Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse a... more Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when...
Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's diseas... more Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. 49% (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 de...
In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileo... more In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileostomy (after colectomy) was mad in 203 patients affected by chronic inflammatory bowel disease. Patients were followed up prospectively to evaluate the frequency and severity of the complications. The cumulative rate of surgical reoperation was significantly higher in the group of patients with Crohn disease in comparison with those affected by ulcerative colitis. After 8 years it reached 75% in the first group and only 44% in the second. The most frequent indication for surgery reoperation were stenosis and retraction. 83% of the operations were only local not requiring laparotomy. No statistically significant correlation was found for the reoperation rate, the surgical technique, the length of the ileal resection and the post-operative weight gain. Only a systematic and accurate follow-up done by the surgeon and the enterostomist can detect an optimal functioning of the ileostomy. In c...
In the present work we have studied two consecutive series of patients who underwent a posterior ... more In the present work we have studied two consecutive series of patients who underwent a posterior abdominal rectopexy according to Wells or Ripstein. During the year of follow up no recurrences were observed. Functional results, evaluated according to a protocol, by history of the patient and manovolumetry, shoved an improvement of fecal continence in more than half of the incontinents in both series. However, constipation increased after Wells' rectopexy, while no major changes were observed after Ripstein's rectopexy. We conclude that the first surgical technique may offers worse functional results.
Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease... more Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for gynaecological problems and fertility. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly-fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident...
The authors make clear the importance of extrabdominal fibromatosis as a rare pathology that inte... more The authors make clear the importance of extrabdominal fibromatosis as a rare pathology that interests many people in Italy. The pathology is of relatively easy diagnosis with the common investigations, required a radical surgical removed to avoid the frequent local recidivists.
21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the on... more 21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pressure and maximal squeeze pressure were both significantly lower in the five patients who remained incontinent, 23 (17-31) mm Hg vs 50 (31-52) mm Hg (p < = 0.02) and 52 (17-75) mm Hg vs 108 (89-110) mm Hg (p < = 0.02), respectively. Moreover the manometric results showed evidence that in patients who remained incontinent, the anal pressure in response to rectal distention, was significantly lower than patients who regained continence (p < = 0.05) both before and after operation. We conclude that incontinent patients with rectal prolapse who exhibit a markedly low minimal residual anal pressure on recto-anal reflex inhibition are less likely to improve after rec...
Diagnostic laparoscopy has been an integral part of our surgical practice for over 4 years. Betwe... more Diagnostic laparoscopy has been an integral part of our surgical practice for over 4 years. Between 1988-1992, 100 diagnostic laparoscopies have been performed in this institution without mortality. We have found the procedure to be particularly useful in the following situation: 1) Hepatobiliary disease where it is used in conjunction with targeted liver biopsy. 2) Acute emergency cases. These include the diagnosis of acute peritonitis, abdominal trauma and in patients with suspected mesenteric ischaemia. 3) In the staging of intra-abdominal malignancy especially gastric, oesophageal, colonic, peritoneal and pancreatic neoplasms.
The aim of this study was to attempt to gain insight in to the pathophysiologic characteristics o... more The aim of this study was to attempt to gain insight in to the pathophysiologic characteristics of rectal prolapse by evaluating rectal compliance in patients with complete or incomplete rectal prolapse, before and after rectopexy. 21 subjects with complete rectal prolapse and 10 subjects with internal procidentia of rectum were treated with one of two abdominal rectopexies, according to Wells or according to a modified Ripstein's technique. For comparison, measurements were also carried out in 17 age and sex control subjects who had no bowel disturbances or anal symptoms. On distension with 40 cm H2O rectal volume amounted to 218 (175-255) ml for controls, 225 (178-256) ml for complete prolapses and 200 (125-225) ml for invaginations. Compliance amounted respectively to 9.5 (5-11,4), 8.5 (5-12,6), 7.5 (4-10,6) ml/cm H2O in the pressure interval 0-10 cm H2O with a decrease in compliance at higher pressure intervals. There was no correlation between rectal volume and compliance a...
