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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
- 15,353 View
- 503 Download
- 14 Citations
-
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.
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Citations
Citations to this article as recorded by
- 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 - Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis
Marcelo Albuquerque Barbosa Martins, Luiz Felipe Costa de Almeida, Anelise Poluboiarinov Cappellaro, Luís Fernando Rosati Rocha, Rachid Eduardo Noleto da Nobrega Oliveira
Updates in Surgery.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)
Oliver Schwandner
Die Chirurgie.2025; 96(9): 709. CrossRef - Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study
Michele Schiano di Visconte
The Surgeon.2025;[Epub] CrossRef - Postoperative Perianal Abscess and Concomitant Anorectal Fistula: An Extremely Rare Complication After Emergency Transanal Hemorrhoidal Dearterialization With Mucopexy for Hemorrhoidal Disease
Charito Chatzinikolaou, Konstantinos Perivoliotis, Amalia Moula, Kyriakos Psarianos, Alexios Stavrou, Ioannis Baloyiannis, George Rallis
Case Reports in Surgery.2025;[Epub] CrossRef - Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids
Rong Huang, Minghu Fan, Hongwu Lin, Laibin Luo
BMC Surgery.2025;[Epub] CrossRef - 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
Annals of Coloproctology.2025; 41(4): 330. CrossRef - Hemorrhoidal Disease
Jean H. Ashburn
JAMA.2025; 334(17): 1541. CrossRef - From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef - 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
- Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease
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
- 7,947 View
- 235 Download
- 14 Web of Science
- 16 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
Citations to this article as recorded by- 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?
Sami Alahmadi, David L. Berger, Christy E. Cauley, Robert N. Goldstone, William V. Kastrinakis, Marc Rubin, Hiroko Kunitake, Rocco Ricciardi, Grace C. Lee
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 - 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
Francesco Crafa, Serafino Vanella, Adele Noviello, Giuseppe Longo, Francesco Longo
Colorectal Disease.2022; 24(7): 887. CrossRef - Laparoscopic TME and hepatic resection after total neoadjuvant chemotherapy plus short course radiotherapy for low rectal cancer with single synchronous liver metastases – A video vignette
Francesco Crafa, Serafino Vanella
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
- 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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