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6. Development of a core descriptor set for Crohn's anal fistula

Author

Lee M. J., Williams K. M., Lamidi S., Coe P. O., Bordeianou L. G., Hart A. L., Hind D., Lindsay J. O., Lobo A. J., Myrelid P., Raine T., Sebastian S., Fearnhead N. S., Adams K., Almer S., Ananthakrishnan A., Bethune R. M., Block M., Brown S. R., Cirocco W. C., Cooney R., Davies J., Atici S. D., Dhar A., Din S., Drobne D., Espin-Basany E., Evans J. P., Fleshner P. R., Folkesson J., Fraser A., Graf W., Hahnloser D., Hager J., Hancock L., Hanzel J., Hargest R., Hedin C. R. H., Hill J., Ihle C., Jongen J., Kader R., Karmiris K., Katsanos K. H., Keller D. S., Kopylov U., Koutrabakis I. E., Lamb C. A., Landerholm K., Lee G. C., Litta F., Limdi J. K., Lopes E. W., Madoff R. D., Martin S. T., Martin-Perez B., Michalopoulos G., Millan M., Munch A., Nakov R., Noor N. M., Oresland T., Paquette I. M., Pellino G., Perra T., Porcu A., Roslani A. C., Samaan M. A., Sebepos-Rogers G. M., Segal J. P., de Silva S., Soderholm M., Spinelli A., Speight A., Steinhagen R. M., Stenstrom P., Tsimogiannis K. E., Varma M. G., Verma A. M., Verstockt B., Warden C., Yassin N., Zawadzki A., Carr P., Devlin B., Mannick S., Avery P., Gecse K. B., Goren I., Hellstrom P. M., Kotze P. G., McWhirter D., Naik A. S., Sammour T., Selinger C. P., Stein S. L., Torres J., Wexner S. D., Younge L. C., Lee, M. J., Williams, K. M., Lamidi, S., Coe, P. O., Bordeianou, L. G., Hart, A. L., Hind, D., Lindsay, J. O., Lobo, A. J., Myrelid, P., Raine, T., Sebastian, S., Fearnhead, N. S., Adams, K., Almer, S., Ananthakrishnan, A., Bethune, R. M., Block, M., Brown, S. R., Cirocco, W. C., Cooney, R., Davies, J., Atici, S. D., Dhar, A., Din, S., Drobne, D., Espin-Basany, E., Evans, J. P., Fleshner, P. R., Folkesson, J., Fraser, A., Graf, W., Hahnloser, D., Hager, J., Hancock, L., Hanzel, J., Hargest, R., Hedin, C. R. H., Hill, J., Ihle, C., Jongen, J., Kader, R., Karmiris, K., Katsanos, K. H., Keller, D. S., Kopylov, U., Koutrabakis, I. E., Lamb, C. A., Landerholm, K., Lee, G. C., Litta, F., Limdi, J. K., Lopes, E. W., Madoff, R. D., Martin, S. T., Martin-Perez, B., Michalopoulos, G., Millan, M., Munch, A., Nakov, R., Noor, N. M., Oresland, T., Paquette, I. M., Pellino, G., Perra, T., Porcu, A., Roslani, A. C., Samaan, M. A., Sebepos-Rogers, G. M., Segal, J. P., de Silva, S., Soderholm, M., Spinelli, A., Speight, A., Steinhagen, R. M., Stenstrom, P., Tsimogiannis, K. E., Varma, M. G., Verma, A. M., Verstockt, B., Warden, C., Yassin, N., Zawadzki, A., Carr, P., Devlin, B., Mannick, S., Avery, P., Gecse, K. B., Goren, I., Hellstrom, P. M., Kotze, P. G., Mcwhirter, D., Naik, A. S., Sammour, T., Selinger, C. P., Stein, S. L., Torres, J., Wexner, S. D., Younge, L. C., Gastroenterology and Hepatology, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Crohn's disease, anal fistula, consensus, methodology, Gastroenterologi, Gastroenterology, consensu, Gastroenterology and Hepatology
Abstract

Aim: Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research.Method: Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting.Results: One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life.Conclusion: The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.

Published
2022
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14. 93rd annual convention podium and poster abstracts

