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Journal of Laparoendoscopic & Advanced... 2012Transanal endoscopic microsurgery (TEM) is a well-known technique for the removal of rectal lesions. This operation poses several advantages over traditional anal...
Transanal endoscopic microsurgery (TEM) is a well-known technique for the removal of rectal lesions. This operation poses several advantages over traditional anal excision, which include better visibility of the rectum, more precise border excision, and a lower recurrence rate of benign and stage T1 malignant neoplasms. Introducing a SILS™ port (Covidien) into the anal canal (originally developed for single-incision laparoscopic surgery), instead of the TEM proctoscope, may further enhance the technique. We performed excisions of rectal lesions in 3 patients using a SILS port in TEM. In all cases, it was easy to maintain the rectum insufflated, and the visibility was excellent. The rectal lesions were successfully resected without significant intraoperative complications. Postoperative recovery was uneventful in both cases. TEM with a SILS port is a promising technique that may provide several advantages over the traditional TEM, including cost-effectiveness, and can be easily implemented in the setting of a community hospital.
Topics: Adenoma; Aged; Digestive System Surgical Procedures; Endoscopy; Female; Hospitals, Community; Humans; Male; Microsurgery; Middle Aged; Rectal Neoplasms
PubMed: 22142029
DOI: 10.1089/lap.2011.0408 -
Ugeskrift For Laeger Sep 2011In this case a patient presented with an intrauterine device (IUD) which was displaced into the sigmoid. The IUD was successfully removed through a proctoscope under...
In this case a patient presented with an intrauterine device (IUD) which was displaced into the sigmoid. The IUD was successfully removed through a proctoscope under laparoscopic guidance. Displacement of IUD into the sigmoid is a rare complication and should be treated proactively.
Topics: Adult; Colon, Sigmoid; Device Removal; Female; Humans; Intrauterine Device Migration; Intrauterine Devices, Copper; Laparoscopy; Proctoscopes
PubMed: 21936982
DOI: No ID Found -
Colorectal Disease : the Official... Mar 2012Selection of patients for investigation of suspected colorectal cancer is difficult. One possible improvement may be to measure DNA isolated from exfoliated cells... (Clinical Trial)
Clinical Trial
AIM
Selection of patients for investigation of suspected colorectal cancer is difficult. One possible improvement may be to measure DNA isolated from exfoliated cells collected from the rectum.
METHOD
This was a cohort study in a surgical clinic. Participants were aged ≥40 years and referred for investigation of suspected colorectal cancer. Exclusion criteria were inflammatory bowel disease, previous gastrointestinal malignancy, or recent investigation. A sample of the mucocellular layer of the rectum was taken with an adapted proctoscope (the Colonix system). Haemoglobin, mean cell volume, ferritin, carcino-embryonic antigen and faecal occult bloods were tested. Analysis was by logistic regression.
RESULTS
Participation was offered to 828 patients, of whom 717 completed the investigations. Three were lost to follow up. Seventy-two (10%) had colorectal cancer. Exfoliated cell DNA was higher (P<0.001) in cancer (median 5.4 μg/ml [inter-quartile range 1.8,12]) compared with those without cancer (2.0 μg/ml [IQR 0.78,5.5]). Seven variables were independently associated with cancer, including age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02,1.08; P<0.001) DNA (OR, 1.05; CI, 1.01,3.6; P=0.01), mean cell volume (OR, 0.93; CI, 0.89,0.97; P=0.001), carcino-embryonic antigen 1.02 per μg/l (CI, 1.00,1.04; P=0.02), male sex (OR, 2.0; CI, 1.1,3.6; P=0.02), rectal bleeding (OR, 2.4; CI, 1.3,4.5; P=0.007) and positive faecal occult blood (OR, 6.7; CI, 3.4, 13; P<0.001). The area under the receiver-operating characteristic curve for the DNA score was 0.65 (0.58-0.72) and for the seven variable model 0.88 (CI, 0.84-0.92).
CONCLUSION
Quantification of exfoliated DNA from rectal cellular material has promise in the diagnosis of colorectal cancer, but this requires confirmation in a larger study.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Colon; Colorectal Neoplasms; DNA, Neoplasm; Female; Humans; Intestinal Mucosa; Logistic Models; Male; Middle Aged; Multivariate Analysis; Proctoscopy; ROC Curve; Rectum
PubMed: 21689307
DOI: 10.1111/j.1463-1318.2011.02615.x -
Diseases of the Colon and Rectum Jun 2011Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation.
OBJECTIVE
Our aim was to compare the hemorrhoid laser procedure with rubber band ligation for outpatient treatment of symptomatic hemorrhoids with moderate mucosal prolapse.
DESIGN
This was a randomized controlled trial with balanced allocation to hemorrhoid laser procedure or rubber band ligation, with stratification by study center.
SETTING
This study was conducted at 2 teaching hospitals in Italy.
