing a simple and effective perineorrhaphy, the main surgical intervention at the vaginal introitus.
Topics: Anal Canal; Clitoris; Female; Humans; Pelvic Organ Prolapse; Perineum; Vagina
PubMed: 35592994
DOI: 10.1002/nau.24961 -
Revista Da Escola de Enfermagem Da U S P 2020To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position.
METHOD
A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles.
RESULTS
There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations.
CONCLUSION
Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Parturition; Patient Positioning; Perineum; Pregnancy
PubMed: 32935765
DOI: 10.1590/S1980-220X2018027503610 -
The Journal of Maternal-fetal &... Mar 2020Different techniques have been analyzed to reduce the risk of perineal trauma during labor. To evaluate whether perineal massage techniques during vaginal delivery... (Meta-Analysis)
Meta-Analysis
Different techniques have been analyzed to reduce the risk of perineal trauma during labor. To evaluate whether perineal massage techniques during vaginal delivery decreases the risk of perineal trauma. Electronic databases (Medline, Prospero, Scopus, ClinicalTrials.gov, Embase, ScienceDirect, the Cochrane Library, SciELO) were searched from their inception until February 2018. No restrictions for language or geographic location were applied. We included all randomized controlled trials (RCTs) comparing the use of perineal massage during labor (i.e. intervention group) with a control group (i.e. no perineal massage) in women with singleton gestation and cephalic presentation at ≥36 weeks. Perineal massage was defined as massage of the posterior perineum by the clinician's fingers (with or without lubricant). Trials on perineal massage during antenatal care, before the onset of labor, or only in the early part of the first stage, were not included. All analyses were done using an intention-to-treat approach. The primary outcome was severe perineal trauma, defined as third and fourth degree perineal lacerations. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI). Nine trials including 3374 women were analyzed. All studies included women with singleton pregnancy in cephalic presentation at ≥36 weeks undergoing spontaneous vaginal delivery. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant. Women randomized to receive perineal massage during labor had a significantly lower incidence of severe perineal trauma, compared to those who did not (RR 0.49, 95% CI 0.25-0.94). All the secondary outcomes were not significant, except for the incidence of intact perineum, which was significantly higher in the perineal massage group (RR 1.40, 95% 1.01-1.93), and for the incidence of episiotomy, which was significantly lower in the perineal massage group (RR 0.56, 95% CI 0.38-0.82). Perineal massage during labor is associated with significant lower risk of severe perineal trauma, such as third and fourth degree lacerations. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Massage; Models, Statistical; Obstetric Labor Complications; Perineum; Pregnancy; Treatment Outcome
PubMed: 30107756
DOI: 10.1080/14767058.2018.1512574 -
Journal of Gastrointestinal Surgery :... Jul 2021
Topics: Anus Diseases; Humans; Perineum; Tuberculosis
PubMed: 33515174
DOI: 10.1007/s11605-021-04907-4 -
CMAJ : Canadian Medical Association... Sep 2023
Topics: Humans; Male; Fournier Gangrene; Skin; Skin Diseases; Perineum
PubMed: 37748781
DOI: 10.1503/cmaj.230658-f -
BMJ (Clinical Research Ed.) Jan 2021
Topics: Anal Canal; Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Delayed Diagnosis; Diagnosis, Differential; Humans; Hypesthesia; Low Back Pain; Magnetic Resonance Imaging; Perineum; Prognosis; Urination Disorders
PubMed: 33436390
DOI: 10.1136/bmj.n32 -
Surgical Oncology Clinics of North... Apr 2022This article reviews the oncological principles of rectal cancer surgery, beginning with an overview of the pertinent rectal and pelvic anatomy, followed by a discussion... (Review)
Review
This article reviews the oncological principles of rectal cancer surgery, beginning with an overview of the pertinent rectal and pelvic anatomy, followed by a discussion of the historical evolution in surgical management. Evidence supporting current practices with respect to proximal, distal, and circumferential margins are reviewed. Finally, operative approaches to restorative proctectomies and abdominoperineal resections are highlighted.
Topics: Humans; Margins of Excision; Perineum; Rectal Neoplasms; Rectum; Treatment Outcome
PubMed: 35351275
DOI: 10.1016/j.soc.2021.11.005 -
Cancer Treatment and Research... 2022
Review
Topics: Abdomen; Humans; Perineum; Proctectomy; Rectal Neoplasms; Rectum
PubMed: 35668011
DOI: 10.1016/j.ctarc.2022.100580 -
Current Problems in Surgery Sep 2021
Review
Topics: Digestive System Surgical Procedures; Humans; Pelvic Floor; Perineum; Rectal Prolapse; Rectum; Surgical Mesh
PubMed: 34489052
DOI: 10.1016/j.cpsurg.2020.100952