iProcto: new digital technology in Proctology. A randomized study

BACKGROUND AND AIM

Advancements in technology have proved useful for many businesses including medical practices. Consequently, these improvements have increased the need to develop new applications for mobile devices. Our group conceived and developed an application for tablets, PCs, and smartphones with the aim to assist the physician in the management of the pelvic floor diseases: iProcto. The aim of this study was to evaluate the receptivity of patients resulting from using the said pelvic floor application (iProcto) during a colon-proctologic visit; and to establish whether it can be more efficient in helping with diagnosis compared to a traditional visit.

METHODS

We enrolled 126 patients with pelvic floor disorders during the period of 2013 and 2014. The average age of the patients ranging from 16 - 43 years of age, 80 of those, being women. Sixty-three patients were randomly assigned to iProcto consultation (group A), the remaining 63 patients to attended a regular consultation that did not include iProcto (group B). Post consultation, all patients were asked to answer a questionnaire anonymously where they were asked questions about their level of satisfaction, and clarity of the doctor's explanation, on a scale from 1 (dissatisfied) to 5 (completely satisfied).

RESULTS

Patients in group A have a score average relative to the degree of satisfaction of 4.2 ± 0.7 vs 3.5 ± 0.7 in the group B (m ± sd; p 0.001). Only 3 patients in group A and 15 in group B did not consider the visit satisfactory (score ≤2). With regard to the clarity of the physician the group A patients presented a means score of 4.4 ± 0.8 vs 3.5 ± 0.4 in the group B (m ± ds; p 0.001). Data shows that 95% showed a gain in satisfaction during the iProcto visit as compared to 78% without iProcto.

CONCLUSIONS

In conclusion the use of iProcto for the pelvic floor diseases can improve the understanding of the disease and increase the degree of patient satisfaction.

Anal function after endoluminal locoregional resection by transanal endoscopic microsurgery and radiotherapy for rectal cancer

AIM

In patients with rectal cancer, surgery and chemoradiotherapy may affect anal sphincter function. Few studies have evaluated anorectal function after neoadjuvant chemoradiotherapy (n-CRT) and/or transanal endoscopic microsurgery (TEM). The aim of this study was to evaluate the effects of n-CRT and TEM on anorectal function.

METHOD

Thirty-seven patients with rectal cancer underwent anorectal manometry and Wexner scoring for faecal incontinence at baseline, after n-CRT (cT2-T3N0 cancer) and at 4 and 12 months after surgery. Water-perfused manometry measured anal tone at rest and during squeezing, rectal sensitivity and compliance. Twenty-seven and 10 patients, respectively, underwent TEM without (Group A) or with n-CRT (Group B).

RESULTS

In Group A, anal resting pressure decreased from 68 ± 23 to 54 ± 26 mmHg at 4 months (P = 0.04) and improved 12 months after surgery (60 ± 30 mmHg). The Wexner score showed a significant increase in gas incontinence (59%), soiling (44%) and urgency (37%) rates at 4 months, followed by clinical improvement at 1 year (41%, 26% and 18%, respectively). In group B, anal resting pressure decreased from 65 ± 23 to 50 ± 18 mmHg at 4 months but remained stable at 12 months (44 ± 11 mmHg, P = 0.02 vs preoperative values - no significant difference compared with evaluation at 4 months). Gas incontinence, soiling and urgency were observed in 50%, 50%, 25% and in 38%, 12% and 12% of cases, respectively, 4 and 12 months after treatment.

CONCLUSION

TEM does not significantly affect anal function. Instead, n-CRT does affect anal function but without causing major anal incontinence.

[Rubber band ligation in treatment of hemorrhoids: our experience]

OBJECTIVES

Hemorrhoids are a very common condition. The treatment depends upon persistence and severity of symptoms. For hemorrhoids of II and III grade the rubber band ligation may be therapeutic. Our aim is to report the outcomes of rubber band ligation of hemorrhoids, with a follow up of 6 months.

MATERIALS AND METHODS

A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse, between June 2012 and June 2014. All patients underwent plug test to rule out presence of rectal mucosal prolapse and were classified according to PATE classification (1). Each hemorrhoid was ligated with one rubber band through a ligator. All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment. Patient's demographic and operative data were collected and analyzed.

RESULTS

The mean patients age was 47.6±12.3 years (range 24-72). All procedures were performed without complications. Before rubber band ligation, 42 patients had rectal bleeding, 38 had perineal discomfort and 27 had itching. Ten days after the treatment, 12 patients presented self-limited rectal bleeding, but 10 of these had more hemorrhoids and underwent a second rubber band ligation. No patients complained perineal discomfort, and 8 patients had itching; 78% and 16% of patients respectively, experienced feeling of a foreign body inside the canal anal and anal pain. After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching. Three more patients presented both perineal discomfort and hitching. None had the feeling of a foreign body in anal canal or anal pain.

CONCLUSIONS

Rubber band ligation is an efficacious, cost-effective and simple treatment for the second and third degree hemorrhoids without rectal mucosal prolapsed. In our hands, no severe complications developed and minor complications could be handled with ease.

Manual reduction in acute haemorrhoids

AIM

In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids.

MATERIALS OF STUDY

Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction.

RESULTS

At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery.

CONCLUSIONS

Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.

[Local and late complications in anorectal surgery]

BACKGROUND AND AIMS

Our experience in colon-proctology showed the need to update the post-surgical complications score we published (1), adding others that may have an impact on outcome of treatment. The aim of this study was to assess the efficacy of a score obtained from the analysis of the quality of life and severity of complications after proctologic surgery.

MATERIALS AND METHODS

Between January and December 2013, we studied 150 patients undergoing several ano-rectal surgeries for the presence of hemorrhoids of grade III and IV (63 patients), anal fissures (42 patients), anal fistulas (19 patients), rectocele (15 patients) and mucosal prolapse of the rectum (11 patients). After surgery, patients were evaluated through outpatient visits at 3, 6 and 12 months, by a questionnaire concerning the surgery complications and quality of life, the latter expressed with a score from 0 (poor) to 10 (excellent).

RESULTS

Only 134 patients [mean age: 49 years (range 35-61 years), 62 M] completed the entire follow-up. The score of complications has been gradually decreasing from 11.3 (baseline) to 9.6 to 3 months, 3.6 to 6 months and 2.3 at 12 months, while the score of the quality of life progressively increased from 4.5 to 6, 8 and 8.5 respectively (p<0.05), with a correlation between the two score (r=-0.6, p= 0.03).

CONCLUSIONS

The quantification by scores of quality of life and postoperative complications in colon-proctology is an important prognostic predictor.