Author

Davis, C. M., Strong, S. A., Hellinger, M. D., Williamson, P. R., Larach, S. W., Ferrara, A., Blake, T. B., Medich, D. S., Ziv, Y., Oakley, J. R., Reissman, P., Piccirillo, M., Ulrich, A., Nogueras, J. J., Wexner, S. D., Rubin, M. S., Bodenstein, L. E., Kent, K. C., Williamson, M. E. R., Lewis, W. G., Sagar, P. M., Holdsworth, P. J., Johnston, D., Fazio, V. W., Goldblum, J. R., Sirimarco, M. T., Lavery, I. C., Petras, R. E., Treem, W. R., Cohen, J., Davis, P. M., Hyams, J. S., Eu, K. W., Bartolo, D. C. C., Green, J. D., Riether, R. D., Rosen, L., Stasik, J. J., Sheets, J. A., Reed, J., Khubchandani, I. T., Armitage, N. C., Chapman, M., Hardcastle, J. D., Viamonte, M., Plasencia, G., Wiltz, O., Jacobs, M., Finan, P. J., Passaro, M., Church, J. M., McGannon, E., Wilson, M., Hull-Boiner, S., Kollmorgen, C. F., Meagher, A. P., Wolff, B. G., Pemberton, J. H., Martenson, J. A., Ilstrup, D. M., Moran, M. R., Ramos, A., Rothenberger, D. A., Goldberg, S. M., Johnson, D., Madoff, R. D., Wong, W. D., Finne, III, C. O., Konishi, F., Furuta, K., Kanazawa, K., Lockhart, D., Schmitt, S., Caushaj, P. P., Garcia-Aguilar, J., Belmonte, C., Schiesel, E. C., Mazier, W. P., Senagore, A. J., Piccirillo, M. F., Teoh, T. -A., Yoon, K. -S., Paul, R. A. Patino, Lucas, J., Nelson, R., Norton, N., Cautley, E., Schouten, W. R., Briel, J. W., Auwerda, J. J. A., de Graaf, E. J. R., Lowry, A. C., Sentovich, S. M., Blatchford, G. J., Rivela, L. J., Thorson, A. G., Christensen, M. A., Jorge, J. M. N., Yang, Y. K., Shafik, A., Allendorf, J. D. F., Kayton, M. L., Libutti, S. K., Trokel, M. J., Whelan, R. L., Treat, M. R., Nowygrod, R., Bessler, M., Frank, R. E., Saclarides, T. J., Leurgans, S., Speziale, N. J., Drab, E., Rubin, D., Hull, T. L., Schroeder, T. K., Scholefield, J. H., Ogunbiyi, O. A., Smith, J. H. F., Rogers, K., Sharp, F., Longo, W. E., Vernava, III, A. M., Wade, T. P., Coplin, M. A., Virgo, K. S., Johnson, F. E., Brady, M., Kavolius, J., Quan, S. H. Q., Goldstein, E. T., Feldman, S., Shub, H. A., Bennett, D. R., Kumar, R., McMillen, M. A., Thornton, S., Khoury, D. A., Opelka, F. G., Teoh, T -A., Cohen, S. M., Weiss, E. G., Ortiz, H., De Miguel, M., Armendáriz, P., Rodriguez, J., Chocarro, C., Farouk, R., Dorrance, H. R., Duthie, G. S., Rainey, J. B., Morgado, Jr., P. J., Corman, M. L., Kawamura, Y. J., Sawada, T., Muto, T., Nagai, H., Hill, J., MacLennan, I., Binderow, S. R., Daniel, N., Ehrenpreis, E. D., Jensen, J. E., Bonner, G. F., Ruderman, W. B., Milsom, J. W., Gibbs, D. H., Beck, D. E., Hicks, T. C., Timmcke, A. E., Gathright, Jr, J. B., Cheong, D., Lucas, F. V., McGinity, M., Taylor, B. A., Godwin, P., Holdsworth, P., Lewis, W., Quirke, P., Williamson, M., Kokoszka, J., Pavel, D., Abcarian, H., Stephenson, B. M., Morgan, A. R., Salaman, J. R., Wheeler, M. H., Tran, T. C. K., Willemsen, W., Kuijpers, H. C., Lehman, J. F., Wiseman, J. S., MacFie, J., Sedman, P., May, J., Mancey-Jones, B., Johnstone, D., Nwariaku, F. E., Rochon, R. B., Huber, P. J., Carrico, C. J., Ortega, A., Beart, R., Winchester, D., Steele, G., Green, R., Caushaj, P. F., Devereaux, D., Griffey, S., Reiver, D., Kmiot, W. A., Baker, R., Luchtefeld, M. A., Anthone, G., Schlinkert, R., Roig, J. V., Villoslada, C., Solana, A., Alos, R., Hinojosa, J., Lledo, S., Johnson, D. R. E., Buie, W. D., Jensen, L. L., Heine, J., Hoffmann, B., Timmcke, A., Hicks, T., Opelka, F., Beck, D., Sousa, Jr., A., AraÚjo, S. A., Damico, F. M., Cordeiro, A. C., Pinotti, H. W., Gama, A. H., Fengler, S., Pearl, R., Orsay, C., Seow-Choen, F., Ho, J. M. S., Wiltz, O. H., Torregrosa, M., Brasch, R. C., Bufo, A. J., Krienberg, P., Johnson, G. P., Gowen, G. F., Mullen, P. D., Behrens, D., Hughes, T. G., Wynn, M., Pollack, J. S., Rajagopal, A. S., Huynh, T., Schanbacher, C., Hickson, W. G. E., Yang, Y. -K., Heymen, S., Choi, S. -K., Teoh, T. -A., Wexner, S. D., Vaccaro, C. A., Teoh, T. A., Nogueras, J. J., Choi, S. K., Cheong, D. M. O., Salanga, V. D., MacDonald, A., Baxter, J. N., Finlay, I. G., Mellgren, A., Bremmer, S., Dolk, A., Gillgren, P., Johansson, C., Ahlbäck, S. O., Udén, R., Holmström, B., Ferrara, A., O'Donovan, S., Larach, S. W., Williamson, P. R., Neto, J. A. Reis, Ciquini, S., Quilici, F. A., Reis, Jr., J. A., Torrabadella, L., Salgado, G., Whelan, R. L., Horvath, K. D., Golub, R., Ahsan, H., Cirocco, W., Ziv, Y., Fazio, V. W., Oakley, J. R., Church, J. M., Milsom, J. W., Lavery, L. C., Cohen, S. M., Kmiot, W. A., Reiver, D., Reissman, P., Weiss, E. G., Alós, R., García-Granero, E., Roig, J. V., Uribe, N., Sala, C., Lledo, S., Ozuner, G., Strong, S. A., Bufo, A. J., Daniels, G., Lieberman, R. C., Feldman, S., Lucas, F. V., Longo, W. E., Polites, G., Deshpande, Y., Vernava, A. M., Niehoff, M., Chandel, B., Berglund, D. D., Madoff, R. D., Gemlo, B. T., Spencer, M. P., Goldberg, S. M., Lowry, A. C., Marcello, P. W., Roberts, P. L., Schoetz, D. J., Murray, J. J., Coller, J. A., Veidenheimer, M. C., Koltun, W. A., Bloomer, M. M., Colony, P., Ruggeiro, F., Fleshner, P. R., Michelassi, F., Lewis, W., Williamson, M., Holdsworth, P., Finan, P., Ash, D., Johnston, D., Moran, M. R., Ramos, A., Rothenberger, D. A., Antonenko, D. R., Khanduja, K. S., Fitzgerald, S. D., Meagher, A. P., Moniz-Pereira, P., Wolff, B. G., Outwater, E. K., Marks, G. J., Mohiuddin, M., Sagar, P. M., Hartley, M. N., Mancey-Jones, B., Sedman, P., May, J., MacFie, J., Holbrook, R. F., Rodriguez-Bigas, M. A., Ramakrishnan, K., Palmer, M. L., Petrelli, N. J., Takahashi, T., Nivatvongs, S., Batts, K. P., Lucas, S. W., Klein, S. N., Keidan, R. D., Bannon, J. P., Zhou, J., Armitage, N. C., Hunt, L. M., Robinson, M. H., Hugkulstone, C. E., Clarke, B., Vernon, S. A., Gregson, R. H., Hardcastle, J. D., Ryan, M., Dutta, S., Levine, A., Ortega, A., Anthone, G., Beart, R., Dominguez, J. M., Saclarides, T. J., Bolan, P., Bines, S. D., Adachi, M., Watanabe, T., Sawada, T., Okinaga, K., Muto, T., Hase, K., Shatney, C., Mochizuki, H., Johnson, D., Ure, T., Dehghan, K., Andrus, C. A., Daniel, G. L., D'Emilia, J. C., Rodriguez-Bigas, M., Suh, O. K., Brewer, D. A., Fung, C., Chapuis, P., Bokey, E. L., Garcia, J. C., Banerjee, S., Remzi, F. H., Lavery, I. C., Jorge, J. M. N., Ger, G. C., Gonzalez, L., Gee, A. S., Roe, A. M., Durdey, P., Kaye, M. D., Kyzer, S., Gordon, P. H., Hasegawa, M., Bun, P. Tae, Ikeuchi, D., Onodera, H., Imamura, M., Maetani, S., Blake, T., Hellinger, M., Grewal, H., Klimstra, D. S., Cohen, A. M., Guillem, J. G., Rooney, P. S., Gifford, K. -A., Clarke, P. A., Kuhn, J. A., Bryce, K., Frank, N., Dignan, R. D., Lichliter, W. E., Franko, E., Jacobson, R. M., Preskitt, J. T., Lieberman, Z., Tulanon, P., Steinbach, H., McCarty, T., Simons, T., Plasencia, G., Viamonte, M., Wiltz, O., Jacobs, M., Chen, W. S., Leu, S. Y., Hsu, H., Bessler, M., Halverson, A., Kayton, M. L., Treat, M. R., Nowygrod, R., Congilosi, S., Madoff, R., Wong, W. D., Rothenberger, D., Buie, W. D., Paterson, R., Cartmill, J. A., Trokel, M. J., Gingold, B. S., Cooper, M., Gorfine, S. R., Bauer, J. J., Gelernt, I. M., Kreel, I., Harris, M. T., Vallejo, J. F., Kestenberg, A., Miyajima, N., Kano, N., Ishikawa, Y., Sakai, S., Yamakawa, T., Otchy, D. P., Van Heerden, J. A., Ilstrup, D. M., Weaver, A. L., Winter, L. D., Mav, J., Lee, P. Y., Vetto, J. T., Sullivan, E. S., Rabkin, J., Mayoral, J. L., Matas, A. J., Bove, P., Visser, T., Barkel, D., Villalba, M., Bendick, P., Glover, J., Golub, R. W., Cirocco, W. C., Daniel, N., Altringer, W., Domingues, J. M., Brubaker, L. T., Smith, C. S., Kumar, S., and Gilbert, P.

Published
1994
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15. 1992 Scientific Session of the Society of American Gastrointestinal Surgeons (SAGES) Washington, D.C., USA, April 11–12, 1992

Author

Salky, Barry, Bauer, Joel, Easter, D. W., Cuschieri, A., Lavelle-Jones, M., Nathanson, L., Brandt, C. P., Priebe, P. P., Eckhauser, M. L., Henriques, III, Horace F., Deziel, Daniel J., Millikan, Keith W., Staren, Edgar D., Economou, Steven G., Lexer, G. W., Lexer, G. Ch., Lehofer, F., Meiser, G., Boeckl, O., Williams, Mark D., Murr, Peter C., Shimomura, Kazuyuki, Ohtomo, Yumiko, Ishizaki, Yoichi, Noie, Tamaki, Abe, Hideki, Nayeem, Sarder Abdun, Bandai, Yasutsugu, Idezuki, Yasuo, Kam, David, Scheeres, David, Nagai, Hideo, Kondo, Yasuo, Yasuda, Toshihiko, Kasahara, Kogoro, Kanazawa, Kyotaro, Wittgen, C. M., Andrus, J. P., Andrus, C. H., Kaminski, D. L., Fried, G. M., Sigman, H. H., Meakins, J. L., Hinchey, E. J., Garzon, J., Barkun, J. S., Mamazza, J., Wexler, M. J., Bordelon, B. M., Hobday, K. A., Hunter, J. G., Saunders, C. J., Gardiner, B., Leary, B. F., F. N. P., Frey, C. F., Wolfe, B. M., Kozarek, R. A., Traverso, L. W., Ball, T. J., Brandabur, J., Jolly, P. C., Patterson, D. J., Ryan, J. A., Thirlby, R. C., Wechter, D. G., Hunter, J. A., Fletcher, D. P., Molnar, Robert G., Apelgren, Keith N., Kisala, John M., Way, Lawrence W., Wetter, Albert, Pietrafitta, Joseph J., Schultz, Leonard S., Graber, John N., Hickok, David F., Congreve, D., Zinnecker, H., Lohmuller, J., Legrand, M., Detroz, B., Honore, P., Jacquet, N., Yamamoto, M., Stiegmann, G., Durham, J., Berguer, R., Fujiyama, Y., Oba, Y., Downey, J., Miho, O., Green, P., Satava, R., Hill, J., Simon, I., Brodish, R. J., Soper, Nathaniel J., Dunnegan, Deanna L., Peters, Jeffrey H., Innes, Jeffrey T., Front, Mary E., Ellison, E. Christopher, Swanstrom, Lee, Sangster, William, Stoker, Mark E., Phillips, E., Carroll, B., Fallas, M., Daykhovsky, L., Murphy, B., Miller, S., Keiter, N., Halpern, Norman B., Escudero-Fabre, Angel, Sack, Jonathan, Himal, H. S., Luchette F., Doerr R., Kulaylat M., Stephan R., Kelly K., Fowler, Dennis L., White, Sharon A., Church, James M., De Paula, A. L., Hashiba, K., Ambroze, Jr, W. L., Nezhat, C., Nezhat, F., Orangio, G., Brooks, D. C., Becker, J. M., Connors, P. J., Carr-Locke, D. L., Adams, D. B., Borowicz, M. R., Wootton, III, F. T., Cunningham, J. T., Cirocco, W. C., Rusin, L. C., Franceschi, Dido, Pritchard, Timothy, Eckhauser, Marc, Estes, J. M., Szabo, Z., Harrison, M. R., Krishnan, S. M., Goh, P. M. Y., Ambroze, Jr., W. L., Orangio, G. R., Tucker, J. G., Baird, D., Herndon, M., Lucas, G. W., Bell, R. C. W., Stiegmann, G. V., Sun, J., Kim, J., Lucia, M. S., Bender, J. S., Talamini, M. A., Bessler, Marc, Treat, Michael R., Canady, J., Nicolo, E., Jagdeo, C., McQueen, J., Fontana, F., Dewitty, R., Castellano, M., Elmann, E. M., Lobbato, V. J., Cosgrove, John M., Franklin, Howard, Margolis, Irving B., de la Torre, R., Donahue, PE, Schlesinger, P., Sluss, K., Attar, B., Nyhus, L. M., Anan, K., Fletcher, D. R., Flowers, J. L., Zucker, K. A., Graham, S. M., Scovill, W. A., Imbembo, A. L., Bailey, R. W., Gagner, M., Rheault, M., Dubuc, J., Ghobrial, Rafik, MacFadyen, Jr., Bruce V., Catalano, Mark, Raijman, Isaac, Haicken, Barry N., Daijo, Hashimoto, Shuji, Kajiwara, Takanobu, Hoshino, Fukuyo, Tsuneo, Kitano, S., Moriyama, M., Sugimachi, K., Kudo, Shin-ei, Kusaka, Takashi, Nakajima, Kouji, Kimata, Hiroyuki, Miura, Kouji, Takano, Yukio, Lamphier, Jonathan B., Diflo, Thomas, Kondi, Edward S., Larson, G. M., Vitale, G. C., Voight, W., Cheadle, W., Miller, F., Leahy, P. F., Pennino, R. P., Furman, R. H., Libutti, Steven K., Williams, Mathew R., Litwin, D., Johnson, D., Osachoff, J., Gallagher, C., Church, D., Mansour, M. A., Martin, Matt B., Abrams, Arkin, Ballen, Blievernicht, Bowman, Davis, Farley, Hoxworth, Ingram, Leone, Lindsey, Newman, Price, Streck, Weatherly, Young, Miscusi, Route G., Masoni, L., Gasparrini, M., Montori, A., Montori, A., Munakata, Y., Kawasaki, S., Hashikura, Y., Hashimoto, S., Hayashi, K., Numata, M., Makuuchi, M., Mustafa, I. A., Reed, W. P., Coe, N. P. W., Leigh H., Nadler, Nelson, M. T., Nakashima, M., Mulvihill, S. J., Olsen, Douglas O., Corbitt, John D., Edleman, David S., Unger, Stephen, Unger, Harold, Orkin, B. A., Smith, L. E., Paz-Partlow, M., Berci, G., Sackier, J. M., Miller, John, Kieth E., Nichols, Ollila, David, Gibbons, Gregory E., Davanzo, Mark A., Polacek, Michael A., Pons, R., Grannan, K., Welling, R., Pritchard, Timothy J., Richards, William O., Unger, S. W., Rosenbaum, G., Unger, H. M., Edelman, D. S., Schirmer, B. D., Dix, J., Schmieg, Jr., R. E., Aguilar, M., Schirmer, B. D., Dix, J., Scott, T. R., Zucker, K. A., Bailey, R. W., Bergstein, J. M., Seone, D., Wittmann, D. H., Quebbeman, E. J., Aprahamian, C., McGrath, Michael, Shapiro, Stephen, Gordon, Leo, Adashek, Kenneth, Daykhovsky, Leon, Shoop, Stephen A., Sackier, Jonathan, Meakin, J. L., Snyder, Samuel K., Symmonds, Richard E., Roberts, John W., Hendricks, John C., Smith, Randall W., Frazee, Richard C., Soper, Nathaniel J., Brunt, L. Michael, Fleshman, James, Meininger, Thomas A., Dunnegan, Deanna L., RN, Sudan, Debra, Mellinger, John, Miller, Sidney, Sugawa, C., Lucas, C. E., Szabo, Zoltan, Berci, George, Hunter, John G., Unger, S. W., Unger, H. M., Edelman, D. S., Weaver, Donald W., Bouwman, David, Tyburski, James, and Wierson, T. A.

Published
1992
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16. 90th Annual Convention Poster Presentations and Abstracts

