Surgical treatment of pilonidal disease / 中华普通外科杂志

Objective To study the surgical treatment of the pilonidal disease.Methods The clinical data of 33 cases of the pilonidal disease were retrospectively analyzed from Jul 2007 to Feb 2014.18 cases were treated with Excision and Marsupialization,and 15 cases were treated with Rhomboid excision and Limberg flap.Results All 18 cases in the excision and marsupialization group,were cured by surgery.all 15 cases in the rhomboid excision and Limberg flap group were cured,five of these cases were delayed healing dehiscence or necrosis,all this cases were healed after dressing drainage.The average healing time of the Limberg flap group was shorter than that of the Marsupialization group[(19 ±7) d vs.(37 ± 12) d,t =6.556,P ＜ 0.01].Postoperative recurrence of the Marsupialization group was 1 case,the recurrence rate was 5.6％,and there was no recurrence after Limberg flap transfer.The recurrence rate of the 2 groups was statistically insignificant (P ＞ 0.05).Conclusion The excision and marsupialization and the rhomboid excision and Limberg flap are effective in the treatment of the pilonidal disease,and the Limberg flap transfer is recommended in complicated and recurrence cases.

Magnetic resonance imaging features of persistent perineal sinus / 中华消化外科杂志

Objective To summarize the magnetic resonance imaging (MRI) features of the persistcnt perineal sinus (PPS).Methods The retrospective and descriptive study was conducted.The clinical data of 7 patients with PPS who were admitted to the Nanjing University of Traditional Chinese Medicine between July 2010 and January 2017 were collected.Patients received horizontal,anteroposterior axes and coronal scanning of MRI after abdominoperineal resection (APR) of rectal cancer.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) MRI features;(2) treatment and follow-up situations.Patients underwent resection of PPS according to results of MRI examination,and then regular pathological examination.Follow-up using telephone interview was performed to detect sinus recurrence and reoperation up to April 2017.Results (1) MRI features:① Lesion location:lesions of PPS in 7 patients were located at the presacral areas,top side was up to the third sacral plane,and lower side extended down to the pubic area.② Morphology and signal:sinus tract of 7 patients showed irregular flaky and tubular abnormal signals;fibrotic sinus tract wall showed low signals in T1 weighted imaging (T1WI) and T2WI;contents of sinus tract in 7 patients showed low signal in T1WI and high signals in T2WI and T2WI-fat suppression (T2WI-FS).Of 7 patients,uniform signal and mixed signal were respectively detected in 2 and 5 patients.③ Branches and cystic spaces:1 patient had a branch at the tip of the coccyx,extending to the rear of the sacral vertebra.The top of sinus tract in 4 patients enlarged to form a cavity.④ Signs of infection:signs of infection in 3 patients included blurred and exuded fat gaps around the sinus tract,unclear and partially adhesion with pelvic organ;the pelvic floor muscles in 1 patient were thickened and swollen,with a high signal in T2WI-FS;flaky fluid shadows in 2 patients were seen in the posterior sinus,with a high signal in T2WI-FS,showing a tissue edema of anterior sacrum.⑤ Enhancement features:result of MRI examination of 1 patient showed mild and heterogeneous enhancement of sinus.(2) Treatment and follow-up situations:among 7 patients undergoing sinus resection,2 received curettage of superior sinus due to high location,and 5 received successfully operation.All patients underwent postoperatively regular antibiotic therapy.The healing time was 14-78 days,with an average time of 42 days.The postoperative pathological examination showed different degrees of inflammatory cell infiltration.Seven patients were followed up for 2-74 months,with an average time of 40 months.Of 7 patients,sinus in 6 patients was healed,1 had recurrence of sinus and didn't receive therapy.Seven patients didn't undergo debridement or transposition of skin flap again.Conclusion The MRI imaging features of PPS includes flaky and tubular abnormal signal in the the anterior sacrum,low signal in T1WI,high signals in T2WI and T2WI-FS,and the enhanced scanning of sinus duet shows mild and heterogeneous enhancement.

