© Borgis - Nowa Medycyna 2/2017, s. 46
Editorial by the Editor-in-Chief
In the current issue you can find three review papers.
I especially recommend the article which is a compendium of knowledge about Hirschsprung’s disease. It’s an interdisciplinary article because its authors are Colleagues from the Paediatric Department and from the Department of General and Colorectal Surgery for adult patients in Łódź. As we know, in adulthood Hirschsprung’s disease is very rare, most patients are diagnosed and treated in childhood, including 80-90% of children with Hirschsprung’s disease showing symptoms already in the neonatal period. General surgeons may come across adult patients with not diagnosed congenital aganglionosis who had earlier been for years treated due to chronic constipations and abdominal pain. General surgeons therefore don’t deal with these patients on an everyday basis, that is why a reminder and an update of knowledge related to the diagnostics and treatment of this disease seems to be important.
The author of the second review paper is an anaesthesiologist. The article presents the methods of increasing the safety of patients undergoing colonoscopy. The author assesses the risk of analgosedation, the monitoring of the patient both during the anaesthesia and in the post-anaesthesia care unit.
The next review paper is an article devoted to the treatment of patients with anal fistulae developed in the course of Leśniowski-Crohn’s disease. It is another interdisciplinary paper – written by a surgeon, a radiologist and a gastrologist. The article presents the current methods of conservative treatment, selected recommendations of the European Crohn’s and Colitis Organisation (ECCO) from 2016 referring to the conservative and surgical therapy in the treatment of anal fistulae as well as the recommendations of the Polish Club of Coloproctology related to this scope. The percentage of therapeutic failures which is still high indicates that the treatment of fistulae of this type remains an open topic and the success of the therapy depends on the interdisciplinary approach of physicians of several specialties, a gastroenterologist, a surgeon and a radiologist.
The present issue also includes two casuistic papers related to perianal lesions. Lesions of the retrorectal, presacral area are diagnostically difficult, they are often diagnosed accidentally and may be asymptomatic. The first article refers to a female patient who underwent surgery due to a epidermal cyst lesion located in the presacral/retrorectal area. A similar case of a female patient with an epidermal cyst located in this area was described in our Journal in 2015, however due to the rarity of the occurrence of retrorectal cysts (1:40 000 patients) it seems that every published surgical experience in this scope is valuable.
In the second casuistic paper the authors have presented a case of a female patient with leiomyoma located in the left ischioanal fossa. The location of a myoma in the anorectal area is extremely rare. Tumours of the anorectal area may cause the feeling of discomfort, constipations or urination disorders. In the presented case the lesion was asymptomatic and was accidentally detected in a CT scan. The complete excision of the tumour with a margin of healthy tissues minimizes the risk of its recurrence.
I wish you a pleasant reading.