In section P0725, Efferent loop stimulation prior to ileostomy closure: A practical and cost-effective approach in general surgery, the author list was shown as follows:
L. A. Gómez; K. Ponceliz Khristenko; M. de la Antonia Montoro; C. G. Gomez; M. G. J. Antonio; R. A. Moret; I. P. Miguelañez; I. R. Perez
The correct author list should read as follows:
L. Asensio-Gomez; K. Ponceliz Khristenko; M. de la Antonia Montoro; C. Gonzalez Gomez; J. A. Gazo Martinez; R. Abad Moret; I. Pascual Miguelañez; I. Rubio-Perez
{"title":"Correction to ‘E-Posters’","authors":"","doi":"10.1111/codi.70349","DOIUrl":"https://doi.org/10.1111/codi.70349","url":null,"abstract":"<p>E-Posters. Colorectal Dis 2025; 27: e70174. https://doi.org/10.1111/codi.70174.</p><p>In section P0725, Efferent loop stimulation prior to ileostomy closure: A practical and cost-effective approach in general surgery, the author list was shown as follows:</p><p>L. A. Gómez; <span>K. Ponceliz Khristenko</span>; M. de la Antonia Montoro; C. G. Gomez; M. G. J. Antonio; R. A. Moret; I. P. Miguelañez; I. R. Perez</p><p>The correct author list should read as follows:</p><p>L. Asensio-Gomez; <span>K. Ponceliz Khristenko</span>; M. de la Antonia Montoro; C. Gonzalez Gomez; J. A. Gazo Martinez; R. Abad Moret; I. Pascual Miguelañez; I. Rubio-Perez</p><p>We apologize for this error.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145824466","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}
Giuseppe Vita, Pietro Santocchi, Stefano Amore Bonapasta
{"title":"Laparoscopic splenic flexure resection with en-bloc gastric wedge resection for locally advanced colon cancer with liver metastases: A video vignette","authors":"Giuseppe Vita, Pietro Santocchi, Stefano Amore Bonapasta","doi":"10.1111/codi.70339","DOIUrl":"10.1111/codi.70339","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741589","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}
Ruth Walsh, Edward Murphy, Éanna J. Ryan, Ronan A. Cahill
Background
Anastomotic leak (AL) following rectal cancer resection significantly increases the clinical care, risks morbidity and mortality and impairs oncological outcomes. AL management is not standardised. This systematic review and pooled analysis evaluated the comparative efficacy of the various reported strategies.
Method
After protocol generation with AMSTAR2, a systematic search was conducted in EMBASE, PubMed and SCOPUS. Primary and secondary outcome measures were pooled using the DerSimonian–Laird method with 95% confidence intervals, I2 statistics for heterogeneity and Egger and Begg's testing for bias, defining success as resolution of pelvic sepsis and/or healing of AL.
Results
Sixteen studies published between 2010 and 2024 comprising 7236 patients, 850 with AL, met eligibility criteria albeit with significant heterogeneity (I2 > 50%), reporting variability and moderate bias. Overall, success rates with conservative management (CM) was 44.4%, drainage procedures (DP) 73.7% (78.7% for passive drainage and 73.5% for active drainage), anastomosis conserving surgery (ACS) 69.7% and anastomotic takedown (SAT) 77.0%. Short-term mortality was CM: 0%, DP: 0.97%, ACS: 2.92% and SAT: 1.49%. Mean length of stay was CM: 28.7 days, DP: 59.9 days, ACS: 19.8 days and SAT: 14.7 days. Further intervention occurred in CM: 55.6%, DP: 29.1%, ACS: 53.3% and SAT: 41.1%. Long-term stoma rates were CM: 33.3%, DP: 22.5%, ACS: 27.6% and SAT: 46.0%.
Conclusion
Drainage techniques demonstrate high success with low mortality and further intervention rate albeit with lengthened hospital stay. Surgical approaches also achieve success although mortality and long-term stoma rates are higher. Future studies need a core outcome set.
