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The British Journal of Venereal Diseases Oct 1977Eight hundred and twenty-three examinations were carried out on 662 homosexual patients. At each examination a blind anorectal swab and a rectal swab taken via a... (Comparative Study)
Comparative Study
Eight hundred and twenty-three examinations were carried out on 662 homosexual patients. At each examination a blind anorectal swab and a rectal swab taken via a proctoscope were inoculated on to a culture plate. From a total of 100 gonococcal infections of the rectum 96 gave positive results from blind anorectal swabs and 99 from swabs taken via a proctoscope. Blind anorectal swabs proved to be a reliable method in the diagnosis of rectal gonorrhoea.
Topics: Gonorrhea; Humans; Male; Methods; Neisseria gonorrhoeae; Proctoscopy; Rectal Diseases; Rectum; Specimen Handling
PubMed: 412559
DOI: 10.1136/sti.53.5.311 -
Case Reports in Surgery 2016. In the last years many mini-invasive approaches were developed in order to reduce postoperative pain and complication after haemorrhoid surgery: one of these...
. In the last years many mini-invasive approaches were developed in order to reduce postoperative pain and complication after haemorrhoid surgery: one of these alternatives is represented by Hemorpex System, a relatively young technique that combines transanal dearterialization with mucopexy through a dedicated proctoscope. . A 78-year-old male patient was admitted to the Emergency Department for acute urinary retention and elevated temperature. Hemorpex procedure was performed 4 years before. Clinical, endoscopic, and radiological findings demonstrated the presence of multiple diverticula-like structures fulfilled by purulent fluid and a deep alteration of the normal anatomy of the rectum. He was treated following the standard protocol of acute diverticulitis and full recovery from symptoms was achieved. . Hemorpex System is a young technique, and nowadays-available studies lack long-term follow-up data. Anatomical changes induced by the procedure are consistent and definitive. Our patient luckily demonstrated a prompt response to conservative treatment, but it must be taken into account that, in case of medical treatment failure, surgical approach would be necessary and the actual patient anatomical changes could lead the surgeon to unavoidable threatening maneuvers.
PubMed: 27974987
DOI: 10.1155/2016/3298048 -
Acta Cirurgica Brasileira 2008The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include:... (Comparative Study)
Comparative Study
PURPOSE
The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery.
METHODS
The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques.
RESULTS
The results were favorable and equivalent to those described in the literature.
CONCLUSIONS
The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.
Topics: Adenocarcinoma; Adenoma; Anal Canal; Equipment Design; Follow-Up Studies; Humans; Length of Stay; Neoplasm Recurrence, Local; Proctoscopes; Proctoscopy; Rectal Neoplasms; Time Factors; Treatment Outcome
PubMed: 18516455
DOI: 10.1590/s0102-86502008000700016 -
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 -
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 -
Minerva Chirurgica Oct 2018Conservative surgery of hemorrhoidal disease is less painful than traditional hemorrhoidectomy, and mucopexy has less risk of serious postoperative complications than...
Mucopexy-recto anal lifting: a standardized minimally invasive method of managing symptomatic hemorrhoids, with an innovative suturing technique and the HemorPex System®.
BACKGROUND
Conservative surgery of hemorrhoidal disease is less painful than traditional hemorrhoidectomy, and mucopexy has less risk of serious postoperative complications than stapled hemorrhoidopexy. The aim of this study was to evaluate the safety and effectiveness of a standardized, modified hemorrhoidopexy, named Mucopexy-Recto Anal Lifting (MuRAL) with the HemorPex System (HPS) in patients with symptomatic III and IV degree hemorrhoids.
METHODS
Patients were enrolled from May 2013 to Dec 2015 and operated on with the MuRAL technique, based on arterial ligation and mucopexy at 6 locations, using a standardized clockwise/anti-clockwise rotation sequence of the HPS anoscope. Follow-up controls were carried out by independent observers, as follows: a digital exploration 3 weeks after the intervention, digital exploration plus proctoscopy at 3 and 12 months and repeated at a 12 months interval. Patients who did not strictly follow the postoperative controls were excluded from the study. Primary outcome measurement was the recurrence rate. Secondary measurements were: operative time, hospital stay, postoperative pain, postoperative symptoms and satisfaction score.
