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BACKGROUND: Anal fistula is a common benign anorectal disease that often requires surgical intervention for effective treatment. In recent years, preoperative colonoscopy as a diagnostic tool in patients with anal fistula has garnered increasing attention due to its potential clinical application value. By investigating underlying inflammatory bowel disease (IBD), polyps, and other abnormalities, preoperative colonoscopy can offer insights to refine surgical strategies and improve patient outcomes. METHODS: This retrospective study focused on 1796 patients with various benign anorectal diseases who underwent preoperative intestinal endoscopy and met surgical criteria within the preceding three years at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Among these patients, 949 diagnosed with anal fistula comprised group A, while 847 patients without anal fistula were assigned to group B for comparison. The investigation encompassed an analysis of general patient information, endoscopic findings, polyp histopathology, distribution of bowel inflammation sites, and results of inflammatory bowel disease assessments between the two patient cohorts. A subgroup analysis was also conducted on 2275 anal fistula patients with no surgical contraindications. This subgroup was categorized into Group A (949 patients who underwent preoperative intestinal endoscopy) and Group C (1326 patients who did not undergo preoperative colonoscopy). The study compared the rates of detecting endoscopic lesions and IBD-related findings between the two subgroups. RESULTS: The study initially confirmed the comparability of general patient information between groups A and B. Notably, the abnormal detection rate in group A was significantly higher than in group B (P < 0.01). In terms of endoscopic findings, the anal fistula group (group A) exhibited higher rates of detecting bowel inflammation, inflammatory bowel disease, and polyps compared to the non-anal fistula group (group B) (P < 0.05). The distribution of inflammation locations indicated higher detection rates in the terminal ileum, ileocecal region, and ascending colon for group A compared to group B (P < 0.05). Although the incidence of IBD in group A was higher than in group B, this difference did not reach statistical significance (P > 0.05). Subsequently, the analysis of the subgroup (groups A and C) revealed a significant disparity in intestinal endoscopic detection rates (P < 0.01) and statistically significant differences in detecting IBD (P < 0.05) and Crohn's disease (P < 0.05) between the two anal fistula subgroups. CONCLUSIONS: The findings of this study underscore the substantial clinical value of preoperative colonoscopy in the comprehensive evaluation of patients with anal fistula. Preoperative colonoscopy aids in ruling out localized perianal lesions caused by underlying inflammatory bowel disease, thereby mitigating the likelihood of missed diagnoses and enhancing treatment outcomes. This research highlights the importance of incorporating preoperative colonoscopy as a valuable diagnostic tool in managing anal fistula patients.

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Background: Anal fistula is an anorectal infectious disease caused by a perianal abscess or perianal disease. Accurate anorectal examinations are of great significance. The two-finger digital rectal examination (TF-DRE) has been used in clinical practice, with a lack of comprehensive research on the value of the TF-DRE in the diagnosis of anal fistula. This study will compare the difference in the diagnostic value of the TF-DRE, traditional digital rectal examination (DRE), and anorectal ultrasonography in the diagnosis of anal fistula. Methods: For patients who meet the inclusion criteria, a TF-DRE will be performed to explore the number and location of the external and internal orifices, the number of fistulas, and the relationship between the fistula and the perianal sphincter. A DRE and anorectal ultrasonography will also be performed, and the same data will be recorded. To make a comparison, the final diagnosis results of the clinicians during the operation will be taken as the gold standard, the accuracy of the TF-DRE in diagnosing anal fistula will be calculated, and the significance of the TF-DRE in the preoperative diagnosis of anal fistula will be studied and analyzed. All the statistical results will be analyzed using SPSS22.0 (IBM, USA), and a P value <0.05 will be considered statistically significant. Discussion: The research protocol details the advantages of the TF-DRE compared to the DRE and anorectal ultrasonography in the diagnosis of anal fistula. This study will provide clinical evidence of the diagnostic value of the TF-DRE in the diagnosis of anal fistula. Currently, there is a lack of high-quality research using scientific methods on this innovative anorectal examination method. This study will provide rigorously designed clinical evidence on the TF-DRE. Registration: Chinese Clinical Trials Registry ChiCTR2100045450.

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Introduction: health literacy has an increasing relevance as the disseminated access to online contents may impact on community health. This study aimed to evaluate the suitability of the online content of benign proctological disorders.Methods: the platforms Google© and YouTube™ were searched using the keywords hemorrhoidal disease, anal fistula, anal fissure, anal pruritus and fecal incontinence. Each page was analyzed for: interactivity, credibility, readability and content adequacy. For each video, the content, reactions and comments of the users were analyzed. Three validated scales were applied: Simple Measure of Gobbledygook (SMOG); Suitability Assessment of Materials (SAM), and quality criteria for consumer health information on treatment choices (DISCERN).Results: a total of 127 webpages and 113 videos were evaluated. Forty webpages (31.50 %) included images and ten (37.04 %) had informative videos. The SMOG scale had an average value of 9.91 ± 0.94, which estimates the need for ten years of schooling for comprehension and 64 webpages (52.07 %) presented a reading level higher than the recommended B1. The mean SAM score was 39.46 ± 11.2 % and the DISCERN scale averaged 40.33 ± 5.69, corresponding to a reasonable content. Only 20 pages (15.75 %) included interactivity tools and 44 (34.64 %) contained bibliographic references. The videos posted by patients (n = 67, 59.2 %) had the highest number of views and positive comments whereas videos from health professionals (n = 21; 18.75 %) had the highest proportion of requests for additional information.Discussion: online content regarding benign proctological disorders is globally inappropriate for the health literacy level of the Portuguese population, both at the written and reading levels. (AU)

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The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.

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The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.

