{"title":"Faecal Incontinence","authors":"F. L. Torre, Diego Coletta","doi":"10.5772/intechopen.77393","DOIUrl":"https://doi.org/10.5772/intechopen.77393","url":null,"abstract":"Fecal incontinence (FI) is an extremely common condition, whose true prevalence is dif- ficult to assess. It was defined as the uncontrolled passage of fecal material recurring for >3 months. Fecal incontinence is related to many etiologic factors, but one of the most frequent causes is secondary to pelvic and/or anal and rectal surgery, childbirth-related damage, or other pelvic trauma. Fecal incontinence after surgery may be elicited by many pelvic, rectal, and anal surgical/obstetric procedures, which contribute through differ ent mechanisms to incontinence. After accurate evaluation, the first line approach with medical and behavioral treatments often fails in treating FI. Rehabilitative therapy and less invasive procedures are preferred before performing standard surgical intervention, while invasive procedures are to be discouraged.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126221603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Introductory Chapter: A Surgical Point of View on Proctology","authors":"P. Cianci","doi":"10.5772/INTECHOPEN.79661","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79661","url":null,"abstract":"Proctology is the specialized branch of general surgery that studies anorectal diseases. Anorectal disorders are common conditions. Their prevalence in the general population is probably much higher than that seen in clinical practice as most patients do not seek medical attention. There is no prevalence of sex, men and women of any age can be affected. The spectrum of anorectal disorders ranges from benign to potentially life-threatening (anorectal cancer). Gupta [1] divided the anorectal lesions into common, less common, and uncommon (Table 1). The symptoms are often not specific and difficult to evaluate; cultural and social constraints make it difficult for some patients to talk about problems in anal disorders, and doctors do not always ask patients about potential symptoms, which can delay diagnosis. In a study conducted in France, Abramovitz et al. [2] contacted 39 doctors who have joined","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127213107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fissure-In-ANO","authors":"Muhammad Fahadullah, C. Peirce","doi":"10.5772/INTECHOPEN.76887","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76887","url":null,"abstract":"This chapter provides a summary of the aetiology, diagnosis, investigation and man- agement of anal fissure. It gives an overview of clinical anatomy and pathophysiology related to anal fissure. Focusing on anal sphincter hypertonia as the key factor for anal fissure progression, the chapter draws attention to perpetuating factors that contribute to a vicious cycle of fissure non-healing and addresses management options for these factors. This chapter also looks at the way how different treatment options for anal fis sure emerged over time and uses evidence-based medicine to compare these options. “ Fissure-in-ANO” concludes with summarising the treatment options and suggesting an algorithm for management of acute and chronic anal fissures.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123899831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiation Proctitis","authors":"R. Trzciński, M. Mik, L. Dziki, A. Dziki","doi":"10.5772/intechopen.76200","DOIUrl":"https://doi.org/10.5772/intechopen.76200","url":null,"abstract":"Pelvic radiotherapy (RT) has become a vital component of curative treatment for various pelvic malignancies. The fixed anatomical position of the rectum in the pelvis and the close proximity to the prostate, cervix, and uterus, makes the rectum especially vulner - able to secondary radiation injury resulting in chronic radiation proctitis (CRP). Clinical symptoms associated with CRP are commonly classified by the EORTC/RTOG late radia - tion morbidity scoring system. Rectal bleeding is the most frequent symptom of CRP occurring in 29–89.6% of patients. Endoscopy is essential to determine the extent and severity of CRP as well as to exclude other possible causes of inflammation or malignant disease. Typical endoscopic findings of rectal mucosal damage in the course of radiation- induced proctitis include friable mucosa, rectal mucosal hypervascularity, and telangiec -tases. There is no consensus available for the treatment of CRP, and different modalities present a recurrence rate varying from 10 to 30%. CRP can be managed conservatively, and also includes ablation (formalin enemas, radiofrequency ablation, YAG laser or argon plasma coagulation) as well as some patients require surgery. Although modifications of radiation techniques and doses are continually being studied to decrease the incidence of CRP, trials investigating preventive methods have been disappointing to date . anticoagulants, inflammatory bowel disease, hormonal therapy, collagen vascular disease, atherosclerosis, preexisting inflammatory bowel disease, smoking, pelvic inflammatory con -ditions, previous abdominopelvic surgery and possibly secondary anatomical changes with intraabdominal adhesions leading to immobility of intestinal loops in the radiation field (e.g., hysterectomy), radiation dosages to the lower pelvis >54 the volume of ated, or ataxia-telangiectasia ,","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"438 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116017600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Role of Three-Dimensional Endoanal Ultrasound in Preoperative Evaluation of Anorectal Diseases","authors":"M. M. Coura","doi":"10.5772/INTECHOPEN.76620","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76620","url":null,"abstract":"Three-dimensional endoanal ultrasound (3D EAUS) has increased its application in colo- proctology, both in pre- or in post-operative settings, since