Past and present

Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment

Bowel function and its associated variables in Saudi adults a population based study

To study bowel patterns [function/habits] and its associated variables in an adult Saudi population. In a cross sectional study, a 21-item questionnaire on bowel function [habits and frequency] was distributed to 10,000 high school students from all 5 regions of Riyadh City, Saudi Arabia, between February and April 2011. The randomly selected students, and 2 of their household or family members completed the questionnaire. Socio-demographic characteristics, eating habits, chronic diseases, and medications used were studied. Sixty-one percent [N=4918] were above the age of 16 years, of which 51.5% were males, and 88.1% were Saudis. It was observed that 18.1% of respondents perceived their bowel movements as being irregular and abnormal. There was no association between gender and abnormal/irregular bowel movement [OR: 0.89; p=0.13]. Individuals over 60 years suffered from bowel pattern abnormalities [OR=1.8; p=0.01]. Educational status [secondary], occupation [teacher and unemployed], diet habits, and chronic diseases of study subjects were also statistically significantly associated with their bowel movements. Respondents consuming more vegetables, fruits, meats, dairy products, and rice had significantly more normal bowel movements. Females tended to defecate less frequently as compared with males [p<0.0001]. Approximately 40% of both genders have bowel movements at least once a day. Our results may serve as a baseline for appropriate intervention strategies, and also for future studies to substantiate, negate, or add more observations/conclusions.

Artificial bowel sphincters for severe fecal incontinence. Are they a solution?

Fecal incontinence is a debilitating and common problem with a profound effect on a patient's well being medically, socially, and economically. Non-operative management of this condition includes dietary modification, antidiarrheal medications, and biofeedback. Patients with severe incontinence can be divided into 2 categories. The first group includes patients with an identifiable and isolated anatomic sphincter defect who can expect 80% short-term surgical success using overlapping sphincteroplasty. The second group is patients who will not benefit from sphincteroplasty; fortunately, they are not obligated to permanent stomas. Artificial bowel sphincter [ABS] implantation is a well-established surgical technique, offers a chance for continence, restoration, and improved quality of life with significant functional success rate. The surgeon needs to understand how they function. They should be proficient in different procedure types and match these with the patient's need. Post-operative long-term follow-up continues to help surgeons better serve this type of patient population