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Postoperative Perineal HerniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Perineal hernia is an uncommon complication following major pelvic surgery. The estimated incidence of herniation is 0.2%-3.5% following abdominoperineal resection. Symptomatic patients may undergo repair by a transabdominal, transperineal, combined abdominoperineal, or laparoscopic approach. Controversy continues with regard to the method of repair with many surgeons employing the use of mesh or local muscular flaps to buttress the pelvic floor. Recurrence rates are moderate but are also limited by small number of cases reported in the literature. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Jeffrey K. Wang, Bruce G. Wolff Source Type: journals

Graft Augmentation in Surgical Repair of Anterior Vaginal Wall ProlapseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present here a review of these procedures with and without graft reinforcement as well as the current report supporting their use. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Joseph M. Novi, James Q. Pulvino Source Type: journals

Prevalence, Management, and Prevention of Mesh Complications After Use in the Posterior Vaginal CompartmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The literature regarding mesh-related complications especially in the posterior vaginal compartment is incomplete and often it remains unclear whether the surgical technique or the employed mesh caused the complication. As the industry pushes and surgical training of conventional techniques diminishes, the use of synthetic mesh is tempting and anatomical results are promising. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Kaven Baessler, Bettina Wildt, Ralf Tunn Source Type: journals

The Role of Biological Implants in the Repair and Prevention of Parastomal HerniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Parastomal herniation is an often encountered consequence of stoma formation. Most parastomal hernias never require surgical intervention. Of the numerous procedures for the repair of parastomal hernias, the best outcomes have been obtained with the application of synthetic mesh. The potential for serious complications arising from synthetic mesh has prompted investigations of biological implants as an alternative. These grafts provide an acellular collagen scaffold into which host cells migrate, producing the appropriate native tissue. The experience with the biomaterials AlloDerm, Permacol, Surgisis Gold, and Veritas for...
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Ursula M. Szmulowicz, Tracy L. Hull Source Type: journals

Complications of Incisional Hernia RepairEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complications after open or laparoscopic approaches to ventral or incisional hernia repair with mesh span a wide range of severity. Intraoperative injuries to the bowel are rare but may necessitate a change in the operative plan. Postoperative complications are comprised of those common to all general surgery, for example, thromboembolism and superficial surgical site infection, and are typically managed no differently. Unique to recovery from hernia surgery however can be increased pain after mesh placement, seroma related to large dissection planes, infections of the mesh, as well as pulmonary insufficiency due to change...
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Joshua I.S. Bleier, Andrew S. Resnick Source Type: journals

Laparoscopic Ventral Hernia Repair: Mesh Options and OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Laparoscopic ventral hernia repair (LVHR) offers a minimally invasive option for the repair of congenital or incisional abdominal wall hernias. A key component of LVHR is the placement of a prosthetic or biological mesh intraperitoneally to cover the defect without reapproximating the fascial edges with a primary suture repair. The optimum mesh provides high tensile strength, reducing the risk of recurrence, stimulates host tissue ingrowth without promoting adhesion or fistula formation, resists secondary infection and seroma formation, and is affordable. Numerous mesh materials are available on the market, each with speci...
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Jayme B. Stokes, Charles M. Friel Source Type: journals

Synthetic and Biological Graft Materials: Biological ConceptsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this review is to describe the biomechanical properties of commonly used mesh materials and the available evidence regarding their effects on wound healing. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Tirsit S. Asfaw, Gina Northington Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The concept of using a reinforcing material in the repair of hernias is ancient, as Dr Northington and Dr Asfaw point out in this issue. The practice has, at various times and points in recent history, fallen in and out of favor as new uses, and new complications, have arrived. It is evident from most data that the use of mesh in the repair of large ventral and inguinal hernias has clear benefit in reduction of recurrence rates over primary repair alone. Clearly, this comes at the price of mesh-related complications, as Drs Resnick and Bleier point out. The main problem using mesh in these circumstances seems to be determi...
Source: Seminars in Colon and Rectal Surgery - August 31, 2009 Category: Gastroenterology Authors: Najjia N. Mahmoud Source Type: journals

Redo Ileal Pouch Surgery—Indications and OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abdominal salvage surgery is a major undertaking for patients with imminent ileal pouch failure. The success of abdominal salvage surgery for sepsis is less than for a nonseptic indication. Although functional outcomes following abdominal revisional surgery can improve significantly, pouch failure after abdominal salvage continues steadily over time. Complications may occur and the duration of treatment, including in-hospital stay, may have a serious impact on a patient who has already suffered disappointment and ill health owing to the threatened failure after primary restorative proctocolectomy. The chance of success is ...
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Paris P. Tekkis, R. John Nicholls Source Type: journals

Ileal Pouch Rectal Anastomosis: Technique, Indications, and OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
An extended resection of the colon and rectum may be required in a variety of diseases, including neoplastic, inflammatory, and functional conditions. Restorative procedures after an extended resection are meant to avoid a permanent stoma, achieve good function and quality of life (QoL), and reduce complication rates to a minimum. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Felix Averboukh, Yehuda Kariv Source Type: journals