it provides more detailed information about anorectal anatomy and function. Perianal fistula complex, internal opening location and fistula tract relation with anal canal muscles are easily viewed on 3D EAUS. Moreover, hemorrhoidectomy, sphincterotomy and transanal rectal excisions hold potential in damaging anal sphincters and should be taken into account by the surgeon. Likewise, 3D EAUS has also a significant role in staging locoregional anal and rectal tumors with comparable accuracy to pelvic magnetic resonance imaging (MRI), particularly in regard to T staging in early lesions and tumor response after neoadjuvant therapy. Finally, patients with pelvic floor dysfunction or pelvic organ prolapse (POP) may benefit from 3D EAUS dynamic evaluation in order to rule out an occult sphincter defect or to unveil unsuspected anatomical multi-compartment dysfunction. Therefore, this review will address the current role of 3D EAUS as a valuable tool in modern colorec - tal surgical practice, highlighting its application in evaluating benign anorectal diseases, anal canal and rectal tumors and evacuation disorders, namely echodefecography.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"348 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132765438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Challenges in the Surgical Treatment of Rectal Prolapse","authors":"R. Pietroletti","doi":"10.5772/INTECHOPEN.78059","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78059","url":null,"abstract":"The approach to a patient with overt rectal prolapse remains controversial since the choice of the most appropriate technical option may be a difficult task. The different approaches are based upon patients’ age, comorbidities, sex, size of prolapse, associated incontinence, constipation, and urinary and genital disturbances. However, analysis of the literature failed to detect a significant evidence favoring one among the large number of those different surgical techniques proposed for the treatment of rectal prolapse. In fact, many randomized prospective controlled trials, comparing perineal and abdominal operations, rectopexy alone, resection alone and/or resection plus rectopexy could not find significant differences in terms of morbidity, mortality, improvement of incontinence or constipation, quality of life and recurrence. Therefore, without a clear-cut support by the literature, a pragmatic approach is necessary, applying common sense, experience and considering the availability of resources as well. Nevertheless, we may expect that definitive answers to many open questions about surgery of rectal prolapse may come from larger studies and longer follow-up.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128478602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Applications of Anorectal Ultrasound in Anorectal Disorders","authors":"K. Tantiphlachiva","doi":"10.5772/INTECHOPEN.78326","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78326","url":null,"abstract":"Endoanal ultrasound (EAUS) and endorectal ultrasound (ERUS) have been introduced to clinical use since the 1980s. The techniques have been used to assess various anorectal disorders and conditions, including anorectal abscess and fistula, fecal incontinence, anorectal tumor, anorectal pain and occasionally evaluation of adjacent pelvic pathology. Information acquired includes anatomical location of disease, extent of disease, involvement of anal sphincter by disease and the status of anal sphincter. This information is valuable for treatment planning, prevention of disease recurrence, prevention and/or correction of sphincter defect and follow-up evaluation. The technique is cheap, simple, well tolerated, and repeatable with acceptable accuracy. Although the interpretation is operator-dependent, technology has developed to improved image quality such as 3D-reconstruction, peroxide-enhanced technique and volume render mode. This chapter reviews the current application of anorectal ultrasound in the common anorectal disorders.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"9 11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126211445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Mattart, M. Stevens, D. Magis, P. Magotteaux, D. Francart, C. Jehaes, B. Monami, V. Verdin, C. Wahlen, J. Weerts, S. Markiewicz
{"title":"Clinical Pathway Evaluation for Left and Sigmoid Colectomy in Abdominal Surgery","authors":"L. Mattart, M. Stevens, D. Magis, P. Magotteaux, D. Francart, C. Jehaes, B. Monami, V. Verdin, C. Wahlen, J. Weerts, S. Markiewicz","doi":"10.5772/INTECHOPEN.78588","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78588","url":null,"abstract":"At the end of 2008, a new left colon clinical pathway was implemented in our hospital and set up by a multidisciplinary team, monitored by a clinical pathway coordinator. Our aim was to evaluate the quality of left and sigmoid colectomy management, to simplify the clinical pathway and to assess its impact on the patient, the medical and nursing staffs. A sample of 290 patients with benign or malignant disease requiring a laparoscopic of laparotomy left colon resection (mainly sigmoid) was included in this clinical pathway during the years 2009–2017. Our analysis focused particularly on the compliance with the protocol, the pain felt, the suture leak rate, the hospital stay, the re-hospitalization rate and redo surgery within 30 days. Our work leads to the conclusion that the introduction of a clinical pathway, when it is well prepared and brings together all the implicated per-sons with the same goal, is feasible with convincing results. These are directly beneficial to the patient and to the quality of its management.","PeriodicalId":270834,"journal":{"name":"Proctological Diseases in Surgical Practice","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114752659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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