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Clinics in Colon and Rectal Surgery Mar 2022Transanal endoscopic surgery encompasses the minimally invasive surgical techniques used to operate in the rectum under magnification while maintaining pneumorectum via... (Review)
Review
Transanal endoscopic surgery encompasses the minimally invasive surgical techniques used to operate in the rectum under magnification while maintaining pneumorectum via a resectoscope or port. The view, magnification, and surgical precision afforded by these advanced transanal techniques have resulted in excellent specimen quality and low recurrence rates, especially compared with traditional transanal surgery. For rigid platforms, the surgeon operates through a rigid 4-cm diameter steel proctoscope of varying lengths that is clamped to the operating table with an articulating arm. Transanal minimally invasive surgery (TAMIS) is a newer flexible platform using a disposable port which "hooks" into the anorectal ring to remain in place. The cost-effectiveness and versatility of the TAMIS platform have resulted in its popularity and use in more advanced applications such as transanal total mesorectal excision. Ultimately, the choice of operating platform should be based on surgeon preference, patient characteristics, availability, and cost. The pros and cons of each platform will be discussed in this article.
PubMed: 35237103
DOI: 10.1055/s-0041-1742108 -
Annals of Coloproctology Dec 2022The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively...
PURPOSE
The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance.
METHODS
Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score.
RESULTS
There were 36 adult patients (26 males; the range of age, 23-92 years). The mean operative time was 27 minutes (range, 23-50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48-84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001).
CONCLUSION
Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.
PubMed: 34674514
DOI: 10.3393/ac.2021.00262.0037 -
Acta Cirurgica Brasileira 2020This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The...
PURPOSE
This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques.
METHODS
We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer.
RESULTS
This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months.
CONCLUSIONS
The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.
Topics: Adenoma; Aged; Anal Canal; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Proctoscopes; Rectal Neoplasms; Treatment Outcome
PubMed: 32965304
DOI: 10.1590/s0102-865020200080000007 -
Medicine Jan 2020Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the...
INTRODUCTION
Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the safety and feasibility of novel - trimodal intraoperative colorectal anastomosis testing technique.
METHODS AND ANALYSIS
This multi-center prospective cohort pilot study will include patients undergoing colorectal anastomosis formation below 15 cm from the anal verge. Trimodal anastomosis testing will include testing for blood supply by ICG fluorescence trans-abdominally and trans-anally, testing of mechanical integrity of anastomosis by air-leak and methylene blue leak tests and testing for tension. The primary outcome of the study will be AL rate at day 60. The secondary outcomes will include: the frequency of changed location of bowel resection; ileostomy rate; the rate of intraoperative AL; time, taken to perform trimodal anastomosis testing; postoperative morbidity and mortality; quality of life.
DISCUSSION
Trimodal testing of colorectal anastomosis may be a novel and comprehensive way to investigate colorectal anastomosis and to reveal insufficient blood supply and integrity defects intraoperatively. Thus, prevention of these two most common causes of AL may lead to decreased rate of leakage.
STUDY REGISTRATION
Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03958500, May, 2019.
Topics: Anastomosis, Surgical; Anastomotic Leak; Colorectal Surgery; Humans; Ileostomy; Methylene Blue; Operative Time; Pilot Projects; Postoperative Complications; Prospective Studies
PubMed: 31914032
DOI: 10.1097/MD.0000000000018560 -
Diseases of the Colon and Rectum May 2022Core factors involved in the treatment of hemorrhoids include the engorgement of hemorrhoids, prolapse, recurrence, and pain.
BACKGROUND
Core factors involved in the treatment of hemorrhoids include the engorgement of hemorrhoids, prolapse, recurrence, and pain.
OBJECTIVE
The goal of this study was to assess the safety, pain, and efficacy of the transanal suture mucopexy for the treatment of hemorrhoids.
DESIGN
This was a retrospective study over a 13-year period.
SETTING
This procedure was performed, and data collected, from medical records at six centers in India.
PATIENTS
This study includes 5634 patients who had grade II to IV symptomatic hemorrhoids. Patients suffering from thrombosed hemorrhoids, inflammatory bowel disease, anal strictures, and anorectal carcinoma were excluded.
INTERVENTIONS
Hemorrhoidal swelling was reduced by manual massage and a steep Trendelenburg position under saddle block. The reduced hemorrhoids were fixed to the muscles of the rectal wall using sutures. Each suture measured 0.5 to 1.0 cm in length; double-locking continuous sutures were used, along the complete circumference of the rectum, at 2 and 4 cm proximal to the dentate line.
