Seminars in Colon and Rectal Surgery This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Introduction
It has been more than 5 years since Seminars in Colon & Rectal Surgery has published an issue on Anal Fistula. In that time, we have seen major changes in the way we approach fistulas, largely due to the popularizing of the LIFT procedure. The last five years have also seen continued investigation into what is working and what isn’t, and how to do it better. In this edition, we have an incredible lineup of authors, including 3 past Presidents of the ASCRS, and multiple world-experts contributing their thoughts and data. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Joshua Bleier Source Type: research

Preface
The surgical management of anal fistula is deceptively straight forward. Hippocrates wrote about it nearly 2500 years ago. What time has demonstrated, however, is that not all fistulas are the same, and the straightforward lay open fistulotomy carries with it a significant risk of incontinence to both gas and feces. These complications may take years to develop, and so remain underappreciated. In addition, while idiopathic cryptoglandular infection is the dominant etiology, less common causes must be considered as they may alter the surgical approach. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Stanley M. Goldberg, Joshua Bleier Source Type: research

History of Anal Fistulas
The recorded history of anal fistulas dates back to the Ancient Greeks, but no fistula in history has been as well or interestingly documented as that of Louis XIV, the Sun-King of France. His story illustrates not only the state (or lack thereof) of medicine at the time, but also the first recorded use of the fistulotomy. This narrative provides a unique perspective for the role of the surgeon in 17th century France as well as cementing the place of cryptoglandular fistula disease in history. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Robert D. Fry Source Type: research

Anal Fistula Plug –
The controversy associated with the treatment of complex fistula disease is rooted within the balance of the therapeutic index – highly efficacious techniques, such as fistulotomy, have unfavorably high rates in incontinence. Unfortunately, safer techniques, such as fibrin glue and anal fistula plugs sacrifice better cure rates for lower rates of post-operative incontinence. This chapter will discuss the use of the anal fistula plug (AFP) from its inception, evolution of technique and its predictors of success, while summarizing the literature on the bioprosthetic anal fistula plugs in the management of anal fistulas. (S...
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Skandan Shanmugan, Bradley J. Champagne Source Type: research

Complex fistulas and advanced soft tissue techniques
Perianal fistulas are categorized as “complex” under the following conditions: a high tract passing the upper two third of the external sphincter, presence of multiple fistula tracts, rectovaginal fistulas, previous local irradiation, and association with the presence of an anorectal stricture or Crohn's disease. Treatment of complex fistulas can be challenging and carries a high risk of poor wound healing, recurrences and incontinence. Therefore a detailed understanding of perianal anatomy, knowledge of the extent of the disease and its relation to the various structures is required for proper management. (Source: Sem...
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: E.J. de Groof, C.J. Buskens, W.A. Bemelman Source Type: research

The Use of Biologics in Anal Fistulas
The management of anal fistulas is often challenging. Simple fistulotomy is ideal for intersphincteric tracts and low transsphincteric fistulas that incorporate a small amount of the sphincter muscles. More complex fistulas require a sphincter-sparing approach. The general goal of the numerous established procedures for the treatment of anal fistulas is to eliminate the fistula tract with the lowest rate of recurrence while preserving sphincter function. As such, the use of biologic materials in this cohort of fistulas has gained popularity over the years because they are resistant to infection, have limited foreign body r...
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Cary B. Aarons Source Type: research

Modern Management of Deep Post-Anal Space Abscess and Horseshoe Fistulas
Deep post-anal space abscesses and horseshoe fistulas are complicated anorectal diseases that can lead to significant morbidity. Surgical intervention is the treatment of choice, however the anatomical location and natural course of the disease makes management difficult. The goals of care are to eliminate the source of infection, prevent recurrence, and preserve anorectal function. Several different treatment strategies have been described. The modified Hanley procedure is the most commonly utilized technique with low recurrence rates and minimal anorectal dysfunction. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Reuben D. Shin, Jason F. Hall Source Type: research

Simple Anal Fistulae
The perianal abscess is a disease process which affects the general population, predominantly middle aged men. They are believed to result from infection of the anal crypt glands which seeds infection of the perianal tissues1. The principle of management for cryptoglandular infection is incision and drainage, facilitating clearance of the perianal sepsis. The pathogenesis of anal fistulae is intimately related to that of the perianal abscess; these fistulae both contribute to the abscess, and are a sequela of the treatment2. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 26, 2014 Category: Gastroenterology Authors: Peter Glen, Husein Moloo Source Type: research

