The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.

Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached.

Biosynthetic Mesh Reconstruction after Abdominoperineal Resection for Low Rectal Cancer: Cross Relation of Surgical Healing and Oncological Outcomes: A Multicentric Observational Study.

Background: Local wound complications are among the most relevant sequelae after an abdominoperineal resection (APR) for low rectal cancer. One of the proposed techniques to improve the postoperative recovery and to accelerate the initiation of adjuvant chemotherapy is the mesh reinforcement of the perineal wound. The aim of the current study is to compare the surgical and oncological outcomes after APR performed with a biosynthetic mesh reconstruction versus the conventional procedure.

Sacral Nerves Reconstruction After Surgical Resection of a Large Sacral Chordoma Restores the Urinary and Sexual Function and the Anal Continence.

Objective: Chordomas are slow-growing tumors, with a high tendency to local relapse. En bloc resection is related to the most favorable outcome in terms of survival but is frequently associated with permanent neurological deficits involving sphincters and sexual functions. In the present article, we describe an innovative technique of en bloc resection followed by reconstruction of the sacral nerves with nerve grafts.

Prospective Comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: air-balloon versus gel for rectal filling.

Purpose: to prospectively compare two rectal filling techniques for dynamic MRI of pelvic floor disorders (PFD).

Methods And Materials: Twenty-six patients with PFD underwent the two techniques during the same procedure, one based on rectal placement of a balloon-catheter filled with saline and air insufflation (air-balloon technique or AB); another based on rectal filling with 180 cc of gel (gel-filling technique or GF). The examinations were compared for assessment and staging of PFD, including rectal-descent, rectocele, cystocele, colpocele, enterocele, rectal invagination.

Appendiceal abscess in a giant left-sided inguinoscrotal hernia: a rare case of Amyand hernia.

The hernia of Amyand is an inguinal hernia containing the appendix in the sac. It is a rare pathology often diagnosed only intra-operatively. We report a case even more rare of a giant left-sided inguinoscrotal Amyand hernia with appendiceal abscess without clinical findings of incarceration/strangulation, occlusion, perforation, or acute scrotum and with the presence in the sac of the caecum and other anatomical structures (last ileal loops, bladder and omentum).

Laparoscopic cholecystectomy in Steinert's myotonic dystrophy. About two clinical cases.

Myotonic dystrophy type 1, or Steinert's myotonic dystrophy, is a rare RNA-mediated autosomal dominant disease. Here we describe two clinical cases of patients with Steinert's disease who underwent laparoscopic cholecystectomy under general anaesthesia in conjunction with thoracic peridural anaesthesia, without muscle relaxants. Using such an anaesthesiological technique allowed for rapid recovery from anaesthesia, quick and complete recovery of autonomous breathing, and a significant haemodynamic and arterial blood gases stability, as well as an adequate and complete analgesic coverage over the entire perioperative period.

Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders.

Aim: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.

Methods: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed.

Altemeier operation associated with dynamic graciloplasty: a case report.

Introduction: More than 80% of patients with full-thickness rectal prolapse have co-existing fecal incontinence. Choosing the ideal surgical strategy is always a difficult task. We combined an Altemeier rectosigmoid resection with anal dynamic graciloplasty to provide a functional neosphincter.

Splenic infarction, rare cause of acute abdomen, only seldom requires splenectomy. Case report and literature review.

Splenic infarction is a rare disorder, commonly without a characteristic symptomatology, that rarely requires surgical procedure; in fact it has the peculiar feature of an high tendency for complete healing after the only medical approach. Furthermore in order to prevent OPSI, only in case of clear, persistent symptoms or complications it may be necessary surgical laparoscopic or open approach. The Authors report on a recent case observed in emergency of splenic infarction with infectious complications that made the surgical procedure mandatory.

Neurectomy to prevent persistent pain after inguinal herniorraphy: a prospective study using objective criteria to assess pain.

Background: Although tension-free mesh repair has markedly improved the outcome of inguinal hernia surgery, it has only minimally reduced the incidence of persistent postoperative pain. The pathogenesis of this complication and treatment remain unclear.

Study Design: In order to objectively assess whether iliohypogastric neurectomy reduces the incidence and intensity of persistent postoperative pain, we prospectively studied 100 male patients with bilateral inguinal hernia who underwent tension-free surgical repair, combined with iliohypogastric neurectomy on the right side alone.