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Journal of Vascular Surgery Aug 2015The management of an infected aortic endograft can be challenging both operatively and clinically. Although aortic endograft infection is rare, the incidence is likely...
The management of an infected aortic endograft can be challenging both operatively and clinically. Although aortic endograft infection is rare, the incidence is likely to increase in the coming years because of ever rising numbers of endovascular aneurysm repairs. Definitive management involves the removal of the endograft through laparotomy. Removal of the graft is technically challenging; no manufacturer's device is available to assist in disengagement of barbed hooks that hold the endograft in position. We present a new technique using the disposable proctoscope as a device to facilitate safe removal of the endograft with minimal damage to the aortic wall.
Topics: Aged, 80 and over; Aortic Aneurysm, Abdominal; Axillofemoral Bypass Grafting; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Device Removal; Endovascular Procedures; Humans; Male; Prosthesis Design; Prosthesis-Related Infections; Radionuclide Imaging; Stents; Treatment Outcome; Vascular Surgical Procedures
PubMed: 25937607
DOI: 10.1016/j.jvs.2015.03.033 -
The Pan African Medical Journal 2014Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct...
INTRODUCTION
Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct current electrotherapy in the treatment of haemorrhoids.
METHODS
Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated. Exposure and evaluation was with an operative proctoscope which visualized one-eighth of the anal canal at a time. All diseased segments were treated per visit, indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip. Patients were followed up for two weeks. No bowel preparations, medications, anesthesia nor admission was required.
RESULTS
Four hundred and fifty six segments were exposed, 252(55.3%) were diseased. eight patients with either grades 2 or 3 diseases required two treatment visits. The most common symptom was rectal bleeding (94.7%), followed by prolapsed but manually reduced hemorrhoids (68%). Prolapse of tuft of haemorrhoidal tissue with spontaneous return was seen in 59.6%, anal pain in 29.8%, and itching in 3.5%. the median number treated segments per patient was 4. No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months.
CONCLUSION
Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease.
Topics: Adolescent; Adult; Electric Stimulation Therapy; Female; Follow-Up Studies; Hemorrhoidectomy; Hemorrhoids; Humans; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Young Adult
PubMed: 25419283
DOI: 10.11604/pamj.2014.18.145.3119 -
Diseases of the Colon and Rectum Sep 2014The transanal approach for rectal resection is a promising approach, because it increases the circumferential radial margin, especially for difficult cases. Meanwhile,...
The transanal approach for rectal resection is a promising approach, because it increases the circumferential radial margin, especially for difficult cases. Meanwhile, functional sequelae are frequent after rectal cancer surgery and are often due to neurological lesions. There is little literature describing surgical anatomy from bottom to top. We combined our surgical experience with our fetal and adult anatomical research to provide a bottom-up surgical description focusing on neurological anatomy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A148).
Topics: Adult; Anal Canal; Carbon Dioxide; Dissection; Humans; Insufflation; Proctoscopes; Rectal Neoplasms; Rectum
PubMed: 25101614
DOI: 10.1097/DCR.0000000000000187 -
Surgical Endoscopy Mar 2015Perineal approaches for rectal prolapse repair have low complication rates but high recurrence rates, while abdominal approaches that include sigmoidopexy have lower...
BACKGROUND
Perineal approaches for rectal prolapse repair have low complication rates but high recurrence rates, while abdominal approaches that include sigmoidopexy have lower recurrence rates but higher complication rates. To optimize both recurrence and complication rates, we developed a novel procedure that uses transanal endoscopic microsurgery (TEM) to perform a sigmoidopexy via a perineal approach.
METHODS
We created a rectal prolapse model in six swine and two human cadavers using a previously published technique. The rectum was mobilized and eviscerated transanally. After marking the planned point of sigmoid transection, the rectum was returned to the peritoneal cavity. A TEM proctoscope was inserted transanally alongside the rectum, and the lateral sigmoid colon walls were sutured to the sacrum. The sigmoid colon was then transected where previously planned, and a primary sigmoid anastomosis was performed. Total operative time, sigmoidopexy operative time, and suture security were measured and compared to standard rectosigmoidectomy and abdominal sigmoidopexy times.
