Annals of Coloproctology

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Anorectal physiology & pelvic floor disorder

The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome: Adolfo Renzi, Luigi Brusciano, Pasquale Talento, Luigi Marano, Francesca Iacobellis, Antonio Vallo, Giovanna Frezza, Maurizio Grillo, Alessio Palumbo, Elisa Palladino, Benedetto Neola, Fabrizio Foroni, Michele Lanza, Massimo Antropoli, Carmine Antropoli, Mauro Natale Maglio, Maria Laura Sandoval Sotelo, Gianluca Pagano, Maria Michela Di Nuzzo, Luciano Vicenzo, Michele Schiano di Visconte, Gabriele Naldini, Leonardo Lenisa, Marcello Gasparrini, Giuseppe Candilio, Massimo Pezzatini, Francesca Ascari, Alberto Di Leo, Monica Urbani, Simona Ascanelli, Alessandro Bussotti, Natale Calomino, Domenico Izzo, Roberto Peltrini, Michele D'Ambra, Giovanni Greco, Giuseppe D'Oriano, Alfredo Giordano, Claudio Gambardella, Diletta Paola Iovino, Andrea Grego, Luigi Pellecchia, Luigi Monaco, Ilaria Ferrante, Giovanni Luca Lamanna, Vinicio Mosca, Sergii Girnyi, Gianluca Minieri, Luigi Losacco, Giacomo Sarzo, Giuseppe Calabrò, Francesco Ghiglione, Sergio Agradi, Michele Pinto, Andrea Marazzi, Mariangela Desantis, Federico Maria Mongardini, Massimo Mongardini, Aurora Marotta, Andrea Lauretta, Giovanni Ferreri, Alfredo Annicchiarico, Francesca Da Pozzo, Alfredo Ansalone, Matteo Zuin, Nadine Osman, Paolino Mauro, Corrado Rispoli, Tomasz Cwalinski, Roberto Rizzato, Nando Gallese, Marta Mozzon, Alessandro Stazi, Luana Franceschilli, Angelo Stuto, Eugenio Cudazzo, Silvia Malerba, Riccardo Brachet Contul, Antonio Canero, Nicola Antonacci, Francesca Milazzo, Costantino Magnani, Cristina Folliero, Francesca Babic, Silvia Marola, Andrea Braini, Guido Benegiamo, Umberto Cocozza, Bruno Masci, Rita Laforgia, Angela Pezzolla, Antonio Colangelo, Carmelo Geremia, Raffaella Marina Di Renzo, Claudio Pagano, Roberto Picheo, Umberto Favetta, Fabrizio Gambarini, Laura Chimisso, Gianmattia Terracciano, Adelaide Andriani, Giovanni Marino, Patrizia Liguori, Carmen Formisano, Izabela Zofia Paszkiewicz, Alfonso Reginelli, Francesco Tumminelli, Martina Caruso, Marianna Pennacchio, Francesco Antonio Ciarleglio, Nicola Lizza, Francesco d’Aniello, Lorenzo Asciore, Pierluigi Bianchi, Emanuela Tessari, Eleonora Rossin, Maria Paola Menna, Giampiero Ucchino, Fabrizio Vittadello, Monica Oliva, Francesca Gatto, Raffaella Ferrando, Ilaria Granese, Mario Cicconi, Massimiliano Mistrangelo, Giovanna Ioia, Valeria Gianfreda, Ettore Greco, Adriana Maria Landolfi, Giandomenico Di Sarno, Vincenzo Landolfi, Carolina Bartolini, Luciano Onofrio, Domenico De Vito, Salvatore Napolitano, Vincenzo Bottino, Antonio Longo, Antonio Brescia, Chiara Casiraghi, Alfonso Alderisio, Mario Massimo Mensorio, Ludovico Docimo, Antonio Brillantino; Ann Coloproctol. 2026;42(2):151-178. Published online April 28, 2026; DOI: https://doi.org/10.3393/ac.2025.00899.0128

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Abstract PDF: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) on the diagnosis and management of obstructed defecation syndrome (ODS), with the purpose of guiding physicians in the selection of the most appropriate treatment option. A panel of experts was appointed by the Board of the SIUCP to develop key questions addressing the main topics related to the management of ODS and to perform an accurate literature search for each topic, in order to provide evidence-based answers and to summarize them in structured statements. All clinical questions were discussed by the expert panel over multiple rounds using the Delphi approach, and consensus among the experts was achieved for each statement. The questions were formulated according to PICO (patients, intervention, comparison, outcome) criteria, and the statements were developed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In patients with ODS refractory to first-line medical therapy, rehabilitation may be considered as a therapeutic option, particularly in cases of dyssynergic defecation, whereas a surgical approach may be indicated in patients with a high symptom score and an Oxford prolapse grade system score ≥3 on defecography (using magnetic resonance imaging or another modality). Surgical options include stapled transanal rectal resection and ventral mesh rectopexy, eventually combined, respectively, with pelvic organ prolapse suspension and sacrocolpopexy in the presence of multicompartment pelvic prolapse. A transverse perineal support procedure may be considered in the presence of excessive perineal descent. In patients with recurrent symptoms after surgery, transanal irrigation may represent a useful therapeutic option.