Rectal invagination has been considered an important cause of defecation difficulties and blockad... more Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). In the present study defecographies performed on 15 patients, with previous diagnosis of rectal invagination have been reviewed. Six patients had an intra-rectal (IR) invagination, three had an intra-anal (IA) invagination, while two patients did not show a typical rectal invagination. In the present series there is a suspected radiologic recurrence of the invagination. Three patients show a tendency to rectal stenosis. Anorectal angles at rest and under straining appears higher than the ones in normal subjects, after rectopexy, anorectal angles do not appear to be significantly changed and the pelvic floor is not significantly raising post-operatively. 7 out of 10 women had a rectocele preoperatively and 4 out 9 postoperatively. In 8 patients it was possible to compare a pre to a post-operative defecography. All patients but one displayed a reduction in the ab...
It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the ... more It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and re...
Electrical Stimulation for Pelvic Floor Disorders, 2014
Acupuncture was not accepted by physicians for a long time, in part due to the mysterious and une... more Acupuncture was not accepted by physicians for a long time, in part due to the mysterious and unexplainable mechanisms of traditional Chinese acupuncture. Subsequently the neurophysiological mechanism of acupuncture has been clarified. The technology has become scientifically approved and has been considered on par with other medical treatments.
Controversial Issues in Rectal Cancer Surgery Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, G... more Controversial Issues in Rectal Cancer Surgery Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, Gianluca Colucci Introduction Ernest Miles [1] postulated that ... Devlin et al.[14] and Williams andJohnston [15] painted a very gloomy picture of colostomy patients' QoL, the majority ...
19th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts to ag... more 19th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts to age, BMI, parity, time from delivery, episiotomy, epidural anesthesia, birth weight, or delivery mode, but there was a trend towards higher TUI scores with a prolonged second stage (0.061). Women with a higher BMI had larger levator hiatal area dimensions (P=0.05), whereas shorter women tended to have more severe avulsion defects on TUI (P=0.027). Women with an avulsion defect in addition to the perineal tear were also more likely to have anorectal symptoms, although this was statistically significant only for fecal urgency (< 0.05). We observed a decrease in the incidence (61.4% vs. 29.5%, P<0.001) and TUI score of avulsion defects (6.18 ± 6.4 vs. 2.43 ± 4.8, (P<0.001), for the enrolment and last visits, respectively. Conclusion: There seems to be a change in the appearance of levator ani trauma during long term follow-up in women with 3 rd and 4 th degree perineal tears suggesting the need for continued evaluation. Relationship between ultrasound measurements of tissue thickness, manometry and multichannel sEMG of the external anal sphincter
The risk of cancer transformation in the residual rectal mucosa in the muscular or columnar cuff ... more The risk of cancer transformation in the residual rectal mucosa in the muscular or columnar cuff is another important factor that may influence the eventual decision. This article critically reviews our experience and the literature.
Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be... more Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be a rational alternative to the conventional single stage proctocolectomy for ulcerative colitis. One of the great attractions of the method is that the preserved anal canal and anal sphincters may subsequently be used for restoration of intestinal continuity. Two patients are described who were both successfully treated by construction of a pelvic pouch at a second stage. This approach should be considered an alternative for patients with severe ulcerative colitis particularly those in whom preservation of the rectum is judged to be hazardous. were subsequently used for restoration of intestinal continuity after construction of a pelvic ileal pouch.
Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Di... more Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Diarrhea and bleeding hemorrhoids frequently contribute to the morbidity, and patients with such problems cause an increasing load on many outpatient clinics. Twenty-two patients (17 males) with acquired immunodeficiency syndrome had injection treatment for bleeding second-degree to fourth-degree hemorrhoids according to standard outpatient clinic routines. Mean follow-up was 24 months. No complications were recorded. The treatment was successful in all patients, and no hemorrhoidectomy was necessary. Nineteen patients improved after their first injection, whereas 3 patients required two to six weeks repeated treatments to improve. Four subjects with the longer follow-up (4 years) showed an improvement lasting 12 to 18 months and then required one to two treatments per year to stop recurrent bleeding. Because of their poor general condition and poor wound healing, a conservative approach is preferable to avoid a formal hemorrhoidectomy in patients with acquired immunodeficiency syndrome. Sclerotherapy seems to be an attractive alternative.