Author

Ellis, C. N., Coyle, D. J., Boggs, H. W., Slagle, G. W., Cole, P. A., Kuramoto, S., Ihara, O., Oohara, T., Nichols, J., Opelka, F., Gathright, J. B., Green, J. B., Poulard, J. B., Ott, A., Bank, S., Margolis, I. B., Meagher, A., Stuart, M., Heine, J. A., Rothenberger, D. A., Nemer, F. D., Christenson, C. E., Saad, R. C., Church, J. M., Fazio, V. W., Lavery, I. C., Oakley, J. R., Milsom, J. W., Schroeder, T. K., Påhlman, L., Frykholm, G., Glimelius, B., Kashtan, H., Papa, M., Wilson, B., Stern, H., Zelnick, R., Haas, P., Ajlouni, M., Fox, T., Szilagy, E., Cummings, B. J., Fleshman, J. W., Dreznick, Z., Fry, R. D., Kodner, I. J., Perry, R. E., Pemberton, J. H., Litchy, W. L., Ferrara, A., Levin, K. E., Hanson, R. B., Cali, R. L., Blatchford, G. J., Thorson, A. G., Christenson, M. A., Pitsch, R. M., Jensen, L. L., Lowry, A. C., Keighley, M. R. B., Oya, M., Oritz, J., Pinho, M., Asperer, J., Chattaphaday, G., Baeten, C., Konsten, J., Spaans, F., Soeters, P., Habets, A., Schouten, W. R., Ruseler van Embden, J. G. H., Auwerda, J. J. A., Sagar, P. M., Goodwin, P., Holdsworth, P. J., Johnston, D., Bundy, C. A., Jacobs, D. M., Bubrick, M. P., Kashiwagi, H., Konishi, F., Kanazawa, K., Woodland, D. O., Saclarides, T. J., Bapna, M. S., Kubota, Y., Sunouchi, K., Ono, M., Muto, T., Masaki, T., Suzuki, K., Adachi, M., Wong, W. D., Goldberg, S. M., Wexner, S. D., Daniel, N., Jagelman, D. G., Christiansen, J., Rasmussen, O., Zhu, B. -W., Williams, J. G., Schottler, J. L., Heyman, S., Marchetti, F., Timmcke, A. E., Hicks, T. C., Ray, J. E., Bernstein, M. A., Madoff, R. D., Caushaj, P. F., Zarbo, R. J., Ma, C. K., Shida, H., Yamamoto, T., Machida, T., Imanari, T., Wang, J. Y., You, Y. T., Tang, R. P., Chen, J. S., Chang-Chien, C. R., Sugihara, K., Hojo, K., Moriya, Y., Hasegawa, H., Krueger, B., Warren, W., Faber, L. P., Abel, M. E., Chiu, Y. S. Y., Russell, T. R., Volpe, P. A., Frazee, R. C., Roberts, J., Symmonds, S., Snyder, S., Hendricks, J., Smith, R., Merchant, N., Hashmi, H., Scalea, T., Whelan, R., Longo, W. E., Gusberg, B. J., Ballantyne, G. H., Davidson, T., Allen-Mersh, T. G., Gazzard, B., Miles, A. J. G., Wastell, C., Viponde, M., Stotter, A., Miller, R. F., Fieldman, N., Slack, W. W., Tjandra, J., Savoca, P. E., Flannery, J. T., Modlin, I. M., Tsukada, K., Tazawa, K., Lavery, E. C., Voeller, G. R., Bunch, G., Britt, L. G., Neto, J. A. Reis, Quilici, F. A., Cordeiro, F., Reis, Jr, J. A., Wojcik, J. B., Banerjee, S. R., Walters, D. L., Cherry, D. A., Bleday, R., Pena, J. P., Buls, J. G., Pascual, R., Tripodi, G., Padmanabhan, A., Schouter, W. R., Blankensteijn, J. D., Moenning, S., Huber, P., Simonton, C., Odom, C., Kaplan, E., Nightengale, S., Shah, P. C., Hashami, H. F., Kottmeier, P., Velcek, F., Klotz, D., Whelan, R. L., Sher, M. E., Bauer, J. J., Gelernt, I., Launer, D. P., Gerber, A., Nogueras, J. J., Finne, C. O., Sohn, N., Weinstein, M. A., Lugo, R. N., Eisenberg, M. M., Tsao, J., Galandiuk, S., Tuckson, W. B., Strong, S., Oakey, J. R., Ambroze, W. L., Dozois, R. R., Carpenter, H. A., Kartheuser, A. H., LaRusso, N. F., Wiesner, R. H., Ilstrup, D. M., Schleck, C. D., Ambroze, W., Beart, R., Dozois, R., Wolff, B., Pemberton, J., Kelly, K., Devine, R., Nivatvongs, S., Metzger, P., Phillips, S. F., Zinmeister, A. R., Pezim, M. E., Vignati, P., Cohen, J., Stahl, T. J., Roberts, P. L., Schoetz, Jr., D. J., Murray, J. J., Coller, J. A., Veidenheimer, M. C., Yamazaki, Y., Ribeiro, M. B., Sachar, D., Heimann, T. M., Aufses, A. H., Greenstein, A. J., Stryker, S. J., Green, D., McLeod, R. S., Cohen, Z., Cullen, J., Greenberg, G. R., Ho, C. S., Reznick, R., Wolff, B. G., Cangemi, J., Carryer, P., Jeejeebhoy, K. N., MacCarty, R., Weilland, L., Senagore, A. J., MacKeigan, J. M., Guillem, J., Ondrula, D. P., Prasad, M. L., Nelson, R. L., Abcarian, H., Coughlin, R. J., Corman, M. L., Prager, E. D., Borison, D. I., Bloom, A. D., Pritchard, T. J., McGannon, E., Sivak, M. V., van Stolk, R., Hull-Boiner, S., Milson, J. W., Sullivan, M., Rosato, G. O., Jorge, J. M., Durdey, P., Kennedy, M. J., Oster, M., Murray, J., Cirocco, W. C., Rusin, L. C., Brown, A. C., Reilly, J. C., Cataldo, P., Luchtefeld, M. A., Mazier, W. P., Wolkomir, A. F., Ruiz-Moreno, F., Alvarado-Cerna, R., Rodriguez, U., Amaro, J., Kerner, B. A., Oliver, G. C., Eisenstat, T. E., Rubin, R. J., Salvati, E. P., Dominguez, J. M., Coon, J. S., Weinstein, R. S., Kameyama, M., Fukuda, I., Imaoka, S., Iwanga, T., Kyzer, S., Mitmaker, B., Gordon, P. H., Wang, E., Grace, R. H., Gibbons, P., Scott, K. M. W., Berger, A., Mischinger, H. J., Arian-Schad, K., Davis, M., Miller, D., Fielding, L. P., Begin, L. R., Bell, A. M., Shafik, A., Abdel-Moneim, K., Khalid, A., Devine, R. M., Beart, Jr., R. W., Melton, L. J., Ngoi, S. S., Chia, J., Goh, P., Sim, E., Godwin, P., Quirke, P., Barrett, R. C., Koltun, W. A., Smith, R. J., Loehner, D., Roberts, P., Veidenheimer, M., Schoetz, D., Chattopadhyay, G., Kumar, D., Hosie, K., Kmiot, W., Mostaf, A., Tulley, N., Harding, I., Falcone, R. E., Wanamaker, S., Santanello, S. A., Carey, L. C., Rivera, D. E., Durdley, P., Gross, P. T., Sarles, J. C., Arnaud, A., Sielezneff, I., Orsoni, P., Joly, A., Limberg, B., Stolfi, V. M., Lavery, I., Oakley, J., Church, J., Fazio, V., Asbun, H. J., Castellanos, H., Asbun, J., Franko, E. R., Ivatury, R. R., Schwalb, D., Saad, R., Schroeder, T., Reis, Jr., J. A., Dziki, A. J., Duncan, M. D., Harmon, J. W., Saini, N., Malthaner, R. A., Fernicola, M. T., Hakki, F. Z., Trad, K. S., Ugarte, R. M., Ryan, P., Chang, H. R., Chavoshan, B., Barsoum, G., Bonardi, R., Scaramelo, A., Possebon, A., Peres, C., Röhrig, C., Kappas, A. M., Ortiz, J., Fan, H. A., Milsom, J., Lechner, P., Lind, P., Cesnik, H., Venkatesh, K. S., Larson, D. M., Morrison, D. N., Ramanujam, P. J., Rubbini, M., Mascoli, F., Mari, C., Bresadola, V., and Donini, I.

