Darya Shlyk, Vladimir Balaban, Mingze He, Maria Pikuza, Petr Tsarkov
Aim
Pilonidal sinus disease (PSD), also known as pilonidal disease, is a common chronic disorder in coloproctology and general surgery. It predominantly affects young male patients and is typically located in the sacrococcygeal region. Nowadays, various approaches are used to address this condition, but no consensus on a gold standard has been established. The aim of this study was to analyse and assess current PSD practice, diagnostic and surgical approaches, training and attitudes among Russian surgeons.
Method
A comprehensive online survey comprising 35 structured questions was developed by the Russian Society of Colorectal Surgeons and distributed to its members. The survey targeted colorectal and general surgeons and collected data on demographics, professional experience, surgical training, PSD management practices and both elective and abscess surgery techniques. Categorical data are reported as frequencies and percentages.
Results
Of the 158 respondents, the vast majority were coloproctologists and general surgeons (n = 152, 96%) with over 10 years of experience (n = 110, 69.6%) and performing 10–50 operations per year. The most popular surgical procedures were excision with midline closure (68%), open healing (62%) and marsupialization (59%). PSD-associated abscesses were managed through incision and drainage by 81 surgeons (51%). About half of surgeons had access to laser therapy for treating PSD, but sinus laser-assisted closure was used by only 16%. Most surgeons had received training in PSD surgery under specialist supervision and felt sufficiently trained.
Conclusion
Our findings suggest that PSD surgery in Russia has not yet shifted from midline excisions to off-midline flap procedures and minimally invasive surgery. This study calls for attention to this underprioritized group of patients and underscores the importance of developing national guidelines in Russia.
{"title":"Current surgical practices and attitudes toward pilonidal sinus disease among Russian surgeons: A national survey","authors":"Darya Shlyk, Vladimir Balaban, Mingze He, Maria Pikuza, Petr Tsarkov","doi":"10.1111/codi.70020","DOIUrl":"https://doi.org/10.1111/codi.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Pilonidal sinus disease (PSD), also known as pilonidal disease, is a common chronic disorder in coloproctology and general surgery. It predominantly affects young male patients and is typically located in the sacrococcygeal region. Nowadays, various approaches are used to address this condition, but no consensus on a gold standard has been established. The aim of this study was to analyse and assess current PSD practice, diagnostic and surgical approaches, training and attitudes among Russian surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A comprehensive online survey comprising 35 structured questions was developed by the Russian Society of Colorectal Surgeons and distributed to its members. The survey targeted colorectal and general surgeons and collected data on demographics, professional experience, surgical training, PSD management practices and both elective and abscess surgery techniques. Categorical data are reported as frequencies and percentages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 158 respondents, the vast majority were coloproctologists and general surgeons (<i>n</i> = 152, 96%) with over 10 years of experience (<i>n</i> = 110, 69.6%) and performing 10–50 operations per year. The most popular surgical procedures were excision with midline closure (68%), open healing (62%) and marsupialization (59%). PSD-associated abscesses were managed through incision and drainage by 81 surgeons (51%). About half of surgeons had access to laser therapy for treating PSD, but sinus laser-assisted closure was used by only 16%. Most surgeons had received training in PSD surgery under specialist supervision and felt sufficiently trained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that PSD surgery in Russia has not yet shifted from midline excisions to off-midline flap procedures and minimally invasive surgery. This study calls for attention to this underprioritized group of patients and underscores the importance of developing national guidelines in Russia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maxime K. Collard, Jean-Jacques Tuech, Charles Sabbagh, Amine Souadka, Jérome Loriau, Eric Rullier, Frédéric Marchal, Adeline Germain, Stéphane Benoist, Jean-Luc Faucheron, Gilles Manceau, Anne Dubois, Anaïs Laforest, Isabelle Sourrouille, Aurore Protat, Diane Mège, Zaher Lakkis, Michel Prudhomme, Simon Derieux, Mehdi Ouaissi, Aurélien Venara, Cécile Brigand, Bernard Lelong, Karine Pautrat, Leon Maggiori, Gil Lebreton, Philippe Rouanet, Marc Pocard, Emilie Duchalais, Quentin Denost, Yann Parc, Jérémie H. Lefevre, for the GRECCAR Group
Aim
Alteration of bowel function after delayed coloanal anastomosis (DCAA) might be a limitation to its utilization. Our aim was to assess the long-term bowel function of DCAA in a large multicentric cohort.