The aim of this study was to investigate the influence of surgical technique on functional and ma... more The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex | mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H20 vs. 25 cm of H20, P< 0.05 and 25 cm of HaO vs. 45 cm of H20, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.
Objectives: Acupuncture has been used successfully for the treatment of urinary bladder dysfuncti... more Objectives: Acupuncture has been used successfully for the treatment of urinary bladder dysfunction. The aim of this study was therefore to investigate if manual acupuncture might also affect fecal incontinence favorably. Methods: The study comprises 15 female patients, median age 60 years (39 -75). Before treatment and at regular intervals after acupuncture sessions the defects of anal continence were assessed. Ano-rectal function was assessed by means of recto anal manovolumetry. Each patient was submitted to one acupuncture treatment per week for a ten-week period. Subsequently, a control session was repeated once per month up to 7 months for six patients. A final functional assessment was performed at 18 months. Result: Patients experienced a significant improvement in anal continence, the overall continence score which changed from 10 (3 -21) estimated before treatment to zero (0 -7) (p b 0.05) at 10 weeks. Patients with irregular bowel habits and/or loose stools reported significant improvement. On the manovolumetric variables a limited increase of resting from 25 (17-35) mmHg to 36 (20-42) mmHg, (p = 0.05) and sustained squeeze anal pressure, changing from 41 (32-68) mmHg to 60 (40-100) mmHg (p b 0.05) were reported. Rectal sensory function remained unchanged. Conclusion: Acupuncture offers good opportunities for improving fecal incontinence. The mechanism of action is obscure but might be an effect of the "neuromodulation" of the recto-anal function similar to that explaining the favorable results achieved by sacral nerve stimulation. The concomitant regulation of disordered bowel habits may also contribute to the satisfactory results.
Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse a... more Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when...
Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's diseas... more Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. 49% (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 de...
In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileo... more In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileostomy (after colectomy) was mad in 203 patients affected by chronic inflammatory bowel disease. Patients were followed up prospectively to evaluate the frequency and severity of the complications. The cumulative rate of surgical reoperation was significantly higher in the group of patients with Crohn disease in comparison with those affected by ulcerative colitis. After 8 years it reached 75% in the first group and only 44% in the second. The most frequent indication for surgery reoperation were stenosis and retraction. 83% of the operations were only local not requiring laparotomy. No statistically significant correlation was found for the reoperation rate, the surgical technique, the length of the ileal resection and the post-operative weight gain. Only a systematic and accurate follow-up done by the surgeon and the enterostomist can detect an optimal functioning of the ileostomy. In c...
In the present work we have studied two consecutive series of patients who underwent a posterior ... more In the present work we have studied two consecutive series of patients who underwent a posterior abdominal rectopexy according to Wells or Ripstein. During the year of follow up no recurrences were observed. Functional results, evaluated according to a protocol, by history of the patient and manovolumetry, shoved an improvement of fecal continence in more than half of the incontinents in both series. However, constipation increased after Wells' rectopexy, while no major changes were observed after Ripstein's rectopexy. We conclude that the first surgical technique may offers worse functional results.
Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease... more Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for gynaecological problems and fertility. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly-fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident...
The authors make clear the importance of extrabdominal fibromatosis as a rare pathology that inte... more The authors make clear the importance of extrabdominal fibromatosis as a rare pathology that interests many people in Italy. The pathology is of relatively easy diagnosis with the common investigations, required a radical surgical removed to avoid the frequent local recidivists.
21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the on... more 21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pressure and maximal squeeze pressure were both significantly lower in the five patients who remained incontinent, 23 (17-31) mm Hg vs 50 (31-52) mm Hg (p < = 0.02) and 52 (17-75) mm Hg vs 108 (89-110) mm Hg (p < = 0.02), respectively. Moreover the manometric results showed evidence that in patients who remained incontinent, the anal pressure in response to rectal distention, was significantly lower than patients who regained continence (p < = 0.05) both before and after operation. We conclude that incontinent patients with rectal prolapse who exhibit a markedly low minimal residual anal pressure on recto-anal reflex inhibition are less likely to improve after rec...