MAIN OUTCOME MEASURES
Pain assessed using the visual analog scale and hemorrhoid recurrence served as outcome measures.
RESULTS
The transanal suture mucopexy procedure was performed for 5634 patients with symptomatic hemorrhoids. A dull pain compatible with a visual analog score of 2 to 3 was reported in 126 (2.2%) patients; in the remaining 5508 (97.8%) patients, the visual analog score was 1 to 2. Effective treatment without complications occurred for 5541 patients (98.65%). A recurrence rate of 1.3% was recorded in 5634 cases with a mean follow-up of 7 ± 6 years.
LIMITATIONS
Utilization of a self-illuminating proctoscope or Brinckerhoff or anal speculum is essential.
CONCLUSION
Transanal suture mucopexy, designed with 2 suture rows, is a safe procedure with a short learning curve. It is associated with minimal pain, low recurrence rate, and fewer complications. See Video Abstract at http://links.lww.com/DCR/B841.
MUCOPEXIA TRANSANAL CON SUTURA PARA ENFERMEDAD HEMORROIDAL
ANTECEDENTES:Los factores centrales involucrados en el tratamiento de la enfermedad hemorroidal incluyen congestión de hemorroides, prolapso, recurrencia y dolor.OBJETIVO:Evaluar la seguridad, el dolor y la eficacia de la mucopexia transanal con sutura para el tratamiento de la enfermedad hemorroidal.DISEÑO:Estudio retrospectivo durante un período de 13 años.ESCENARIO:Este procedimiento se realizó y se recopilaron datos de expedientes médicos en seis centros en India.PACIENTES:Este estudio incluye 5634 pacientes con enfermedad hemorroidal sintomática grado II a IV. Se excluyeron pacientes que padecían hemorroides trombosadas, enfermedad inflamatoria intestinal, estenosis anales y carcinoma anorrectal.INTERVENCIONES:La inflamación hemorroidal se redujo mediante masaje manual y posición Trendelenburg profundo bajo bloqueo caudal. Las hemorroides reducidas se fijaron a los músculos de la pared rectal mediante suturas. Cada sutura midió 0.5 a 1.0 cm de longitud, se utilizaron suturas en surgete continuo de doble anclado, a lo largo de la circunferencia completa del recto, a dos y cuatro cm proximales a la línea dentada.PRINCIPALES MEDIDAS DE RESULTADO:El dolor se evaluó mediante la escala de puntuación analógica visual y se evaluó la presencia de recurrencia.RESULTADOS:El procedimiento de mucopexia transanal con sutura se realizó en 5634 pacientes con hemorroides sintomáticas. Se informó un dolor sordo compatible con una puntuación analógica visual de 2-3 en 126 (2.2%) pacientes; en los 5508 (97.8%) pacientes restantes, la puntuación analógica visual fue de 1-2. La mayoría (5541 pacientes [98.65%]) tuvo un tratamiento eficaz sin complicaciones. Se registró una tasa de recurrencia del 1.3% en 5634 casos con un seguimiento medio de 7 ± 6 años.LIMITACIONES:La utilización de un proctoscopio autoiluminado o de Brinckerhoff o espéculo anal es esencial.CONCLUSIÓN:La mucopexia transanal con sutura es un procedimiento seguro diseñado con dos filas de suturas asociadas con dolor mínimo y baja tasa de recurrencia con menos complicaciones. Tiene una curva de aprendizaje corta. Consulte Video Resumen en http://links.lww.com/DCR/B841. (Traducción-Dr. Jorge Silva Velazco).
Topics: Carcinoma; Hemorrhoids; Humans; Pain; Retrospective Studies; Sutures
PubMed: 34958048
DOI: 10.1097/DCR.0000000000002191 -
British Medical Journal Feb 1968
Topics: Humans; Proctoscopes; Sigmoidoscopes
PubMed: 5643724
DOI: 10.1136/bmj.1.5590.504 -
Journal of the Anus, Rectum and Colon 2021There was an urgent need to create a simple, reliable hemorrhoidectomy procedure for high-risk cases in our university hospital. We performed linear pinched...
OBJECTIVES
There was an urgent need to create a simple, reliable hemorrhoidectomy procedure for high-risk cases in our university hospital. We performed linear pinched hemorrhoidectomy (LPH) and evaluated its effectiveness compared to conventional hemorrhoidectomy (CH).