Surgical management of rectovaginal fistula
Despite various advances in surgical technique, improvements in technology and the ongoing accumulation of knowledge gained by clinical experience, rectovaginal fistulas remain complicated entities to treat. Arguably, achieving definitive success in its repair can be as troublesome to the surgeons undertaking the challenge of treatment as it is debilitating to those that suffer from its manifestations. Multiple options exist in the armamentarium to repair rectovaginal fistula. Low, small fistulas, typically a result of cryptoglandular disease or obstetrical trauma, are amenable to local repairs, often without protective di...
Source: Seminars in Colon and Rectal Surgery - August 26, 2014 Category: Gastroenterology Authors: Danielle M. Pastor, Ann C. Lowry Source Type: research

Recurrent infection: The scope of the problem and management decisions
Clostridium difficile-associated infection is a growing problem worldwide, contributing to increased morbidity and mortality. More recently, there have been epidemics of C. difficile-associated disease in the United States and Canada with emergence of a hypervirulent NAP1/BI/027 strain (Loo et al., 2005).1 As many as 35% of patients develop recurrent C. difficile-associated disease after an initial episode. Of these patients, 50%–65% have multiple recurrences of C. difficile infection (McFarland et al., 2002). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - June 19, 2014 Category: Gastroenterology Authors: Mohamed Sageer, Amy Barto Source Type: research

Recurrent clostridium difficile infection- the scope of the problem and management Decisions
Clostridium difficile associated infection is a growing problem worldwide, contributing to increased morbidity and mortality. More recently there have been epidemics of Clostridium difficile associated disease in the United States and Canada with emergence of a hypervirulent NAP1/BI/027 strain.1 As many as 35% of patients develop recurrent Clostridium difficile associated disease after an initial episode. Of these patients, 50 to 65% have multiple recurrences of Clostridium difficile infection.2 Still other patients develop refractory or life-threatening fulminant Clostridium difficile colitis despite standard antibiotic t...
Source: Seminars in Colon and Rectal Surgery - June 19, 2014 Category: Gastroenterology Authors: Mohamed Sageer, Amy Barto Source Type: research

infection and gut microbiota
Clostridium difficile infection (CDI) is associated with disturbance of intestinal microbiota. Microbiota of CDI patients usually shows decreased diversity, increase of facultative anaerobes, and decreased levels of bifidobacteria, Bacteroidetes, Lachnospiraceae, and butyrate-producing bacteria. Studies including symptomatic, asymptomatic, recurrent, and fecal therapy-treated patients could result in the recognition of microbial markers for CDI risk or could provide the combination of beneficial microbes for a C. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 12, 2014 Category: Gastroenterology Authors: Sabina Zalig, Maja Rupnik Source Type: research

Role of endoscopy in the assessment and treatment of infection
As our ability to diagnose and treat Clostridium difficile infections (CDI) has improved over time, the role that endoscopy plays in the management of these patients has evolved. We reviewed the medical literature to describe the role of endoscopy in the management of CDI. A search of PubMed, Ovid, and the Cochrane Library was performed. Abstracts were reviewed to determine their scientific merit and relevance. The selected articles and relevant embedded references from the primary articles were also examined, with recommendations based on consensus conclusions of the data. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 12, 2014 Category: Gastroenterology Authors: Robert Shawhan, Scott R. Steele Source Type: research

Clinical and radiographic findings in the patient with infection
Though Clostridium difficile can be found in the colon of asymptomatic patients, it is well known to exhibit pathogenic behavior in the setting of an altered colonic bacterial flora. This leads to a broad spectrum of disease states ranging from simple diarrhea to toxic colitis. The focus of this article is to detail the factors associated with the clinical presentation of C. difficile infection and to describe radiographic adjuncts to diagnosing the severity of C. difficile infection. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 12, 2014 Category: Gastroenterology Authors: Jonathan R. Snyder, Ian M. Paquette Source Type: research

Contemporary approaches for the laboratory diagnosis of infections
Since its recognition 35 years ago as a major cause of diarrheal disease in the industrialized world, the laboratory diagnosis of Clostridium difficile infections (CDI) has been in constant evolution. Currently, two approaches are recommended: a multi-step algorithm using glutamate dehydrogenase (GDH) detection as a screening test and a method to detect either C. difficile toxins or toxigenic C. difficile organisms as a confirmatory test for GDH-positive specimens. One potential algorithm uses the detection of both toxin and organisms in a stepwise manner. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 12, 2014 Category: Gastroenterology Authors: Peter H. Gilligan Source Type: research