Diagnostic laparoscopy has been an integral part of our surgical practice for over 4 years. Betwe... more Diagnostic laparoscopy has been an integral part of our surgical practice for over 4 years. Between 1988-1992, 100 diagnostic laparoscopies have been performed in this institution without mortality. We have found the procedure to be particularly useful in the following situation: 1) Hepatobiliary disease where it is used in conjunction with targeted liver biopsy. 2) Acute emergency cases. These include the diagnosis of acute peritonitis, abdominal trauma and in patients with suspected mesenteric ischaemia. 3) In the staging of intra-abdominal malignancy especially gastric, oesophageal, colonic, peritoneal and pancreatic neoplasms.
The aim of this study was to attempt to gain insight in to the pathophysiologic characteristics o... more The aim of this study was to attempt to gain insight in to the pathophysiologic characteristics of rectal prolapse by evaluating rectal compliance in patients with complete or incomplete rectal prolapse, before and after rectopexy. 21 subjects with complete rectal prolapse and 10 subjects with internal procidentia of rectum were treated with one of two abdominal rectopexies, according to Wells or according to a modified Ripstein's technique. For comparison, measurements were also carried out in 17 age and sex control subjects who had no bowel disturbances or anal symptoms. On distension with 40 cm H2O rectal volume amounted to 218 (175-255) ml for controls, 225 (178-256) ml for complete prolapses and 200 (125-225) ml for invaginations. Compliance amounted respectively to 9.5 (5-11,4), 8.5 (5-12,6), 7.5 (4-10,6) ml/cm H2O in the pressure interval 0-10 cm H2O with a decrease in compliance at higher pressure intervals. There was no correlation between rectal volume and compliance a...
Rectal invagination has been considered an important cause of defecation difficulties and blockad... more Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). In the present study defecographies performed on 15 patients, with previous diagnosis of rectal invagination have been reviewed. Six patients had an intra-rectal (IR) invagination, three had an intra-anal (IA) invagination, while two patients did not show a typical rectal invagination. In the present series there is a suspected radiologic recurrence of the invagination. Three patients show a tendency to rectal stenosis. Anorectal angles at rest and under straining appears higher than the ones in normal subjects, after rectopexy, anorectal angles do not appear to be significantly changed and the pelvic floor is not significantly raising post-operatively. 7 out of 10 women had a rectocele preoperatively and 4 out 9 postoperatively. In 8 patients it was possible to compare a pre to a post-operative defecography. All patients but one displayed a reduction in the ab...
It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the ... more It has been suggested that incontinent patients with rectal prolapse develop a relaxation of the internal sphincter at a lower filling volume than those with the same disorder who were continent. A constant relaxation of the internal sphincter during filling before the individual experiences a need to defecate could be a contributory cause of the incontinence in these patients. Aiming to evaluate the former observations we have investigated continent and incontinent patients, with complete and internal rectal prolapse, by mean of the recto-anal manovolumetry. 31 patients were studied, 21 had a complete rectal prolapse and 10 had internal rectal prolapse and 28 sex and age matched controls were selected among volunteers. No difference has been found between the continent and incontinent patients with rectal prolapse, in term of sensory function studied by graded isobaric distention. Moreover, no difference has been found between the rectal volume at which perception of filling and re...
Electrical Stimulation for Pelvic Floor Disorders, 2014
Acupuncture was not accepted by physicians for a long time, in part due to the mysterious and une... more Acupuncture was not accepted by physicians for a long time, in part due to the mysterious and unexplainable mechanisms of traditional Chinese acupuncture. Subsequently the neurophysiological mechanism of acupuncture has been clarified. The technology has become scientifically approved and has been considered on par with other medical treatments.
Controversial Issues in Rectal Cancer Surgery Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, G... more Controversial Issues in Rectal Cancer Surgery Leif Hultèn, Gian Gaetano Delaini, Marco Scaglia, Gianluca Colucci Introduction Ernest Miles [1] postulated that ... Devlin et al.[14] and Williams andJohnston [15] painted a very gloomy picture of colostomy patients' QoL, the majority ...
