In patients with high transsphincteric anal fistulas, both ligation of intersphincteric fistula track procedure and mucosal advancement flap have a similar long-term healing rate, recurrences, continence, and quality of life. However, ligation of the intersphincteric fistula track has the advantage of less postoperative pain.

STARR is a safe surgical procedure that effectively restores the anatomy and function of the anorectum in patients with ODS. This correction improves functional and QOL scores; however, a high rate of symptomatic recurrence and QOL score decline are expected after 18 months.

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BACKGROUND: Posterior tibial nerve stimulation influences both motor and sensory pathways, as well as the central nervous system. Stimulation of posterior tibial nerve roots (L4 to S3) could improve stool evacuation through S3 and/or S2 stimulation. OBJECTIVE: This study aimed to assess the efficiency of bilateral posterior tibial nerve stimulation in the treatment of rectal evacuation disorder without anatomic obstruction. DESIGN: This was a prospective case series studying the treatment of patients with obstructed defecation by posterior tibial nerve stimulation. SETTING: The study was conducted at a tertiary referral academic medical center. PATIENTS: Patients with rectal evacuation disorder without anatomic obstruction who were failing maximal conservative treatments were included. INTERVENTION: Thirty minutes of bilateral transcutaneous posterior tibial nerve stimulation was applied 3 times weekly for each patient for 6 consecutive weeks. MAIN OUTCOME MEASURES: The primary end point was the change in the modified obstructed defecation score. Secondary end points were changes in rectal sensitivity volumes (urge to defecate volume and maximal tolerable volume) and quality of life using the Patient Assessment of Constipation–Quality of Life questionnaire. RESULTS: Thirty-six patients (25 women) completed the trial. The mean age of patients was 57.2 years (SD = 14.4 y). No adverse events were reported. Symptomatic successful outcome was reported in 17 patients (47%) and modified obstructed defecation score decreased over 6 weeks (mean decrease = 10 points (95% CI, 8.7–11.3 points); p < 0.0001). Patients with successful outcome (responders) had relatively lower preoperative modified obstructed defecation score compared with patients with unsuccessful outcome (nonresponders). In the successful group, there were significant improvement after 6 weeks in both Patient Assessment of Constipation–Quality of Life score (mean improvement = 43.0 points (95% CI, 35.2–50.7 points); p < 0.0001) and rectal sensitivity (significant reductions in urge to defecate volume (from 258.1 ± 21.2 to 239.6 ± 15.3; p < 0.0001) and maximal tolerable volume (from 304.5 ± 24.8 to 286.8 ± 19.7; p < 0.0001)). No significant change in Patient Assessment of Constipation–Quality of Life or rectal sensitivity was observed in the nonresponders. LIMITATIONS: The study was designed just to proof the concept, but small sample size is a limitation. Another limitation is the short duration of study of only 6 weeks. CONCLUSIONS: Current data showed that bilateral transcutaneous posterior tibial nerve stimulation can improve symptoms in a considerable percentage of patients with obstructed defecation without anatomic obstruction. The procedure is more effective in patients with a less-modified obstructed defecation score. Additional studies are needed to discover the predictive factors for success.

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Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure’s outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients’ records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.

Background: To evaluate results of pre-operative Complete Blood Count (CBC), with special emphasis on lymphocytic count and ratio as predictive factors for rectal cancer response to neoadjuvant chemoradiotherapy and prediction of complete pathological response. The Aim of the Study: Is to evaluate results of pre-operative complete blood count, with special emphasis on lymphocytic count and lymphocyte ratio as predictive factors of rectal cancer response to neoadjuvant chemoradiotherapy. Patients and Methods: This research studied the association between CBC results of patients with stage II or III Locally Advanced Rectal Cancer (LARC) before neoadjuvant therapy and the pathological response found in the specimen after standard surgical management. Patients were divided into two groups; Group I included patients with complete pathological response and Group II included patients with no or partial pathological response to study the predictive factors for complete pathological response. Results: A total of 36 patients (20 females and 16 males) were included. Mean age was 56.40 ± 11.18 years. 19 patients (52.7%) underwent low anterior resections and 17 patients (47.2%) underwent abdomino-perineal resections. Lymphocytic count and ratio were significant predictive factors for the pathological response of the tumor to neoadjuvant therapy (p=0.011 and 0.048, respectively). Comparison between Group I and Group II showed that lymphocytic count and ratio were significant predictive factors for patients in Group I compared to Group II (p=0.001 and p=0.049, respectively). Conclusions: Lymphocytic count and ratio can play an important role as predictive factors for pathological response to neoadjuvant therapy in patients with LARC and also as predictive factors for complete pathological response. Further multicenter studies with larger number of patients are needed.