RESULTS
No sigmoid colon, iliac vessel, bladder, or ureteral injuries occurred. At least two sigmoidopexy sutures were secure on inspection in all animals and human cadavers, with increasing success of secure suture placement as experience increased. Operative length was similar to traditional abdominal sigmoidopexy.
CONCLUSIONS
TEM sigmoidopexy is technically feasible. This approach has the potential to reduce the recurrence rate associated with perineal approaches alone, but further study is needed to confirm this hypothesis.
Topics: Animals; Cadaver; Colon, Sigmoid; Feasibility Studies; Humans; Male; Microsurgery; Natural Orifice Endoscopic Surgery; Perineum; Rectal Prolapse; Severity of Illness Index; Suture Techniques; Swine
PubMed: 25060682
DOI: 10.1007/s00464-014-3722-4 -
Techniques in Coloproctology Jul 2014
Topics: Adenocarcinoma; Follow-Up Studies; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Natural Orifice Endoscopic Surgery; Proctoscopes; Proctoscopy; Rectal Neoplasms; Treatment Outcome
PubMed: 24500727
DOI: 10.1007/s10151-014-1123-2 -
The American Journal of Gastroenterology Jan 2014High-resolution microendoscopy (HRME) is a low-cost, "optical biopsy" technology that allows for subcellular imaging. The purpose of this study was to determine the in...
OBJECTIVES
High-resolution microendoscopy (HRME) is a low-cost, "optical biopsy" technology that allows for subcellular imaging. The purpose of this study was to determine the in vivo diagnostic accuracy of the HRME for the differentiation of neoplastic from non-neoplastic colorectal polyps and compare it to that of high-definition white-light endoscopy (WLE) with histopathology as the gold standard.
METHODS
Three endoscopists prospectively detected a total of 171 polyps from 94 patients that were then imaged by HRME and classified in real-time as neoplastic (adenomatous, cancer) or non-neoplastic (normal, hyperplastic, inflammatory).
RESULTS
HRME had a significantly higher accuracy (94%), specificity (95%), and positive predictive value (PPV, 87%) for the determination of neoplastic colorectal polyps compared with WLE (65%, 39%, and 55%, respectively). When looking at small colorectal polyps (less than 10 mm), HRME continued to significantly outperform WLE in terms of accuracy (95% vs. 64%), specificity (98% vs. 40%) and PPV (92% vs. 55%). These trends continued when evaluating diminutive polyps (less than 5 mm) as HRME's accuracy (95%), specificity (98%), and PPV (93%) were all significantly greater than their WLE counterparts (62%, 41%, and 53%, respectively).
CONCLUSIONS
In conclusion, this in vivo study demonstrates that HRME can be a very effective modality in the differentiation of neoplastic and non-neoplastic colorectal polyps. A combination of standard white-light colonoscopy for polyp detection and HRME for polyp classification has the potential to truly allow the endoscopist to selectively determine which lesions can be left in situ, which lesions can simply be discarded, and which lesions need formal histopathologic analysis.
Topics: Adenoma; Aged; Colonic Neoplasms; Colonic Polyps; Colonoscopes; Colonoscopy; Comparative Effectiveness Research; Diagnosis, Differential; Fiber Optic Technology; Humans; Image Enhancement; Male; Microscopy; Middle Aged; Precancerous Conditions; Predictive Value of Tests; Proctoscopes; Proctoscopy; Rectal Neoplasms
PubMed: 24296752
DOI: 10.1038/ajg.2013.387 -
Gastrointestinal Endoscopy Jan 2014Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative... (Review)
Review
Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative effectiveness, RBL is currently the most widely used technique.
Topics: Cryosurgery; Diathermy; Electrocoagulation; Hemorrhoids; Humans; Infrared Rays; Laser Coagulation; Ligation; Proctoscopes; Sclerotherapy
PubMed: 24239254
DOI: 10.1016/j.gie.2013.07.021 -
Journal of Medicine and Life Sep 2013To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. (Clinical Trial)
Clinical Trial
OBJECTIVE
To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure.
