Overview of pelvic floor disorders

[A modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis]

OBJECTIVE

To develop a modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis.

MATERIALS AND METHODS

Minimally invasive surgical technologies were used in 74 patients with infected acute necrotic collections at the Krasnodar Regional Clinical Hospital No. 2 between 2017 and 2019. Of these, 59 (79.7%) people underwent percutaneous drainage as a final treatment. In 11 (14.9%) patients, video sequestrectomy through the fistula was additionally used to increase efficiency of percutaneous drainage.

RESULTS

PCD in our modification implies delivery of double-lumen drains 26-32 Fr in the same plane to zones of necrosis, their programmed replacement for prevention of obstruction and flexible endoscopy for control of pathological process. Local purulent-necrotic parapancreatitis occurred in 31 (41.9%) patients, widespread parapancreatitis - in 43 (58.1%) patients. There were 339 minimally invasive interventions. Laparotomy was required in 4 (5.4%) patients. Incidence of perioperative complications was 10.6%, mortality - 16.2%.

CONCLUSION

A modified percutaneous drainage method may be used as final surgical treatment in 79.7% of patients with infected pancreatic necrosis.

Transanal vs transvaginal repair of symptomatic rectocele: Analysis of 50 cases

AIM: To compare the results of transanal vs transvaginal repair of symptomatic rectocele and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.

METHODS: This study included 50 women suffering from rectocele. They were randomized into two groups: 25 women (group A) receiving a transanal repair and 25 (group B) receiving a transvaginal repair. The relevant postoperative indexes were compared for the two groups.

RESULTS: At 12 mo after surgery, 17 women in each group (group A/B, 77%/74%) reported improvement of their symptoms. However, only 11 and 13 women of groups A and B (group A/B, 55%/59%), respectively, maintained their improvement during the median follow-up of 50 mo. Better results were reported in patients with a greater change in the depth of their rectocele ( ≥ 4 cm) after the procedure (P = 0.001).

CONCLUSION: In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased. A preoperative larger rectocele might have a better postoperative outcome.