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Background: Video-assisted anal fistula treatment (VAAFT) is now a mature technique, supported by many short-term published case series., Methods: We designed a monocentric, retrospective and observational study in order to evaluate early and long-term outcomes of VAAFT in the treatment of primary and recurrent complex anal fistula. Between November 2011 and March 2014, 224 consecutive patients affected by complex perianal fistula underwent Video Assisted Anal Fistula Treatment. Fifty-two were affected by primary and 172 by recurrent disease. We registered all intra and postoperative complications and healing rate. Median follow-up was 48 months (range 27-60 months)., Results: In the primary fistula group, 40 of the 52 patients were completely healed within 3 months after surgery (77%); at 12 months, considering also 12 patients (23%) treated with a second VAAFT due to recurrent disease, the overall healing rate was 92.3% In the second group with recurrent anal fistula (N.=172), primary healing was observed in 110 patients (64%; P=0.1) within 3 months after surgery and increases to 80.2%, after 12 months (P=0.06). Few patients required analgesics in the postoperative period (N.=33, 14.7%), the remaining did not require pain killers at all. All patients were able to resume daily activities within 7 days from surgery (range 2-12 days). Main limitation of our study was its retrospective and monocentric design., Conclusions: VAAFT seems to be a safe and effective technique for treating primary and recurrent perianal fistula, providing a very good healing rate without sphincters impairment and allowing a very quick return to normal activities.

Amyand's hernia is defined as an inguinal hernia within the hernial sac containing the appendix. It is a rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be complicated by acute appendicitis in 0.13% of cases. This disease is often very difficult to diagnose, and most of the time it can be confused with an incarcerated or strangulated inguinal hernia. Often, it requires an emergent surgical treatment. This article describes the case of a 82-year-old female who was admitted for an intestinal obstruction and a bulge in the right inguinal region. An abdominal computed tomography scan showed dilated small bowel loops with multiple air/liquid levels and one loop herniating into the right inguinal canal. The patient underwent a laparotomy that showed the presence of an acute appendicitis and a necrotized ileal loop protruding into the right inguinal canal. The patient underwent an appendectomy and small bowel resection and she was discharged on postoperative day 10. Amyand's hernia can be a challenge for the surgeon. Its treatment depends on the grade of inflammation of the appendix. In fact, it can range from the simple repair of the abdominal defect with a prosthetic mesh, to appendectomy, small bowel resection and repair of the abdominal wall defect without a mesh.

A practical and effective method for rapid and bloodless preparation of the rectum using endovascular stapler devices during low anterior resection, or abdominal-perineal excision, is described. This method is presented as an effective means for easily dividing the anterior and lateral attachment of the rectum. The application of this technique is the absence of intraoperative bleeding related to injury of middle hemorrhoidal vessels, with minimal risk of autonomic pelvic nerve damage. An additional factor relevant in the choice of this technique, is the easier possibility to perform rectal dissection of an oncologically adequate tumor clearance from the margin of rectal tumor and with complete radical transection of the lateral ligaments fastly proceeding with the downward mobilization of the rectum close to the pelvic side walls, between the parietal and visceral layer of the pelvic fascia.