Method
All patients who underwent DCAA interventions at 29 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Low anterior resection syndrome (LARS) score or confection of a stoma due to poor bowel function was assessed in eligible patients. Good bowel function was defined by the preservation of bowel continuity with no LARS or a minor LARS.
Results
Among the 385 eligible patients to assess long-term bowel continuity, 63% (n = 243) responded to the questionnaire or had a definitive stoma because of poor bowel function. After a median follow-up of 32 months, good bowel function was reported by 60% (n = 146) of patients (with no LARS 36% and minor LARS 24%), whereas 40% of patients (n = 146) had a poor bowel function including major LARS (36%) and definitive stoma due to poor bowel function (4%). No variables tested were predictive of a poor bowel function after DCAA, including a history of pelvic radiotherapy (P = 0.722), salvage DCAA after failure of a previous anastomosis (P = 0.755), presence of a diverting stoma (P = 0.556), occurrence of an anastomotic leakage (P = 0.416) and time interval from the DCAA to the bowel function assessment (P = 0.350).
Conclusions
No LARS or minor LARS was reached for 60% of patients after DCAA. Less than 5% of patients received a definitive stoma due to a poor bowel function.
{"title":"Long-term bowel function following delayed coloanal anastomosis: Analysis of a multicentric cohort study (GRECCAR)","authors":"Maxime K. Collard, Jean-Jacques Tuech, Charles Sabbagh, Amine Souadka, Jérome Loriau, Eric Rullier, Frédéric Marchal, Adeline Germain, Stéphane Benoist, Jean-Luc Faucheron, Gilles Manceau, Anne Dubois, Anaïs Laforest, Isabelle Sourrouille, Aurore Protat, Diane Mège, Zaher Lakkis, Michel Prudhomme, Simon Derieux, Mehdi Ouaissi, Aurélien Venara, Cécile Brigand, Bernard Lelong, Karine Pautrat, Leon Maggiori, Gil Lebreton, Philippe Rouanet, Marc Pocard, Emilie Duchalais, Quentin Denost, Yann Parc, Jérémie H. Lefevre, for the GRECCAR Group","doi":"10.1111/codi.70013","DOIUrl":"https://doi.org/10.1111/codi.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Alteration of bowel function after delayed coloanal anastomosis (DCAA) might be a limitation to its utilization. Our aim was to assess the long-term bowel function of DCAA in a large multicentric cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>All patients who underwent DCAA interventions at 29 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Low anterior resection syndrome (LARS) score or confection of a stoma due to poor bowel function was assessed in eligible patients. Good bowel function was defined by the preservation of bowel continuity with no LARS or a minor LARS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 385 eligible patients to assess long-term bowel continuity, 63% (<i>n</i> = 243) responded to the questionnaire or had a definitive stoma because of poor bowel function. After a median follow-up of 32 months, good bowel function was reported by 60% (<i>n</i> = 146) of patients (with no LARS 36% and minor LARS 24%), whereas 40% of patients (<i>n</i> = 146) had a poor bowel function including major LARS (36%) and definitive stoma due to poor bowel function (4%). No variables tested were predictive of a poor bowel function after DCAA, including a history of pelvic radiotherapy (<i>P</i> = 0.722), salvage DCAA after failure of a previous anastomosis (<i>P</i> = 0.755), presence of a diverting stoma (<i>P</i> = 0.556), occurrence of an anastomotic leakage (<i>P</i> = 0.416) and time interval from the DCAA to the bowel function assessment (<i>P</i> = 0.350).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>No LARS or minor LARS was reached for 60% of patients after DCAA. Less than 5% of patients received a definitive stoma due to a poor bowel function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anette Højer Mikkelsen, Anne Thyø, Anne-Dorte Seyer-Hansen, Asbjørn Mohr Drewes, Birgitte Schantz Laursen, Peter Christensen, Tina Schwennesen, Therese Juul
Aim
Sexual dysfunction after colorectal and anal cancer is common but rarely identified and treated, although effective treatment options do exist. Therefore, we recently established nurse-led clinics for the treatment of sexual dysfunction after pelvic organ cancer at two Danish university hospitals. The aim of this paper is to present patients' clinical characteristics, the treatments offered and improvements in sexual function recorded.
