Surgeon Performed Ultrasound In Proctological Practice

2,047 views

Published on

Published in: Health & Medicine
1 Comment
0 Likes
Statistics
Notes



  • <b>[Comment posted from</b> http://www.u-surgery.com/index.php?option=com_content&view=article&id=132:surgeon-performed-ultrasound-in-proctological-practice&catid=54:anorectal&Itemid=168]
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

No Downloads
Views
Total views
2,047
On SlideShare
0
From Embeds
0
Number of Embeds
31
Actions
Shares
0
Downloads
0
Comments
1
Likes
0
Embeds 0
No embeds

No notes for slide

Surgeon Performed Ultrasound In Proctological Practice

  1. 1. SURGEON-PERFORMED ULTRASOUND IN PROCTOLOGICAL PRACTICE A.P. ZBAR MD MBBS FRCS (Ed) FRCS (Gen) FRACS Universities of New England and Newcastle Tamworth Rural Referral Centre Tamworth NSW Provincial Surgeons Meeting Wagga Wagga 2008 1
  2. 2. ENDOLUMINAL ULTRASONOGRAPHY First introduced by Law and Bartram in 1989 Association with normal anatomy Constitutive variations with age Modifications – 3-dimensional, Contrast enhancement and Transperineal technology UTILIZATION Perirectal Sepsis Faecal Incontinence Rectal and Anal Cancers Functional Disorders 2
  3. 3. PRINCIPLES OF ULTRASOUND Resolution depends on frequency (MHz) and pulse repetition frequency Lateral resolution is controlled by beam width A standard BK 10 MHz transducer has an axial resolution < 0.05 mm with a lateral resolution of 0.5-1 mm and a focal range of 5-45 mm. 3
  4. 4. TECHNIQUES - ENDOANAL LM IAS EAS 4
  5. 5. TECHNIQUES - ENDORECTAL 3-DIMENSIONAL ENDOANAL TRANSPERINEAL 5
  6. 6. PERIRECTAL SEPSIS Primary information 6
  7. 7. 7
  8. 8. TRANSPERINEAL SONOGRAPHY Sensitivity for detection of trans- sphincteric and extrasphincteric fistulae = 100% Sensitivity for internal opening with TPUS is 90% and 80% for EAUS Sensitivity for horseshoeing with TPUS is 28.6% Sensitivity for ancillary abscess and secondary tracks with TPUS Zbar AP et al. Techniques in Coloproctol 2007 is 63.6% 8
  9. 9. FAECAL INCONTINENCE PREOPERATIVE ENDOANAL PREOPERATIVE TRANSPERINEAL 9
  10. 10. Intraoperative Endoanal Postoperative Endoanal Postoperative Transperineal 10
  11. 11. RECTAL AND ANAL TUMOURS 11
  12. 12. NORMAL ENDOSONOGRAPHIC RECTAL WALL LAYERS 12
  13. 13. T1 SM PF INFILTRATIVE VILLOUS LESION NOT INVADING SUBMUCOSA (SM) 13
  14. 14. T2 TUMOUR T3 TUMOUR 14
  15. 15. T4 TUMOUR – SEMINAL VESICLE INFILTRATION Accuracy for T stage = 85% Accuracy for N staging = 50% SENSITIVITY 75% PPV 82% 15
  16. 16. PARARECTAL NODES Inherent endosonographic problems with nodal detection 16
  17. 17. WORLDWIDE FIGURES OF ERUS - T AND N STATUS OF RECTAL CANCERS AUTHOR YEAR NR T ACC OVERSTAGE UNDERSTAGE N ACC (%) (%) HILDEBRANDT 1985 25 92 BEYNON 1987 100 93 RIFKIN 1987 102 67 50 GLASER 1990 117 90 80 KATSURA 1992 120 92 8.3 5.3 72.3 HERZOG 1993 152 89 10.2 0.8 80.2 FEDAYEV 1995 132 91 3.7 3.7 54.5 ZRIHEN 1996 62 84 71 GENNA 2000 42 81 71.4 GARCIA- 2002 545 69 18 13 64 AGUILAR NESBAKKEN 2003 91 74 65 HSIEH 2003 67 88 9 3 73 MACKAY 2003 356 89 66 BALI 2004 33 79 10 10 59 PRESENT 2005 40 85 5 10 50 SERIES 17
  18. 18. TRANSPERINEAL SONOGRAPHY IN RECURRENT ANORECTAL TUMOUR 18
  19. 19. Managing Evacuatory Disorders 19
  20. 20. DYNAMIC TRANSPERINEAL IMAGING AXIAL IAS SAGITTAL 20
  21. 21. Rectocele Rectoanal intussusception RECTOCELE RECTOANAL INTUSSUSCEPTION PERITONEOCELE Peritoneocele ENTEROCELE Enterocele 21
  22. 22. DYNAMIC TRANSPERINEAL ULTRASONOGRAPHY AND THE ANTERIOR COMPARTMENT 22
  23. 23. DYNAMIC TRANSPERINEAL SONOGRAPHY IN FUNCTIONAL DISORDERS RECTOCELE CYSTOCELE 23
  24. 24. Beer-Gabel M, Zbar AP DCR 2002 Zbar AP et al. Dis Colon Rectum 2004 24
  25. 25. DTP-US VERSUS DEFAECOGRAPHY IN EVACUATORY DYSFUNCTION PATHOLOGY DTP-US DEFAECOGRAPHY One 6 (18.2%) 12 (36.4%) Two 19 (57.6%) 15 (45.4%) Three 6 (18.2%) 3 (9.1%) None 2 (6%) 3 (9.1%) P = 0.3 RECTOCELE 8/17 (47.1%) 4/18 (22.2%) PLUS Enterocele P = 0.15 RECTOCELE Sensitivity 88.9% Specificity 100% RECTOANAL INTUSSUSCEPTION Sensitivity 89.5% Specificity 100% Beer-Gabel M, Zbar A et al. Int J Colorect Dis 2005 25
  26. 26. BLAND-ALTMAN PLOT OF ARA AT REST 70 60 50 40 30 °° ° (Proctography-Ultrasound)Degrees Difference in Ano-Rectal Angle 20 ° ° ° ° ° ° 10 ° ° ° 0 ° ° ° ° ° ° -10 ° °°° °° -20 ° ° ° ° -30 ° ° -40 ° -50 -60 ° -70 ° 50 60 70 80 90 100 110 120 130 Average Change in Ano-Rectal Angle measured by Proctography and Ultrasound (Degrees) 26
  27. 27. BLAND-ALTMAN PLOT OF ARJ DURING STRAINING 70 60 ° 50 ° ° Difference in Ano-Rectal Junction Displacement 40 ° 30 ° ° 20 °° (Proctography-Ultrasound)Degrees ° 10 ° ° ° ° ° 0 ° ° °° ° ° ° °° -10 ° ° ° ° -20 ° ° -30 ° ° ° -40 ° -50 -60 -70 70 80 90 100 110 120 130 140 150 160 Average Change in Ano-Rectal junction displacement measured by Proctography and Ultrasound (Degrees) 27
  28. 28. DYNAMIC TRANSPERINEAL ULTRASONOGRAPHY (DTP-US) Simple Non-invasive Avoids radiation in young patients Repeatable Portable Simultaneously assesses the anterior and posterior perineum & pelvic floor Avoids the need for multiorgan opacification Dynamic transperineal ultrasound is accurate in the diagnosis of specific pelvic floor conditions It tends to diagnose multiple conditions in functional disorders Quantitative assessment of the pelvic floor is comparable with defaecography for pelvic floor disorders at rest and during straining 28

×