Tech Coloproctol (2014) 18:87–88 DOI 10.1007/s10151-013-1091-y
CONGRESS REPORT
Update on common anorectal diseases V. Lohsiriwat
Published online: 1 November 2013 Ó Springer-Verlag Italia 2013
The 9th East–West Colorectal Days and the 11th Annual Meeting of the Association of Coloproctology of Hungary, one of the most important coloproctology conferences in Eastern Europe, were held on 4–6 September 2013 in Hajduszoboszlo, a charming city of thermal baths in Hungary. This year the congress aimed to provide up-todate knowledge and management of common anorectal diseases. Some highlights of the event are described below. Dr. Hans Joachim Schmoll from Halle, Germany, opened the scientific session with a comprehensive talk on the treatment for locally advanced rectal cancer with or without liver/lung metastasis. He emphasized that the management of such lesions required a multidisciplinary team approach to make a personalized clinical decision for optimal treatment for each patient, providing long-term survival and satisfactory quality of life. He also addressed the treatment algorithm for localized rectal cancer, rectal cancer with resectable and unresectable synchronous metastasis based on the European Society for Medical Oncology (ESMO) 2012 Consensus Guidelines for management of patients with colon and rectal cancer. Dr. Varut Lohsiriwat from Bangkok, Thailand, discussed the emerging pathophysiology and modern treatment for hemorrhoids. Basically, the current pathophysiology of hemorrhoids includes the degenerative change in supportive tissue within the anal cushions, internal rectal prolapse, vascular hyperplasia, and hyperperfusion of the hemorrhoidal plexus. Although treatment options mainly depend on the grade and severity of
V. Lohsiriwat (&) Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand e-mail: [email protected]
hemorrhoids, the recent approaches including non-surgical and surgical management aim not only to cure the disease (or reduce recurrence) but also to minimize postprocedural complications including pain. Dr. Richard Nelson from Sheffield, UK, described the evidence-based management of chronic anal fissure. He concluded that chemical sphincterotomy (currently consisting of topical glyceryl trinitrate, topical calcium channel blockers or botulinum toxin injection) could be recommended as first-line treatment. However, the healing success rate of chemical sphincterotomy is lower than partial lateral internal sphincterotomy (LIS), which remains the gold standard treatment for chronic anal fissure. V–Y anoplasty can be offered in case of failure of LIS or in fissures without anal spasm. Dr. Nelson also reported his personal experience treating 40 patients with severe defecation disorders using the Malone antegrade continence enema (the appendix was used as a conduit). With a mean follow-up of about 2 years, approximately 80 % of patients reported good functional outcomes. Dr. Nelson emphasized that the Malone antegrade continent enema could be a valuable option providing a less invasive procedure than colectomy or ileostomy for severe defecation disorders. He delivered another interesting talk on the up-to-date treatment for Clostridium difficile-associated diarrhea in adults. Dr. Mario Pescatori from Rome, Italy, who this year received the Herczel Award from the Association of Coloproctology of Hungary (president: Dr. Ivan Bartha), delivered a provocative and outstanding talk entitled ‘‘Innovations in anorectal and pelvic floor surgery: successes and failures.’’ He concluded that successful innovations in the last 2 decades included transanal endoscopic microsurgery (TEM) for rectal cancer, botulinum toxin injection for chronic anal fissure, sacral nerve stimulation
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for fecal incontinence, LigasureTM hemorrhoidectomy, and vacuum-assisted closure. He pointed out that some novel innovations still require further evaluation. These include transanal hemorrhoidal dearterialization (THD), fistula plug, video assisted anal fistula treatment (VAAFT), stapled transanal rectal resection (STARR) for obstructive defecation disorders, biofeedback, and posterior tibial nerve stimulation for fecal incontinence, and magnetic anal sphincter. In his opinion, cryotherapy or laser treatment has no existing role on the treatment for hemorrhoids, and dynamic graciloplasty has failed to substantially improve fecal incontinence. Dr. Mario Pescatori also gave another wonderful lecture on the prevention of postoperative complications after anorectal surgery. Using a teleconference, Dr. Donato Altomare from Bari, Italy, illustrated his new score in patients with procto- and uro-gynecological problems in obstructed defecation.
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Tech Coloproctol (2014) 18:87–88
Dr. Varut Lohsiriwat closed the second day of the meeting with a talk on perioperative pain control (surgeon’s perspective), with some applications for enhanced recovery after surgery (ERAS) protocols. He stated that, together with the concept of preemptive and preventive analgesia, multimodal analgesia, preferably non-opioid analgesics (e.g., selective cyclooxygenase 2 inhibitors), should be utilized to minimize acute postoperative pain, decrease adverse events, and enhance recovery. In conclusion, there is a continuing progress in the field of coloproctology, in both surgical and non-surgical approaches. Aiming to improve care of patients with various colorectal diseases, East–West Colorectal Days is an important platform for up-to-date knowledge, and sharing of ideas.