Anorectal benign disease

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease: Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Claudio Gambardella, Luigi Monaco, Ilaria Ferrante, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferreri, Andrea Braini, Umberto Cocozza, Massimo Pezzatini, Valeria Gianfreda, Alberto Di Leo, Vincenzo Landolfi, Umberto Favetta, Sergio Agradi, Giovanni Marino, Massimiliano Varriale, Massimo Mongardini, Claudio Eduardo Fernando Antonio Pagano, Riccardo Brachet Contul, Nando Gallese, Giampiero Ucchino, Michele D’Ambra, Roberto Rizzato, Giacomo Sarzo, Bruno Masci, Francesca Da Pozzo, Simona Ascanelli, Patrizia Liguori, Angela Pezzolla, Francesca Iacobellis, Erika Boriani, Eugenio Cudazzo, Francesca Babic, Carmelo Geremia, Alessandro Bussotti, Mario Cicconi, Antonia Di Sarno, Federico Maria Mongardini, Antonio Brescia, Leonardo Lenisa, Massimiliano Mistrangelo, Matteo Zuin, Marta Mozzon, Alessandro Paolo Chiriatti, Vincenzo Bottino, Antonio Ferronetti, Corrado Rispoli, Ludovico Carbone, Giuseppe Calabrò, Antonino Tirrò, Domenico de Vito, Giovanna Ioia, Giovanni Luca Lamanna, Lorenzo Asciore, Ettore Greco, Pierluigi Bianchi, Giuseppe D’Oriano, Alessandro Stazi, Nicola Antonacci, Raffaella Marina Di Renzo, Gianmario Edoardo Poto, Giuseppe Paolo Ferulano, Antonio Longo, Ludovico Docimo; Ann Coloproctol. 2024;40(4):287-320. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2023.00871.0124

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Abstract PDF

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Citations

Citations to this article as recorded by

Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis
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Updates in Surgery.2026; 78(1): 169. CrossRef
Laser Hemorrhoidoplasty for Grade III Hemorrhoidal Disease: Safety and Efficacy in a Brazilian Multicenter Retrospective Cohort Study
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Photobiomodulation, Photomedicine, and Laser Surgery.2026;[Epub] CrossRef
Comparative Effectiveness of Lidocaine- Versus Nifedipine-Based Multimodal Conservative Regimens for Acute Hemorrhoidal Disease
Michele Schiano di Visconte, Sonia Sarnari, Angelo Guttadauro, Marco Chiarelli, Umberto Favetta
Journal of Clinical Gastroenterology.2026;[Epub] CrossRef
Determinants influencing decision-making for operative and perioperative management of grade III and IV hemorrhoidal disease: secondary analysis of a multicenter nationwide prospective cohort study
Metin Kement, Orhan Ali̇moğlu, Hakan Baysal, Salih Tosun, Atif Tekin, Ilker Sucullu, Osman Ci̇vi̇l, Nevi̇n Sakoğlu, Naci̇ye Çi̇ğdem Arslan, Ci̇had Tatar, Rozan Kaya, Ali̇ Emre Nayci, Taygun Gülşen, Serhat Meri̇c, Farid Mohamad Hamad, Ahmed Salhat, Ni̇hat
Langenbeck's Archives of Surgery.2026;[Epub] CrossRef
The Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of obstructed and ineffective defecation syndrome
Adolfo Renzi, Luigi Brusciano, Pasquale Talento, Luigi Marano, Francesca Iacobellis, Antonio Vallo, Giovanna Frezza, Maurizio Grillo, Alessio Palumbo, Elisa Palladino, Benedetto Neola, Fabrizio Foroni, Michele Lanza, Massimo Antropoli, Carmine Antropoli,
Annals of Coloproctology.2026; 42(2): 151. CrossRef
Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease
Gaetano GALLO, Mario TROMPETTO
Minerva Surgery.2025;[Epub] CrossRef
Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Qing Long, Yong Wen, Jun Li
BMC Gastroenterology.2025;[Epub] CrossRef
Critical appraisal of transperineal Doppler ultrasound as a diagnostic tool for hemorrhoidal recurrence
Michele Schiano di Visconte
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study
Antonio Brillantino, Francesca Iacobellis, Luigi Marano, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Claudio Gambardella, Umberto Favetta, Michele Schiano Di Visconte, Luigi Monaco, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palum
Annals of Coloproctology.2025; 41(3): 207. CrossRef
Acute thrombosis of hemorrhoidal nodes: conservative against surgical treatment
A. Ya. Ilkanich, R. A. Kolomyts, Yu. S. Voronin
Yakut Medical Journal.2025; (2): 40. CrossRef
Hämorrhoidalleiden und stadienabhängige Behandlung (inklusive Analprolaps)
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Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study
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Postoperative Perianal Abscess and Concomitant Anorectal Fistula: An Extremely Rare Complication After Emergency Transanal Hemorrhoidal Dearterialization With Mucopexy for Hemorrhoidal Disease
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Case Reports in Surgery.2025;[Epub] CrossRef
Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids
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Transverse perineal support improves long-term outcomes in patients undergoing stapled transanal rectal resection for obstructed defecation syndrome: a multicenter observational case-control study
Adolfo Renzi, Luigi Marano, Pasquale Talento, Luigi Brusciano, Angela Pezzolla, Domenico Izzo, Carmine Antropoli, Francesco D’Aniello, Giandomenico Di Sarno, Gianluca Minieri, Grazia Cantore, Gianmattia Terracciano, Domenico Barbato, Ludovico Docimo, Mass
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Hemorrhoidal Disease
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Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef

Original Article

Malignant disease, Rectal cancer,Colorectal cancer,Surgical technique

The “reverse air leak test”: a new technique for the assessment of low colorectal anastomosis: Francesco Crafa, Augusto Striano, Francesco Esposito, Amalia Rosaria Rita Rossetti, Mario Baiamonte, Valeria Gianfreda, Antonio Longo; Ann Coloproctol. 2022;38(1):20-27. Published online December 4, 2020; DOI: https://doi.org/10.3393/ac.2020.09.21.1

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14 Web of Science
17 Citations

Abstract PDF

Purpose
Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution.
Methods
From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis.
Results
The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned.
Conclusion
The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.

Citations

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Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
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Journal of Gastrointestinal Surgery.2025; 29(2): 101899. CrossRef
Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
Cureus.2025;[Epub] CrossRef
Laparoscopic discoid rectal resection as surgical treatment for endometrial cancer recurrence
Francesco Cosentino, Alessio Colalillo, Claudia Tucci, Francesco Corbisiero, Daniele Neola, Diego Raimondo, Antonio Raffone
International Journal of Gynecological Cancer.2025; : 101637. CrossRef
Usefulness of AirSeal Leak Test for taTME‐Assisted Surgery for Lower Rectal Cancer
Yume Minagawa, Yasumitsu Hirano, Sohei Akuta, Akihito Nakanishi, Yusuke Nishi, Hisashi Hayashi, Takatsugu Fujii, Yasuhiro Ishiyama, Chikashi Hiranuma
Asian Journal of Endoscopic Surgery.2025;[Epub] CrossRef
Solo surgery for low rectal cancer: trans‐circular anal dilator low rectal dissection associated with laparoscopic total mesorectal excision—A Video Vignette
Crafa Francesco, Vanella Serafino, Emanuele Caruso, Madoka Hamada, Nozomi Ueno
Colorectal Disease.2024; 26(4): 805. CrossRef
Colorectal eversion technique combined with modified single‐stapled double‐purse‐string low colorectal anastomosis
Crafa Francesco, Vanella Serafino
Colorectal Disease.2024; 26(4): 772. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Treatment of anastomotic leak in colorectal surgery by endoluminal vacuum therapy with the VACStent avoiding a stoma - a pilot study
Markus M. Heiss, Jonas Lange, Judith Knievel, Alexander Yohannes, Ulrich Hügle, Arno J. Dormann, Claus F. Eisenberger
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Propuesta de una técnica quirúrgica modificada para prevenir fugas anastomóticas colorrectales
Malik Takkal, Xavier Delgadillo, Amel Takkal, Sara Al-Maimouni
Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon.2024; 20(1): 12. CrossRef
Risk stratification of anastomotic leakages after colonic resection and reconstructive procedures
A. A. Vaganov, A. Yu. Korol’kov, P. I. Bogdanov, Z. Kh. Osmanov, V. P. Morozov, A. V. Babich
Grekov's Bulletin of Surgery.2023; 181(6): 98. CrossRef
Colorectal eversion technique combined with modified DST (CET‐M‐DST) for low colorectal anastomosis after laparoscopic TME for colorectal cancer – Video correspondence
Crafa Francesco, Vanella Serafino, Baiamonte Mario, Longo Antonio
Colorectal Disease.2023; 25(12): 2473. CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Laparoscopic PME with colorectal anstomosis with transanal control – A video vignette
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Colorectal Disease.2022; 24(7): 887. CrossRef
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Colorectal Disease.2022; 24(10): 1264. CrossRef
Initial experience with intraoperative testing and repair of colorectal anastomosis using a TAMIS approach after a positive leak test
J. Valdes-Hernandez, J. Cintas-Catena, F. J. Del Rio-Lafuente, A. Cano-Matias, C. Torres-Arcos, A. Perez-Sanchez, L. Capitan-Morales, F. Oliva-Mompean, J. C. Gomez-Rosado
Techniques in Coloproctology.2022; 26(11): 901. CrossRef
Minimally invasive colorectal surgery learning curve
Serafino Vanella, Enrico Coppola Bottazzi, Giancarlo Farese, Rosa Murano, Adele Noviello, Tommaso Palma, Maria Godas, Francesco Crafa
World Journal of Gastrointestinal Endoscopy.2022; 14(11): 731. CrossRef

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