BACKGROUND: In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE: To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS: Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS: The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION: MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

• MeSH
• anorektální malformace * diagnostické zobrazování   chirurgie   MeSH
• kolostomie MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie MeSH
• magnetická rezonanční tomografie metody   MeSH
• rektální píštěl * chirurgie   MeSH
• rektum diagnostické zobrazování   chirurgie   abnormality   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Postoperative constipation (PC) in patients with imperforate anus and perineal fistula (PF) has been reported in up to 60%. Histological studies of PF revealed innervation anomalies which seem to be one of the reasons for PC. Perioperative histologically controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP). MATERIALS AND METHODS: A total of 665 patients with anorectal malformations underwent surgery between 1991 and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH Tetrazolium-reductase histochemical method were used. Four and more ganglion cells in the myenteric plexus represented a sufficient length of the resection. The continence was scored according to the modified Krickenbeck scoring system. Final scores ranged from 1 to 7 points. Values are given as median. RESULTS: A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile range [IQR]: 20-30). The median total continence score was 7 (IQR: 6-7). Post-op constipation was observed in 6/92 (6.5%) patients. CONCLUSION: PHCFR diminished PC to 6.5% of patients.

• MeSH
• anální atrézie * chirurgie   MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• perineum chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• předškolní dítě MeSH
• rektální píštěl * chirurgie   MeSH
• rektum chirurgie   abnormality   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• zácpa etiologie   chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: It is still unclear if pathological complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients treated for rectal cancer causes worse postoperative outcomes, especially after transanal total mesorectal excision (TaTME). Worse postoperative outcomes might be an argument for an organ preserving watch and wait strategy in fragile patients and patients with comorbidities. The aim of this study is to evaluate whether patients treated for rectal cancer who had pCR to neoadjuvant therapy develop worse postoperative outcomes after TaTME than patients without complete response. METHODS: Comparative retrospective analysis (with nearest neighbor matching algorithm) of postoperative outcomes in two groups of patients, with pCR, n = 15 and without pCR (non-pCR), n = 57. All patients were operated on only by one surgical approach, TaTME, for middle and distal rectal tumors. All procedures were performed by one surgical team between 2014 and 2020 at the University Hospital Brno in Czech Republic. RESULTS: Overall morbidity was comparable between the groups (pCR group - 53.8% vs. non-pCR - 38.6%, p = 0.381). Anastomotic leak (AL) was observed in 33.3% of patients with pCR and in 17.5% of patients in the non-pCR group without statistical significance (p = 0.281). CONCLUSION: In conclusion, pathological complete response after neoadjuvant therapy does not appear to affect postoperative morbidity in rectal cancer after TaTME. Therefore, in patients with complete response who are not adherent to W&W surveillance, surgical resection can be perform without increased postoperative complications.

• MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• morbidita MeSH
• nádory rekta * chirurgie   patologie   MeSH
• neoadjuvantní terapie MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• rektum chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Kolorektální trauma se v soudobých válečných konfliktech vyskytuje v 5–10 %. Nejčastější příčinou je střelné nebo střepinové poranění, kontuzně-lacerační mechanismus je ve válečné zóně ojedinělý. I přes moderní léčebné postupy je ale zatíženo vysokou mírou morbidity, zejména pokud není včas diagnostikováno a léčeno. Management chirurgické léčby upřesňují jednoduchá skórovací schémata – colon injury scale, rectal injury scale a Flintův skórovací systém. Resekční výkony tračníku s primární nebo odloženou anastomózou nemají vyšší riziko komplikovaného hojení a v dnešní době jsou upřednostňovány před konstrukcí terminálních stomií. Ty jsou indikovány při závažné oběhové nestabilitě při hemoragicko-traumatickém nebo septickém šoku s pokročilou difuzní peritonitidou. K traumatu intraperitoneálního segmentu rekta se přistupuje stejně jako k tračníku. Poranění extraperitoneálního rekta bez devastace měkkých tkání může být ošetřeno transanální suturou nebo i bez ní. Naopak devastující poranění rekta spolu s měkkými tkáněmi pánve se mají primárně zajistit derivační stomií a odloženou rekonstrukcí. Presakrální drenáž nebo laváž rekta již nejsou doporučovány.