PATIENTS
Patients with symptomatic grade II or grade III hemorrhoids with minimal mucosal prolapse were eligible for the study.
INTERVENTIONS
In the hemorrhoid laser procedure operation, a Doppler probe was inserted into the anal canal through a dedicated disposable proctoscope to identify the terminal branches of superior hemorrhoidal arteries approximately 3 cm above the dentate line. Five pulsed laser shots were delivered to each identified artery through the proctoscope to close the terminal branches. The procedure was repeated for each artery through clockwise rotation of the proctoscope. Absence of a Doppler signal after treatment confirmed arterial coagulation. Rubber band ligation was performed by positioning rubber bands at the base of left lateral, right anterior, and right posterior piles. No anesthesia was given for either technique.
MAIN OUTCOME MEASURES
Operative time, complications, postoperative pain (visual analog scale), postoperative downgrading of hemorrhoids, resolution of symptoms, and quality of life were evaluated.
RESULTS
A total of 60 patients (35 women, 25 men; mean age, 46 years) entered the trial and were analyzed. No significant differences between rubber band ligation and hemorrhoid laser procedure were observed in operative time or intraoperative morbidity. The median postoperative pain score was 2.9 (range, 1-5) with rubber band ligation vs 1.1 (range, 0-2) for hemorrhoid laser procedure (P < .001). At 6 months, resolution of symptoms was observed in 16 patients (53%) with ligation vs 27 (90%) with hemorrhoid laser procedure (P < .001), and reduction of hemorrhoids by at least 1 grade was observed in 12 patients (40%) with ligation vs 24 (80%) with hemorrhoid laser procedure (P < .001). Significantly higher quality of life was seen in the hemorrhoid laser procedure group (P = .002).
LIMITATIONS
Follow-up was not longer than 1 year (median, 6 mo).
CONCLUSIONS
Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II or III hemorrhoids with incomplete mucosal prolapse.
Topics: Endosonography; Female; Hemorrhoids; Humans; Italy; Laser Coagulation; Ligation; Male; Middle Aged; Pain Measurement; Postoperative Complications; Quality of Life; Statistics, Nonparametric; Treatment Outcome
PubMed: 21552053
DOI: 10.1007/DCR.0b013e3182112d58 -
Colorectal Disease : the Official... Apr 2011This technical note describes use of a footpedal to switch on a rigid sigmoidoscope/proctoscope, demonstrating increased speed and efficiency of proctoscopy examination.
AIM
This technical note describes use of a footpedal to switch on a rigid sigmoidoscope/proctoscope, demonstrating increased speed and efficiency of proctoscopy examination.
METHOD
Use of a footpedal to control the light source of a rigid sigmoidoscope/proctoscope, enabling the user to switch the light source on and off with their foot, rather then at the wall, switch, leaving hands free.
RESULTS
Benefits include increased efficiency and speed of examination with reduced time on the couch for the patient and reduced risk of the halogen lighting bulb being left switched on, thus prolonging the life of the equipment.
CONCLUSION
Although we do not claim originality for its use we have found it particularly helpful and believe that its use should be more widely publicised.
Topics: Humans; Lighting; Proctoscopes; Proctoscopy; Sigmoidoscopes
PubMed: 21385298
DOI: 10.1111/j.1463-1318.2010.02490.x -
Updates in Surgery Mar 2011Over the last 10 years a number of mini-invasive procedures have been introduced which have revolutionized the surgical treatment of hemorrhoidal disease. I would like...
Over the last 10 years a number of mini-invasive procedures have been introduced which have revolutionized the surgical treatment of hemorrhoidal disease. I would like to present a very effective method of approaching this disease with reduced postoperative pain. I have been using this technique since the year 2000 with excellent results. From 1999 to 2006 we used a proctoscope, especially, designed and patented by me to perform Doppler-guided ligation of the branches of the superior hemorrhoidal artery in the treatment of prevalently grade III hemorrhoids (THD method). Since 2006, we have performed the hemorrhoidopexy procedure alone, without Doppler-guided ligation of the arteries, and achieved excellent results (67 cases), with greater simplicity (easy-learning curve) and reduced surgery times. We use the "beak" proctoscope to this end, as it provides good illumination of the surgical field and enables the excision of areas of grade IV prolapse which are irreducible with this conservative technique.
Topics: Equipment Design; Female; Hemorrhoids; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative; Proctoscopes; Treatment Outcome; Ultrasonography, Interventional
PubMed: 21359658
DOI: 10.1007/s13304-011-0058-7 -
Diseases of the Colon and Rectum Feb 2011Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade...
BACKGROUND
Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids. Development of a special proctoscope enabled the combination of hemorrhoidal artery ligation with transanal rectoanal repair (mucopexy), which serves to lift and then secure the protruding hemorrhoids in place.
OBJECTIVE
The purpose of this study was to describe our experience with this combined procedure in the treatment of grade IV hemorrhoids.
DESIGN
Prospective observational study.
SETTING
Outpatient colorectal surgery unit.
PATIENTS
Consecutive patients with grade IV hemorrhoids treated from April 2006 to December 2008.
INTERVENTION
Hemorrhoidal artery ligation-rectoanal repair.
MAIN OUTCOME MEASURES
Operating time, number of ligations, number of mucopexies and associated procedures, and postoperative symptoms were recorded. Pain was graded on a visual analog scale. Follow-up was at 2, 6, and 12 months after surgery, and then annually.
RESULTS
A total of 100 consecutive patients (64 women, 36 men) with grade IV hemorrhoids were included. Preoperative symptoms were bleeding in 80 and pain in 71 patients; 19 patients had undergone previous surgical treatment for the disease. The mean operative time was 35 (range, 17-60) minutes, with a mean of 9 (range, 4-14) ligations placed per patient. Eighty-four patients were discharged on the day of the operation. Nine patients developed early postoperative complications: pain in 6, bleeding in 4, dyschezia in 1, and thrombosis of residual hemorrhoids in 3. Late complications occurred in 4 patients and were managed conservatively. Recurrence was observed in 9 patients (9%), with a mean follow-up of 34 (range, 14-42) months.
LIMITATIONS
The 2 main weaknesses of the study were the lack of very long-term follow-up and the absence of a comparison with hemorrhoidectomy or hemorrhoidopexy.
CONCLUSION
Doppler-guided hemorrhoidal artery ligation with rectoanal repair is safe, easy to perform, and should be considered as an effective option for the treatment of grade IV hemorrhoids.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Arteries; Female; Follow-Up Studies; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Postoperative Complications; Proctoscopes; Prospective Studies; Rectum; Recurrence; Ultrasonography, Doppler; Ultrasonography, Interventional
PubMed: 21228673
DOI: 10.1007/DCR.0b013e318201d31c -
BMC Public Health Dec 2011Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex...
BACKGROUND
Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data.
METHODS
The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed.
RESULTS
A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period.
CONCLUSIONS
The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.
Topics: Adult; Cohort Studies; Female; HIV; HIV Infections; Health Promotion; Homosexuality, Male; Humans; India; Male; Medical Records; Patient Acceptance of Health Care; Preventive Health Services; Risk Factors; Sex Workers; Sexually Transmitted Diseases; Substance Abuse, Intravenous; Transsexualism; Young Adult
PubMed: 22970436
DOI: 10.1186/1471-2458-11-s6-s10 -
International Surgery 2010We present preliminary data from a prospective observational study on an initial group of 40 patients, selected from our Department, affected by grade III-IV hemorrhoids...
We present preliminary data from a prospective observational study on an initial group of 40 patients, selected from our Department, affected by grade III-IV hemorrhoids and treated with a new less invasive technique called Doppler-guided recto-anal repair [DG-RAR; Agency for Medical Innovations GmbH (AMI), Feldkirch, Osterreich, Austria]. This study was performed by analyzing bleeding, pain, and prolapse in the preoperative period and after surgery. Follow-up ranged from 5 to 37 months. We used this technique to treat the "vascular factor" with a Doppler-guided suture of the terminal branches of the hemorrhoidal arteries (HAL Doppler), and then we reduced hemorrhoidal prolapse [recto-anal repair (RAR)]. Recto-anal repair was performed with a special proctoscope with an oblique slot that when rotating shows a progressively wider portion of anorectal mucosa and submucosa in a longitudinal direction. Furthermore, this rotation enables the performance of a longitudinal pexy where the prolapse is located. The result is an immediate reduction of hemorrhoidal prolapse. Postoperative follow-up showed disappearance of pain and no bleeding. Relapse of prolapse occurred in 2 (5%) patients. Complications included 2 rectal impactions and 2 cases of thrombosis. The data appear encouraging for grade III-IV hemorrhoids treated with DG-RAR because of reduced trauma and a lower rate of complications with respect to other techniques used for prolapse reduction.
Topics: Adult; Aged; Female; Hemorrhoids; Humans; Male; Middle Aged; Proctoscopy; Prolapse; Surgery, Computer-Assisted; Suture Techniques; Ultrasonography, Doppler
PubMed: 21067008
DOI: No ID Found -
Surgical Endoscopy May 2011According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode...
Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.
BACKGROUND
According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser.
METHODS
A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment.
RESULTS
Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases.
CONCLUSIONS
The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.
Topics: Adult; Aged; Animals; Female; Hemorrhoids; Humans; Laser Therapy; Ligation; Male; Middle Aged; Minimally Invasive Surgical Procedures; Proctoscopes; Rectum; Sus scrofa; Ultrasonography, Doppler; Ultrasonography, Interventional
PubMed: 20976499
DOI: 10.1007/s00464-010-1370-x