METHODS
We included 215 Goligher grade 3 and 4 hemorrhoid cases in this study. Of these cases, 167 were in the CH group, and 48 patients were in the LPH group. We retrospectively compared the lengths of hospital stay, operative times, blood loss, and complications.
RESULTS
The age tended to be higher in the LPH group (mean: CH 60 years, LPH 68 years). In the univariate analysis, LPH had more resections, shorter operative times, and less blood loss. LPH had shorter operative times in the multivariate analysis, less blood loss, and more anticoagulant use. There were no significant differences between the two groups in terms of complications. Five and two patients in the CH and LPH groups, respectively, had postoperative hemorrhage requiring hemostasis. Only the CH group had three and four cases of anal stenosis and wound edema, respectively.
CONCLUSIONS
We studied simplified hemorrhoidectomy using an ultrasonic scalpel and cylindrical proctoscope in a university hospital. We found that it a useful procedure with few complications and was easy for residents to learn. We believe that advances in surgical devices will make it possible to perform safer and simpler hemorrhoidectomy in the future.
PubMed: 34395938
DOI: 10.23922/jarc.2020-076 -
Techniques in Coloproctology Dec 2017The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to... (Review)
Review
BACKGROUND
The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to assess the clinical efficacy and the satisfaction of patients in a large series treated with THD and to review the relevant literature.
METHODS
In this retrospective, single-institution, study consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure. Dearterialization was performed in all cases and mucopexy in case of prolapse. The dearterialization procedure evolved from "proximal artery ligation" to "distal Doppler-guided dearterialization." Follow-up was scheduled at 15 days, 1, 3, 12 months, and once a year thereafter. Complications were recorded. Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher's classification) at baseline versus last follow-up. Uni-/multivariate analysis evaluated factors affecting the outcome.
RESULTS
There were 1000 patients (619 men; mean age: 48.6 years, range 19-88 years). Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%). At mean follow-up duration of 44 ± 29 months, the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients). The recurrence rate was 8.5, 8.7, and 18.1% in patients with grade 2, 3, and 4 hemorrhoids, respectively. Seventy out of 95 patients with recurrence needed surgery (reoperation rate: 7.0%). At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination. Younger age, grade 4 disease, and high artery ligation affected the outcome negatively.
CONCLUSIONS
Our results show that the THD Doppler procedure is safe and effective in patients with hemorrhoidal disease and associated with low morbidity and recurrence rates and a high rate percentage of treatment success.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Arteries; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Postoperative Hemorrhage; Proctoscopes; Recurrence; Retrospective Studies; Severity of Illness Index; Symptom Assessment; Transanal Endoscopic Surgery; Treatment Outcome; Urinary Retention; Young Adult
PubMed: 29170839
DOI: 10.1007/s10151-017-1726-5 -
Cirugia Espanola Sep 2006Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims... (Review)
Review
Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.
Topics: Adenoma; Equipment Design; Forecasting; Humans; Microsurgery; Proctoscopes; Proctoscopy; Rectal Neoplasms
PubMed: 16956547
DOI: 10.1016/s0009-739x(06)70940-x -
La Clinica Terapeutica Jul 2021Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet... (Comparative Study)
Comparative Study
INTRODUCTION
Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet found. In 1995, Doppler-guided haemorrhoidal artery ligation was introduced, aiming to reduce postoperative pain and complications. In this work, an evolu-tion of the aforementioned surgical technique was described.
MATERIALS AND METHODS
183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation. The procedures were performed under local anaes-thesia with patients in lithotomy position. A special proctoscope and a dedicated Colourdoppler US probe were employed in the second group. Superior haemorrhoidal artery terminal branches were con-secutively ligated according to provided technique in the first group and under vision in the second. In all cases, each ligation was followed by mucopexy.
RESULTS
No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated. Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL. No late complications (after one-year follow-up) were registered in both groups.
CONCLUSIONS
Colour Doppler-Guided Haemorrhoidal Artery Li-gation represents an ideal management for 1-day surgery, and fulfils the requirements of minimally invasive surgery in patients with III-IV grade haemorrhoids. The absence of complications and the evidence of significant wellness of patients are the best advantages. Colour Doppler-Guided Haemorrhoidal Artery Ligation is a safe and easy procedure with good results and a very short-time training. It could be considered an easy and reliable method to treat symptomatic haemorrhoids.
Topics: Adult; Echocardiography, Doppler, Color; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Mesenteric Artery, Inferior; Middle Aged; Ultrasonography, Doppler
PubMed: 34247216
DOI: 10.7417/CT.2021.2337