The rate of colorectal trauma is 5–10 % in modern war conflicts. The most common causes include gunshots or shrapnel injuries; the contusion-laceration mechanism occurs in sporadic cases in the war zone. Despite modern surgical procedures, however, it is associated with a high rate of morbidity, especially if it is not diagnosed and treated in time. Surgical management is specified by simple scoring schemes – the colon injury scale, rectal injury scale and the Flint grading system. Colonic resection with primary or delayed anastomosis is not associated with a higher risk of complicated healing and is nowadays preferred over the construction of terminal stomas. These are indicated only for cases with severe hemodynamic instability in traumatic-hemorrhagic or septic shock with severe diffuse peritonitis. Trauma to the intraperitoneal segment of the rectum is treated in the same way as trauma to the colon. An extraperitoneal rectal injury without soft tissue devastation can be treated with or without a transanal suture. On the contrary, devastating injuries to the rectum including the pelvic soft tissues should be primarily controlled with a stoma with delayed reconstruction. Presacral drainage or rectal stump lavage are no longer recommended.

• MeSH
• anastomóza chirurgická MeSH
• kolon chirurgie   diagnostické zobrazování   zranění   MeSH
• lidé MeSH
• penetrující rány * chirurgie   diagnostické zobrazování   MeSH
• poranění břicha chirurgie   diagnostické zobrazování   MeSH
• rektum chirurgie   diagnostické zobrazování   zranění   MeSH
• válečná poranění * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE: The aim of this experimental study was to test the method of prevention of postoperative complications, especially infectious, in partial dehiscence following stapler anastomosis in rectal surgeries. METHODS: The method includes the application of a hyaluronic acid-based gel in combination with triclosan, which has antibacterial properties. The gel was applied to the space around the rectum with an artificial, precisely defined dehiscence so that the dehiscence was separated from the rest of pelvis and the peritoneal cavity to avoid the spread of infection. The study included 30 female pigs. The rectosigmoid colon was mobilized and transected completely. Anastomosis was constructed with circular staplers. A perforator was then used to create precisely defined artificial dehiscence. Subsequently the lesser pelvis was filled with hyaluronic gel such that the site of artificial dehiscence was covered completely. RESULTS: All animals survived for 14 days until the second-look revision with no signs of failure in the anastomosis healing, local inflammation, and sepsis or postoperative complications, such as chills, refusal of liquid or feed, abdominal distension, and bowel obstruction. CONCLUSION: Hyaluronic acid applied as a precursor solution around the rectal anastomosis fills the lesser pelvis perfectly. It prevents the leakage of intestinal contents in the lesser pelvis. Triclosan as an antibacterial substance prevents the spread of inflammation in the pelvis or even in the abdominal cavity.

• MeSH
• anastomóza chirurgická metody   MeSH
• antibakteriální látky terapeutické užití   MeSH
• kyselina hyaluronová MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy MeSH
• pánev chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• prasata MeSH
• rektum chirurgie   MeSH
• triclosan * MeSH
• zánět MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS: A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS: Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION: In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.

• MeSH
• anastomóza chirurgická metody   MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy etiologie   chirurgie   MeSH
• prasata MeSH
• rektum chirurgie   MeSH
• sepse * MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Kazuistika popisuje případ 17leté dívky opakovaně vyšetřované pro dlouhodobé bolesti břicha. Její potíže splňovaly kritéria pro funkční zácpu dle IV. revize Římské klasifikace, a proto jí bylo doporučeno užívání osmotických laxativ, režimová opatření a rehabilitace. Tato terapie však neměla dostatečný efekt. Pro přetrvávání potíží a progresi bolestí břicha při defekaci bylo doplněno proktologické vyšetření. To odhalilo možnou příčinu obtíží pacientky, a to anus ventralis - vrozenou anomálii řazenou ke skupině anorektálních malformací. Anus ventralis je stav, při kterém se na hrázi nachází anální otvor normálního vzhledu, ovšem v různé míře dislokovaný ventrálním směrem. Tento posun může být velmi mírný, a unikat tak odhalení, jak tomu bylo přes opakovaná vyšetření i v případě naší pacientky. Obvyklou manifestací této anomálie je nástup obstipace brzy po porodu, nicméně k rozvoji chronických potíží může dojít i později. Operace v tomto případě přinesla jejich řešení. Cílem sdělení je rozšířit povědomí o této méně obvyklé, avšak nikoli vzácné, organické příčině zácpy a seznámit čtenáře s možnostmi její diagnostiky a terapie.

We describe the case of a 17year old girl who was repeatedly examined for chronic abdominal pain. Her symptoms met the Rome IV. criteria for functional obstipation and therefore she was recommended the use of osmotic laxatives, régime measures and physiotherapy. However, this therapy brought insufficient effect. For ongoing symptomatology, further diagnostic steps were performed including proctological examination by which anus ventralis was diagnosed. This anorectal malformation represents a condition in which the anal orifice of a normal appearance is shifted in the ventral direction. Clinical symptoms depend on the level of the anal orifice shift. The usual manifestation of this anomaly is the onset of obstipation soon after birth, but if only slight shift is present, chronic problems may develop over time. Surgical reconstruction brought permanent improvement of the symptoms. The aim of this case report is to raise awareness of this less common, but not rare, organic cause of chronic obstipation and to describe its therapeutic and diagnostic modalities.

