Iacopo Giani

Publications (2)5.6 Total impact

• Article: Why do we have to review our experience in managing cases with idiopathic fistula-in-ano regularly?

  Claudio Fucini, Iacopo Giani
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  ABSTRACT: "Why do we have to review our experience in managing idiopathic fistula-in-ano regularly?" In order to answer this apparently simple question, we reviewed our clinical and surgical cases and most important relevant literature to find a rational and scientific answer. It would appear that whatever method you adopt in fistula management, there is a price to pay regarding either rate of recurrence (higher with conservative methods) or impairment of continence (higher with traditional surgery). Since, at the moment, reliable data to identify a treatment as a gold standard in the management of anal fistulas are lacking, the correct approach to this condition must consider all the anatomic and clinicopathological aspects of the disease; this knowledge joined to an eclectic attitude of the surgeon, who should be familiar with different types of treatment, is the only guarantee for a satisfactory treatment. As a conclusion, it is worthwhile to remember that adequate initial treatment significantly reduces recurrence, which, when it occurs, is usually due to failure to recognise the tract and primary opening at the initial operation.
  World Journal of Gastroenterology 07/2011; 17(28):3297-9. · 2.47 Impact Factor
• Article: Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results.

  Filippo Pucciani, Maria Novella Ringressi, Stefania Redditi, Attilio Masi, Iacopo Giani
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  ABSTRACT: Some patients, having undergone sphincter-saving operations for rectal cancer, may suffer from fecal incontinence. This study was designed to evaluate the results of rehabilitative treatment in patients with fecal incontinence after sphincter-saving operations and to identify the negative factors that influence therapeutic success. Between January 2000 and June 2007, 88 incontinent patients (54 women; age range, 47-73 years; 69 had received a low anterior rectal resection; 19 a straight coloanal anastomosis) were included in the study. After a preliminary clinical evaluation, including the Wexner Incontinence Scale score, anorectal manometry was performed. All 88 patients underwent rehabilitative treatment according to the "multimodal rehabilitative program" for fecal incontinence. At the end of program, all 88 patients were reassessed by means of a clinical evaluation and anorectal manometry; their results were compared with the clinical and manometric data from ten healthy control subjects. Postrehabilitative Wexner Incontinence Scale scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score </=3); Class II, fair (score >3 to </=6); Class III, poor (score >6). After rehabilitation, there was a significant improvement in the overall mean Wexner Incontinence Scale score (P < 0.03) for both surgical operation types (low anterior rectal resection: P < 0.05; coloanal anastomosis: P < 0.02). Only 21 patients (23.8 percent) were symptom-free, and 37 (42 percent) were considered Class III. A significant postrehabilitative direct correlation was found between: 1) Wexner Incontinence Scale score and degree of genital relaxation (rrho (s) 0.78; P < 0.001); 2) Wexner Incontinence Scale score and irradiation (rrho (s) 0.72; P < 0.01); and 3) Wexner Incontinence Scale score and pelvic (rrho (s) 0.65; P < 0.01) or anal surgery (rrho (s) 0.68; P < 0.01). No significant differences were found between prerehabilitative and postrehabilitative anal pressures in low anterior rectal resection and coloanal anastomosis patients. After rehabilitation, some patients become symptom-free, many patients show an improvement in the Wexner Incontinence Scale score, and others exhibit the highest grades of fecal incontinence. Genital relaxation, radiotherapy, and previous pelvic, and/or anal surgery are impeding factors to rehabilitative success.
  Diseases of the Colon & Rectum 05/2008; 51(10):1552-8. · 3.13 Impact Factor