Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation.

Purpose  Faecal incontinence (FI) is a frequent condition that can occur due to different causes; with negative impact on self-esteem and quality of life, secondary morbidity, disability and significant costs. For its treatment there is a wide range of options, being medical treatment, hygienic dietary modifications and biofeedback, the first line of treatment; reserving surgery for patients who do not respond or with severe FI; this with variable success rates and high cost. This study has the primary aim to assess the efficacy and describe the Technique of Application of Autologous Fat with Platelet Rich Plasma (AFPRiP) in patients with faecal incontinence as well as secondary endpoints of quality of life, manometric and ultrasound evaluation, safety of implantation, and complications. Methods  A single-centre prospective, experimental study, was conducted from January 2017 to February 2018 in Domingo Luciani Hospital. Wexner and FIQL scores were filled preoperative and compared at follow-up at 3, 6 and 12 months as well as anorectal manometry and endoanal ultrasound were performed before and 6 months after surgery. Results  Twelve patients were operated, mean time 43 min, no major complications. Wexner finding continence improvement from 10.4 pre to 4 in the 3rd month (p = 0.066) 4.74 at the 6th month (p = 0.001) and 5 at one year (p = 0.001); that is, improvement of >50% in 83.4%. FIQL 50.9 prior to 98.6 at 3rd month (p = 0.001) 95.5 to 6th month (p = 0.001) and 91.3 a year (p = 0.066). Conclusions  We conclude that AFPRiP is innovative, safe and with adequate results.

The operation described by Miles in 1908, an effective method in the radical treatment of tumors of the anus and lower rectum [1], and with better survival, leaves the stigma of the definitive iliac colostomy that leads to various psychosocial disorders [2]. Seeking to reduce social and family rejection, in addition to gas elimination and lack of control of the stools by the absence of sphincter, several methods of stools retention have been described [3-6]. Dr. Lázaro Da Silva, in Brazil, made the first perineal valve colostomy in 1991, when performing 2 to 3 extra-mucosal circular seromiotomies with invaginating seromuscular synthesis, with the meso-redundant occupying the pelvis, the distal valve stayed extra peritoneal and the proximal fixed to the promontory, this prevents or delays the excretion of stools directly [7]. It is indicated in patients proposed for abdominoperineal resection post-neoadjuvant, benign lesions with extensive sphincter involvement, extensive or intractable stenosis after perineal radiotherapy. This procedure is reserved for young or older patients in good physical condition, good cognitive level and without indication of postoperative radiotherapy [8].

Objective: To analyse the clinical features of perineal endometriosis (PEM), its treatment and outcome. Methods: Prospective, single-centre study with 13 patients with PEM who were treated between 2011-2018 at Domingo Luciani Hospital and mean followed up for 58.4 months. Results: Mean age was 32,2 years. All cases had a history of vaginal delivery with an episiotomy. All complained of perineal pain related to the menstrual cycle; the perineal mass progressively increased in size and was tender during menstrual periods. Mean VAS was 7. 69,2% with rectal bleeding. The mean size of the lesion was 3.42 cm. CA125 levels were measured in all patients, 3 (23,1%) with abnormal range; all patients were subjected to transvaginal, endoanal ultrasonography (EUS) and FNAB before surgery. Anal sphincter (AS) involvement was demonstrated by EUS in 46.2% (6). Mean EUS pre-treatment volume 18.98 ml. First, these 6 patients received hormonal therapy based on GnRH and evaluated response. Mean EUS post-treatment volume 10.21 ml p < 0.05. Complete local excision was performed on all cases. Mean CCFIS preoperative was 2.46 and postoperative 3.01 p=0.01. No major complications or recurrences were noted. Conclusion: PEM presents with typical clinical features when it involves the AS, it could benefit from first a hormonal therapy before surgery. EUS is a useful preoperative tool to decide what we should do. The main idea at the time of surgery is performed a complete local excision with non-touch AS, and in cases where these aren’t possible, a sphincteroplasty is mandatory with good continence results, minor complications and no recurrences.

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