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Management of Rectovaginal Fistula
Rectovaginal fistulas remain a challenging problem for surgeons to correct despite advances in surgical techniques. These fistulas may be caused by a variety of disease processes and multiple options exist for the repair of a rectovaginal fistula. The etiology, location and status of the surrounding tissue determine the most appropriate option for repair. Low, small fistulas caused by cryptoglandular disease or obstetrical trauma, are generally amenable to local repairs. In contrast, high or more complex fistulas and ones which result from inflammatory bowel disease, malignancy, or radiation, often warrant more extensive r...
Source: Seminars in Colon and Rectal Surgery - January 11, 2016 Category: Gastroenterology Authors: Ann C. Lowry Source Type: research

Surgical Management of Severe Constipation Due to Slow Transit and Obstructed Defecation Syndrome
Chronic constipation is a common frustrating condition. It is classified according to symptoms, physical exam and diagnostic testing into three categories: slow colonic transit, obstructed defecation and a combination of these two entities. Each category has different treatment algorithms, but medical therapy including dietary changes and biofeedback training (for obstructed defecation) should always be tried first. If appropriate medical therapy fails, several surgical options could be considered, though data regarding their efficacy is mixed. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 18, 2015 Category: Gastroenterology Authors: Venetia Giannakaki, Liliana Bordeianou Source Type: research

Other options in the treatment of fecal incontinence
Fecal incontinence (FI) is a debilitating condition. Luckily, there are several new treatment options recently introduced or being introduced in the near future. Conservative or “non-operative” management of FI is the first step in management of a patient suffering from FI. Retrograde colonic irrigation is one alternative and is especially valuable in patients suffering from concomitant constipation. Anal plugs are disposable devices that control continence by blocking the passage of stool and may be helpful in selected groups of patients. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 16, 2015 Category: Gastroenterology Authors: Paul A. Lehur, Emilie Duchalais Source Type: research

Pelvic Floor Anatomy and Imaging
The pelvic floor is a complex, three-dimensional mechanical apparatus, that consists of several components: the pelvic organs and endopelvic fascia, the ligament and perineal membrane, the levator ani muscles and superficial perineal muscles, the pelvic nerves. The support for the pelvic organs comes from connections to the bony pelvis and its attached muscles. Any damage to the structural and functional interactions of the pelvic floor elements can potentially cause multicompartmental dysfunction. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 16, 2015 Category: Gastroenterology Authors: Giulio A. SANTORO, Abdul H. SULTAN Source Type: research

“New Options in The Treatment of Fecal Incontinence”
Fecal incontinence (FI) is a debilitating condition. Luckily there are several new treatment options recently introduced or being introduced in the near future.Conservative or “non-operative” management of FI is the first step in management of a patient suffering from FI. Retrograde colonic irrigation is one alternative and is especially valuable in patients suffering from concomitant constipation. Anal plugs are disposable devices that control continence by blocking the passage of stool and may be helpful in selected groups of patients. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 16, 2015 Category: Gastroenterology Authors: Paul A Lehur, E. Duchalais Source Type: research

Management of fecal incontinence
Fecal incontinence is not a rare condition. In the majority of patients, no operative means result in symptom relief. Only if these fail surgical intervention is indicated. Various new surgical options have evolved over the last decades. The evidence of their efficacy varies substantially. The mainstays of surgical treatment of fecal incontinence are sphincteroplasty and sacral nerve stimulation. Data of other techniques, like posterior tibial nerve stimulation, radiofrequency energy delivery and bulking agents, are less robust. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Klaus E. Matzel, Birgit Bittorf Source Type: research

Ventral rectopexy for rectal procidentia
The main objective of this section is a detailed review of the new approach to rectal procidentia: minimally invasive nerve-sparing ventral rectopexy, laparoscopic ventral rectopexy (LVR), robotic ventral rectopexy (RVR), and its contextual relevance in the surgical treatment of rectal and pelvic organ prolapse. A brief review of rectal prolapse is offered outlining the main perineal and abdominal surgical approaches to its treatment. Further details regarding LVR and its effectiveness in treatment of pelvic organ prolapse, fecal incontinence, and constipation will be reviewed as it applies to external rectal prolapse (ERP...
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Saleh Eftaiha, Johan Nordenstam Source Type: research

Multidisciplinary Management of Pelvic Floor Disorders
The pelvic floor can be thought of as three distinct components. In its simplest form, the anterior compartment, includes the urethra and bladder, the vaginal compartment includes the cervix, vagina, and uterus, and the posterior compartment, includes the anus and rectum.1 The current practice for treating disorders of the pelvic floor is evolving from a segmented, single compartment model, into a multidisciplinary approach, appreciating the pelvic floor as a multi compartment dynamic system. The collaborative expertise of urologists, gynecologists, colorectal surgeons, gastroenterologists, and physical therapists is often...
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Andrea Kakos, Mickey Karram, Ian Paquette Source Type: research

