Juaquito Jorge

By Nathalie Mantilla and Juaquito Jorge

Pruritus ani is a benign anorectal disorder characterized by an itching sensation of the perianal skin. It is a source of embarrassment and frustration for those who suffer from it. Multiple conditions can be responsible for perianal itching; however, most cases are idiopathic. Skin breakdown from constant scratching creates a vicious cycle exacerbating the symptoms. Empiric treatment resolves the problem in most cases, but additional testing should be performed when deemed necessary. Guided management to control associated diseases, lifestyle modifications, as well as skin protection, is paramount in the management.

Part of the book: Benign Anorectal Disorders

By Juaquito M. Jorge and Frederick M. Tiesenga

Obesity is a multifactorial, chronic, and progressive disease whose pathogenesis is tied to a strong genetic component as well as a multitude of hormonal, metabolic, psychological, cultural and behavioral factors. Understanding the role these factors play, screening for them, and managing them appropriately, is important for effective weight loss. Psychology and behavior have profound implications on a patient’s willingness and ability to engage in treatment and to follow up after bariatric surgery. Dietary education, presence of clear expectations, patient adherence to recommendations, and follow-up, directly impact bariatric surgery outcomes. Understanding postsurgical outcome success and failure and identifying best clinical practices for optimizing and maintaining results after bariatric surgery continues to be a work in process.

Part of the book: Bariatric Surgery

By Carolina Baz, Mario Masrur and Juaquito Jorge

Duodenal exclusion is used in surgery for multiple reasons. It can be used to treat primary pathology, such as with peptic ulcer disease, malignancy, gastric outlet obstruction, or after trauma. It is also used in metabolic surgery to add a hypoabsorptive effect for weight loss and beneficial impact on various co-morbidities. There are additional neurohormonal implications of duodenal exclusion that vary, depending on where the intestine is divided, and how long of a common channel or absorptive limb is left in place. Impact on diseases such as diabetes is mediated via complex pathways that continue to be researched today. Duodenal exclusion exhibits indisputable benefits but is linked to well-known side effects and complications. Understanding the physiological importance of the duodenum, the implications of its exclusion, the variety of methods for reconstruction and their impact is important in caring for these patients after surgery.

Part of the book: Current Concepts and Controversies in Laparoscopic Surgery

By Nathalie Mantilla and Juaquito M. Jorge

Chronic anal fissure is a common complaint that is associated with excruciating anal pain and bright red bleeding associated to bowel movements. The classic findings during the physical examination are helpful in differentiating the different types of fissures (acute versus chronic and typical versus atypical). Most cases of chronic anal fissures are successfully treated with conservative measures such as dietary and lifestyle modifications, adequate bowel regimen, and topical muscle relaxants such as nifedipine, diltiazem, or nitroglycerine. Refractory cases are usually managed with botulinum toxins injections or more invasive approaches such as internal lateral sphincterotomy with excellent healing rates at the expense of risk of fecal incontinence. In patients without hypertonicity of the anal sphincter, cutaneous flaps can be used with remarkable results.

Part of the book: Anorectal Disorders