Method
In this cohort study, colorectal and anal cancer patients were referred to the clinics at any time point after their cancer treatment. Specialized treating nurses identified and registered organic sexual disorders and psychological concerns at the first visit, and initiated treatments. Treatments were algorithm-based and rooted in a biopsychosocial approach. Patient-reported outcome measures were completed at baseline and 3 months after discharge.
Results
Among 127 referred patients, 78% were men. The mean age was 60.6 years (SD 10.4 years) and the women were a mean 7.3 years younger than the men (p = 0.001). Eighty per cent were rectal cancer patients. The most prevalent disorder was erectile dysfunction in men (95%) and dyspareunia in women (71%). Psychological concerns were registered in 53% of men and 54% of women. Pharmacological treatments, mainly phosphodiesterase-5 inhibitors, were prescribed to 87% of men, and local oestrogens were prescribed to 54% of women. Instructions in the use of sexual aids were given to 22% of men and 42% of women. Furthermore, sexual counselling/therapy was offered to 44% of men and 92% of women to address sexuality related psychological problems. Three months after discharge, a clinically relevant improvement of ≥1 point was found in 68% of patients in at least one of three single items measuring ‘Meaningful sex life’, ‘Sexual needs met’ and ‘Overall rating of sex life’ on a five-point Likert-scale.
Conclusion
At nurse-led clinics, specialized nurses can effectively identify and treat sexual problems in patients with sexual dysfunction following colorectal/anal cancer. Organic dysfunctions were prevalent, and psychological problems characterized most patients. This highlights that treatment needs to be multidisciplinary and that patients benefit from specialized care.
{"title":"Sexual dysfunction after colorectal and anal cancer—treatment in nurse-led sexological clinics","authors":"Anette Højer Mikkelsen, Anne Thyø, Anne-Dorte Seyer-Hansen, Asbjørn Mohr Drewes, Birgitte Schantz Laursen, Peter Christensen, Tina Schwennesen, Therese Juul","doi":"10.1111/codi.70018","DOIUrl":"https://doi.org/10.1111/codi.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Sexual dysfunction after colorectal and anal cancer is common but rarely identified and treated, although effective treatment options do exist. Therefore, we recently established nurse-led clinics for the treatment of sexual dysfunction after pelvic organ cancer at two Danish university hospitals. The aim of this paper is to present patients' clinical characteristics, the treatments offered and improvements in sexual function recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>In this cohort study, colorectal and anal cancer patients were referred to the clinics at any time point after their cancer treatment. Specialized treating nurses identified and registered organic sexual disorders and psychological concerns at the first visit, and initiated treatments. Treatments were algorithm-based and rooted in a biopsychosocial approach. Patient-reported outcome measures were completed at baseline and 3 months after discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 127 referred patients, 78% were men. The mean age was 60.6 years (SD 10.4 years) and the women were a mean 7.3 years younger than the men (<i>p</i> = 0.001). Eighty per cent were rectal cancer patients. The most prevalent disorder was erectile dysfunction in men (95%) and dyspareunia in women (71%). Psychological concerns were registered in 53% of men and 54% of women. Pharmacological treatments, mainly phosphodiesterase-5 inhibitors, were prescribed to 87% of men, and local oestrogens were prescribed to 54% of women. Instructions in the use of sexual aids were given to 22% of men and 42% of women. Furthermore, sexual counselling/therapy was offered to 44% of men and 92% of women to address sexuality related psychological problems. Three months after discharge, a clinically relevant improvement of ≥1 point was found in 68% of patients in at least one of three single items measuring ‘Meaningful sex life’, ‘Sexual needs met’ and ‘Overall rating of sex life’ on a five-point Likert-scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>At nurse-led clinics, specialized nurses can effectively identify and treat sexual problems in patients with sexual dysfunction following colorectal/anal cancer. Organic dysfunctions were prevalent, and psychological problems characterized most patients. This highlights that treatment needs to be multidisciplinary and that patients benefit from specialized care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pernilla Stenström, Francesca Maestri, Dalia Aminoff, Ivo de Blaauw, Johanna Ludwiczek, Paola Midrio, Alessio Pini Prato, Alejandra Vilanova-Sanchez, Anna Morandi, Iris van Rooij, The ARM-Net Consortium
Aim
There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors.
