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Free Paper - Juan García-Armengol at ESCP Copenhagen 2011

Oral poster - Michael Dessily at ESCP Belgrade 2013

One of the Six Best Papers - Nick Battersby at ESCP Belgrade 2013

Oral poster - Michael Shapiro at ESCP Sorrento 2010

While accidental anal and rectal trauma is relatively rare, iatrogenic injuries to this region – particularly the anus – are quite common. This chapter describes the most frequent etiologies of anal/rectal trauma and the basic clinical and instrumental investigations necessary to provide the most appropriate treatment, particularly in emergencies, when saving patient’s life is a surgeon’s primary concern.

The surgical management of anal and rectal trauma and retention of foreign bodies in the rectum is discussed using a dedicate algorithm. Finally, the possible functional consequences of these traumas are reviewed and how to preserve fecal continence and normal evacuation is described.

An anal fissure is a tear in the epithelial lining of the anal canal, distal to the dentate line. It is accompanied by a significant increase in the tone of the internal anal sphincter. Anal pain is usually intense, occurs during or minutes after a bowel movement, and can last from minutes to hours. It may be accompanied by minimal bleeding. A fissure is usually located in the posterior (in 90 % of cases) or anterior midline (in 10 % of women and 1–5 % of men with anal fissure). If there are multiple fissures or occur at a lateral position, other anal pathologies must be ruled out (e.g., tuberculosis, syphilis, HIV, Crohn’s disease). Treatment of anal fissure is based on general measures and pharmacological intervention. General measures consist of sitz baths, avoiding the presence of hard stools by using laxatives or significantly increasing fiber intake, and using analgesics. Pharmacological treatment is based on three groups: a nitric oxide donor (glyceryl trinitrate), calcium channel antagonists (diltiazem, nifedipine), and botulinum toxin. The results of these treatments are better than placebo but inferior to surgery. If these treatments fail, surgery is the best option. Sphincterotomy is an outpatient procedure with a success rate greater than 90 %, but it has a postoperative incontinence rate between 3 % and 15 %. A chance of postoperative incontinence is the main reason why drug treatment is now considered as the first therapeutic option, especially in patients with a high risk for incontinence.

Trainee video session - Pasquale Giordano at ESCP Barcelona 2014

Trainee Video Session - David Zimmerman (The Netherlands) at ESCP Nice 2018

Trainee Video Session - Lilli Lundby (Denmark) at ESCP Nice 2018

Trainee Video Session - Carlo Ratto (Italy) at ESCP Nice 2018

Video Surgery - Claudia Menconi at ESCP Barcelona 2014

Student Oral Poster - Diane Mege at ESCP Dublin 2015

Student Oral Poster - Diane Mege at ESCP Dublin 2015

Within the past few decades the incidence of anal cancer has increased worldwide, especially among the male homosexual population (men who have sex with men [MSM]), with an incidence up to 225 in 100,000. Human papillomavirus (HPV) infections are a main risk factor for the occurrence of anal cancer. The prevalence of anal HPV infection in human immunodeficiency virus (HIV)–negative MSM is 50–60 %, whereas the prevalence reaches almost 100 % in HIV-positive MSM. Anal intraepithelial neoplasia (AIN), which is associated with HPV, has been identified as a precursor lesion for anal cancer. Approximately 20 % of HIV-negative MSM are diagnosed with AIN, and high-grade epithelial neoplasia is already present in 5–10 %. The prevalence of high-grade AIN among HIV-positive MSM is considerably higher and can reach 50 %. In hypothetical models, screening examinations such as anal cytology and high-resolution anoscopy have been shown to be cost-effective and efficient in MSM. Based on these findings, regular anal screening tests should be recommended for at-risk patients. If anal cancer is diagnosed, positron emission tomography/computed tomography is recommended for staging. Radiochemotherapy is the standard treatment for most patients. Surgery is only advisable in patients with small tumors (<2 cm) of the anal margin or as a salvage procedure. Follow-up should be performed for 3 years and should include digital rectal examination and palpation of inguinal lymph nodes.

Consultants corner - Raminta Luksaite Lukste (Lithuania) at ESCP Vilnius 2023

Interactive Trainee Workshop - Ethem Gecim at ESCP Barcelona 2014

Oral Poster (Neoplasia) - Beatriz Arencibia at ESCP Dublin 2015

Free paper - Hirotoshi Hasegawa at ESCP Sorrento 2010

Oral Poster (Functional) - Axel Kraenzler at ESCP Dublin 2015

Symposium - Gordon Carlson at ESCP Milan 2016

Symposium - Pieter Tanis at ESCP Milan 2016

Symposium - Frederic Ris at ESCP Milan 2016

Free Paper (Neoplasia) - Eloy Espin-Basany at ESCP Barcelona 2014

Interactive Trainee Workshop - Annika Sjövall at ESCP Barcelona 2014

Oral poster - Léon Maggiori at ESCP Vienna 2012

Oral poster - Peter-Martin Krarup at ESCP Vienna 2012

ESCP/EAES Symposium - Sebastiano Biondo (Spain) at ESCP Nice 2018

ESCP/EAES Symposium - Pieter Tanis (The Netherlands) at ESCP Nice 2018

ESCP/EAES Symposium - Francesco Bianco (Italy) at ESCP Nice 2018

Top abstract 16 - Helene Juul Würtz (Denmark) at ESCP Virtually Vilnius 2020