PLACE AND DURATION OF STUDY
Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments.
MATERIALS AND METHODS
This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits.
CONCLUSION
IRC is a safe, simple and effective procedure for early hemorrhoids without any complications. IRC is nowadays the world's leading office treatment for hemorrhoids. IRC is a better option than the surgical treatment as it is easy, well tolerated, and remarkably complication-free. In our study, we have not used any course of antibiotics. In the management of early hemorrhoids, IRC should be considered as a simple trouble-free and painless option.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Coagulation; Hemorrhage; Hemorrhoids; Hospitals; Humans; Infrared Rays; Middle Aged; Proctoscopy; Young Adult
PubMed: 24146691
DOI: No ID Found -
Techniques in Coloproctology Mar 2014Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can...
Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called "mucopexy") can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Following adequate clinical assessment, patients undergo THD under general or spinal anesthesia, in either the lithotomy or the prone position. In all patients, distal Doppler-guided dearterialization is performed, providing the selective ligation of hemorrhoidal arteries identified by Doppler. In patients with hemorrhoidal/muco-hemorrhoidal prolapse, the mucopexy is performed with a continuous suture including the redundant and prolapsing mucosa and submucosa. The description of the surgical procedure is complemented by an accompanying video (see supplementary material). In long-term follow-up, there is resolution of symptoms in the vast majority of patients. The most common complication is transient tenesmus, which sometimes can result in rectal discomfort or pain. Rectal bleeding occurs in a very limited number of patients. Neither fecal incontinence nor chronic pain should occur. Anorectal physiology parameters should be unaltered, and anal sphincters should not be injured by following this procedure. When accurately performed and for the correct indications, THD is a safe procedure and one of the most effective treatments for hemorrhoidal disease.
Topics: Anal Canal; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Patient Positioning; Proctoscopes; Rectum; Ultrasonography, Doppler; Ultrasonography, Interventional
PubMed: 24026315
DOI: 10.1007/s10151-013-1062-3 -
Colorectal Disease : the Official... Sep 2013Following subtotal colectomy, the retained rectal stump is a potential source of morbidity. Although restorative ileal pouch-anal anastomosis is the gold standard for...
AIM
Following subtotal colectomy, the retained rectal stump is a potential source of morbidity. Although restorative ileal pouch-anal anastomosis is the gold standard for ulcerative colitis, up to 14% of patients will opt for a permanent ileostomy and undergo completion proctectomy, traditionally by an abdomino-perineal approach, which itself carries significant morbidity. We describe a new technique of perineal proctectomy using transanal endoscopic microsurgery (TEMS) equipment. To our knowledge, this technique has not previously been described in the literature.
METHOD
Twelve patients, mean (SD) age 66 (±13) years, underwent TEMS proctectomy, performed by a single surgeon between January 2007 and October 2011. Excision began with an intersphincteric dissection following which the TEMS (WOLF) proctoscope was inserted and close rectal dissection was performed, entering the peritoneal cavity (if the top of the stump was intraperitoneal). Following perineal extraction of the specimen, the external sphincter and skin were closed with an absorbable suture.
RESULTS
Nine patients had inflammatory bowel disease, two had neoplasia and one had intractable radiation proctitis. The mean (SD) rectal stump length was 17.8 (±6.1) cm and the peritoneal cavity was entered in nine patients, with no small-bowel injury. The median postoperative hospital stay was 5.5 days. In four patients there was delayed healing of the perineal wound. There was no perioperative mortality.
CONCLUSION
TEMS perineal proctectomy is a novel, but safe, technique that may avoid the need for a traditional abdominoperineal approach in selected patients.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Colectomy; Digestive System Surgical Procedures; Female; Humans; Ileostomy; Inflammatory Bowel Diseases; Male; Microsurgery; Middle Aged; Proctitis; Proctoscopy; Radiation Injuries; Rectal Diseases; Rectal Neoplasms; Rectum
PubMed: 24011233
DOI: 10.1111/codi.12316