No abstract

Background. Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose. To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results. Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion. The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.

Background:The preferred perineal repair method for full-thickness rectal prolapse is the Altemeier procedure, a perineal proctosigmoidectomy with handsewn anastomosis. A recently described variant of this procedure combines the resection and anastomosis into 1 step by means of linear and transverse stapling. There are few published data comparing the characteristics and outcomes of these 2 approaches.Methods: This retrospective review, performed at 2 Canadian academic hospitals, compares surgical and cost outcomes between the perineal stapled prolapse resection (PSPR) and the Altemeier procedure. All patients who underwent these procedures between 2015 and 2019 were included.Results: There were 25 patients in the PSPR group and 19 in the Altemeier group. Patients in the PSPR group were significantly older than those in the Altemeier group (81 [95% confidence interval (CI) 70-92] yr v. 74 [95% CI 63-85] yr; p = 0.047), had a lower body mass index ]; p = 0.042) and had equivalent American Society of Anesthesiologists scores (2.84 [95% CI 2.09-3.59] v. 2.68 [95% CI 1.93-3.43]; p = 0.49). The operative time for PSPR was significantly less ] min v. 67 [95% CI 43-91] min; p < 0.001), as were the operative costs. Recurrence (28.0% v. 36.8%; p = 0.53) and complication rates were equivalent. Conclusion:PSPR is a safe, efficient and effective approach to perineal proctosigmoidectomy. It is associated with surgical outcomes comparable to those of the Altemeier procedure, but with a significant reduction in operative time and cost. Contexte :La technique de réparation périnéale privilégiée pour le prolapsus rectal de pleine épaisseur est la technique d'Altemeier, une proctosigmoïdectomie périnéale avec anastomose manuelle. Une variante de cette intervention décrite récemment allie la résection et l'anastomose en 1 seule étape, par agrafage linéaire et transverse. Peu de données ont été publiées pour comparer les caractéristiques et les résultats de ces 2 approches. Méthodes: La présente revue rétrospective, effectuée dans 2 centres hospitaliers universitaires canadiens, compare les résultats chirurgicaux et les coûts de la résection du prolapsus par agrafage péritonéal (RPAP) et par technique d'Altemeier. Tous les patients ayant subi ces 2 types d'interventions entre 2015 et 2019 ont été inclus. Résultats : On comptait 25 patients dans le groupe soumis à la RPAP et 19 dans le groupe soumis à la technique d'Altemeier. Les patients du groupe RPAP étaient significativement plus âgés que ceux du groupe Altemeier (81 [intervalle de confiance (IC) de 95 % 70-92] ans c. 74 [IC de 95 % 63-85] ans; p = 0,047), avaient un indice de masse corporelle plus bas (21,4 [IC de 95 % 17,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)1] c. 24,4 [IC de 95 % 18,3]; p = 0,042) et un score de l'American Society of Anesthesiologists semblable (2,84 [IC de 95 % 2,59] c. 2,68 [IC de 95 % 1,43]; p = 0,49). Le temps opératoire pour la RPAP a été significativement moindre (30,3 [IC de 95 % 16,3] min c. 67 [IC de 95 % 43-91] m...