Goran Barisic

Function after intersphincteric resection for low rectal cancer and its influence on quality of life

Aim  The aim of the study was to investigate function and quality of life after different types of intersphincteric resection (ISR).

Perineal endometriosis in episiotomy scar with anal sphincter involvement: report of two cases and review of the literature

Perineal endometriosis with anal sphincter involvement is a rare occurrence with only nine cases reported so far. Two such cases are presented, and the literature is reviewed. In presented cases, diagnosis was suspected at clinical exam. Anal manometry was performed in both cases and endoanal ultrasound in one case. Wide surgical excision of endometriotic mass together with part of external anal sphincter was carried out in both cases. The procedure was followed by anal sphincter reconstruction in an “overlapping” fashion in the first and “apposition” technique in the second case. Histopathologic tests confirmed endometriosis. The recovery was uneventful in both cases with excellent functional results. Two years after the operation, patients are asymptomatic and fully continent. According to the literature and our own experience, wide excision of endometrioma with primary sphincteroplasty seems to be the best chance of cure with satisfactory functional results and should be recommended.

Adynamic and dynamic muscle transposition techniques for anal incontinence

Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal incontinence. Dynamization, through a schedule of continuous electrical stimulation, converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle mass. The differences between gluteoplasty and graciloplasty, as well as the techniques and complications of both procedures, are outlined in this review. Overall, these techniques are rarely carried out in specialized units with experience, as there is a high revision and explantation rate.

Primary repair of colon injuries: clinical study of nonselective approach

BackgroundThis study was designed to determine the role of primary repair and to investigate the possibility of expanding indications for primary repair of colon injuries using nonselective approach.MethodsTwo groups of patients were analyzed. Retrospective (RS) group included 30 patients managed by primary repair or two stage surgical procedure according to criteria published by Stone (S/F) and Flint (Fl). In this group 18 patients were managed by primary repair. Prospective (PR) group included 33 patients with primary repair as a first choice procedure. In this group, primary repair was performed in 30 cases.ResultsGroups were comparable regarding age, sex, and indexes of trauma severity. Time between injury and surgery was shorter in PR group, (1.3 vs. 3.1 hours). Stab wounds were more frequent in PR group (9:2), and iatrogenic lesions in RS group (6:2). Associated injuries were similar, as well as segmental distribution of colon injuries. S/F criteria and Flint grading were similar.In RS group 15 primary repairs were successful, while in two cases relaparotomy and colostomy was performed due to anastomotic leakage. One patient died. In PR group, 25 primary repairs were successful, with 2 immediate and 3 postoperative (7-10 days) deaths, with no evidence of anastomotic leakage.ConclusionsResults of this study justify more liberal use of primary repair in early management of colon injuries.Trial registrationCurrent Controlled Trials ISRCTN94682396

Problems During Hartmann’s Reconstruction

Reversal of a Hartmann’s resection is often challenging and requires planning, and the assessment of the rectal stump is dependent upon the original indication for the nonrestorative procedure. The reported complication rate after Hartmann’s reconstruction is high, with morbidity rates of 30–40 %, anastomotic leakage rates as high as 15 %, and a reported mortality of up to 10 %. Advanced age and multiple comorbid conditions in a large proportion of patients who recover after Hartmann’s procedure further discourages both surgeons and patients from sometimes opting for reconstruction; 40 % of patients undergoing Hartmann’s resection never have stoma reversal. In this chapter, the technical aspects of Hartmann’s reconstruction are discussed, operative tips are provided, and the selective use of a laparoscopic-assisted approach is considered.