RESULTS
We operated on 126 patients (72 males, mean age 53.9, range 29-83): 87 (69.6%) with III degree and 39 with IV degree hemorrhoids; 13 patients had a MuRAL as a revisional procedure of a previous operation for hemorrhoids. Mean duration of follow-up was 554 days (range 281-1219). Four patients were excluded from the study. One-year recurrence rate was 4.1%. The mean duration of the intervention was 29.5 minutes (range 23-60) and 92 patients (73%) were discharged during the same day of the operation. Pain VAS Score in the first, second and third postoperative day was 3.9, 2.5, and 1.9, respectively. Twenty-two patients (18%), all submitted to spinal anesthesia, had postoperative acute urinary retention. Fecal urgency, observed in 18.8% of patients at the first control, disappeared within one year after the operation. Mean time to return to normal activity was 8 days (range 5 -10). The patient satisfaction scores at one-year follow up were 31.1% excellent, 57.4% good, 7.4% fairly good and 4.1% poor. In patients with III degree hemorrhoids operative time was significantly shorter, postoperative pain better and transient fecal urgency lower than in IV degree patients. In our experience the standardization of MuRAL operation with HPS, turned out to be a safe and effective minimally invasive approach in managing symptomatic III and IV degree hemorrhoids, avoiding the risk of severe complications, with the possibility to perform a redo-MuRAL in the event of recurrence.
CONCLUSIONS
In our series up to 88% of the patients reported a good, or excellent one-year satisfaction score. Further comparative randomized studies with longer follow-up period are needed.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Equipment Design; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Intestinal Mucosa; Male; Middle Aged; Minimally Invasive Surgical Procedures; Proctoscopes; Suture Techniques
PubMed: 29652112
DOI: 10.23736/S0026-4733.18.07425-4 -
Cancers May 2024High-resolution anoscopy (HRA) plays a central role in the detection and treatment of precursors of anal squamous cell carcinoma (ASCC). Artificial intelligence (AI)...
Deep Learning and High-Resolution Anoscopy: Development of an Interoperable Algorithm for the Detection and Differentiation of Anal Squamous Cell Carcinoma Precursors-A Multicentric Study.
High-resolution anoscopy (HRA) plays a central role in the detection and treatment of precursors of anal squamous cell carcinoma (ASCC). Artificial intelligence (AI) algorithms have shown high levels of efficiency in detecting and differentiating HSIL from low-grade squamous intraepithelial lesions (LSIL) in HRA images. Our aim was to develop a deep learning system for the automatic detection and differentiation of HSIL versus LSIL using HRA images from both conventional and digital proctoscopes. A convolutional neural network (CNN) was developed based on 151 HRA exams performed at two volume centers using conventional and digital HRA systems. A total of 57,822 images were included, 28,874 images containing HSIL and 28,948 LSIL. Partial subanalyses were performed to evaluate the performance of the CNN in the subset of images acetic acid and lugol iodine staining and after treatment of the anal canal. The overall accuracy of the CNN in distinguishing HSIL from LSIL during the testing stage was 94.6%. The algorithm had an overall sensitivity and specificity of 93.6% and 95.7%, respectively (AUC 0.97). For staining with acetic acid, HSIL was differentiated from LSIL with an overall accuracy of 96.4%, while for lugol and after therapeutic manipulation, these values were 96.6% and 99.3%, respectively. The introduction of AI algorithms to HRA may enhance the early diagnosis of ASCC precursors, and this system was shown to perform adequately across conventional and digital HRA interfaces.
PubMed: 38791987
DOI: 10.3390/cancers16101909 -
Digestive Surgery 2007We evaluated the results of the Doppler-guided hemorrhoidal arterial ligation (DG-HAL) method in the management of symptomatic grade 2 and 3 hemorrhoids.
AIM
We evaluated the results of the Doppler-guided hemorrhoidal arterial ligation (DG-HAL) method in the management of symptomatic grade 2 and 3 hemorrhoids.
PATIENTS AND METHODS
Between June 2005 and March 2006, 110 consecutive patients with symptomatic grade 2 and 3 hemorrhoids according to the DG-HAL method were treated. All procedures were performed in daycare under spinal anesthesia. The primary objective was the reduction in hemorrhoidal gradation as determined by proctoscopy; the secondary was patient satisfaction. This was measured by interviewing patients over the telephone.
