ABSTRACT
BACKGROUND: Perianal fistula is a common colorectal condition with an incidence of 9 per 100,000. Many surgical treatments exist, all aiming to eliminate symptoms with minimal risk of recurrence and impact upon continence. Despite extensive evaluation of the therapeutic modalities, no clear consensus exists as to what is the gold standard approach. This systematic review aimed to examine all available evidence pertaining to the surgical management of perianal fistulas. Primary outcomes examined were recurrence and incontinence. SUMMARY: This study was conducted according to PRISMA guidelines. Primary outcomes were analyzed for each group and expressed as pooled odds ratio with confidence intervals of 95%. 687 studies were identified from which 28 relevant studies were included. There was no significant difference in rates of incontinence identified between various surgical approaches. Glues and plugs show higher recurrence rates. Newer treatments continue to emerge with promise but lack supporting evidence of benefit over conventional therapies. Key Messages: While we await more robust randomized data, we will continue to proceed cautiously trying to offset the benefits of fistula healing against the inherent risk of altered continence.
Subject(s)
Rectal Fistula/surgery , Fecal Incontinence/etiology , Fibrin Tissue Adhesive/therapeutic use , Humans , Recurrence , Suture Techniques , Wound HealingABSTRACT
Ulcerative colitis (UC) is a chronic inflammatory disorder of poorly understood aetiology. While medical treatment is first-line management, approximately 10% of patients with UC will require a colectomy either as an emergency or elective procedure. There are multiple surgical options available in the current era and the choice of operation(s) is highly dependent on the clinical presentation, patient preference and individual surgeon or institutional practice. We present a review of modern surgical practices in ulcerative colitis, addressing some current controversies and diversities.
Subject(s)
Colectomy/methods , Colectomy/trends , Colitis, Ulcerative/surgery , Endoscopy, Gastrointestinal/methods , Laparoscopy/methods , Proctocolectomy, Restorative/methods , Anastomosis, Surgical/methods , Anastomosis, Surgical/trends , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/trends , Emergencies , Endoscopy, Gastrointestinal/trends , Humans , Ileum/surgery , Laparoscopy/trends , Proctocolectomy, Restorative/trends , Rectum , Surgical Stapling/methods , Surgical Stapling/trendsABSTRACT
Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.
