Parasitic Infections.

Parasitic infections of the gastrointestinal tract are a cause of morbidity to millions of individuals worldwide. These parasites are endemic in underdeveloped countries with poor sanitation allowing for spread through contaminated water supplies. While much is known about these parasites, the cutaneous manifestations caused by infection are infrequently reported in the literature.

Optimal timing of anticoagulation pre- and post-colonoscopy with polypectomy.

Purpose: An increasing number of patients are treated with anticoagulation for many medical conditions. Our practice is to suspend warfarin 5-7 days, aspirin 3 days, and clopidogrel (Plavix) 7 days prior to colonoscopy that may require polypectomy. Generally, we accept an INR of ≤1.

Is there a post-PPH syndrome?

Background: Despite early studies reporting significant decreases in postoperative pain and morbidity with the procedure for prolapse and hemorrhoids (PPH) compared to traditional hemorrhoidectomy, certain complications and long-term efficacy remain uncertain. This study was performed to assess the prevalence of usage of PPH and the observed postoperative complaints and complications.

Methods: A questionnaire was mailed to national and international members of the American Society of Colon and Rectal Surgeons (ASCRS) and the accumulated data were reviewed.

Stapled hemorrhoidectomy with local anesthesia can be performed safely and cost-efficiently.

Purpose: This prospective study was designed to assess the feasibility of performing the procedure for prolapsing hemorrhoids, or stapled hemorrhoidectomy, under local anesthesia supplemented with conscious sedation.

Methods: Seventy consecutive patients (mean age, 56 years; 37 males) with Grade 3 or 4 hemorrhoids underwent the procedure for prolapsing hemorrhoids after perianal infiltration of 0.5 percent lidocaine with 1:200,000 epinephrine and supplemental conscious sedation.

Internal sphincterotomy with hemorrhoidectomy does not relieve pain: a prospective, randomized study.

Purpose: Pain after hemorrhoidectomy is universal. Several attempts have been made to reduce or alleviate the pain after excisional hemorrhoidectomy. The origin of pain is undetermined.

Actual colonoscopy: what are the risks of perforation?

Recent studies have suggested that virtual colonoscopy (VC) and actual colonoscopy (AC) have similar efficacy for detection of polyps >6 mm. However, procedural risks with emerging technology such as VC need to be assessed before widespread implementation. We propose to demonstrate complication rates after AC that can be used for a comparative benchmark in VC.

Readmissions after colorectal surgery cannot be predicted.

Introduction: Readmission after discharge from the hospital is an undesirable outcome. In an attempt to prevent unplanned readmissions after abdominal or perineal colon resection, we proposed to identify risk factors associated with return to the hospital.

Methods: Study participants consisted of 249 patients who were operated on from July 1, 1996, to March 30, 1998.

Rectal prolapse: a search for the "best" operation.

There is a lack of consensus regarding the optimal operative treatment for full-thickness rectal prolapse. We describe our experience in the management of procidentia and evaluate our current practice for improvement of results. The medical records of patients undergoing surgery for rectal prolapse between 1989 to 1999 were retrospectively reviewed.

Transanal endoscopic microsurgery for excision of rectal lesions: technique and initial results.

The aim of this study was to review experience with transanal endoscopic microsurgery (TEM) and to assess its applicability to an existing practice of colorectal surgeons. Patients undergoing TEM excision of rectal lesions from March 1997 through May 1999 were selected for this study. Medical records were reviewed retrospectively to obtain pertinent data, including indications for TEM, tumor size, distance from anal verge, duration of operation, completeness of tumor resection, postoperative complications, duration of stay and follow-up, and recurrence.

Hyperplastic polyps: "more than meets the eye"? Report of sixteen cases.

The vast majority of hyperplastic polyps are small, left-sided, and inconsequential in nature. However, hyperplastic polyps that are large, right-sided, mixed, and found in association with a family history of carcinoma may represent an "atypical" group, and their clinical significance is uncertain. We believe that these atypical lesions should not be lumped together with the common variety of diminutive hyperplastic polyps.

Dieulafoy's lesion of the anal canal: a new clinical entity. Report of two cases.

Dieulafoy's lesion is an unusual source of massive lower gastrointestinal hemorrhage. It is characterized by severe bleeding from a minute submucosal arteriole that bleeds through a punctate erosion in an otherwise normal mucosa. Although Dieulafoy's lesions were initially described only in the stomach and upper small intestine, they are being identified with increasing frequency in the colon and rectum.

Neoplasia after ureterosigmoidostomy.

Purpose: The occurrence of neoplasia after ureterosigmoidostomy is well-documented in the literature. Because of its rarity, few general surgeons will gain significant exposure to this entity, and colorectal surgeons are likely to be involved with the care of these patients. The purpose of this article is to apprise colorectal surgeons about the management of neoplasia after ureterosigmoidostomy and to familiarize them with the unique anatomy of the reconstructed pelvis.

Colorectal cancer after surveillance colonoscopy: false-negative examination or fast growth?

Purpose: Colonoscopy is the preferred method for colorectal cancer surveillance of high-risk patients. Despite its high sensitivity, polyps or cancers may be undetected by colonoscopy and later attributed to an accelerated adenoma-carcinoma sequence. This study assesses how the characteristics of colorectal cancers found at intervals between surveillance relate to the adenoma-carcinoma sequence and its prevention.

Retrorectal carcinoid tumor.

Retrorectal masses comprise a varied group of rarely encountered tumors. We present the case of a 42-year-old white woman with a retrorectal carcinoid tumor treated by abdominosacral resection. Diagnostic and therapeutic strategies are discussed.

Value of carcinoembryonic antigen monitoring in curative surgery for recurrent colorectal carcinoma.

Purpose: This study is designed to review a carcinoembryonic antigen (CEA)-driven postoperative protocol designed to identify patients suitable for curative reresection when recurrent colorectal cancer is identified.

Methods: A total of 285 patients who were operated on for colon or rectal carcinoma between 1981 and 1985 were evaluated (with CEA levels) every two months for the first two years, every three months for the third year, every six months for years 4 and 5, and annually thereafter. CEA levels above 5 microg were considered abnormal and were evaluated with diagnostic imaging and/or endoscopy.

Endorectal repair of rectocele revisited.

Background: Transanal repair of rectocele involving the suprasphincteric portion of the rectovaginal septum has been shown to provide excellent results in up to 90 per cent of cases. Selection of patients suitable for repair is important. Rectocele with concomitant cystocele is best repaired transvaginally.

Anal stenosis.

Anal stenosis is an abnormally tight inelastic anal opening that resists digital examination and is most commonly the result of excessive scarring following anorectal surgery. Surgical correction consists of excision of scar tissue, judicious internal sphincterotomy, and replacement of tissue with healthy skin or mucosa. The author's preferred procedure of advancement mucosal anoplasty is described in detail.

Is simple fistula-in-ano simple?

Purpose: A study of 523 fistulas of cryptoglandular origin operated on between January 1985 and December 1991 at the Lehigh Valley Hospital was undertaken for the purpose of establishing whether the "so-called" simple fistula-in-ano has a favorable outcome. High transsphincteric fistulas with or without high blind tract, suprasphincteric, extrasphincteric, and horseshoe fistulas as well as fistulas associated with inflammatory bowel disease were excluded.

Methods: Four-hundred sixty-one patients with anal fistulas classified as simple fistulas-in-ano (uncomplicated transsphincteric, low and high blind track intersphincteric) were studied retrospectively.