Published
1991
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22. The reliability of cecal landmarks during colonoscopy.

Author

Cirocco, William, Rusin, Lawrence, Cirocco, W C, and Rusin, L C

Abstract

Confirming colonoscopic intubation of the cecum can be a laborious, time-consuming, and often frustrating endeavor. Anatomic landmarks may offer visual clues of cecal intubation, but the predictability of this evidence is unclear. The presence of three cecal landmarks, alone and in combination, were evaluated to precisely define their reliability. Between February and October of 1991, 601 of 708 (85%) consecutive colonoscopic examinations were able to be completed to the cecum as confirmed by fluoroscopy. All three cecal landmarks studied were present in 64% (386/601), two cecal landmarks in 32% (189/601), and one cecal landmark in 4% (26/601) of the patients. Therefore, at least two cecal landmarks were identified in 96% (575/601) of the patients. The ileocecal sphincter was identified in 98% (591/601) of patients overall, in 98% (185/189) of patients and 2 cecal landmarks, and in 77% (20/26) of patients with 1 cecal landmark. The appendiceal orifice was seen in 87% (524/601) of patients overall and in 72% (137/189) of patients with 2 cecal landmarks. Transillumination through the abdominal wall was possible in 74% (447/601) of patients overall and in 30% (56/189) of patients with 2 cecal landmarks. In summary, the ileocecal sphincter is the most reliable cecal landmark and is invariably visualized, even when all other landmarks are obscure. While other cecal landmarks, such as the appendiceal orifice and transillumination, are consistently identified, they are most valuable when found in association with the ileocecal sphincter. [ABSTRACT FROM AUTHOR]

Published
1993
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23. Documenting the use of fluoroscopy during colonoscopic examination: a prospective study.

Author

Cirocco, William, Rusin, Lawrence, Cirocco, W C, and Rusin, L C

Abstract

To determine the patterns of fluoroscopy use during colonoscopy, 500 consecutive patients undergoing colonoscopic examination were studied over a 6-month period. The procedures were performed on 195 patients by three gastroenterologists and on 305 patients by three colon and rectal surgeons. The study group comprised 237 women and 263 men aged an average of 62 years (range, 12-90 years). The results revealed that fluoroscopy was used during 37% of colonoscopic examinations. The most common indications for fluoroscopy were the treatment of sigmoid loops (42%) and the localization of the colonoscope tip (51%), totaling 93% of 312 fluoroscopic checks. The suspected position of the colonoscope tip was inaccurate in 15% (47/312) of fluoroscopic checks. The most common bowel location of the colonoscope tip during the fluoroscopic checks was the hepatic flexure (24%), followed by the cecum (21%). In all, 53% (166/312) of fluoroscopic checks involved the right colon. The selective use of fluoroscopy during more difficult cases was emphasized by the significantly longer time required for the procedure (36 vs 26 min) and the significantly lower cecal intubation rate (79% vs 99%). In summary, fluoroscopy is deemed to be a safe, reliable technique that facilitates the completion of difficult colonoscopic examinations. It is especially helpful in the treatment of sigmoid loops and in the precise localization of the position of the colonoscope tip, especially during negotiation of the right colon. [ABSTRACT FROM AUTHOR]

Published
1991
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35. Factors that predict incomplete colonoscopy.

Author

Cirocco WC and Rusin LC

Subjects
Abdomen surgery, Adolescent, Adult, Aged, Aged, 80 and over, Child, Colectomy, Diverticulitis, Female, Humans, Hysterectomy, Male, Middle Aged, Prospective Studies, Risk Factors, Colonoscopy
Abstract

Purpose and Methods: Certain factors in a patient's history, such as prior abdominal surgery or complicated diverticular disease, have been reported to hinder cecal intubation during colonoscopy. Over a 16-month period, 1,047 consecutive colonoscopies were prospectively evaluated to determine whether these factors were indeed clinically relevant., Results: Of the 90 patients (9 percent) who had incomplete intubation of the colon, there were significantly more women (66 percent) than men (34 percent) (P < 0.001). Women with a history of abdominal hysterectomy had a significantly lower cecal intubation rate (P < 0.01). A history of diverticulitis did not alter the cecal intubation rate. In patients with incomplete colonic intubation, the most proximal extent of intubation was the sigmoid colon in women (31 percent) and the right colon in men (68 percent). Sixty-seven percent of patients with incomplete intubation of the colon had a prior colonoscopy completed to the cecum (67 percent women, 67 percent men), whereas 50 percent had a follow-up colonoscopy completed to the cecum (56 percent women, 40 percent men)., Conclusions: Women, especially those with a history of abdominal hysterectomy, had a significantly lower cecal intubation rate usually because of an impassable sigmoid colon. Prior inability to complete colonoscopy to the cecum does not necessarily forecast future failure.

Published
1995
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36. Effect of catheter diameter on resting pressures in anal fissure patients.

Author

Horvath KD, Whelan RL, Golub RW, Ahsan H, and Cirocco WC

Subjects
Adult, Female, Humans, Male, Pressure, Prospective Studies, Anal Canal physiopathology, Catheterization, Fissure in Ano physiopathology, Manometry instrumentation
Abstract

Purpose: Controversy exists as to whether fissure patients have elevated resting pressures when compared with control patients. The diameter of manometry catheters used in past studies varies widely (1.5-25 mm) and may have contributed to differences observed in resting pressures. A prospective study was undertaken to determine the influence of manometry catheter diameter on maximum resting pressure in patients with idiopathic chronic anal fissures., Methods: A total of 28 fissure patients and 28 control patients had manometry performed with both a 1.8-mm and a 4.8-mm (external diameter) water-perfused catheter., Results: Mean maximum resting pressure (RP) for fissure patients as measured with the 1.8-mm catheter was 86 (range, 65-115) mmHg and 83 (range, 47-117) mmHg with the 4.8-mm catheter (P = 0.65). Mean maximum RP for control patients with the 1.8-mm catheter was 70 (range, 30-108) mmHg and 72 (range, 35-109) mmHg with the 4.8-mm catheter (P = 0.07). When fissure and control patients were compared, a significantly higher mean RP was observed in the fissure group for both the 1.8-mm catheter (86 vs. 70 mmHg, respectively; P = 0.01) and the 4.8-mm catheter (83 vs. 72 mmHg, respectively; P = 0.03). There was no significant difference in length of the high-pressure zone within each group or when the fissure group and controls were compared, regardless of catheter used. For both groups of patients, there was a significantly higher incidence of ultraslow waves (USWs) observed with the 4.8-mm catheter when compared with the 1.8-mm catheter. The USW frequency was not significantly different when fissure and control groups were compared with either catheter type., Conclusions: Catheter size did not influence measured maximum RP in fissure patients. The maximum RP was significantly greater for fissure patients overall when compared with the control group, regardless of catheter used. There was an increased frequency of USWs noted with the larger catheter size in all patients; however, these USWs only became apparent when catheter was left at each station until a true baseline RP was obtained.