“Management of Fecal Incontinence: Surgical Treatement”
Fecal incontinence is not a rare condition. In the majority of patients no operative means result in symptom relief. Only if these fail surgical intervention is indicated. Various new surgical options have evolved over the last decades. The evidence of their efficacy varies substantially. The mainstays of surgical treatment of fecal incontinence are sphincteroplasty and sacral nerve stimulation. Data of other techniques, like posterior tibial nerve stimulation, radiofrequency energy delivery and bulking agents, are less robust. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Klaus E. Matzel, Birgit Bittorf Source Type: research

Management of Patients with Rectocele
The main objective of this chapter is to review the management of patients with posterior vaginal wall prolapse. The posterior vaginal wall is inconsistent both in terms of correlating patient symptoms to objective findings and correlating correction of anatomic defects to symptom relief. Therefore, the management of patients with pelvic organ prolapse is challenging and emphasizes the need for surgeons to clearly communicate expectations of surgical repair. Despite these limitations, surgical repair of pelvic organ prolapse in properly selected patients can provide symptomatic relief and improvement in their quality of li...
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Jeremy Sugrue, William Kobak Source Type: research

Ventral Rectopexy: The New Option for Rectal Procidentia
The main objective of this section is a detailed review of the new approach to rectal procidentia: minimally invasive nerve sparing ventral rectopexy, Laparoscopic Ventral Rectopexy (LVR), Robotic Ventral Rectopexy (RVR), and its contextual relevance in the surgical treatment of rectal and pelvic organ prolapse. A brief review of rectal prolapse is offered outlining the main perineal and abdominal surgical approaches to its treatment. Further details regarding LVR and its effectiveness in treatment of pelvic organ prolapse, fecal incontinence, and constipation will be reviewed as it applies to external rectal prolapse (ERP...
Source: Seminars in Colon and Rectal Surgery - December 14, 2015 Category: Gastroenterology Authors: Saleh Eftaiha, Johan Nordenstam Source Type: research

Treatment of rectal prolapse
Numerous approaches have been described for the treatment of rectal prolapse. The two basic categories of operation are transabdominal and perineal. The former type tend to be more durable with lower recurrence rates but at the expense of higher morbidity. The latter group tends to be safer but associated with higher recurrence rates and less functional recovery. More recently the abdominal approaches have been modified to be laparoscopically accomplished in most cases. Different methods and indications for rectal prolapse management will be described and discussed based in literature evidences. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - December 11, 2015 Category: Gastroenterology Authors: Sthela M. Murad-Regadas, Rodrigo A. Pinto Source Type: research

Reoperative Surgery for Fecal Incontinence
Recent studies showed that in the United States approximately 19% aged ≥45 years females have had at least one episode of FI, with severe impact on quality of life.Complex integration and synergy among sphincter muscles, the pelvic floor, rectal compliance, and sensory function need to co-exist in order to maintain effective continence. When the function of any of these “compartments” is damaged bowel control becomes suboptimal and may worsen with time. The overall success rate of surgery for FI varies between 30 to 80% and progressively worsens with patient age. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 22, 2015 Category: Gastroenterology Authors: Isacco Montroni, Steven D Wexner Source Type: research

Reoperative Transabdominal Surgery for Ileoanal Pouch Salvage
Restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) is performed for surgical management of ulcerative colitis (UC) familial adenomatous polyposis (FAP), indeterminate colitis and an extremely selected subset of patients with Crohn's disease (CD). Around one/tenth of ileoanal pouches fail in longterm due to septic, mechanic, functional or biologic complications. Transanal, abdominal or combined approaches are safe and feasible to salvage ileoanal pouch. This chapter focuses on reoperative transabdominal surgery for ileoanal pouch salvage. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 22, 2015 Category: Gastroenterology Authors: Erman Aytac, Feza H. Remzi, Rupert B. Turnbull Source Type: research

Reoperative surgery for pilonidal disease
Pilonidal disease is a condition of chronic inflammation and foreign body reaction of loose and abundant hair in the gluteal cleft leading to pits, sinuses, and recurrent bouts of infection. Several management strategies have been used since initial description of the disease in 1833; however, all of them have been complicated by the potential of recurrence. Episodes of recurrence have been attributed to incomplete management of diseased tissue, either by unfinished excision or by disruption of sinuses, as well as a persistence of a deep gluteal cleft after excision with or without primary closure. (Source: Seminars in Col...
Source: Seminars in Colon and Rectal Surgery - September 21, 2015 Category: Gastroenterology Authors: Greta V. Bernier, Eric K. Johnson, Justin A. Maykel, Scott R. Steele Source Type: research