Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented

Rectal prolapse diagnosis and clinical management

The pathophysiology of this disabling condition is still uncertain and its clinical and instrumental diagnostic assessment needs to be clarified. The appropriate surgical or medical approach is much debated and has never been definitively stated. The rarity of the condition prevents randomised controlled trials from being carried out in a single institution, so the opinions of outstanding leaders in this field are particularly important. This textbook addresses the best way of evaluating patients with rectal prolapse, the underlying pathophysiology, the different surgical approaches, the expec

Consistency of replicated datasets in Grid computing

Data replication is a well-known technique used in distributed systems in order to improve fault tolerance and make data access faster. Several copies of a dataset are created and placed at different nodes, so that users can access the replica closest to them, and at the same time the data access load is distributed among the replicas. In today's Grid middleware solutions, data management services allow users to replicate datasets (i.e., flat files or databases) among storage elements within a Grid, but replicas are often considered read-only because of the absence of mechanisms able to propagate updates and enforce replica consistency. In this entry we analyze the replica consistency problem and provide hints for the development of a Replica Consistency Service, highlighting the main issues and pros and cons of several approaches

Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): Management and Treatment of Complete Rectal Prolapse

Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and

The ProTect device in the treatment of severe fecal incontinence: Preliminary results of a multicenter trial

Background: Patients suffering from severe fecal incontinence (FI) in whom surgical treatment has either failed or is inappropriate due to high operative risks and those who refuse to undergo surgery are condemned to living with their embarrassing symptoms, often responsible for progressive social isolation. ProTect is a new, relatively simple, medical device intended for selected patients suffering from severe FI. It consists of a pliable, silicone catheter with an inflatable balloon that seals the rectum at the anorectal junction, acting like an anal plug. The proximal part of the catheter incorporates two contacts that monitor the rectum for the presence of feces. The patient is alerted to an imminent bowel movement and, hence, a potential fecal accident, through a beeper. Methods: A multicenter trial has been set up to assess the reliability of the device in preventing episodes of FI and to evaluate its impact on quality of life. Patients with significant FI (CCF>10) were prospectively entered into this 14-day study. Two quality of life questionnaires and a daily log of bowel activity and incontinent episodes were completed before and during the study. Results: Currently, the study enrolled 17 patients and 11 patients (9 women, 2 men) with a mean age of 66 years (range, 46-85) completed the trial. In these 11 subjects, there was an overall significant improvement in the quality of life (p<0.05) and a significant reduction in incontinence scores (p<0.001) while using ProTect compared to baseline. Conclusions: The ProTect is a safe non-surgical device that is able to prevent episodes of FI. It is unique because it can be used according to a patient's needs without interfering with activities of daily living. © 2007 Springer-Verlag