Fecal incontinence in adults:diagnose and treatment / 临床外科杂志

This paper delineate the definition,etiology and treatment of fecal incontinence,Initial management of fecal incontinence consists of supportive care and medical therapy.If patients fail to re-spond to initial management,such patients should undergo additional evaluation(such as anorectal manom-etry,endorectal ultrasound and magnetic resonance imaging)to detect functional and structural abnormali-ties causing fecal incontinence and to guide subsequent management.For patients who fail to respond to initial management,options include biofeedback,injectable anal bulking agent,sacral nerve stimulation, and anal sphincteroplasty.Dynamic graciloplasty and artificial anal sphincter devices are associated with significant morbidity and should therefore only be used to treat refractory fecal incontinence.Fecal diver-sion with a colostomy should be reserved for patients with intractable symptoms who are not candidates for any other therapy,or in whom other treatments have failed.

Diagnosis and surgical treatment for rectovaginal fistula / 中华胃肠外科杂志

Rectovaginal fistulas are distressing conditions to patients and present a therapeutic challenge to surgeons. Whether the etiology of the fistula is obstetric, Crohn's disease-related, or cryptoglandular, a thorough anatomy evaluation is required in order to select the correct repair. No single surgical technique is suitable for all rectovaginal fistulas as of now. Less invasive surgery should be selected in primary repair, and endorectal advancement flap repair was recommended as the first line therapy in most guidelines for the treatment of rectovaginal fistulas. Preoperative fecal diversion has not been shown consistently to lead to better outcomes, thus most surgeons suggested that diverting stoma is not imperative in majority of patients, unless the tissue interposition was undertaken. The tissue interposition or transabdominal repair should be considered for multiple failure or recurrent complex rectovaginal fistulas. Familiarity with the various surgical techniques described and the ability to apply the appropriate surgery to correct patients will increase the chance of a successful intervention.

The past, presence and future of ligation of intersphincteric fistulous tract for the treatment of fistula in ano / 中华胃肠外科杂志

This paper is to summarize the successful rate, complication morbidity, and the impact of ligation of the intersphinteric fistula tract (LIFT) on anal continence, and to illustrate the efficacy of LIFT procedure for the treatment of high transphinteric fistula in ano and the challenging problems existed in practice through literature review retrospectively. LIFT procedure appears to be an effective sphincter conserving approach with less complications and minimal impact on anorectal function for the treatment of high transsphincteric fistula in ano.

Clinical management of pilonidal diseas-interpretation of practice parameters for the management of pilonidal disease from American Society of Colon and Rectal Surgeons / 中华胃肠外科杂志

Pilonidal disease is a common clinical condition which is not sufficiently recognized with regard to the clinical manifestation and treatment by colorectal surgeons in China, resulting in high misdiagnosis rate and recurrent rate. With reference to the Practice Parameters for the Management of Pilonidal Disease published in 2013 by The American Society of Colon and Rectal Surgeons, we discuss the management of pilonidal disease in four aspects, including etiology, diagnoses, nonoperative and operative management.

Effect of the transabdominal posterior rectopexy with resection of the partial rectosigmoid colon on adult rectal prolapse / 国际外科学杂志

Objective To explore the effect of transabdominal posterior rectopexy with resection of the partial rectosigmoid colon on adult rectal prolapse.Methods During the 2006 to 2011,transabdominal posterior rectopexy with resection of the partial rectosigmoid colon was performed on 6 selected adult patients with complete rectal prolapse.Results All patients were cured,the median length of hospital stay was 13.7 days.Followed up for 3-61 months,there was no recurrent case.Conclusions The operation offers a safe and effective alternative to other more complex procedures for the treatment of adult rectal prolapse.The procedure can not only treat the rectosigmoid disease,but also improve the rectosigmoid disease,improve the function of bowel and reduce the recurrence rate.