{"title":"Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis","authors":"Ruth Walsh, Edward Murphy, Éanna J. Ryan, Ronan A. Cahill","doi":"10.1111/codi.70335","DOIUrl":"10.1111/codi.70335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anastomotic leak (AL) following rectal cancer resection significantly increases the clinical care, risks morbidity and mortality and impairs oncological outcomes. AL management is not standardised. This systematic review and pooled analysis evaluated the comparative efficacy of the various reported strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>After protocol generation with AMSTAR2, a systematic search was conducted in EMBASE, PubMed and SCOPUS. Primary and secondary outcome measures were pooled using the DerSimonian–Laird method with 95% confidence intervals, <i>I</i><sup>2</sup> statistics for heterogeneity and Egger and Begg's testing for bias, defining success as resolution of pelvic sepsis and/or healing of AL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies published between 2010 and 2024 comprising 7236 patients, 850 with AL, met eligibility criteria albeit with significant heterogeneity (<i>I</i><sup>2</sup> > 50%), reporting variability and moderate bias. Overall, success rates with conservative management (CM) was 44.4%, drainage procedures (DP) 73.7% (78.7% for passive drainage and 73.5% for active drainage), anastomosis conserving surgery (ACS) 69.7% and anastomotic takedown (SAT) 77.0%. Short-term mortality was CM: 0%, DP: 0.97%, ACS: 2.92% and SAT: 1.49%. Mean length of stay was CM: 28.7 days, DP: 59.9 days, ACS: 19.8 days and SAT: 14.7 days. Further intervention occurred in CM: 55.6%, DP: 29.1%, ACS: 53.3% and SAT: 41.1%. Long-term stoma rates were CM: 33.3%, DP: 22.5%, ACS: 27.6% and SAT: 46.0%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Drainage techniques demonstrate high success with low mortality and further intervention rate albeit with lengthened hospital stay. Surgical approaches also achieve success although mortality and long-term stoma rates are higher. Future studies need a core outcome set.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713528","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}
Vipul D. Yagnik, Pankaj Garg, Kaushik Bhattacharya
{"title":"Complex anal fistulas and laser therapy: A critical appraisal of the FISTULASER study","authors":"Vipul D. Yagnik, Pankaj Garg, Kaushik Bhattacharya","doi":"10.1111/codi.70343","DOIUrl":"10.1111/codi.70343","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713521","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}
Thomas J. Curtis, Roberta Bugeja, Stephen C. Radley, Thomas G. Gray
Aim
The accepted model for the pathogenesis of female urinary tract infection (UTI) is ascending infection with bowel flora from anus to urethra, though anal incontinence (AI) and obstructive defecation (ODS) have not previously been demonstrated to be risk factors for recurrent UTI (rUTI). This study aimed to use patient-reported outcome (PROM) data to investigate the association between AI and ODS with self-reported rUTI in women.
Method
Data obtained from 7990 completed ePAQ-Pelvic Floor PROMs at seven participating NHS hospitals between 2018 and 2022 were analysed. Essential inclusion criteria were completion of both the bowel dimension and item assessing self-reported rUTI in consenting participants. Participants were divided into cases and controls based on self-reported frequency of UTI. Mann–Whitney, logistic regression and Spearman's rank analyses were performed to assess for associations between self-reported rUTI with AI and ODS.
Results
rUTI was reported by 931 women (11.7%). Significantly worse symptom scores for flatus incontinence (p < 0.0001) (OR 1.24), liquid AI (p < 0.0001) (OR 1.38), solid AI (p = 0.0031) (OR 1.24), passive faecal incontinence (p < 0.0001) (OR 1.40), use of pads for AI (p < 0.0001) (OR 1.34), perineal splinting/vaginal digitation (p < 0.0001) (OR 1.19) and anal digitation (p < 0.0001) (OR 1.30) were reported in participants with rUTI. Frequency of UTI weakly correlated with all AI and ODS symptoms (r = 0.069–0.151, p < 0.0001).
Conclusion
AI and ODS symptoms are significantly associated with increased rates of self-reported rUTI in this study, supporting the theory that these conditions may contribute to the pathogenesis of rUTI in women. Whilst the aetiology of rUTI is multifactorial, AI and ODS are contributory risk factors.
