ABSTRACT
BACKGROUND: Cutting setons have been used in complicated perirectal sepsis with good effect, although there is a moderately high incidence of fecal leakage after their use. The aim of this study was to compare a modified cutting seton, which repaired the internal anal sphincter muscle and re-routed the seton through the intersphincteric space, with a conventional cutting seton. METHODS: A total of 34 patients were randomized between 1998 and 2002. They were prospectively assessed by continence score and anorectal manometry, and for anal function, clinical sepsis and fistula recurrence. RESULTS: There was no difference in postoperative continence score, incidence of recurrent fistula or healing time between groups after a mean follow-up of 12 months. Resting anal manometric pressures and vector volumes were consistently higher with the modified seton (although not statistically significant), as was the area under the inhibitory curve during elicitation of the rectoanal inhibitory reflex across the full sphincter length. ( p<0.05). CONCLUSION: A larger prospective study of internal anal sphincter-preserving seton use in cryptogenic high transshincteric fistula-in-ano appears justified.
Subject(s)
Anal Canal/surgery , Rectal Fistula/diagnosis , Rectal Fistula/surgery , Suture Techniques , Adult , Aged , Anal Canal/physiopathology , Analysis of Variance , Confidence Intervals , Female , Humans , Male , Manometry/methods , Middle Aged , Probability , Prognosis , Prospective Studies , Recovery of Function , Reference Values , Risk Assessment , Severity of Illness Index , Surgical Procedures, Operative/methods , Treatment Outcome , Wound HealingABSTRACT
BACKGROUND: Rectocele is a common finding in patients with intractable evacuatory disorders. Although much rectocele surgery is conducted by gynecologists en passant with other forms of vaginal surgery, many reports lack appreciation of the importance of coincident anorectal symptoms, and do not report functional and clinical outcome data. The pathogenesis of rectocele is still controversial, as is the embryological and anatomical importance of the rectovaginal septum as well as recognizable defects in its integrity and its relevance in formal repair when rectocele is operated upon as the principal condition in patients with intractable evacuatory difficulty. DISCUSSION: The investigation and surgical management of rectocele is controversial given the relatively small numbers of operated patients in any single specialist unit and the relative lack of prospective data concerning functional outcome in operated cases. The imaging of rectocele patients is currently in a state of change, and the newer diagnostic modalities including dynamic magnetic resonance imaging frequently display a multiplicity of pelvic floor disorders. When surgery is indicated, coloproctologists most commonly utilize an endorectal defect-specific repair, but there are few controlled randomized data regarding outcome and response criteria of specific symptoms with particular surgical approaches. A Medline-based literature search was conducted for this review to assess the clinical results of defect-specific rectocele repairs using the endorectal, transvaginal, transperineal, or combined approaches. Only the studies are included that report both pre- and postoperative symptoms including constipation, evacuatory difficulty, pelvic pain, the impression of a pelvic mass, fecal incontinence, dyspareunia or the need for assisted digitation to aid defecation. CONCLUSION: The history of rectocele repair, its clinical and diagnostic features and the advantages, disadvantages and indications for the different surgical techniques are presented in this review. Suggested diagnostic and surgical therapeutic algorithms for management have been included. It is recommended that a multicenter controlled randomized trial comparing surgical approaches for symptomatic evacuatory dysfunction where rectocele is the principal abnormality should be conducted.
Subject(s)
Rectocele/diagnosis , Rectocele/surgery , Rectum/surgery , Vagina/surgery , Algorithms , Fascia/anatomy & histology , Female , Humans , Laparoscopy , Perineum/surgery , Rectum/anatomy & histology , Vagina/anatomy & histologyABSTRACT
In an individual feeding experiment with 48 Holstein-Friesian heifers divided into 3 groups, the effect of various energy levels on live weight development and energy expenditure in the age bracket of 97 days (78 kg live weight) to conception (350 kg LW) and from conception to calving (500 kg LW) was investigated. Rations with differing concentrate--roughage ratios were used. The differentiation of energy intake per day between groups 1 and 2 and group 3 amounted to 7.5% in the 1st development period and to 20% between group 1 and groups 2 and 3 in the 2nd development period. There were significant differences in the live weight gain of 95 g/animal and day in the first development period (up to conception) and of 81 g/animal and day in the second period of development (from conception to calving). Under the tropical climatic conditions the energy expenditure in these studies was approximately 10% under the energy expenditure recommended by the NRC (1978). While there was a clear reciprocal relation between energy expenditure and live weight gain in the first period of development, this relation was less distinct in the second period of development.
Subject(s)
Cattle/metabolism , Energy Intake , Energy Metabolism , Pregnancy, Animal/metabolism , Weight Gain , Age Factors , Animal Feed , Animals , Cattle/growth & development , Cuba , Dietary Proteins/administration & dosage , Female , Pregnancy , Tropical ClimateABSTRACT
Experimental results of an individual feeding experiment with 48 Holstein-Frisian heifers were generalized with regard to live weight development and energy intake by means of the Janoschek function and the extended e-function resp. The requirement of metabolizable energy was derived from the results of energy intake on dependance on live weight and live weight gain. In comparison with the data of the NRC (1978) a requirement by 10% lower was the result. Due to adding a 10% deficiency supplement at present required under Cuban conditions of production the use of the NRC recommendations (1978) is still justified. Without the addition of the deficiency supplement the results showed good agreement with requirement data of INRA 1978.