Published
1995
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37. Endoscopic treatment of postoperative hemorrhage from a stapled colorectal anastomosis.

Author

Cirocco WC and Golub RW

Subjects
Aged, Aged, 80 and over, Anastomosis, Surgical instrumentation, Blood Transfusion, Colectomy, Female, Follow-Up Studies, Humans, Surgical Stapling instrumentation, Survival Rate, Anastomosis, Surgical adverse effects, Colon surgery, Colonoscopy, Electrocoagulation, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Rectum surgery, Surgical Stapling adverse effects
Abstract

We present the sixth reported case of endoscopic electrocoagulation to successfully treat postoperative hemorrhage from a stapled colorectal anastomosis. A literature review revealed 17 patients with postoperative hemorrhage from a combined total of 775 patients (1.8 per cent) after stapled colorectal anastomosis requiring blood transfusion and/or emergency surgery. Twelve of the 17 cases involved a circular stapler (71 per cent) used during an anastomosis to the rectum (69 per cent). Nonoperative therapy was successful in 14 of the 17 patients (82 per cent), using endoscopic electrocoagulation in six patients (43 per cent) and blood transfusion alone in another six patients (43 per cent). In follow-up there was one death (cardiac) and two anastomotic fistulas (one requiring temporary colostomy) in the nonoperative group. Both anastomotic fistulas occurred following hemorrhage from an anastomosis to the rectum using the circular stapler, one after endoscopic electrocoagulation and the second after blood transfusion alone. In summary, postoperative hemorrhage from a stapled colorectal anastomosis, although rare, is most likely to occur in a colorectal anastomosis constructed with the circular stapler. Nonoperative treatment is usually successful. Endoscopic electrocoagulation may be safely and effectively used in the early postoperative period to cease unremitting anastomotic hemorrhage.

Published
1995

38. Confirmation of cecal intubation during colonoscopy.

Author

Cirocco WC and Rusin LC

Subjects
Abdominal Muscles, Appendix, Colonoscopy statistics & numerical data, Fluoroscopy, Humans, Intubation, Gastrointestinal statistics & numerical data, Observer Variation, Reproducibility of Results, Cecum, Colonoscopy methods, Ileocecal Valve, Intubation, Gastrointestinal methods
Abstract

Purpose: Establishing intubation of the cecum can be a laborious, frustrating, and sometimes erroneous endeavor. Following confirmed colonoscopic intubation of the cecum, the presence of three anatomic landmarks (alone and in combination) were evaluated to precisely define their reliability., Methods: Between February 1991 and January 1992, 771 of 904 consecutive colonoscopic examinations were completed to the cecum as confirmed by fluoroscopy., Results: All three cecal landmarks studied (ileocecal valve, appendiceal orifice, and transillumination) were present in 64 percent of patients, and two landmarks were seen in 32 percent (96 percent of patients had multiple landmarks). The ileocecal valve was the most reliable cecal landmark (98 percent), followed by the appendiceal orifice (87 percent) and transillumination through the abdominal wall (75 percent)., Conclusions: The ileocecal valve is the most reliable cecal landmark and is invariably visualized, even when all other cecal landmarks are obscure. Although other cecal landmarks are usually identifiable, they are most valuable when found in association with the ileocecal valve.

Published
1995
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41. Life-threatening hemorrhage and exsanguination from Crohn's disease. Report of four cases.

Author

Cirocco WC, Reilly JC, and Rusin LC

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Blood Transfusion, Colitis complications, Colitis diagnosis, Colitis surgery, Crohn Disease diagnosis, Crohn Disease surgery, Female, Gastrointestinal Hemorrhage surgery, Humans, Ileitis complications, Ileitis diagnosis, Ileitis surgery, Male, Middle Aged, Prognosis, Crohn Disease complications, Gastrointestinal Hemorrhage etiology
Abstract

Purpose and Methods: From 1979 through 1991, four patients of 631 admissions (0.6 percent) for Crohn's disease in Erie, Pennsylvania, presented with life-threatening gastrointestinal hemorrhage. These and 34 similar cases from the medical literature were reviewed to provide a composite of those at risk and elucidate appropriate diagnostic and therapeutic maneuvers., Results: The study revealed a preponderance of young men (2:1 ratio) with an average age of 35 (range, 14-89) years, the majority of whom had known Crohn's disease (60 percent) for an average of 4.6 (range, 0-18) years. The site of bleeding resembled the general distribution for Crohn's disease, with small bowel disease predominating (66 percent involved the ileum). The five cases of exsanguination (13 percent of the total) were all men with known Crohn's disease (average, 5.8 years) involving the ileum alone or in part. Mesenteric arteriography was positive in 17 patients, providing precise preoperative localization resulting in no mortality in this group. Excluding those who presented with exsanguination, surgery was necessary to cease hemorrhage in 91 percent (30/33) of patients. Ileocolectomy was the most frequently performed procedure (53 percent). In follow-up, only one patient required further surgical resection for recurrent bleeding (3.5 percent), and two other patients (7 percent) required further therapy for nonhemorrhagic recurrence., Conclusion: Crohn's disease may be responsible for life-threatening gastrointestinal hemorrhage and even exsanguination. Many of the characteristics of these patients resemble the general Crohn's disease population. Surgical resection provides excellent palliation. A long-term benign course can be expected in this subgroup of Crohn's disease patients.

Published
1995
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42. Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease.

