The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year’s follow-up. This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II–III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. A total of 129 patients (69

Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees. Method: Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion. Results: Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS). Conclusion: There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes. (C) 2018. Published by Elsevier Masson SAS.

AimThe study aimed to evaluate outcome at 1year of one- and two-stage fistulotomy for anal fistula in a large group of patients.MethodA prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1year after surgery.ResultsGroup A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0-11) and 2.0 (0-18) (P=0.032) and the median Vaizey scores were 2.0 (0-14) and 3.0 (0-21) (P=0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0-5: 88%, 86%; 6-10: 10.7%, 10.7%; 11-15: 1.0%, 2.6%; and 16-20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1year after the second stage were as follows: 0-5: 86%, 66%; 6-10: 4.5%, 20%; 11-15: 9%, 11%; and 16-20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0-14) vs 4 (0-19) (P<0.001), and the median Vaizey scores were 1.5 (0-11) vs 4 (0-20) (P<0.001). Eighty-eight per cent of the patients were satisfied.ConclusionLow transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.

La prise en charge des troubles de la statique pelvienne est une entreprise difficile. L'objectif à atteindre n'est pas de restituer une anatomie normale mais de diminuer les symptômes fonctionnels sans décompenser ou révéler un incontinence anale ou urinaire. L'examen clinique sera le plus souvent suffisant avant de proposer un traitement médical. En revanche, avant la décision d'un traitement chirurgical, un bilan lésionnel complet des différents étages du périnée devra être réalisé afin de guider le chirurgien dans le choix de la technique opératoire et d'en limiter les éventuels effets secondaires.

Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. Results Two-hundred and sixty-four patients were included (median age, 45years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n=3), local infection (n=4) and faecal impaction (n=1). Healing was achieved in all patients at a median of 7.5weeks after surgery. No recurrence occurred. At 1year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P<0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 (P<0.001) and the KnowlesEckersleyScott Symptom constipation score had decreased from 9/45 to 5/45 (P<0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De-novo clinically significant anal incontinence (Wexner score>5) affected 7% of patients at 1year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. Conclusion Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure.

20 à 30% de mauvaises préparations retrouvées dans les deux jours d'endoscopie 2008: Ces chiffres ne sont pas compatibles avec une coloscopie de qualité. Le but de ce travail était d'évaluer à l'aide d'enregistrements systématiques et grâce au score de Boston la qualité de la préparation colique, d'un nouveau produit associant le picosulfate de sodium au citrate de magnésium sous la forme de 2 sachets associés à une hydratation de 2 à 3 litres.

Aim An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]). Method A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3months and 1year after surgery. Patients assessed their anal symptoms and quality of life (SF-36). Results Six-hundred and thirty-three patients (median age=48years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n=231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n=345, 54.5%), anal fissure (n=56, 8.9%) or low anal fistula (n=1, 0.16%). The median healing time was 6weeks. Early complications included urinary retention (n=3), bleeding (n=11), local infection (n=7) and faecal impaction (n=9). At 1year, the main complications included skin tags (n=2) and anal stenosis (n=23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p<0.001), anal discomfort from 5.5/10 to 0.1/10 (P<0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P<0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied. Conclusion Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1year after surgery. Patient satisfaction was high despite residual anal symptoms.

La constipation terminale est une affection fréquente; sa prévalence dans la population générale allant de 13 à 20 %. Cette dyschésie altère fréquemment la qualité de vie. L’anisme est l’étiologie fonctionnelle la plus fréquente. Cependant ce sont les troubles de la statique pelvienne et tout particulièrement les rectocèles qui représentent la principale étiologie de la constipation terminale. La connaissance des mécanismes mis en jeu, la pratique d’un interrogatoire ciblé et d’un examen clinique précis vont permettre d’orienter les examens complémentaires éventuels et de définir une stratégie thérapeutique dont l’objectif sera avant tout l’amélioration du symptôme « constipation terminale ».

Dyschezia is a frequently occurring ailment; its prevalence in the general population ranges from 13 to 20%, and it often significantly deteriorates quality of life. In most cases, pelvic floor dysfunction (anismus) is the functional aetiology. However, pelvic floor disorders, in particular rectoceles, represent the main aetiologies of the resulting constipation. Understanding the underlying mechanisms, taking a targeted history and performing a precise clinical examination make it possible to determine the need for any additional testing and define a therapeutic strategy whose objective is, most importantly, to relieve the symptom of constipation.