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In the past decade, several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain. Among these radiofrequency (RF), excisional surgery seems to be safe, fast, and accompanied by less postoperative pain. The aim of this study was to evaluate and compare RF (ligasure TM) to conventional diathermy Milligan-Morgan hemorrhoidectomy (MMH).Between January 2003 and July 2009, 210 symptomatic patients were randomized to undergo RF (118 patients) or diathermy MMH (92 patients). Mean follow-up was 39 ± 16 months. Clinical outcome was assessed by validated questionnaire on postoperative symptoms and satisfaction. Primary endpoints were pain and wound healing. Secondary endpoints were operative time, early and late complications (including recurrences), and patient satisfaction. Data was analyzed using chi-squared test and Fisher's exact test.Despite postoperative pain was less after RF, this difference was significant only for severe pain (expressed as VAS score7). Significant differences were observed in terms of wound healing. The two techniques were similar in terms of early and late complications.RF hemorrhoidectomy is followed by reduced severe pain and better wound healing. However, in our experience, this is not followed by earlier return to daily activities.

Laparoscopic ventral mesh rectopexy is a novel procedure to correct internal and external rectal prolapse. Several authors have shown that this approach is safe and improves obstructive defaecation symptoms and faecal incontinence, without inducing new-onset constipation, possible after posterior rectopexy. Over the last decade, as for other procedures, biological meshes are used to correct pelvic floor disorders. Literature data are scant. In this study, we present our experience with this procedure using biological mesh. Prospectively collected data on laparoscopic ventral mesh rectopexy for internal rectal prolapse were analysed. All patients underwent preoperative evaluation with defaecating proctography and/or pelvic dynamic MRI, full colonoscopy, anal physiology studies and endo-anal ultrasound. End-points were to evaluate surgical complications and functional results of this technique such as changes in bowel function (Wexner Constipation Score and Faecal Incontinence Severity Index) at 3 and 6 months. Analysis was performed using Mann-Whitney U test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p test). Thirty-four consecutive patients underwent laparoscopic ventral mesh rectopexy (median age 59, range 25-78 years, mean follow-up was 12 months). Twenty-eight patients (82%) had a constipation score a parts per thousand yen5, while 14 (41%) a FISI score a parts per thousand yen10. Nine patients (26%) had mixed obstructed defaecation and faecal incontinence. One patient required conversion to open (3%). Median length of stay was 2 days. Overall complication rate was 23.5%. Preoperative constipation (median Wexner score 15) and faecal incontinence (median FISI score 12) improved significantly at 3 months (Wexner 5, FISI 5, both p < 0.001). Two patients experienced prolapse persistence or recurrence. No patients had function worsening or complained of sexual dysfunction. Laparoscopic ventral mesh rectopexy using biological mesh for internal rectal prolapse is safe and effective in ameliorating symptoms of obstructed defaecation and faecal incontinence.

Background Ligation of the intersphincteric tract (LIFT), a novel sphincter-saving technique, has been recently described with promising results. Literature data are still scant. In this prospective observational study, we present our experience with this technique. Methods Between October 2010 and April 2011, 18 patients with 'complex' fistulas underwent LIFT. All patients were enrolled in the study after a physical examination including digital examination and proctoscopy. For the purpose of this pilot study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula or pre-existing incontinence. Endpoints were healing time, presence of recurrence, faecal incontinence and surgical complications. Results Ten patients were men and 8 were women; mean age was 39 years; minimum follow-up was 4 months. Three patients required drainage seton insertion and delayed LIFT. After LIFT, 1 patient experienced haemorrhoidal thrombosis. At the end of the follow-up, 15 patients (83%) healed with no recurrence. Three patients had persistent symptoms and required further surgical treatment. We did not observe postoperative worsening of continence. Conclusions Results from our pilot study indicate that this novel sphincter-saving approach is effective and safe for treating complex anal fistula.

PURPOSE: Sphincter-sparing chemoradiotherapy (CRT) is the standard of care for patients with anal canal cancer. Despite good response rates, some patients require radical surgery (abdominoperineal resection or exenteration)for persistent or recurrent disease. The purpose of this study was to evaluate the outcomes of patients following radical resection for persistent or recurrent disease. METHODS: All patients treated with CRT or RT for anal cancer between 1990 and 2008 were identified using the regional cancer registry. Inclusion criteria: pathologically confirmed squamous cell carcinoma of the anal canal, localized disease, receiving ≥ 45Gy of RT. Statistical analysis was conducted to calculate survival rates and identify risk factors for poor outcomes. RESULTS: 105 patients (25 male) were identified. Median age was 57 years (range 33-87 yr). Median follow up was 40 months (range 3185). Median T stage and size at presentation were 2 and 35 mm (range 6-260mm) respectively. Median dose to the primary tumor was 54 Gy (45-76 Gy) at a median 28 fractions (range 20-37). 92 patients(88.5%) received concurrent chemotherapy. At 3 month followup 85 (83.3%) patients had complete clinical response, one patient had insufficient followup. 19 (18.1%) patients had persistent disease, of whom 12 underwent radical resection for cure; 5 (41.7%) are alive at a median of 106 months from diagnosis, while the remaining 7 died at a median 15 months from diagnosis. Recurrence occurred in 17 (20.0 %) patients at a median time of 9 months (4-53m). 8 patients underwent radical resection for recurrence; 2 (25.0%) patients are alive at 127 and 21 months, the remaining 6 died at a median time from recurrence of 24.5 months. Overall, disease specific and disease free survival, were 66%, 71% and 67% respectively for all anal canal carcinoma patients at 5 years. Multivariate analysis showed tumor size to be a significant risk factor for disease free (aOR 1.02, 95% CI: 1.01-1.04) and overall survival (aOR 1.03, 95% CI: 1.01-1.04) for all patients. CONCLUSION: Despite good response rates to sphincter-sparing therapy, 20% still required radical resection for persistent or recurrent disease. Survival rates following radical resection are poor.