Method
Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models.
Results
After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly distributed between the centres (interquartile range 6.3%–21.7%). AP was more frequent in boys than girls (20.9% vs. 8.1%; P < 0.001). In both sexes the incidence of AP was higher in complex ARM subtypes (P < 0.001). AP was most frequent after laparotomy- and laparoscopic-assisted reconstructions (50.0% and 37.5%, respectively). Spinal and sacral anomalies constituted risk factors for AP in univariable analyses, while tethered cord did not. Adjusted risk factors for AP were severity of ARM subtype (40% in long-channel cloaca and bladder neck fistula, OR 3.1, 95% CI 1.0–10.2), laparotomy-assisted posterior sagittal anorectoplasty (50%, OR 3.7, 95% CI 1.6–8.4) and larger neo-anus at 1-year follow-up (Hegar 13.6 vs. 13.1; OR 1.2, 95% CI 1.1–1.4). Constipation was not a risk factor for AP.
Conclusion
Anorectal prolapse is a frequent postoperative sequela. Adjusted analyses indicate that severity of ARM, abdominal open access during reconstruction and larger size of anus are risk factors.
{"title":"Anorectal prolapse after anorectal reconstruction: Incidence and risk factors according to the ARM-Net Consortium","authors":"Pernilla Stenström, Francesca Maestri, Dalia Aminoff, Ivo de Blaauw, Johanna Ludwiczek, Paola Midrio, Alessio Pini Prato, Alejandra Vilanova-Sanchez, Anna Morandi, Iris van Rooij, The ARM-Net Consortium","doi":"10.1111/codi.70010","DOIUrl":"10.1111/codi.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly distributed between the centres (interquartile range 6.3%–21.7%). AP was more frequent in boys than girls (20.9% vs. 8.1%; <i>P</i> < 0.001). In both sexes the incidence of AP was higher in complex ARM subtypes (<i>P</i> < 0.001). AP was most frequent after laparotomy- and laparoscopic-assisted reconstructions (50.0% and 37.5%, respectively). Spinal and sacral anomalies constituted risk factors for AP in univariable analyses, while tethered cord did not. Adjusted risk factors for AP were severity of ARM subtype (40% in long-channel cloaca and bladder neck fistula, OR 3.1, 95% CI 1.0–10.2), laparotomy-assisted posterior sagittal anorectoplasty (50%, OR 3.7, 95% CI 1.6–8.4) and larger neo-anus at 1-year follow-up (Hegar 13.6 vs. 13.1; OR 1.2, 95% CI 1.1–1.4). Constipation was not a risk factor for AP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anorectal prolapse is a frequent postoperative sequela. Adjusted analyses indicate that severity of ARM, abdominal open access during reconstruction and larger size of anus are risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justin Dourado, Victoria Rose DeTrolio, Ebram Salama, Anjelli Wignakumar, Steven D. Wexner
{"title":"Bilateral gracilis muscle flaps for nonhealing perineal wounds—A video vignette","authors":"Justin Dourado, Victoria Rose DeTrolio, Ebram Salama, Anjelli Wignakumar, Steven D. Wexner","doi":"10.1111/codi.70015","DOIUrl":"10.1111/codi.70015","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Kyeong Kim, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee
{"title":"The first video comparison of lateral pelvic lymph node dissection in rectal cancer: Laparoscopic approach using articulating instruments (ArtiSential) versus robotic Xi platform—A video vignette","authors":"In Kyeong Kim, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee","doi":"10.1111/codi.70012","DOIUrl":"10.1111/codi.70012","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. A. J. Becker, A. J. M. Pronk, K. Gecse, R. Hompes, W. A. Bemelman, C. J. Buskens
Aim
This study aimed to analyse long-term outcomes in patients undergoing temporary faecal diversion for therapy-refractory Crohn's perianal fistulas.
Methods
In this retrospective study, Crohn's patients who underwent defunctioning for perianal disease between 2012 and 2022 were included. The primary endpoints were successful ostomy reversal and proctectomy/proctocolectomy rates. Secondary endpoints were clinical fistula closure, development of proximal colonic disease recurrence, and the influence of medication, patient and disease characteristics on ostomy reversal.
