Efficacy of surgical treatments for the management of solitary rectal ulcer syndrome: a network meta-analysis.

Aim: Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings.

Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse.

Background: Different surgical techniques have been proposed for rectocele repair. However, controversial aspects exist on the best approach to use. The study aims to report the early and late outcomes of the sequential transfixed stich technique (STST) for the treatment of rectocele in the absence of mucosal prolapse.

Surgical approach to piles at risk of severe postoperative pain: tricks and tips.

Aim: Aim of the present study is to propose a clinic-therapeutic course for the treatment of hemorrhoidal disease able to combine radical anatomic surgery with a painless postoperative path.

Material Of Study: The present study is based on the evaluation of 20 selected patients who underwent radical hemorrhoidectomy for very high grade hemorrhoidal disease. The clinical course was characterized by careful bowel cleansing, hemorrhoidectomy according to Milligan-Morgan using LigaSure, intraoperative perianal infiltration of Ropivacaine and postoperative use of analgesic drugs.

Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.

Background: An anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe.

Development and testing of a grasper for NOTES powered by variable stiffness pneumatic actuation.

Background: In natural orifice transluminal endoscopic surgery (NOTES) the peritoneal cavity is reached through natural orifices (mouth, rectus and transvaginal duct), by means of little cuttings in the walls of hollow organs. Due to narrow spaces, NOTES needs robotic systems to assure operation/movement precision and patient safety. Variable stiffness actuation (VSA) assures both requirements.

Low energy manual anal stretch: an approach in the treatment of chronic anal fissure.

Background: Anal fissure is a tear in the epitelial lining of the anal canal. This is a very common anorectal disorder, but the choice of treatment is unclear. Sphincterotomy is effective but it is affected by a high risk of fecal incontinence.

Residual Prolapse in Patients with III-IV Degree Haemorrhoids Undergoing Stapled Haemorrhoidopexy with CPH34 HV: Results of an Italian Multicentric Clinical Study.

CPH34 HV, a high volume stapler, was tested in order to assess its safety and efficacy in reducing residual/recurrent haemorrhoids. The clinical charts of 430 patients with third- to fourth-degree haemorrhoids undergoing SH in 2012-2013 were consecutively reviewed, excluding those with obstructed defecation (rectocele >2 cm; Wexner's score >15). Follow-up was scheduled at six and 12 months.

From Nuremberg to bioethics: an educational project for students of dentistry and dental prosthesis.

In the lessons of medical-scientific methodologies of the medical faculty at the Sapienza University of Rome, basic notions on the ethical and deontologic aspects characterizing the history of the medical profession are provided, including the formulation and application of bioethical principles to clinics and biomedical research. Within such framework, an educational project has been initiated on the historical origin of the current normative and juridic dispositions in the regulation of experimental biomedical research and the relationship between health operators and patients, with particular attention to the procedure, the meaning the value either professional or deontologic, of ethics and the legality of the informed consensus. Emphasis is put on medical and experimental abuses that occurred in Germany during the nazi regime.

Efficacy of two different surgical techniques combined in the treatment of rectocele.

Rectocele is defined as the herniation of rectal wall due to a rectovaginal septum defect in direction of the vagina. In most of cases it is a result of vaginal delivery or repeated increases of intra-abdominal pressure due to chronic constipation. Some patients can develop rectocele as a consequence of congenital or inherited weakness of the pelvic support system.

[A new needle for colon-proctological surgery: personal experience].

Rectocele and haemorrhoidal prolapse are two pathologies that in all cases entail partial excision of anorectal tissue possibly with less invasive surgical procedures. For these pathologies, the authors have recently improved their treatment procedures, introducing the sequential transfixed stitch technique (STST) for rectocele and the transfixed stitch technique (TST) for haemorrhoidal prolapse, and thereby obtaining a significant technical and clinical improvement in terms of both outcomes (complete correction of rectal prolapse and haemorrhoidal prolapse) and discomfort and quality of life in the postoperative period. Moreover, in the present study the authors propose a subsequent innovation of the technique developed recently for the treatment of rectocele and haemorrhoidal disease using a new curved siliconate needle, thinner than the traditional lanceolate needles, with a longer, more rigid needle-thread junction in order to achieve less invasiveness and mucosal trauma, enabling the surgeon to perform sutures in a simple, easy manner.