{"title":"Is self-reported recurrent urinary tract infection associated with anal incontinence and obstructive defecation? A multicentre case-control study using electronic PROM data","authors":"Thomas J. Curtis, Roberta Bugeja, Stephen C. Radley, Thomas G. Gray","doi":"10.1111/codi.70336","DOIUrl":"10.1111/codi.70336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The accepted model for the pathogenesis of female urinary tract infection (UTI) is ascending infection with bowel flora from anus to urethra, though anal incontinence (AI) and obstructive defecation (ODS) have not previously been demonstrated to be risk factors for recurrent UTI (rUTI). This study aimed to use patient-reported outcome (PROM) data to investigate the association between AI and ODS with self-reported rUTI in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data obtained from 7990 completed ePAQ-Pelvic Floor PROMs at seven participating NHS hospitals between 2018 and 2022 were analysed. Essential inclusion criteria were completion of both the bowel dimension and item assessing self-reported rUTI in consenting participants. Participants were divided into cases and controls based on self-reported frequency of UTI. Mann–Whitney, logistic regression and Spearman's rank analyses were performed to assess for associations between self-reported rUTI with AI and ODS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>rUTI was reported by 931 women (11.7%). Significantly worse symptom scores for flatus incontinence (<i>p</i> < 0.0001) (OR 1.24), liquid AI (<i>p</i> < 0.0001) (OR 1.38), solid AI (<i>p</i> = 0.0031) (OR 1.24), passive faecal incontinence (<i>p</i> < 0.0001) (OR 1.40), use of pads for AI (<i>p</i> < 0.0001) (OR 1.34), perineal splinting/vaginal digitation (<i>p</i> < 0.0001) (OR 1.19) and anal digitation (<i>p</i> < 0.0001) (OR 1.30) were reported in participants with rUTI. Frequency of UTI weakly correlated with all AI and ODS symptoms (<i>r</i> = 0.069–0.151, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI and ODS symptoms are significantly associated with increased rates of self-reported rUTI in this study, supporting the theory that these conditions may contribute to the pathogenesis of rUTI in women. Whilst the aetiology of rUTI is multifactorial, AI and ODS are contributory risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713506","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}
{"title":"Fusion surgery for intracorporeal anastomosis in robotic colectomy: A video vignette","authors":"Fumi Hasegawa, Masahiro Fuse, Taku Sato, Taira Inutake, Yuri Kawashima, Megumu Enjoji","doi":"10.1111/codi.70341","DOIUrl":"10.1111/codi.70341","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713569","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}
Zoe Marangoni, Louis Onghena, Maddalena Giacomozzi, Yves van Nieuwenhove, Eva Pape, Gabrielle H. van Ramshorst
Introduction
Colorectal surgery for benign indications affects patients' sexual health. LGBTQ+ patients often face discrimination, resulting in unmet health needs. We aimed to investigate how colorectal surgery for benign disease affects LGBTQ+ individuals' sexual health, and which barriers exist to access healthcare.
Methods
PubMed, Embase, Web of Science, Scopus, PsychINFO, Google Scholar, CINHAL, ProQuest, Cochrane library and Joanna Briggs Institute were systematically searched. Screening and data extraction were performed independently by two researchers. Inclusion criteria were adult patients who self-identified as LGBTQ+; colorectal or anal procedures for benign disease; outcomes of sexual health/wellbeing/pleasure. Exclusion criteria were appendicectomy, transrectal procedures or gender-affirming surgery and >50% of patients treated for malignancy.
Results
Of the 719 records, eight articles were selected: one prospective cohort study, three mixed-methods surveys and four literature reviews. Ten main themes were identified: sexual function/activity and pain, anoreceptive intercourse (ARI), sexual satisfaction and pleasure, mental health and body image, obstacles and coping strategies, dating and relationships, partner response and inclusion, experience with healthcare providers, information sources, stigma and discrimination. Colorectal surgery negatively impacts sexual health and relationships. LGBTQ+ patients reported challenges in accessing care and information regarding sexual health after colorectal surgery, whilst facing discrimination and stigma.