19th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts to ag... more 19th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts to age, BMI, parity, time from delivery, episiotomy, epidural anesthesia, birth weight, or delivery mode, but there was a trend towards higher TUI scores with a prolonged second stage (0.061). Women with a higher BMI had larger levator hiatal area dimensions (P=0.05), whereas shorter women tended to have more severe avulsion defects on TUI (P=0.027). Women with an avulsion defect in addition to the perineal tear were also more likely to have anorectal symptoms, although this was statistically significant only for fecal urgency (< 0.05). We observed a decrease in the incidence (61.4% vs. 29.5%, P<0.001) and TUI score of avulsion defects (6.18 ± 6.4 vs. 2.43 ± 4.8, (P<0.001), for the enrolment and last visits, respectively. Conclusion: There seems to be a change in the appearance of levator ani trauma during long term follow-up in women with 3 rd and 4 th degree perineal tears suggesting the need for continued evaluation. Relationship between ultrasound measurements of tissue thickness, manometry and multichannel sEMG of the external anal sphincter
The risk of cancer transformation in the residual rectal mucosa in the muscular or columnar cuff ... more The risk of cancer transformation in the residual rectal mucosa in the muscular or columnar cuff is another important factor that may influence the eventual decision. This article critically reviews our experience and the literature.
Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be... more Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be a rational alternative to the conventional single stage proctocolectomy for ulcerative colitis. One of the great attractions of the method is that the preserved anal canal and anal sphincters may subsequently be used for restoration of intestinal continuity. Two patients are described who were both successfully treated by construction of a pelvic pouch at a second stage. This approach should be considered an alternative for patients with severe ulcerative colitis particularly those in whom preservation of the rectum is judged to be hazardous. were subsequently used for restoration of intestinal continuity after construction of a pelvic ileal pouch.
Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Di... more Patients with acquired immunodeficiency syndrome are often in poor general physical condition. Diarrhea and bleeding hemorrhoids frequently contribute to the morbidity, and patients with such problems cause an increasing load on many outpatient clinics. Twenty-two patients (17 males) with acquired immunodeficiency syndrome had injection treatment for bleeding second-degree to fourth-degree hemorrhoids according to standard outpatient clinic routines. Mean follow-up was 24 months. No complications were recorded. The treatment was successful in all patients, and no hemorrhoidectomy was necessary. Nineteen patients improved after their first injection, whereas 3 patients required two to six weeks repeated treatments to improve. Four subjects with the longer follow-up (4 years) showed an improvement lasting 12 to 18 months and then required one to two treatments per year to stop recurrent bleeding. Because of their poor general condition and poor wound healing, a conservative approach is preferable to avoid a formal hemorrhoidectomy in patients with acquired immunodeficiency syndrome. Sclerotherapy seems to be an attractive alternative.
The aim of this study was to investigate the influence of surgical technique on functional and ma... more The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex | mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H20 vs. 25 cm of H20, P< 0.05 and 25 cm of HaO vs. 45 cm of H20, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.
Objectives: Acupuncture has been used successfully for the treatment of urinary bladder dysfuncti... more Objectives: Acupuncture has been used successfully for the treatment of urinary bladder dysfunction. The aim of this study was therefore to investigate if manual acupuncture might also affect fecal incontinence favorably. Methods: The study comprises 15 female patients, median age 60 years (39 -75). Before treatment and at regular intervals after acupuncture sessions the defects of anal continence were assessed. Ano-rectal function was assessed by means of recto anal manovolumetry. Each patient was submitted to one acupuncture treatment per week for a ten-week period. Subsequently, a control session was repeated once per month up to 7 months for six patients. A final functional assessment was performed at 18 months. Result: Patients experienced a significant improvement in anal continence, the overall continence score which changed from 10 (3 -21) estimated before treatment to zero (0 -7) (p b 0.05) at 10 weeks. Patients with irregular bowel habits and/or loose stools reported significant improvement. On the manovolumetric variables a limited increase of resting from 25 (17-35) mmHg to 36 (20-42) mmHg, (p = 0.05) and sustained squeeze anal pressure, changing from 41 (32-68) mmHg to 60 (40-100) mmHg (p b 0.05) were reported. Rectal sensory function remained unchanged. Conclusion: Acupuncture offers good opportunities for improving fecal incontinence. The mechanism of action is obscure but might be an effect of the "neuromodulation" of the recto-anal function similar to that explaining the favorable results achieved by sacral nerve stimulation. The concomitant regulation of disordered bowel habits may also contribute to the satisfactory results.
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