Video-Assisted Anal Fistula Treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up

BACKGROUND

The aim of this study was to assess the 3-year objective and subjective outcomes of patients with complex anorectal fistula treated with Video-Assisted Anal Fistula Treatment (VAAFT). Furthermore, we evaluated the risk factors associated with recurrence.

METHODS

All consecutive patients with complex anorectal fistula who underwent VAAFT in Beata Vergine Hospital of Mendrisio, Switzerland, from January 2013 to January 2016, were enrolled. Patients with suspicion or diagnosis of Crohn's disease, malignancy, previous history of radiotherapy or radical pelvic surgery were excluded. Preoperative clinical assessment based upon medical history, physical examination and endosonography, was performed in all patients. Data regarding subjective outcomes (the Patient Global Impression of Improvement, patient satisfaction scores and Wexner score), objective cure rate (absence of fistula at clinical examination), and adverse events were collected during follow-up. Uni and multivariate analysis were performed to investigate outcomes.

RESULTS

One hundred and four patients had VAAFT. At 3-year follow-up, 96 patients (92.3%) were available for the evaluation. At 3 years after surgery, 81 of 96 patients (84.4%) declared themselves cured (p = 0.60). Similarly, at 3-year evaluation, 80 of 96 patients (83.3%) were objectively cured (p = 0.52). No serious intraoperative or postoperative complications were reported. All recurrences were treated with a repeat VAAFT procedure resulting in a complete healing. Uni and multivariate analysis of variables potentially involved in the failure of VAAFT showed that age ≥ 50 years was the only factor associated at risk of recurrence.

CONCLUSIONS

VAAFT is a highly effective safe procedure for the treatment of anorectal fistula, with a low recurrence rate at 3-year follow-up. However, our study demonstrated that age ≥ 50 years is a risk factor for failure of VAAFT.

Meckel diverticulum: one pathology, different clinical presentations. A report of two cases

Meckel diverticulum is the most prevalent congenital malformation of gastrointestinal tract and usually it remains asymptomaRomatic. Approximately in 25% of cases Meckel diverticulum comes to be symptomatic with various clinical presentations where lower gastrointestinal hemorrhage or intestinal obstruction represent the most frequent clinical outcome. In present paper two cases of complicated Meckel diverticulum in young patients are described; in both cases diagnosis was difficult and initially mistaken with other pathologies. Surgical resection was the treatment of choice.

NPWTid in the treatment of infected diabetic foot

Negative Pressure Wound Therapy with instillation therapy and dwelling time (NPWTid) represents a good tool to treat severely infected non-healing wounds. This topical treatment consists of negative pressure and retrograde instillation of antiseptic/antibiotic Romasolutions into the wound surface, to promote cleansing and consequently the healing process. We reported our initial experience (five cases) in the treatment of severely infected diabetic foot, that can be considered a life-threatening condition. In our case reports, patients presented with clinical signs and symptoms of severe sepsis. Our treatment based on multidisciplinary approach (surgical, NPWTid, interventional radiology, skin grafts) had satisfying results. NPWT represented an important support to treatment of these diabetic patients.

Endoscopic pilonidal sinus treatment: a prospective multicentre trial

BACKGROUND

Pilonidal disease (PD) is a common inflammatory disease of the gluteal fold, resulting in recurrent acute/chronic infection at the level of the natal cleft. In this study, endoscopic pilonidal sinus treatment (EPSiT), a new endoscopic minimally invasive procedure, was evaluated for its effectiveness in treating PD.

METHODS

Two hundred and fifty prospective patients with chronic PD were enrolled in a prospective multicentre study conducted at a secondary and tertiary colorectal surgery centre. The primary end-point of this study was wound healing, and the short-/long-term outcomes such as healing time, morbidity rate and recurrence rate were analysed. The secondary end-point of this study was quality of life (QoL).

RESULTS

The complete wound healing rate was 94.8%, and the mean complete wound healing time was 26.7 ± 10.4 days. The incomplete healing rate (5.2%) was significantly related to the number of external openings (P = 0.01). There was no difference in the failure rate when EPSiT was performed as the first-line treatment for PD or when it was used after unsuccessful procedures (P = n.s.). Recurrence occurred in 12 cases (5%). The QoL significantly increased from preoperative levels 15 days after the EPSiT procedure (45.3 vs 7.9; P < 0.0001).

CONCLUSIONS

The EPSiT procedure is a safe and effective technique for treating PD. It provides better short- and long-term outcomes than various other techniques that are more invasive. EPSiT is a minimally invasive outpatient procedure, which is associated with a quick recovery and a good QoL outcome.

A giant adrenal pseudocyst mimicking an adrenal cancer: case report and review of the literature

Adrenal pseudocysts are rare lesions that develop within the adrenal glands, generally from vessel ectasia or from degenerative adenomas or hematomas. They are usually non-functional and asymptomatic. The reported potential malignant transformation of an adrenal cyst is ca. 7% and indicates radical excision of these masses. We report the case of a 69-year-old man with hypertension, chronic obstructive pulmonary disease, and obesity in whom microscopic hematuria was detected during a routine examination performed by his family doctor. To investigate the cause of this microscopic hematuria, the patient underwent computed tomography of the abdomen, which showed a well-defined 12-cm lesion of the left adrenal gland with calcification and necrotic components that was compressing the left kidney, pancreas, and spleen. Suspecting adrenal carcinoma, after preoperative staging, a left subcostal laparotomy was performed, with resection of the left adrenal gland, a splenectomy, and resection of the pancreatic tail. The histology showed an adrenal pseudocyst with a fibrous capsule containing amorphous eosinophilic material with calcification and cholesterol crystals. The patient's postoperative course was uneventful, and he was discharged 12 days after surgery.

Gastroscopic removal of an adjustable gastric band after partial intragastric migration

BACKGROUND

Laparoscopic implantation of an adjustable gastric band is being performed widely. One potential complication is the transgastric migration of the band, that should be extracted.

METHODS

The authors report a series of 182 patients, followed prospectively, October 1996 - April 2002, who had undergone insertion of the Swedish adjustable gastric band. All implantations had been completed by laparoscopy alone.

RESULTS

There were no deaths. 15 complications were detected, of which 7 were intragastric migrations of the band (3.8%) at an average follow-up of 40 months. 6 were treated successfully by gastroscopy only, with a new cutter device and without complications.

CONCLUSION

The endoscopic technique is beneficial even when the intraluminal migration is partial.