Sacral nerve stimulation for treatment of anal incontinence [preliminary report]

Neurostimulation is a new treatment option for patients with end- stage faecal incontinence in whome there were failure of all conservative measures and operative interventions to repair the sphincter, where colostomy is the only remaining option. To evaluate the efficacy of sacral nerve stimulation as a neurostimulation in restoration of anal function of incontinent patients. Seven patients have successfully completed the temporary nerve stimulation. All seven patients showed a significant improvement of pre test symptoms with reduction of more than 50% of their symptoms, and reported significant improvement of modified Williams score and anal manometry both resting and squeeze pressure. All these seven cases were submitted for permanent implantation of implantable pulse generator [IPG]. Sacral nerve stimulation is a useful method in a certain group of patients, as it is easy to carry out, well tolerated by the patients and its result can be predicted by the results of temporary nerve stimulation

diverting stoma necessary for different coloanal anastomoses?

To evaluate the importance of diverting stomas in decreasing complications after coloanal anastomosis. Thirty patients with low rectal adenocarcinomas underwent low anterior resection and 15 of them underwent stoma construction. Follow-up was 3 years. There was 18 male and 12 female. Non-stoma patients tended to have more early complications and more probability of being free of stricture at 3 years. Straight anastomosis has greater rates of complications than anastomosis after coloplasty or colonic pouch. Defunctioning stoma has a protective role after low anterior resection after different coloanal anastomosis

Spontaneous reduction of intussusception: avoiding unnecessary surgery

The aim of this work was to study cases of spontaneous reduction of intussusception and their implication on the management and outcome. We routinely use ultrasound for diagnosis and hydrostatic reduction of intussusception with saline enema. The study included 16 patients who were admitted to the Pediatric Surgical Center, Faculty of Medicine, University of Alexandria during the period between January 1996 and October 2000 with the diagnosis of intussusception. They fulfilled the study criteria of spontaneous reduction. Details of the clinical picture were compared with the standard cases of intussusception together with correlation with ultrasound features before and after reduction. All cases were examined on admission and diagnosis of intussusception was confirmed by finding the characteristic target sign on ultrasound. During the period of preparation for hydrostatic reduction or during transport from another center, 12 cases showed evidence of spontaneous reduction, which was confirmed by ultrasound and observation. Hydrostatic reduction was attempted in 4 cases. Four cases showed faint target sign on ultrasound after trial of reduction and were considered questionable. Surgical exploration was performed and showed a reduced intussusception. Spontaneous reduction of intussusception is a possible though rare fate of childhood intussusception. It must be borne in mind to avoid unnecessary surgery in this peculiar subset of patients. The pseudotarget sign on ultrasound can be present for a short period after successful reduction of intussusception and is probably due to residual edema. Awareness, short period of observation and repeating sonography examination after 2 hours will avoid confusion in these cases

Re-appraisal of surgical anatomy of arterial supply of the right colon

Hemorrhagic complications can be a major cause of conversion and/or morbidity during laparoscopic intestinal surgery. The limited exposure currently provided in laparoscopic intestinal resection demands a precise knowledge of mesenteric vascular anatomy to avoid such complications and to expedite the procedure. Most surgical texts depict a "normal pattern" of arterial supply to the right colon consisting of three arterial branches [middle colic artery, right colic artery and ileocolic atery] arising independently from the superior mesenteric artery [SMA]. We performed detailed dissection of the SMA in thirty adult cadavers. We found the ileocolic artery in all of our cases and the middle colic artery in 29 of 30 cadavers but only three cases of a right colic artery arising directly from SMA. Our data, combined with review of published anatomic studies, lead us to conclude that in the vast majority of cases there are only two independent branches arising from SMA that supply the large intestine, the ileocolic and the middle colic arteries. The right colic artery directly arising from SMA is unusual [10%]. This knowledge may help lower the risk of vascular complications during laparoscopic intestinal surgery