Results
In total, 53 patients were included, 35 colostomies and 18 ileostomies. Previous L2 disease was more frequently seen in the ileostomy group (colostomy 29%, ileostomy 83%; P = 0.004). Clinical closure of the fistula was seen in 26%. 21% (11/53 patients) underwent an attempt at ostomy reversal during a median overall follow-up of 90.1 months (interquartile range 17.5–82.5) of which nine ostomies (colostomy 23%, ileostomy 6%; P = 0.244) were closed successfully. In 35%, a proctectomy/proctocolectomy was required to control ongoing perianal sepsis. Factors associated with ostomy reversal were fistula closure (P < 0.001) and L1/L3 disease (P = 0.043). In patients with ostomy reversal attempt (n = 11), successful reversal was associated with colostomy (P = 0.055) and use of anti-tumour necrosis factor (anti-TNF) (P = 0.055) despite being previously classified as anti-TNF refractory.
Conclusion
Ostomy reversal rates are low, so defunctioning ostomies should be carefully considered because in most patients the ostomy will be permanent. In one-third of the patients, a proctectomy/proctocolectomy is required to treat ongoing perianal sepsis. If a patient is eligible for ostomy reversal, reversal should preferably be done under anti-TNF to optimize chances of success.
{"title":"Long-term outcomes of ‘temporary’ defunctioning in patients with severe perianal Crohn's disease","authors":"M. A. J. Becker, A. J. M. Pronk, K. Gecse, R. Hompes, W. A. Bemelman, C. J. Buskens","doi":"10.1111/codi.17289","DOIUrl":"10.1111/codi.17289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to analyse long-term outcomes in patients undergoing temporary faecal diversion for therapy-refractory Crohn's perianal fistulas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, Crohn's patients who underwent defunctioning for perianal disease between 2012 and 2022 were included. The primary endpoints were successful ostomy reversal and proctectomy/proctocolectomy rates. Secondary endpoints were clinical fistula closure, development of proximal colonic disease recurrence, and the influence of medication, patient and disease characteristics on ostomy reversal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 53 patients were included, 35 colostomies and 18 ileostomies. Previous L2 disease was more frequently seen in the ileostomy group (colostomy 29%, ileostomy 83%; <i>P</i> = 0.004). Clinical closure of the fistula was seen in 26%. 21% (11/53 patients) underwent an attempt at ostomy reversal during a median overall follow-up of 90.1 months (interquartile range 17.5–82.5) of which nine ostomies (colostomy 23%, ileostomy 6%; <i>P</i> = 0.244) were closed successfully. In 35%, a proctectomy/proctocolectomy was required to control ongoing perianal sepsis. Factors associated with ostomy reversal were fistula closure (<i>P</i> < 0.001) and L1/L3 disease (<i>P</i> = 0.043). In patients with ostomy reversal attempt (<i>n</i> = 11), successful reversal was associated with colostomy (<i>P</i> = 0.055) and use of anti-tumour necrosis factor (anti-TNF) (<i>P</i> = 0.055) despite being previously classified as anti-TNF refractory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ostomy reversal rates are low, so defunctioning ostomies should be carefully considered because in most patients the ostomy will be permanent. In one-third of the patients, a proctectomy/proctocolectomy is required to treat ongoing perianal sepsis. If a patient is eligible for ostomy reversal, reversal should preferably be done under anti-TNF to optimize chances of success.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miriam Flores-Yelamos, Montserrat Juvany, Josep M. Badia, Ana Vázquez, Marta Pascual, David Parés, Alexander Almendral, Enric Limón, Miquel Pujol, Aina Gomila-Grange, Members of the VINCat Colorectal Surveillance Team
Aim
Oral antibiotic prophylaxis (OAP) lowers rates of surgical site infection (SSI) and may aid anastomotic healing in colorectal surgery. The aim of this study was to analyse the understudied impact of OAP on SSI microbiology after colorectal surgery.
Method
A post hoc analysis was performed on a previous prospective, multicentre study of elective colorectal surgery. For 1000 patients with SSI, this study compared the microbiology of SSIs in procedures without OAP (SSI/OAP–) and with OAP (SSI/OAP+).
