[Design and use of a new disposable fenestrated anoscope in proctology]

Direct exploration of the anal mucosa always plays an essential role in the diagnosis and treatment of the main anal and perineal pathologies. The continuous need to improve coloproctological instruments, enhancing their efficacy and advantages for patients, prompted the authors to design and test a new anoscope for both diagnostic and operative purposes, suitable for simple, immediate use. This study was conducted to demonstrate the advantages and efficacy of a disposable "fenestrated" anoscope for band ligation of haemorrhoids and for performing biopsies on suspect areas of anal mucosa. The new disposable self-lit anoscope, made of inert, non-toxic plastic material tested by the authors, has been defined as "fenestrated" because it is characterised by the presence of a fenestration in the distal part of device, capable of improving visualisation of the anal canal and facilitating operative procedures. A total of 30 consecutive patients (25 with a clinico-instrumental diagnosis of grade II-III haemorrhoids and 5 with evidence of suspect lesions of the anal mucosa) were submitted to anoscopy using the new fenestrated anoscope. In the patients treated for haemorrhoids, ease of execution of band ligation was observed in all cases independently of the number and distribution of nodules. In the patients submitted to biopsy, the presence of condyloma was observed in 3 patients, and the presence of papillary hyperplasia in 2 patients. The new fenestrated anoscope proved to be a useful accessory both for diagnosis and for conservative treatment of haemorrhoids, permitting easy execution of ligation with no side effects. The anoscope was simple to use during diagnostic examinations and biopsies of suspect lesions of the anal canal, permitting accurate histological characterisation of the lesions in all cases.