The study aimed to compare the rate of success and cost of anal fistula plug (AFP) insertion and endorectal advancement flap (ERAF) for anal fistula.

AimTransanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed.MethodConsecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied.ResultsSeventy-five patients (68% male) of mean age 67 (15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 +/- 2.3cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16).ConclusionTransanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1year continence is not compromised.

Intraoperative adverse events significantly influence morbidity and mortality of laparoscopic colorectal resections. Over an 11-year period, the changes of occurrence of such intraoperative adverse events were assessed in this study. Analysis of 3,928 patients undergoing elective laparoscopic colorectal resection based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery was performed. Overall, 377 intraoperative adverse events occurred in 329 patients (overall incidence of 8.4 %). Of 377 events, 163 (43 %) were surgical complications and 214 (57 %) were nonsurgical adverse events. Surgical complications were iatrogenic injury to solid organs (n = 63; incidence of 1.6 %), bleeding (n = 62; 1.6 %), lesion by puncture (n = 25; 0.6 %), and intraoperative anastomotic leakage (n = 13; 0.3 %). Of note, 11 % of intraoperative organ/puncture lesions requiring re-intervention were missed intraoperatively. Nonsurgical adverse events were problems with equipment (n = 127; 3.2 %), anesthetic problems (n = 30; 0.8 %), and various (n = 57; 1.5 %). Over time, the rate of intraoperative adverse events decreased, but not significantly. Bleeding complications significantly decreased (p = 0.015), and equipment problems increased (p = 0.036). However, the rate of adverse events requiring conversion significantly decreased with time (p < 0.001). Patients with an intraoperative adverse event had a significantly higher rate of postoperative local and general morbidity (41.2 and 32.9 % vs. 18.0 and 17.2 %, p < 0.001 and p < 0.001, respectively). Intraoperative surgical complications and adverse events in laparoscopic colorectal resections did not change significantly over time and are associated with an increased postoperative morbidity.

Perineal stapled prolapse (PSP) resection is a novel operation for treating external rectal prolapse. However, no long-term results have been reported in the literature. This study analyses the long-term recurrence rate, functional outcome, and morbidity associated with PSP resection.

Circular stapled mucosectomy is the standard therapy for the treatment of symptomatic third‐degree haemorrhoids and mucosal prolapse. Recently, new staplers made in China have entered the market offering an alternative to the PPH stapling devices. The aim of this prospective randomized study was to compare the safety and efficacy of these new devices.

INTRODUCTION:Primary venous aneurysm is a rare, but essential consideration in the differential diagnosis of an inguinal and femoral hernia.METHODS:We report a case of a 43-year-old man who was referred for evaluation and treatment of a femoral hernia.RESULTS:The patient presented with a 3-month history of an asymptomatic tumor on his right upper inner thigh. Physical examination noted a non-tender, non-indurated tumor.CONCLUSION:Surgical exploration demonstrated a primary venous aneurysm of the proximal saphenous vein.

Although laparoscopy is associated with reduced hospital stay, early recovery, and decreased morbidity compared with open surgery, it is not well established for the treatment of small bowel obstruction (SBO).

Fisteln im Analbereich werden unterteilt in Pilonidalfisteln in der Rima ani und Analfisteln als Verbindung zwischen Anus und perianaler Haut. Bei der Pilonidalfistel erfolgt bei unkompliziertem Befund nach Abheilung akuter Abszesse die minimalinvasive Fistelexzision in Lokalanästhesie. Konservative Therapiekonzepte sowie die radikale Exzision mit offener Wundbehandlung haben sich nicht bewährt. Bei ausgeprägtem, großem Befund erfolgt eine weite Exzision mit plastischer Deckung mittels Limberg-Lappen. Bei der Analfistel muss unterschieden werden zwischen subkutanen und tiefen intersphinktären Fisteln ohne Sphinkterbeteiligung einerseits und hohen intersphinktären, transsphinktären, suprasphinktären und extrasphinktären Fisteln andererseits. Erstere können mit geringer Morbidität und hoher Heilungsrate fistulotomiert werden. Bei der zweiten Gruppe besteht ein erhebliches Inkontinenz- und Rezidivrisiko. Ohne Inkontinenzrisiko, bei allerdings hohem Rezidivrisiko, kann die Fistel mittels „Anal Fistula Plug“ verschlossen werden. Bei Versagen dieser Therapie bietet sich eine Fistulektomie mit Verschluss der inneren Fistelöffnung durch einen anorektalen Verschiebelappen an.

AIM:There is a lack of standardization regarding diagnosis, treatment and surveillance of patients with anal HPV infection.METHOD:An Internet-based survey was sent to members of international, surgical and dermatological societies. Answers were obtained from 1017 dermatologists and 393 colorectal surgeons (n = 1410).RESULTS:More dermatologists than surgeons provided noninvasive treatment of anal condyloma with 5% imiquimod (80.4 vs 28.2%; P < 0.001), whereas the situation was reversed for surgical excision (56.8 vs 91.3%; P < 0.001). To detect dysplastic lesions, 42.0% of surgeons used acetic acid only, 23.2% used this in combination with high-resolution anoscopy and 19.5% applied intra-anal cytological smears. Likewise, 64.6% of dermatologists applied acetic acid only, 16.5% combined acetic acid with high-resolution anoscopy and 30.2% performed intra-anal cytological smears (all P < 0.001 compared with surgeons). The therapy for anal intraepithelial lesions was not influenced by the grade of dysplasia, but it was by immune status.CONCLUSION:There were significant differences in practice between colorectal surgeons and dermatologists. These findings highlight the need for international and cross-disciplinary clinical guidelines.

Die Inzidenz des Analkarzinoms nimmt weltweit zu, vor allem bei männlichen homosexuellen Patienten. Als hauptsächlicher Risikofaktor für die Entstehung des Analkarzinoms gilt die anale Infektion mit dem humanen Papillomavirus (HPV). Die Prävalenz der analen HPV-Infektion bei HIV-negativen homosexuellen Männern beträgt 50–60%. Bei HIV-positiven homosexuellen Männern liegt die Prävalenz bei nahezu 100%. Die HPV-assoziierte anale intraepitheliale Neoplasie (AIN) gilt als Vorläuferläsion des Analkarzinoms. Bei etwa 20% der HIV-negativen homosexuellen Männer lässt sich eine AIN diagnostizieren, wobei bei 5–10% eine hochgradige Epitheldysplasie (AIN II–III) vorkommt. Die Prävalenz der hochgradigen AIN ist jedoch mit bis zu 50% bei HIV-positiven homosexuellen Patienten bedeutend höher. Trotz der Häufigkeit von HPV-bedingten analen Epitheldysplasien und der zunehmenden Fälle von Analkarzinomen gibt es aber noch immer keinen Konsens bezüglich des Screenings, der Therapie und der Überwachung von Patienten mit AIN. Im Falle eines Analkarzinoms ist unabhängig vom HPV- oder HIV-Status heute noch immer die Radiochemotherapie mit 5-FU und Mitomycin C Standard.