Results
There were 340 patients in the SSI/OAP– group and 660 in the SSI/OAP+ group. The use of OAP increased the presence of Gram-positive cocci (GPC) (OR 1.542, 95% CI 1.153–2.062) and fungi (OR 2.037, 95% CI 1.206–3.440), but reduced rates of Gram-negative bacteria (GNB) (OR 1.461, 95% CI 1.022–2.088) and anaerobe isolation (OR 0.331, 95% CI 0.158–0.696). Specifically, it led to increases in the isolation of Enterococcus faecium (OR 1.450, 95% CI 0.812–2.591), methicillin-resistant Staphylococcus aureus (OR 2.000, 95% CI 1.043–3.834) and Candida spp. (OR 2.037, 95% CI 1.206–3.440). In colon surgery with OAP, GPC infections were more likely (OR 1.461, 95% CI 1.022–2.088). In rectal surgery, organ/space SSIs had a higher risk of harbouring GPC (OR 1.860, 95% CI 1.153–2.999) and a lower risk of GNB (OR 0.321, 95% CI 0.200–0.515).
Conclusion
OAP reduced the presence of anaerobes and GNB in SSIs, but increased the isolation of GPCs and fungi, with E. faecium and Candida being of particular concern. This information should guide empirical antibiotic therapy for postoperative colorectal SSIs in patients who have received preoperative OAP.
{"title":"Oral antibiotic prophylaxis induces changes in the microbiology of surgical site infection after colorectal surgery. A matched comparative study","authors":"Miriam Flores-Yelamos, Montserrat Juvany, Josep M. Badia, Ana Vázquez, Marta Pascual, David Parés, Alexander Almendral, Enric Limón, Miquel Pujol, Aina Gomila-Grange, Members of the VINCat Colorectal Surveillance Team","doi":"10.1111/codi.70008","DOIUrl":"10.1111/codi.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Oral antibiotic prophylaxis (OAP) lowers rates of surgical site infection (SSI) and may aid anastomotic healing in colorectal surgery. The aim of this study was to analyse the understudied impact of OAP on SSI microbiology after colorectal surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A post hoc analysis was performed on a previous prospective, multicentre study of elective colorectal surgery. For 1000 patients with SSI, this study compared the microbiology of SSIs in procedures without OAP (SSI/OAP–) and with OAP (SSI/OAP+).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 340 patients in the SSI/OAP– group and 660 in the SSI/OAP+ group. The use of OAP increased the presence of Gram-positive cocci (GPC) (OR 1.542, 95% CI 1.153–2.062) and fungi (OR 2.037, 95% CI 1.206–3.440), but reduced rates of Gram-negative bacteria (GNB) (OR 1.461, 95% CI 1.022–2.088) and anaerobe isolation (OR 0.331, 95% CI 0.158–0.696). Specifically, it led to increases in the isolation of <i>Enterococcus faecium</i> (OR 1.450, 95% CI 0.812–2.591), methicillin-resistant <i>Staphylococcus aureus</i> (OR 2.000, 95% CI 1.043–3.834) and <i>Candida</i> spp. (OR 2.037, 95% CI 1.206–3.440). In colon surgery with OAP, GPC infections were more likely (OR 1.461, 95% CI 1.022–2.088). In rectal surgery, organ/space SSIs had a higher risk of harbouring GPC (OR 1.860, 95% CI 1.153–2.999) and a lower risk of GNB (OR 0.321, 95% CI 0.200–0.515).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OAP reduced the presence of anaerobes and GNB in SSIs, but increased the isolation of GPCs and fungi, with <i>E. faecium</i> and <i>Candida</i> being of particular concern. This information should guide empirical antibiotic therapy for postoperative colorectal SSIs in patients who have received preoperative OAP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jorge Sancho-Muriel, Hanna Cholewa, Francisco Giner, Carmen Gutierrez, Blas Flor, Matteo Frasson
{"title":"One step beyond right hemicolectomy with D3 lymphadenectomy: Central ligation of middle colic vessels—A video vignette","authors":"Jorge Sancho-Muriel, Hanna Cholewa, Francisco Giner, Carmen Gutierrez, Blas Flor, Matteo Frasson","doi":"10.1111/codi.70017","DOIUrl":"10.1111/codi.70017","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 2","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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