Ileal Pouch Anal Anastomosis: Meta-Analysis and Comparison of Outcomes Between TechniquesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ileal pouch anal anastomosis is the procedure of choice for most patients undergoing proctocolectomy for ulcerative colitis and a proportion of patients with familial adenomatous polyposis. Since its first description in 1978, there has been evolution and refinement in the technical aspects of ileoanal pouch construction. This has been facilitated by advancements in stapler technology, and an increased focus on functional outcome. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: A.G. Heriot, A.C. Lynch Source Type: journals

Ileal Pouch-Anal Anastomosis: Indications and TechniqueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) have been the procedures of choice for patients with ulcerative colitis, or familial adenomatous polyposis, and those with other diagnoses who require surgery. The options for this procedure are J, S, or W ileal pelvic pouch anastomosed by either stapled or hand-sewn technique. J-pouch is the preferred technique of most surgeons. The stapled IPAA is quicker, more secure, and safer, with better function, while the hand-sewn IPAA allows removal of the diseased anal transitional zone. Recently, in most of the centers, the use of a hand-sewn IPAA has been l...
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Hasan T. Kirat, Feza H. Remzi Source Type: journals

Ileorectal AnastomosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ileorectal anastomosis (IRA) or ileorectostomy refers to the connection of terminal ileum to rectum following extirpation of the colon by total abdominal colectomy. This procedure is of great historical interest having been initially championed by Stanley Aylett from the UK, and used for over 50 years, as an alternative to proctocolectomy and permanent ileostomy for patients with ulcerative colitis. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Peter Siaperas, John Hartley Source Type: journals

Rectal Reconstruction Using the Turnbull-Cutait Abdominoperineal Pull-Through Anastomosis: Indications and OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article presents current indications, technical aspects and outcomes of this historical procedure, the Turnbull-Cutait abdominoperineal pull-through anastomosis, and reviews the relevant literature. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: I. Emre Gorgun, Jeffrey W. Milsom Source Type: journals

Colonic J-Pouch, Coloplasty, Side-to-End Anastomosis: Meta-Analysis and Comparison of OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Preservation of rectal function after low anterior resection or proctectomy with formation of a neorectum has improved the quality of life of many patients with rectal cancers. This would mean preserving the anal sphincters and avoiding a permanent stoma while reconstructing a neorectum to improve the bowel function of patients. Following proctectomy, the traditional anastomosis will be a straight coloanal end-to-end anastomosis to restore bowel continuity. However, this is associated with very poor bowel function. The construction of a colonic J-pouch anastomosis is introduced to reduce this problem. While colonic J-pouch...
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Boon-Swee Ooi, Jiunn-Herng Lai Source Type: journals

Colorectal/Coloanal Anastomosis Colonic J-Pouch, Coloplasty, Side-to-End Anastomosis: TechniquesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Following a resection of a rectal cancer with a total mesorectum excision, bowel continuity can be restored by different types of coloanal anastomosis: straight anastomosis, J-pouch, coloplasty, or side-to-end. A J-pouch is made after resection of the rectum. Two 6-cm colon limbs are folded up and a colotomy is made at the apex of the J. A side-to-side anastomosis is then performed on the antimesenteric side for 7 cm. For coloplasty, an 8- to 10-cm longitudinal incision is made along the antimesenteric side, starting 4 cm above the distal cut edge and the incision is closed transversely. A side-to-end anastomosis can be ma...
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Jeremie H. Lefevre, Yann Parc Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This edition of Seminars in Colon and Rectal Surgery includes articles that describe the techniques to construct a new rectal reservoir and outcomes after these reconstructive procedures. The first article, by Jeremie H. Lefevre and Yann Parc from Paris, France, describes the techniques of colonic J-pouch, coloplasty, and side-to-end anastomosis. Meta-analysis and comparison of outcomes of colonic J-pouch, coloplasty, and side-to-end anastomosis are covered by Boon-Swee Ooi and Jiunn-Herng Lai from Singapore. Indications and outcomes of rectal reconstruction using the Turnbull-Cutait abdominoperineal pullthrough anastomosi...
Source: Seminars in Colon and Rectal Surgery - May 31, 2009 Category: Gastroenterology Authors: Feza H. Remzi Source Type: journals

Rectovaginal FistulaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Rectovaginal fistulas are a common type of anal fistulous disease that presents a distressing problem for the patient and a challenge for the treating physician. The symptoms can be minimal but frequently are disabling and associated with significant psychosocial and sexual dysfunction. Successful management must consider the etiology of the fistula and the health of both the rectum and the patient. It is important to completely evaluate the patient before any consideration is given to surgical correction. This includes evaluation of the function of the anal sphincter and the involvement of any other organ systems. The sur...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: C. Neal Ellis Source Type: journals