[Usefulness of plug test for the intraoperative staging of rectal mucosal prolapse].

Rectal mucosal prolapse is characterised by protrusion of the rectal mucosa alone in the anal lumen. To correctly establish the intraoperative stage of rectal mucosal prolapse the authors performed a test based on the intrarectal introduction of a large-sized hydrophilic plug, to be extracted later from the anal canal. A total of 40 patients with proctological symptoms and with a diagnosis of rectal mucosal prolapse were submitted, in the outpatient setting, to a minimally invasive test with a small plug and later, in the preoperative stage, in patients under anaesthesia, using a plug entirely inserted into the rectal lumen and extracted via the anus.

[Use of an evaluation score for rectal mucosal prolapse].

Rectal mucosal prolapse is characterised by the protrusion of the mucosa alone in the rectal lumen. The authors, after an experience conducted in ambulatory patients, have produced a score to classify the extent of rectal mucosal prolapse based on evaluation of qualitative and quantitative factors that should help in the correct management of proctological patients. A total of 30 patients with proctological symptoms during outpatient visits were submitted to a minimally invasive test in comparison to the traditional ones, using a simple gauze plug connected to the end of a suture thread, inserted in the rectal lumen and removed via the anus.

The modern treatment of early gastric cancer: our experience in an Italian cohort.

Background: Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors. However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort.

Role of magnified ileoscopy in the diagnosis of cases of coeliac disease with predominant abdominal symptoms.

Objective: Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination.

[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy].

In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique.

[New disposable exploratory vaginal valve: advantages and efficacy].

In current clinical practice, proctological diseases are now classed more appropriately as pertaining to the area of pelvic floor dysfunction. For this reason all proctological examinations should be combined with a gynaecological assessment. The authors report the results of clinical experimentation with a new vaginal valve for use after surgery and in outpatient settings for exploratory purposes.

[Should surgical thread influence the outcome of haemorrhoidectomy with the transfixed stitch technique?].

The technique of haemorrhoidectomy with the transfixed stitch technique (TST) is a surgical treatment modality for haemorrhoids that is available to the surgeon. The authors, through a personal interpretation of haemorrhoids based on the PATE 2006 classification, report the results of a comparative trial, using TST with two different surgical threads, Assufil and Monofil. The aim of this prospective randomised trial was to compare the results with the use of each surgical thread, analysing early postoperative side effects (bleeding, urinary retention, pain), late postoperative side effects (pain, bleeding, stricture, anal secretion, tenesmus and faecal incontinence), return to active life and quality of life.

[Proctological surgery: use of an absorbable haemostatic sponge].

The aim of this study was to demonstrate the advantages and efficacy of an absorbable haemostatic sponge for use in coloproctology during surgery for the most frequent pathologies of the anal canal and perineal region. The haemostatic sponge is made of absorbent gelatin that is insoluble in water and is endowed with haemostatic power. It can be produced in various sizes and forms adaptable to different uses and presents no toxic properties.

[A new accessory for the isostatic anal retractor].

The authors present the characteristics and the advantages deriving from the use of a new accessory to be fitted on the isostatic anal retractor in order to further improve visualisation of the operative field during the treatment of pelvic and anal pathologies. The isostatic anal retractor consists of a system of rotating rings and valves which are positioned with surgical stitches on the patient's buttocks. The new accessory is characterised by one or more elastic systems that can be fixed to the retractor metal ring and attached by means of curved needles to flaps of anal mucosa, affording enhanced visibility of the operative field.

[Design and use of a new disposable fenestrated anoscope in proctology].

Direct exploration of the anal mucosa always plays an essential role in the diagnosis and treatment of the main anal and perineal pathologies. The continuous need to improve coloproctological instruments, enhancing their efficacy and advantages for patients, prompted the authors to design and test a new anoscope for both diagnostic and operative purposes, suitable for simple, immediate use. This study was conducted to demonstrate the advantages and efficacy of a disposable "fenestrated" anoscope for band ligation of haemorrhoids and for performing biopsies on suspect areas of anal mucosa.