RESULTS
The average age was 47.6 years. 42 patients had grade 2 hemorrhoids, 68 grade 3. An average of 7.3 ligations were placed. Proctoscopy showed that, after 6 weeks, 97 (88%) patients had a significant improvement in their hemorrhoidal gradation. After an average follow-up of 37 weeks, 93 of the 110 (84.5%) patients were satisfied with the postoperative result. Mortality was 0% and morbidity 3%.
CONCLUSION
DG-HAL is a safe and effective treatment in the management of symptomatic grade 2 and 3 hemorrhoids.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Equipment Design; Female; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Proctoscopes; Surgery, Computer-Assisted; Treatment Outcome; Ultrasonography, Doppler
PubMed: 17855782
DOI: 10.1159/000108326 -
The British Journal of Venereal Diseases Feb 1979The results of Gram stains and cultures from 145 women with uncomplicated ano-genital gonorrhoea are presented. The site which gave the highest yield of gonococci was...
The results of Gram stains and cultures from 145 women with uncomplicated ano-genital gonorrhoea are presented. The site which gave the highest yield of gonococci was the cervix. Equally good results were obtained with Stuart's transport medium and direct plating in the clinic. Positive results from rectal specimens alone were obtained from 8.4% of the 119 women in whom the rectum was examined. In 89 women the results of rectal specimens taken through a proctoscope were compared with those of swabs passed blindly up the anal canal. When Stuart's transport medium was used swabs taken through a proctoscope gave better results than the swabs taken blindly; the latter gave more positive results when direct plating was used. Thus when Stuart's medium is used a proctoscope is essential for the collection of rectal samples. Up to three sets of investigations were carried out where necessary, but 95% of the 145 cases were diagnosed on the results of the first set. However, only 54% of those patients diagnosed at their first visit had positive Gram-stain results. Further refinement of culture results is unlikely to improve diagnostic yield; what is needed is better, rapid diagnosis in the clinic.
Topics: Anal Canal; Bacteriological Techniques; Cervix Uteri; Female; Gonorrhea; Humans; Male; Rectum; Specimen Handling; Time Factors; Urethra
PubMed: 371745
DOI: 10.1136/sti.55.1.10 -
Cirugia Espanola Nov 2007Transanal endoscopic microsurgery (TEM) is a new technique for local excision of benign and incipient malignant rectal lesions. This technique offers technological... (Comparative Study)
Comparative Study
INTRODUCTION AND OBJECTIVE
Transanal endoscopic microsurgery (TEM) is a new technique for local excision of benign and incipient malignant rectal lesions. This technique offers technological advantages over other procedures and is associated with lower morbidity and mortality. TEM involves prolonged dilatation of the anal sphincter with a large-diameter (4 cm) operating rectoscope. The aim of the present study was to assess the effects of TEM on anorectal function.
MATERIAL AND METHODS
All patients undergoing TEM were included. Continence was scored by a numeric scale and anorectal manometry before surgery and 3 weeks and 4 months after surgery. Variations in anal resting pressure, maximal anal resting pressure and the anal continence questionnaire were evaluated.
RESULTS
Sixty-eight patients underwent TEM between June 2004 and August 2006. Mean anal resting pressure (ARP) and maximal anal resting pressure (MARP) were significantly reduced at 3 weeks after surgery (ARP/MARP before surgery: 38.89/126.28; 3 weeks after surgery: 26.61/104.75). No significant change was found in the mean continence score. No association was found between variation in pressures and operating time.
CONCLUSION
TEM produced statistically significant alterations in anorectal physiology studies which returned to normal at 4 months. The technique did not affect continence scores in the immediate or late postoperative period and consequently can be considered a safe procedure that does not produce significant alterations in anorectal function.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Data Interpretation, Statistical; Fecal Incontinence; Female; Follow-Up Studies; Humans; Male; Manometry; Microsurgery; Middle Aged; Postoperative Complications; Proctoscopes; Proctoscopy; Rectal Neoplasms; Surveys and Questionnaires; Time Factors
PubMed: 18021627
DOI: 10.1016/s0009-739x(07)71726-8