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General surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
An abnormal communication between skin of the perineum and the anorectal canal. Classified according to its site, as: inter-, trans-, supra- or extrasphincteric. Incidence is 2–4 times higher in men; mean age of onset 40 years. Causes: infection of anal glands/crypts, IBD, hidradenitis suppurativa, malignancy (rectal/anal).
Sexual Dysfunction
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Traditionally, pelvic nerve dysfunction has been thought of as less common in surgery for benign diseases, possibly because of the age of the population being, on the whole, younger than for malignant disease, but also because surgical strategies have sought to avoid dissection in the key areas (such as close rectal dissection). In reality, the incidence is almost certainly higher than previously thought, with up to 30% of women suffering dyspareunia or difficulties with orgasm and around 30% men either retrograde ejaculation or some degree of erectile dysfunction9 in surgery for inflammatory bowel disease. Separation from the effect of change in lifestyle is difficult, and it must also be borne in mind that there is a significant impact on sexual function related to disease activity, meaning that the relative change is, perhaps, less dramatic. Very few data exist for sexual function after proctectomy for benign causes other than IBD. It would appear that function, especially in females and particularly related to vaginal stricture, dyspareunia or dysorgasmia is worse with anorectal canal excision and pelvic floor closure, most likely due to direct surgical effects on the low rectovaginal septum.
Cutaneous Manifestations of Sexually Transmitted Disease in the HIV-Positive Patient
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Bryan Gammon, Antoanella Calame, Clay J. Cockerell
Anorectal involvement in early LGV is a well known phenomenon and largely occurs in women and homosexual men who present with acute hemorrhagic proctitis and systemic complaints. Granular or ulcerative proctitis confined to the distal 10 cm of the anorectal canal is visible on proctoscopy.113,114 The clinical presentation is similar to that of ulcerative colitis.
Difference between right-sided and left-sided colorectal cancers: from embryology to molecular subtype
Published in Expert Review of Anticancer Therapy, 2018
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The endodermal gut tube created by body folding during the fourth week of gestation consists of a blind-ended cranial foregut, a blind-ended caudal hindgut, and a midgut open to the yolk sac through the vitelline duct [11]. The midgut forms the distal duodenum, jejunum, ileum, cecum, ascending colon, and proximal two-thirds of the transverse colon. The hindgut forms the distal third of the transverse colon, the descending and sigmoid colon, and the upper two-thirds of the anorectal canal. Just superior to the cloacal membrane, the primitive gut tube forms an expansion called the cloaca. During the fourth to sixth weeks, a coronal urorectal septum partitions the cloaca into the urogenital sinus, which will give rise to urogenital structures, and a dorsal anorectal canal [12]. As the right and left sides of the colon derive from different embryologic origins, anatomically, the proximal colon receives its main blood supply from the superior mesenteric artery with its capillary network being multilayered. The distal colon is perfused by the inferior mesentery artery. Between these two main sources, there is a watershed area located just proximal to the splenic flexure where branches of the left branch of the middle colic artery anastomose with those of the left colic artery. This area represents the border of the embryologic midgut and hindgut. Venous drainage of the colon largely follows the arterial supply with superior and inferior mesenteric veins draining both the right and left halves of the colon.
Hysterectomy via vaginal Natural Orifice Transluminal Endoscopic Surgery in virgin patients: a first feasibility study
Published in Journal of Obstetrics and Gynaecology, 2022
Katrien Nulens, Ralph Kempenaers, Jan Baekelandt
Hysterectomy remains as one of the most frequently performed surgical procedures in benign gynaecology worldwide (Garry 2005; Aarts et al. 2015). The evolution from laparotomy to laparoscopy has significantly reduced morbidity with swifter recovery and return to daily activities (Aarts et al. 2015). Furthermore, even less invasive techniques such as single-incision laparoscopic surgery and Natural Orifice Transluminal Endoscopic Surgery (NOTES) have been developed recently. The NOTES technique gained popularity in the field of gastroenterology, general surgery, urology and gynaecology and uses natural orifices (such as the mouth, oesophagus, anorectal canal, bladder or vagina) instead of skin incisions, through which endoscopic instruments are introduced (Rattner et al. 2006; Yang et al. 2019). Vaginal NOTES (vNOTES), wherein access to the peritoneal cavity is achieved through colpotomy, is the most frequently used approach and has approved to be safe and feasible (Santos and Hungness 2011). In 2012, the first vNOTES hysterectomy has been reported (Su et al. 2012). In the first randomised controlled trial (RCT), vNOTES showed non-inferiority over laparoscopy for successfully performing a hysterectomy by the allocated technique without conversion (Baekelandt et al. 2019). Moreover, hospitalisation stay is shorter (more women can be treated in daycare) and postoperative pain scores are lower after vNOTES hysterectomy, compared to total laparoscopic hysterectomy (TLH) (Baekelandt et al. 2019). Vaginal NOTES is a promising, scar-free technique that combines the advantages of a vaginal hysterectomy (minimally invasive, no abdominal wound or trocar-related complications) with those of endoscopy (better visualisation of pelvic anatomy and accessibility of tubes and ovaries) (Lee et al. 2014; Baekelandt 2015). In this way, vNOTES can broaden the indications of a classic vaginal hysterectomy. Factors that may reduce vaginal accessibility include obesity, nulliparity, large uterine volume, absence of uterine descent and history of caesarean sections. However, these factors are not considered to be contraindications for vNOTES hysterectomy (Lee et al. 2014; Wang et al. 2015; Baekelandt 2015; Baekelandt et al. 2016). On the contrary, virginity was reported to be a contraindication when this novel technique was introduced, seen the narrow vagina and introitus in combination with the absence of uterine descent is thought to complicate technical feasibility (Baekelandt 2015). Therefore, virgin women were not represented in previously reported retrospective series (Y. S. Yang et al. 2014; Baekelandt 2015; Kim et al. 2018; Temtanakitpaisan et al. 2018) and the previously mentioned RCT (Baekelandt et al. 2019). However, notwithstanding the fact that a vaginal approach is more challenging in a nulliparous virgin, vNOTES might be technically feasible in properly selected cases and in the hands of a surgeon experienced in vaginal NOTES. We therefore report the first series of vNOTES hysterectomies in virgin patients, as a first step to assess feasibility and safety.