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Many anorectal opearations may result in damage to anal sphincter function and,as a result,patients have problems when they are defecating.Measuring anal sphincter function not only benefit for operating,but also may help prevent operating complications and do good for rehabilitation.Therefor,measuring anal sphincter function is important.This article will review those measures about anal sphincter function.

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Objective To investigate the clinical significance of preoperative colonoscopy for patients with benign anal diseases,and to compare the success rates of examination done by sedated colonoscopy and conventional colonoscopy.Methods The clinical data of 333 patients with benign anal disease who received preoperative colonoscopy at the Six Affiliated Hospital of Sun Yat-Sen University from April 2010 to March 2011 were retrospectively analyzed.All the patients were divided into the lesion group (120 patients) and normal group (213 patients)according to the results of colonoscopy.The measurement data and count data were analyzed using the t test and chi-square test,respectively.Results The age of patients in the lesion group was (48 ± 14) years,which was significantly older than (42 ± 14) years (t =3.75,P ＜ 0.05).The constituent ratio of patients older than 40 years in the lesion group was 72.50％ (87/120),which was significantly higher than 39.44％ (84/213) in the normal group (x2=33.59,P ＜0.05).The proportions of male and female patients were 71.67％ (86/120) and 28.33％ (34/120) in the lesion group,and 62.44％ (133/213) and 37.56％ (80/213) in the normal group,with no significant difference between the 2 groups (x2 =2.90,P ＞ 0.05).The benign anal diseases in the lesion group included polyp (80 cases),enteritis (30 cases),malignant tumor (7 cases),infflammatory bowel disease (7 cases),diverticulum (5 cases) and ulcer (1 case).The application rates of sedated colonoscopy in the lesion group and the normal goup were 51.67％ (62/120) and 54.93％ (117/213),respectively,with no significant difference between the 2 groups (x2=0.33,P ＞0.05).The success rate of terminal ileum intubation was 99.44％ (178/179) in patients who received sedated colonoscopy,which was significantly higher than 95.45％ (147/154) of patients who received conventional colonoscopy (x2 =5.61,P ＜ 0.05).Conclusion Patients with benign anal disease might complicated with colorectal lesions,and sedated colonoscopy is recommended for preoperative diagnosis,especially for patients who are older than 40 years.

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AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.

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Chronic anal fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically less effective therapy for CAF than LIS. This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy. Aspects of anal fissure etiology, epidemiology and pathophysiology are considered with their meaning for further management of CAF. A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined. Its application may influence the development of optimal therapy for CAF. BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically. Although the effectiveness of BTX vs. LIS has been discussed, the essential focus of the article concerns identifying the best therapy application for anal fissure. Elements are presented which may help us to predict CAF healing. They provide rationale for the expansion of the CAF therapy algorithm. Ethical and economic factors are also considered in brief. As long as the patient is willing to accept the potential risk of fecal incontinence, we have grounds for the 'gold standard' (LIS) as the first-line treatment for CAF. The author concludes that, when the diagnosis of the anal fissure is established, CS should be considered for both ethical and economic reasons. He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier, more practical stage with improved outcomes for the patient.

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O Melanoma Anorretal é um tumor maligno raro com a possibilidade de simular uma doença anorretal, tornando o diagnóstico difícil. Tem baixos índices de cura e elevados índices de mortalidade em curto prazo. Os autores descrevem um caso de melanoma de canal anal cuja interpretação por parte do paciente tratava-se de uma doença hemorroidária que exteriorizava às evacuações. Os autores fazem uma extensa revisão da literatura dando ênfase aos sintomas e a melhor opção terapêutica a ser instituída.

Anorectal melanoma is a rare malignant tumor with the small chance of simulating anorectal disease, making the diagnosis hard. There is a low rate of cure and high rate of short term mortality. The authors describe a case of anal melanoma which by the patients interpretation was hemorrhoid disease that exteriorized evacuations. The authors do an extensive evaluation of the literature, giving emphasis to the symptoms and the best therapeutic option to be used.

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BACKGROUND: It is unknown which proctological position is most embarrassing to patients. METHODS: Individuals consecutively referred to our outpatient clinic in order to determine the causes of anal and/or abdominal complaints were randomized to complete an unvalidated six-item questionnaire which asked for their preferred proctologic positioning either before or after a proctological examination in knee-chest position followed by inspection of the anal verge, digital examination of the anal canal, and anoscopy. A third group of patients referred for gastroscopy was asked to complete the questionnaire before being gastroscoped. RESULTS: One hundred seventy-eight individuals of both genders aged 16-80 years who consecutively entered our outpatient clinic were enrolled. One third in each group had never experienced any of the offered medical positionings. Most patients favored the Sims' position if they had the choice. Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03). Patients favored the positions they had recently experienced irrespective of the other positions offered in the questionnaire (P < 0.05). Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed. The majority of patients (55.2%-71.4%) held that no type of proctological positioning was most embarrassing to them. CONCLUSIONS: The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.

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Anal diseases are very common and it is important for a medical practitioner to understand how to deal with these diseases. To establish diagnoses of specific conditions, detailed history taking, inspection, palpation including digital rectal examination, and anoscopic examination are performed. Sigmoidoscopy is also required if upper lesions are suspected. History taking should include information about bleeding, prolapse, swelling, pain, discharge, irritation, bowel habit, continence, abdominal symptoms, weight loss. Sims' position and lithotomy position are commonly used for physical examination of the anal area. In addition to careful inspection and palpation, digital rectal examination should be performed to evaluate the anal canal width and sphincter strength. Above all, digital examination is a very useful and cheap tool to find rectal cancer which commonly occurs after middle-ages. Common anal diseases such as hemorrhoids, anal fissure, perianal abscess and fistula-in-ano, pruritus anai, and rectal prolapse are reviewed.

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