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Symposium - Paul-Antoine Lehur at ESCP Sorrento 2010

Symposium - Risto Rintala at ESCP Sorrento 2010

Oral Poster (Proctology) - Ruediger Prosst at ESCP Barcelona 2014

Fistula in ano is a common condition mostly caused by inflammation of the proctodeal anal glands. This results in an acute anal abscess or chronic fistula. Anal fistulas are classified according to their relation to the anal sphincter muscles: subcutaneous, subanodermal, intersphincteric, transsphincteric, suprasphincteric or extrasphincteric. Distal fistulas including negligible amounts of sphincter muscle are treated by a lay-open technique (fistulotomy, fistulectomy), whereas proximal fistulas are cured using sphincter-saving procedures (advancement flap, fistulectomy with primary sphincter reconstruction, ligation of intersphincteric fistula tract, fistula plugs, fistula clip). The best surgical method balances the chance of healing and the risk of incontinence. An experienced colorectal surgeon also plays an important role.

Surgical Video Session - Vita Klimasauskiene (UK) at ESCP Berlin 2017

Detailed knowledge of clinical anatomy is an indispensable prerequisite for the diagnosis and therapy of coloproctological diseases. Therefore this chapter presents the essential aspects of the anatomy of the colon, rectum, anal canal, and pelvic floor that are relevant for coloproctologists. Anatomy is described for the different colonic segments, rectal ampulla, upper and lower anal canal, corpus cavernosum recti, proctodeal glands, anal sphincter complex, and pelvic floor muscles. The anatomic structures mediating anal continence are highlighted. Special emphasis is given to topographical aspects and anatomic landmarks relevant for surgical approaches. Access routes to both autonomic and somatic nerves, as well as blood supply and lymphatic drainage, are addressed for each anatomic compartment. In particular, the topography of perirectal fasciae and spaces and their relationship to pelvic autonomic nerves are described in detail to meet the criteria for nerve-sparing total mesorectal excision. Finally, the anatomical peculiarities of the pelvic floor levels (subperitoneal, ischioanal, and perianal spaces) are presented and set in a clinical context.

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

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

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

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

Oral poster - Peter-Martin Krarup at ESCP Vienna 2012

Oral poster - Léon Maggiori at ESCP Vienna 2012

Interactive Trainee Workshop - Annika Sjövall at ESCP Barcelona 2014

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

Symposium - Frederic Ris at ESCP Milan 2016

Symposium - Pieter Tanis at ESCP Milan 2016

Symposium - Gordon Carlson at ESCP Milan 2016

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

Free paper - Hirotoshi Hasegawa at ESCP Sorrento 2010

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

Interactive Trainee Workshop - Ethem Gecim at ESCP Barcelona 2014

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.

Student Oral Poster - Diane Mege at ESCP Dublin 2015

Student Oral Poster - Diane Mege at ESCP Dublin 2015

Video Surgery - Claudia Menconi at ESCP Barcelona 2014

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

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

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

Trainee video session - Pasquale Giordano at ESCP Barcelona 2014

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.