ALA-PDT offers a similarly high efficacy, and a better cosmetic outcome than simple excision surgery in the treatment of BCC.

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Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter TM , American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection. KEYWORDS: Fecal incontinence, muscle transposition, graciloplasty, gluteoplasty, neosphincter constructionObjectives: Upon completion of this article, the reader should be able to: (1) list current therapeutic options for failed overlapping sphincteroplasty; and (2) evaluate the results of each of these procedures.Patients with severe fecal incontinence unresponsive to conservative measures can be divided into two broad categories of surgical approach. The first group includes those patients with an identifiable anatomic sphincter defect who can expect a 40 to 60% long-term surgical success rate with overlapping sphincteroplasty.1 The absence of pudendal neuropathy yields the best outcome in these patients. 2 The second group includes those patients with extensive sphincter damage, muscle loss, or pudendal neuropathy not amenable to direct sphincter repair. With the widespread prevalence of fecal incontinence and development of newer surgical techniques, the patient with severe fecal incontinence is seldom obligated to a permanent stoma. Neosphincter

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The advantages of laparoscopy in the treatment of benign diseases have been well demonstrated. Compared with laparotomy, the laparoscopic approach is associated with a shorter hospitalization period, shorter duration of ileus, decreased postoperative pain, earlier return to work, and improved cosmesis. The role of laparoscopy for the treatment of gastrointestinal malignancy has had a slower evolution and been the subject of considerable debate over the past decade. Since 1991, several concerns have limited the widespread use of laparoscopy for attempted cure of colorectal carcinoma. This review aims to analyze the results of several studies published to date on short and long term outcome of laparoscopy for colorectal carcinoma, based on levels of evidence. From the least to the most convincing data, the hierarchy of study designs progresses through a spectrum ranging from retrospective reviews to prospective series, to case-controlled, cohort, and ultimately randomized controlled trials.