Search

Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including levator ani syndrome, proctalgia fugax, pudendal nevralgia and coccygodynia. History and clinical examination are keys to diagnose acute causes. Diagnosis of chronic anal pain on the other hand is more challenging and based on thorough history and analysis of symptoms. The aim of this article is to discuss the main etiologies and treatments of acute and chronic anal pain, including an update on the management and treatment of hemorrhoidal disease and postoperative pain management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Anal cancer is a disease with a low but gradually increasing incidence, especially in developed countries. Most of these cancers are caused by the HPV. In Switzerland, more than 70 % of the sexually active population is infected with HPV at least once, making it the most common sexually transmitted disease. Immunosuppression and anal sex remain other major risk factors. Precancerous lesions can progress to anal cancer (up to 13 % at 5 years), hence the importance of early detection. High resolution anoscopy is the standard of care for diagnosis and primary treatment of lesions. It is therefore important to monitor at-risk groups and to proactively screen for gynaecological and anal HPV infection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Cervical cancer is preventable through primary and secondary prevention. Vaccination against the human papillomavirus (HPV), the virus necessary for the development of precancerous lesions, can prevent most of them. Screening by cytology for these precancerous (or cancerous) lesions can be replaced by screening for certain types of HPV, high risk (HR-HPV), causing cervical cancer. The presence of HR-HPV on the cervix should raise suspicion of concomitant infection in the anus, as both epithelia are highly susceptible. This attitude is dictated by the increase incidence in anal cancer in the population, which is also HPV-dependent and therefore also potentially preventable through vaccination and screening., Competing Interests: La Dre Martine Jacot-Guillarmod est membre du comité consultatif sur la vaccination HPV chez MSD. L’entier des honoraires est reversé au CHUV. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The key priority for obstructed colon cancer (OCC) is urgent resolution of the large bowel obstruction with ideally no compromise of oncological outcomes and low initial and permanent ostomy rates. Proactive management is pivotal to decrease the risk of perforation and septic shock. Staged procedures have an important place to provide optimal treatment and offer similar treatment and outcomes as in the elective setting. The approach is tailored to the patient's condition, the oncological situation and expertise of the available surgical team. This overview concludes by proposing a comprehensive treatment algorithm for individualized treatment of OCC., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

During surgical procedures, surgery, and anesthesia lead to pathophysiological stress on the human body. The goal of perioperative medicine is to prepare patients and take all possible measures to reduce this pathophysiological stress. The emergence of ERAS over the past 15 years has made it possible to set up a multimodal program based on scientific evidence, showing that the adequate application of an improved rehabilitation program after surgery, ERAS-type, is possible in all surgical specialties, including gynecology, cardiac surgery, and neurosurgery. ERAS improves the quality of life of patients, reduces postoperative complications and lengths of stay, and finally, reduces costs. The purpose of this article is to show the most important elements of such an ERAS program by taking the example of digestive surgery., Competing Interests: Le Pr Demartines est Chair implémentation de la Société internationale ERAS, le Pr Hubner est membre de l’executive board de la Société international ERAS et le Dr Roulin est expert ERAS et a effectué des implémentations ERAS dans divers hôpitaux. Le dernier auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Over the last decade, surgical management of colon cancer became more individualized due to new preoperative, surgical and oncological strategies. Recent high-level evidence demonstrated a favorable impact of these advanced concepts, which require proper planning and challenging surgical management form a technical standpoint, on cancer-specific survival. To tailor the best strategy, cases have to be discussed in multidisciplinary tumor boards with specialists in medical oncology, radiology, gastroenterology and pathology. In this review, these innovations are summarized within their scientific context, with focus on new strategies of preoperative bowel preparation, neoadjuvant chemotherapy and technical aspects, to illustrate the complexity of current colon cancer management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Anal dysplasia is usually caused by HPV infection and can lead to squamous anal cancer. The purpose of this article is to describe the classification of these precursor lesions but above all to identify the groups of patients at risk and to clarify the screening and follow-up that must be initiated., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In this year 2015, the developments of new technologies as well as multidisciplinary management remained successfully. The implementation of enhanced rehabilitation after surgery pathways continued to expand both geographically and in various surgical specialties. The use of the vaporized intraperitoneal chemotherapy (PIPAC) showed promising results. Minimally invasive surgery was further implemented in various fields of rectal, endocrine and oesophageal surgery.

Peritoneal carcinomatosis remains a diagnostic challenge with sparse treatment options. The effect of systemic chemotherapy remains limited inside the peritoneum due to low penetration and a relative resistance of peritoneal nodules. Heated IntraPeritoneal Chemotherapy (HIPEC) improves survival in selected patients but entails a high incidence of complications. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) allows to disperse the active agents inside the peritoneal cavity by laparoscopy. Distribution and tissue penetration of chemotherapy by PIPAC are superior to HIPEC and systemic chemotherapy despite of lower doses. Systemic side effects are uncommon and surgical trauma is limited. Histological and clinical response rates in platinum-resistant patients approach 70% and survival data appear to be favorable compared with standard therapy.

Multidisciplinary management of colorectal liver metastases allows an increase of about 20% in the resection rate of liver metastases. It includes chemotherapy, interventional radiology and surgery. In 2013, the preliminary results of the in-situ split of the liver associated with portal vein ligation (ALLPS) are promising with unprecedented mean hypertrophy up to 70% at day 9. However, the related morbidity of this procedure is about 40% and hence should be performed in the setting of study protocol only. For pancreatic cancer, the future belongs to the use of adjuvant and neo adjuvant therapies in order to increase the resection rate. Laparoscopic and robot-assisted surgery is still in evolution with significant benefits in the reduction of cost, hospital stay, and postoperative morbidity. Finally, enhanced recovery pathways (ERAS) have been validated for colorectal surgery and are currently assessed in other fields of surgery like HPB and upper GI surgery.

2007 was marked by a growing trend towards minimal invasive surgery and enhanced recovery, especially in visceral surgery. In comparison to the laparoscopic revolution in the eighties, Natural orifice transluminal endoscopic surgery (NOTES) must be watched on closely, and will probably have to be taken into account in a near future. Minimal invasive procedures in oesophageal cancer surgery have proved both efficient and oncologically safe. Implementation of Fast track protocols now permits a much faster patient's return to normal daily activity. In hepatobiliary and pancreatic surgery, multidisciplinary efforts have been done to better select patients, widen the indications and increase efficiency.

Sacral nerve stimulation (SNS) became recently an essential therapeutic modality in the treatment of anal incontinence. Indications range from anorectal functional disorders to limited sphincteric lesions. An electrode is inserted through a sacral foramen, generally S3, to stimulate the corresponding nerve root. Patient's selection needs a meticulous multidisciplinary approach. Improved continence of more than 50% is frequently encountered and quality of life is significantly improved after implantation. SNS is a minimal-invasive technique, with very few risks of complications.