Author

Cirocco WC, Priolo SR, and Golub RW

Subjects
Aged, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Colonic Diseases etiology, Diverticulitis, Colonic complications, Intestinal Fistula etiology, Ureteral Diseases etiology, Urinary Fistula etiology
Abstract

Spontaneous ureterocolic fistula is rare and usually caused by urinary calculi. We present the fifth reported case of spontaneous ureterocolic fistula caused by diverticular disease of the colon. Review of these cases revealed a preponderance of women (3:1 ratio), with mean age of 77 years. These patients may have a protracted course before an accurate diagnosis is made (up to 10 years) because of the typical vague presentation. Urologic symptoms predominate, especially urinary tract infection (100%), fecaluria (75%), and abdominal (75%) or flank pain (50%). Barium enema is the most reliable diagnostic test in demonstrating the fistula (75%) compared with intravenous pyelogram (33%) or retrograde pyelogram (25%). The left ureter is usually involved (75%). Surgical intervention is generally directed towards resection of the diseased bowel with primary anastomosis when feasible. Surgical manipulation of the urinary system is unnecessary except for removing a non-functioning, infected kidney. Results of surgery were excellent, with 100 per cent cure and one unrelated mortality on long term follow-up. We recognize the potential for increase in this type of internal fistula, given the increasing lifespan and the established increase in incidence of colonic diverticular disease with advancing age. The correct diagnosis can often be determined preoperatively (75%), and surgical intervention is routinely successful.

Published
1994

43. Abdominal wall recurrence after laparoscopic colectomy for colon cancer.

Author

Cirocco WC, Schwartzman A, and Golub RW

Subjects
Adenoma, Villous secondary, Aged, Aged, 80 and over, Humans, Male, Abdominal Muscles, Abdominal Neoplasms secondary, Adenoma, Villous surgery, Colectomy adverse effects, Colonic Neoplasms surgery, Laparoscopy adverse effects
Abstract

Background: Although rare, abdominal wall recurrences after laparoscopic surgery for cancer have been increasing at an alarming rate as the range and sheer number of laparoscopic surgical procedures have increased. Overall, 13 case reports of abdominal wall cancer recurrence after laparoscopic surgery have been published., Methods and Results: We present the fourth known case of abdominal wall recurrence after laparoscopic colectomy involving a patient with a TNM stage III (T3, N2, M0) colon cancer. Recurrent cancer was located in the abdominal wall incision and also in all four port sites 9 months after surgery. These four cases have all involved patients with advanced cancers of the right side of the colon who underwent a laparoscopic-assisted right hemicolectomy. These cases of abdominal wall cancer recurrence carry ominous implications for the future of laparoscopic surgical procedures involving colorectal malignancy. Recurrent cancer in minilaparotomy incisions may simply be due to local spread of cancerous cells. However, remote port site recurrence may be due to the liberation of cancer cells throughout the abdomen from advanced colorectal cancer no longer confined to the bowel wall facilitated by intraperitoneal carbon dioxide insufflation during laparoscopy., Conclusions: Abdominal wall cancer recurrence is enhanced by the laparoscopic approach to colectomy for colorectal cancer. Except for controlled, clinical studies, laparoscopic colectomy for malignancy should be abandoned.

Published
1994

44. Anterior resection for the treatment of rectal prolapse: a 20-year experience.

Author

Cirocco WC and Brown AC

Subjects
Anastomosis, Surgical methods, Constipation epidemiology, Diarrhea epidemiology, Fecal Incontinence epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Rectal Prolapse epidemiology, Recurrence, Retrospective Studies, Time Factors, Rectal Prolapse surgery
Abstract

Between 1971 and 1991, 41 patients underwent anterior resection for the treatment of complete rectal prolapse. Anterior resection was performed after full rectal mobilization to the levator ani muscles with reanastomosis (39 hand-sewn and two stapled) carried out to peritonealized distal rectum. The 41 patients comprised 35 women and six men with an average age of 56 years (range, 7-88 years). Postoperative follow-up averaged 6 years (range, 6 months to 18 years). Three patients (7%) suffered recurrent prolapse in 2, 2.5, and 5.5 years, respectively. Mortality was 0 per cent; morbidity was 15 per cent including three incisional herniae, two small bowel obstructions, and one stroke. No pelvic sepsis, abscess, or anastomotic dehiscence occurred. Anal incontinence was a preoperative finding in 21 patients (51%) with rectal prolapse. Nineteen of these patients (90%) noted either improvement or no change in postoperative continence. Anterior resection is a familiar, frequently performed operation that does not require a foreign body or rectal suspension. We believe this to be the procedure of choice for patients with complete rectal prolapse. Anterior resection withstands long-term scrutiny both in terms of recurrence rate and associated complications.

Published
1993

45. Challenging the predictive accuracy of Goodsall's rule for anal fistulas.

Author

Cirocco WC and Reilly JC

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Predictive Value of Tests, Rectal Fistula pathology, Retrospective Studies, Rectal Fistula diagnosis
Abstract

To examine the predictive accuracy of Goodsall's rule, the records of 216 patients (155 men and 61 women) who underwent surgery for complete submuscular anal fistulas from 1982 to 1989 were retrospectively reviewed. In accordance with Goodsall's rule, 90 percent of 124 patients with an external opening posterior to the transverse anal line had anal fistulas tracking to the midline (87 percent men and 97 percent women). Only 49 percent of the 92 patients with an external opening anterior to the transverse anal line had anal fistulas that tracked in the radial fashion predicted by Goodsall (57 percent men and 31 percent women). Instead, 71 percent of these patients (62 percent men and 90 percent women) had anterior fistulas tracking to the midline. Overall, 81 percent (77 percent men and 93 percent women) of patients had complete submuscular anal fistulas that coursed to the midline (51 percent midline posterior and 30 percent midline anterior). In summary, Goodsall's rule is accurate only when applied to complete submuscular anal fistulas with posterior external anal openings. The rule is inaccurate in describing the course of complete submuscular anal fistulas with an anterior external opening. The men in this group had anal fistulas that defied Goodsall's rule in an unpredictable manner, whereas 90 percent of the women had fistulas tracking to a midline anterior origin.

Published
1992
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46. Simplified Seton management for complex anal fistulas: a novel use for the rubber band ligator.

Author

Cirocco WC and Rusin LC

Subjects
Humans, Ligation instrumentation, Ligation methods, Rectal Fistula surgery
Abstract

The seton has been useful in the treatment of complex anal fistulas. Various complicated methods to enhance the advancement of the seton through the external sphincter muscles have been described. We use a common office implement, the rubber band ligator, to manage the seton in an outpatient setting.

Published
1991
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