Flaps, Glues, and Plugs—A View From the EastEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complex fistulas are difficult to treat. The options available are advancement flaps, fibrin glue, and, of late, anal fistula plug (AFP). A sizable proportion of the published studies are from the US and Europe. The results from these studies were analyzed and compared to the results of the published literature from the east (Asia and Australia). The overall success rate ranges from 46% to 100% for advancement flaps, 14% to 78% for fibrin glue, and 24% to 87% for AFP technique. However, the present data is insufficient to conclude the superiority of either (ie, fibrin glue or AFP procedure) over the other. So, depending on...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Pankaj Garg Source Type: journals

Anal Fistula Plug: A European PerspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Impressed by the initial success rates (80%) of the Cook Surgisis AFP anal fistula plug for the closure of both cryptoglandular and Crohn's associated anorectal fistulas, the preliminary results from Europe showed healing rates of 41% and 61%, respectively. However, no impairment of continence was documented. Analyzing the current experiences of the plug procedure from a German perspective, a variety of issues are under debate including the role of bowel preparation, treatment of fistula tract, closure of the internal opening, postoperative management, and, finally, financial reimbursement. Furthermore, the “ideal” ind...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: O. Schwandner, A. Fuerst, A. Herold Source Type: journals

Surgisis Fistula Plug: The United States ExperienceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Anorectal fistulae are a heterogeneous group of disorders that can cause significant pain, social impairment, hygienic problems, and, rarely, sepsis. Surgery is the mainstay of treatment for anorectal fistulae, yet no one procedure is universally efficacious and safe. Simple fistulae can often be treated by simple fistulotomy, but complex fistulae present a more complicated scenario—effective surgical treatment options are compromised by increased risk of incontinence. Likewise, safe treatment alternatives have low risk of postoperative incontinence but low success rates. The Surgisis AFP appears to be an effective and s...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Michael F. McGee, Bradley Champagne Source Type: journals

The Role of Fibrin Glue in the Management of Fistula-in-AnoEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article explains the mode of action of fibrin glue, reviews the current literature, and highlights the varied opinions and potential reasons for its lower long-term success rates. It also introduces the fistula plug, which has demonstrated fistula healing in recent reports. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Najib Daulatzai, Gordon N. Buchanan Source Type: journals

Biologics in Fistula Surgery: Parallels with Chronic WoundsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Medical devices fabricated from the tissues of animals have been used for decades to repair failing human tissues and organs. Only recently, however, the notion that these tissues can be processed in ways that retain the natural structure and composition of the extracellular matrix (ECM) and then implanted without inciting adverse immune system reactions has become reality. Because natural ECM contains a complex composition of biologically active molecules able to assist in the restoration of a functional ECM when the patient's ECM is characterized by abnormal levels of pro-inflammatory factors and matrix-degrading enzymes...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Michael Hiles, Edith Nihsen, Jason Hodde Source Type: journals

Endoanal Advancement Flaps in the Management of Complex Anorectal FistulasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complex perianal fistulas are a significant cause of morbidity with detrimental effects on patient's quality of life. Affected individuals often require repeated anorectal surgeries with the potential for fecal incontinence and the need for a permanent stoma. Endoanal advancement flaps which use the basic premise of covering the fistulous opening with healthy tissue are an important surgical option. The rectal advancement flap is the most commonly used. The sleeve advancement flap is reserved for patients with severe fistulous disease in particular perianal Crohn's. If an abdominal approach is required, then one may consid...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Myles R. Joyce, Tracy L. Hull Source Type: journals

FistulotomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Anal fistulotomy, the unroofing of the entire tract from the external to the internal opening, is the most effective and simple treatment for most patients with anal fistula. However, anal fistulotomy carries a risk of fecal incontinence that is related to the loss of sphincter function and the deformity of the anal canal that results from dividing the tissue encircled by the fistula. The main treatment challenge is how to select patients who will be cured of their fistula without developing postoperative fecal incontinence. The decision should be individualized according to the proportion of the muscle involved, the locat...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Carlos Pastor, John Hwang, Julio Garcia-Aguilar Source Type: journals

The Use of Setons in Fistula-in-AnoEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Setons in the treatment of fistula-in-ano have been used for thousands of years. Although there are few high-quality prospective trials, there are numerous retrospective series documenting high cure rates of more than 90% with cutting setons or two stage seton fistulotomy. Both techniques, however, result in a variable rate of incontinence, higher with two stage seton fistulotomy where the internal anal sphincter is routinely divided. Incontinence rates for slow cutting setons are 10%-20% for minor incontinence with rates of 0%-10% for major incontinence; compared to rates of more than 35% and as high as 70% with the two-s...
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: Christopher M. Byrne, Michael J. Solomon Source Type: journals

Imaging of Anorectal FistulaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article aims to discuss the rationale for imaging and to review the options available. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: V. Anik Sahni, David Burling Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complex anorectal fistula is probably the most frustrating and challenging pathology in colorectal surgery. It has plagued mankind since the sun came up and continues to baffle and frustrate us even in the 21st century. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - March 1, 2009 Category: Gastroenterology Authors: David N. Armstrong Source Type: journals