• Klíčová slova
• anus ventralis,
• MeSH
• anální kanál chirurgie   MeSH
• anorektální malformace * chirurgie   diagnóza   MeSH
• bolesti břicha etiologie   MeSH
• lidé MeSH
• mladiství MeSH
• píštěle trávicího systému MeSH
• rektum chirurgie   MeSH
• výsledek terapie MeSH
• zácpa etiologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019-October 2020. The mean age of patients was 61 years (lower-upper quartiles 54-69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower-upper quartiles 3.00-4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien-Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

• MeSH
• anastomóza chirurgická MeSH
• drenáž MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy MeSH
• pilotní projekty MeSH
• rektum * chirurgie   MeSH
• retrospektivní studie MeSH
• sliznice MeSH
• vakuum MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To demonstrate the use of a single-stapler technique during rectosigmoid resection in women with deep infiltrating endometriosis (DIE). DESIGN: A step-by-step video demonstration of rectosigmoid resection and end-to-end anastomosis using two circularly placed sutures and one circular stapler. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic. PATIENT(S): A 39-year-old woman presented with primary sterility and deep infiltrating endometriosis, and an EZIAN score of A2,B2,C3. A nodule was located 9 cm from the anus and was 38 × 9 mm in size. This included an intramural fibroma of 6 cm and a left-sided ovarian endometriotic cyst of 6 cm. Her pain on the visual analogue scale were dysmenorea 6, dyspareunia 5-6, dyschezie 7, dysuria 0, and acyclic pain 5. INTERVENTIONS: The primary objective was to replace the linear-stapler resection with two simple, strictly circularly placed sutures, to cut the intestinal wall between them, and to form the end-to-end anastomosis with a circular stapler. The one-stapler technique consisted of the following steps: intestinal wall cleansing as in the limited segmental resection; placement of one strictly circular suture just below the DIE nodule, without fixation; placement of the first circular suture just below the DIE nodule, ideally with at least three full-thickness "bites" of the intestinal wall; placement of the second circular stitch approximately 2 cm below the first one in a similar manner (three full-thickness "bites"); interruption of the intestinal wall with a harmonic scalpel; end-to-end intestinal anastomosis with a circular stapler; and airtightness test of the anastomosis. This results in only one incision line and therefore a lower risk of leakage. Intestinal resection time was on average 10 minutes longer compared to that for the linear stapler technique. So far, we have successfully performed the procedure in 25 women. Perioperative leakage was observed in two of these 25 patients in the classical procedure group and in none of the 25 patients in the group with the one-stapler technique. There were no differences in C-reactive protein (CRP) on third and fifth postoperative days or in other complications such as bleeding and pyrexia). The cost of procedure is lowered by the decrease in the number of staplers from 3 to 1. The patients' postoperative follow-up was uneventful, and they were discharged from the hospital at the same time as the women in whom the classical stapler technique was performed. MAIN OUTCOME MEASURES(S): The primary outcome was the development of a new surgical approach to resection rectosigmoid endometriotic nodules that would decrease the number of incision lines on the intestine. The secondary outcome measures were peri- and postoperative complications (i.e., bleeding, intestinal leakage, postoperative infection, CRP), length of the surgery and hospitalization, and cost of the procedure. CONCLUSION: Multiple incision lines following resection of the rectosigmoid colon and end-to-end anastomosis are risk factors for postoperative intestinal leakage. Therefore, a single incision line formed with two circular sutures, and one circular stapler may reduce the risk of postoperative complications and also financial expenses of the procedure. We believe that this method is suitable and easiest for nodules located less than 6 cm from the anal verge because of possible complications with angulation of linear stapler.

• MeSH
• colon sigmoideum diagnostické zobrazování   chirurgie   MeSH
• dospělí MeSH
• endometrióza diagnostické zobrazování   chirurgie   MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• rektum diagnostické zobrazování   chirurgie   MeSH
• šicí techniky * MeSH
• sutura * MeSH
• video-asistovaná chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• chirurgické staplery MeSH
• elektrokoagulace metody   přístrojové vybavení   MeSH
• lidé MeSH
• nádory rekta chirurgie   MeSH
• rektum chirurgie   MeSH
• roboticky asistované výkony * dějiny   metody   statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH