Transanal irrigation in functional bowel disorders and LARS: short-term results from an Italian national study.

PURPOSE: To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). METHODS: A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. RESULTS: A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. CONCLUSION: Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions.

Perineal stapled prolapse resection for full-thickness external rectal prolapse: a multicentre prospective study.

AIM: Many different surgical techniques have been reported for the surgical treatment of full-thickness external rectal prolapse. Perianal stapled prolapse resection (PSP) is a relatively newly reported technique for full thickness external rectal prolapse. The aim of this prospective multicentre study was to evaluate the results of this procedure. METHOD: Consecutive patients who underwent a PSP resection for full-thickness external rectal prolapse at five centres were recruited to the study. Median operating time, hospital stay, complications, recurrence and functional results according to the Wexner Incontinence Scale and obstructive defaecation syndrome score were recorded. RESULTS: There were 27 patients treated by PSP. The median Wexner incontinence score improved from 10 presurgery to 5 after surgery (P < 0.001); the median obstructed defaecation syndrome score improved from 12 presurgery to 5 (range 4-10) after surgery (P < 0.001). A laparoscopically assisted procedure was performed in three patients (11.1%). The median number of cartridges used was six (range four to nine). The median operating time was 48 min. Early complications occurred in six patients (22.2%) and late complications in two (7.4%). The median length of hospital stay was 5 days. The recurrence rate at a median follow-up of 30.3 months was 14.8%. CONCLUSION: PSP appears to be an easy, fast and safe procedure. Early functional results are good. The recurrence rate compares favourably with other perineal procedures like the Delorme or the Altemeier operations. Long-term functional results need to be investigated further.

[Stoppa's intervention. The complications nd results]. / L'intervento di Stoppa. Complicanze e risultati.

The authors report their experience with the giant prosthetic reinforcement of the visceral sac (Stoppa procedure), developed in the last 6 years operating 126 cases. Postoperative period was regular for two third of the patients, but only in 4 cases we can consider complication severe: 2 cases of preperitoneal haemorrhage with haematoma formation and subsequent recurrence; one sepsis of the preperitoneal space around the prosthesis, cured with drainage and conservative measures without recurrence, and then one peritonitis in a morbid obese individual. There was no mortality. 93.3% of the patients has been clinically controlled after over 6 months (average 27 months; range 6-67 months): 8 recurrences have been observed (3.6% of the hernias operated). 7 required reintervention. Therefore it is possible to affirm that 91% of the operated patients had good results.

[Prosthetic repair of inguino-crural hernia using Rives technique]. / La riparazione protesica dell'ernia inguino-crurale con la tecnica di Rives.

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected.

Twisting of the spleen observed in a case of polysplenic disorder associated with situs viscerum inversus and Kartagener's syndrome.

The authors describe a rare example of polysplenic disorder observed in a thirteen year-old girl known to be affected by situs viscerum inversus and Kartagener's syndrome. The spleen consisted of ten "mini spleens" positioned along the gastric curve. The twisting of one of these was the cause of the surgical intervention which led to the discovery of the splenic malformation. Grossly, each spleen had its own peduncle depending on a single major peduncle, representing the splenic hilus. The overall weight was 260 g. The twisted spleen was blackish in colour, filled with blood and weighed 100 g. Histopathologically, no particular finding was observed. Although the preoperative diagnosis of polysplenic disorder is difficult, the knowledge of a basic malformative condition should lead to the search for this possibly associated malformation because of its clinical implications.

[Appendico-cecal invagination (considerations on a case)]. / L'invaginazione appendico-ciecale (considerazioni su di un caso).

Taking as their starting point the observation of an isolated case of appendicocecal invagination in a homogeneous series of 4,200 appendicectomies observed, the authors take the opportunity of addressing in some detail the many aspects of the problem posed by this rare condition. With the aid of a review of the literature, an attempt is made to define and explain the aetiology, pathogenesis and classification of such forms. The authors review the various clinical criteria and instrumental aids available for reaching a correct diagnosis, assessing their respective virtues and defects, especially as regards the radiological, ultrasonographic and endoscopic investigations used; they come to the conclusion that none of these is in itself specific for this condition, and stress that a clinical suspicion of appendicocecal invagination can only emerge of the basis of an overall assessment of the various test findings in conjunction with actual clinical experience. Lastly, the authors review the therapeutic possibilities and conclude that surgical therapy, which varies from case to case, is the most reliable approach, in that the endoscopic therapy attempted by some cassies an excessively high degree of risk.

[Carcinoid of Meckel's diverticulum (a case associated with adenocarcinoma of the rectum)]. / Il carcinoide del diverticolo di Meckel (su un caso associato ad adenocarcinoma del retto).

The authors present a clinical case characterized by a rare combination of diseases: Meckel's diverticulum carcinoid and intestinal neoplasm. The clinical aspects and related implications are dealth with at some length, showing the relationship between these and tumour size as well as their importance in the therapeutic management and prognostic evaluation of the carcinoid tumour.

[Prevalence of arterial hypertension in the community. Experience of the province of Veneto]. / La prevalenza di ipertensione arteriosa nella comunita'. L'esperienza del Veneto.

In the context of a W.H.O. Community Control Program of Hypertension, 15.187 subjects aged 20-64 years were examined in three distinct areas of the Veneto region: Camposampiero (Padua), Valdagno (Vicenza) and Mirano (Venice). The prevalence of hypertension was evaluated according to W.H.O. criteria. The prevalence of the three forms of hypertension "systolic only", "diastolic only" and "systo-diastolic together", the difference according to sex and the correlation with age were also calculated. In particular the correlation with age was evaluated in four arbitrary classes of relative weight. The mean prevalence of hypertension into the three samples was 30.7%. The most common form was "systo-diastolic together" (15.5%). The prevalence of hypertension was higher in males and increased with age in both sexes. A positive association between the prevalence of hypertension and the age was observed in all the three classes of relative weight. This association was more noticeable in the classes of a higher relative weight. The association between weight and prevalence of hypertension is discussed in view of a primary prevention of hypertension. The results obtained clearly show the extent of the effort involved in order to control hypertension in the community.