CONGRESS REPORT
Update on common anorectal diseases V. Lohsiriwat
Published online: 1 November 2013 Ó Springer-Verlag Italia 2013
The 9th East–West Colorectal Days and the 11th Annual Meeting of the Association of Coloproctology of Hungary, one of the most important coloproctology conferences in Eastern Europe, were held on 4–6 September 2013 in Hajduszoboszlo, a charming city of thermal baths in Hungary. This year the congress aimed to provide up-todate knowledge and management of common anorectal diseases. Some highlights of the event are described below. Dr. Hans Joachim Schmoll from Halle, Germany, opened the scientific session with a comprehensive talk on the treatment for locally advanced rectal cancer with or without liver/lung metastasis. He emphasized that the management of such lesions required a multidisciplinary team approach to make a personalized clinical decision for optimal treatment for each patient, providing long-term survival and satisfactory quality of life. He also addressed the treatment algorithm for localized rectal cancer, rectal cancer with resectable and unresectable synchronous metastasis based on the European Society for Medical Oncology (ESMO) 2012 Consensus Guidelines for management of patients with colon and rectal cancer. Dr. Varut Lohsiriwat from Bangkok, Thailand, discussed the emerging pathophysiology and modern treatment for hemorrhoids. Basically, the current pathophysiology of hemorrhoids includes the degenerative change in supportive tissue within the anal cushions, internal rectal prolapse, vascular hyperplasia, and hyperperfusion of the hemorrhoidal plexus. Although treatment options mainly depend on the grade and severity of
V. Lohsiriwat (&) Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand e-mail: [email protected]
hemorrhoids, the recent approaches including non-surgical and surgical management aim not only to cure the disease (or reduce recurrence) but also to minimize postprocedural complications including pain. Dr. Richard Nelson from Sheffield, UK, described the evidence-based management of chronic anal fissure. He concluded that chemical sphincterotomy (currently consisting of topical glyceryl trinitrate, topical calcium channel blockers or botulinum toxin injection) could be recommended as first-line treatment. However, the healing success rate of chemical sphincterotomy is lower than partial lateral internal sphincterotomy (LIS), which remains the gold standard treatment for chronic anal fissure. V–Y anoplasty can be offered in case of failure of LIS or in fissures without anal spasm. Dr. Nelson also reported his personal experience treating 40 patients with severe defecation disorders using the Malone antegrade continence enema (the appendix was used as a conduit). With a mean follow-up of about 2 years, approximately 80 % of patients reported good functional outcomes. Dr. Nelson emphasized that the Malone antegrade continent enema could be a valuable option providing a less invasive procedure than colectomy or ileostomy for severe defecation disorders. He delivered another interesting talk on the up-to-date treatment for Clostridium difficile-associated diarrhea in adults. Dr. Mario Pescatori from Rome, Italy, who this year received the Herczel Award from the Association of Coloproctology of Hungary (president: Dr. Ivan Bartha), delivered a provocative and outstanding talk entitled ‘‘Innovations in anorectal and pelvic floor surgery: successes and failures.’’ He concluded that successful innovations in the last 2 decades included transanal endoscopic microsurgery (TEM) for rectal cancer, botulinum toxin injection for chronic anal fissure, sacral nerve stimulation
123
88
for fecal incontinence, LigasureTM hemorrhoidectomy, and vacuum-assisted closure. He pointed out that some novel innovations still require further evaluation. These include transanal hemorrhoidal dearterialization (THD), fistula plug, video assisted anal fistula treatment (VAAFT), stapled transanal rectal resection (STARR) for obstructive defecation disorders, biofeedback, and posterior tibial nerve stimulation for fecal incontinence, and magnetic anal sphincter. In his opinion, cryotherapy or laser treatment has no existing role on the treatment for hemorrhoids, and dynamic graciloplasty has failed to substantially improve fecal incontinence. Dr. Mario Pescatori also gave another wonderful lecture on the prevention of postoperative complications after anorectal surgery. Using a teleconference, Dr. Donato Altomare from Bari, Italy, illustrated his new score in patients with procto- and uro-gynecological problems in obstructed defecation.
123
Tech Coloproctol (2014) 18:87–88
Dr. Varut Lohsiriwat closed the second day of the meeting with a talk on perioperative pain control (surgeon’s perspective), with some applications for enhanced recovery after surgery (ERAS) protocols. He stated that, together with the concept of preemptive and preventive analgesia, multimodal analgesia, preferably non-opioid analgesics (e.g., selective cyclooxygenase 2 inhibitors), should be utilized to minimize acute postoperative pain, decrease adverse events, and enhance recovery. In conclusion, there is a continuing progress in the field of coloproctology, in both surgical and non-surgical approaches. Aiming to improve care of patients with various colorectal diseases, East–West Colorectal Days is an important platform for up-to-date knowledge, and sharing of ideas.