Conclusion
Colorectal surgery for benign disease affects LGBTQ+ patients' sexual health. Literature is scarce, with limited data stratification for sexual orientation or gender identity. Healthcare providers need to be educated about LGBTQ+ needs relating to sexual health and surgery, and inclusive clinical guidelines should be developed.
结直肠手术的良性适应症影响患者的性健康。LGBTQ+患者经常面临歧视，导致健康需求得不到满足。我们的目的是调查结肠直肠良性疾病手术如何影响LGBTQ+个体的性健康，以及在获得医疗保健方面存在哪些障碍。方法系统检索PubMed、Embase、Web of Science、Scopus、PsychINFO、谷歌Scholar、CINHAL、ProQuest、Cochrane library和Joanna Briggs Institute。筛选和数据提取由两名研究人员独立完成。纳入标准为自认为LGBTQ+的成年患者；结肠直肠或肛门良性疾病的手术；性健康/幸福/快乐的结果。排除标准为阑尾切除术、经直肠手术或性别确认手术，50%的患者接受过恶性肿瘤治疗。结果共纳入719篇文献，共选择8篇：1篇前瞻性队列研究，3篇混合方法调查，4篇文献综述。确定了十个主题：性功能/活动和疼痛、无接受性性交（ARI）、性满足和愉悦、心理健康和身体形象、障碍和应对策略、约会和关系、伴侣反应和包容、与卫生保健提供者的经验、信息来源、耻辱和歧视。结直肠手术对性健康和两性关系有负面影响。LGBTQ+患者报告说，在结肠直肠癌手术后获得有关性健康的护理和信息方面存在挑战，同时面临歧视和污名。结论结直肠手术治疗良性疾病会影响LGBTQ+患者的性健康。文献很少，关于性取向或性别认同的数据分层有限。医疗保健提供者需要了解LGBTQ+在性健康和手术方面的需求，并应制定包容性的临床指南。
{"title":"Sexual health of LGBTQ+ patients undergoing colorectal surgery for benign disease and their experience with healthcare: A scoping review","authors":"Zoe Marangoni, Louis Onghena, Maddalena Giacomozzi, Yves van Nieuwenhove, Eva Pape, Gabrielle H. van Ramshorst","doi":"10.1111/codi.70327","DOIUrl":"https://doi.org/10.1111/codi.70327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Colorectal surgery for benign indications affects patients' sexual health. LGBTQ+ patients often face discrimination, resulting in unmet health needs. We aimed to investigate how colorectal surgery for benign disease affects LGBTQ+ individuals' sexual health, and which barriers exist to access healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, Web of Science, Scopus, PsychINFO, Google Scholar, CINHAL, ProQuest, Cochrane library and Joanna Briggs Institute were systematically searched. Screening and data extraction were performed independently by two researchers. Inclusion criteria were adult patients who self-identified as LGBTQ+; colorectal or anal procedures for benign disease; outcomes of sexual health/wellbeing/pleasure. Exclusion criteria were appendicectomy, transrectal procedures or gender-affirming surgery and >50% of patients treated for malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 719 records, eight articles were selected: one prospective cohort study, three mixed-methods surveys and four literature reviews. Ten main themes were identified: sexual function/activity and pain, anoreceptive intercourse (ARI), sexual satisfaction and pleasure, mental health and body image, obstacles and coping strategies, dating and relationships, partner response and inclusion, experience with healthcare providers, information sources, stigma and discrimination. Colorectal surgery negatively impacts sexual health and relationships. LGBTQ+ patients reported challenges in accessing care and information regarding sexual health after colorectal surgery, whilst facing discrimination and stigma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Colorectal surgery for benign disease affects LGBTQ+ patients' sexual health. Literature is scarce, with limited data stratification for sexual orientation or gender identity. Healthcare providers need to be educated about LGBTQ+ needs relating to sexual health and surgery, and inclusive clinical guidelines should be developed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750874","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}
Oscar Hernandez, Stefan D. Holubar, Daniel Joyce, Robert Simon
{"title":"Bowel preserving surgery for stricturing jejunoileal Crohn's disease, part 4: Jaboulay duodenal strictureplasty: A step-by-step video vignette—A video vignette","authors":"Oscar Hernandez, Stefan D. Holubar, Daniel Joyce, Robert Simon","doi":"10.1111/codi.70325","DOIUrl":"10.1111/codi.70325","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713525","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}
Gustav Sandén, Ida Hed Myrberg, Sol Erika Boman, Caroline Nordenvall, Juan-Jesus Carrero, Peter Matthiessen, Martin Rutegård
Aim
To investigate short- and long-term kidney injury incidence in patients undergoing low anterior resection for rectal cancer, comparing those with and without a defunctioning ileostomy.
Method
We identified all Swedish rectal cancer patients ≤80 years old, with ASA fitness grade ≤III and tumour height ≤12 cm from the anal verge, who underwent anterior resection between 2007 and 2021 using CRCBaSe, a nationwide registry linkage. Patients who received a defunctioning ileostomy during surgery were compared with those who did not. Outcomes included chronic kidney failure, chronic kidney disease, acute kidney injury, and dehydration. Cox proportional hazards models were fitted for each outcome, using overlap weights derived from propensity scores for receiving a defunctioning ileostomy. Stoma reversal impact and mediation by anastomotic leakage were also examined.
Results
Among 5286 patients, 4623 (87%) received a defunctioning ileostomy and 663 (13%) did not. A defunctioning ileostomy was not significantly associated with chronic kidney failure (HR 1.68, 95% CI: 0.19–15.16) or chronic kidney disease (HR 1.65, 95% CI: 0.91–2.98) but increased risks of acute kidney injury (HR 3.01, 95% CI: 1.61–5.64) and dehydration (HR 4.02, 95% CI: 2.33–6.94). Risks declined after stoma reversal. Stomas reduced anastomotic leakage with negligible mediation effects on short-term kidney damage.
Conclusion
A defunctioning ileostomy after low anterior resection increases the risks of acute kidney injury and dehydration but not chronic kidney failure or chronic kidney disease. These risks decrease following stoma reversal, highlighting the need for careful perioperative management.
{"title":"The impact of defunctioning ileostomies on postoperative kidney function in rectal cancer surgery","authors":"Gustav Sandén, Ida Hed Myrberg, Sol Erika Boman, Caroline Nordenvall, Juan-Jesus Carrero, Peter Matthiessen, Martin Rutegård","doi":"10.1111/codi.70329","DOIUrl":"10.1111/codi.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate short- and long-term kidney injury incidence in patients undergoing low anterior resection for rectal cancer, comparing those with and without a defunctioning ileostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We identified all Swedish rectal cancer patients ≤80 years old, with ASA fitness grade ≤III and tumour height ≤12 cm from the anal verge, who underwent anterior resection between 2007 and 2021 using CRCBaSe, a nationwide registry linkage. Patients who received a defunctioning ileostomy during surgery were compared with those who did not. Outcomes included chronic kidney failure, chronic kidney disease, acute kidney injury, and dehydration. Cox proportional hazards models were fitted for each outcome, using overlap weights derived from propensity scores for receiving a defunctioning ileostomy. Stoma reversal impact and mediation by anastomotic leakage were also examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5286 patients, 4623 (87%) received a defunctioning ileostomy and 663 (13%) did not. A defunctioning ileostomy was not significantly associated with chronic kidney failure (HR 1.68, 95% CI: 0.19–15.16) or chronic kidney disease (HR 1.65, 95% CI: 0.91–2.98) but increased risks of acute kidney injury (HR 3.01, 95% CI: 1.61–5.64) and dehydration (HR 4.02, 95% CI: 2.33–6.94). Risks declined after stoma reversal. Stomas reduced anastomotic leakage with negligible mediation effects on short-term kidney damage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A defunctioning ileostomy after low anterior resection increases the risks of acute kidney injury and dehydration but not chronic kidney failure or chronic kidney disease. These risks decrease following stoma reversal, highlighting the need for careful perioperative management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707557","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}
Mohit Satish Gupta, Usman Mateen, Nicola Davies, Andrew Clarke
Background
Full-thickness rectal prolapse (FTRP) is heterogeneous, with outcomes varying despite similar anatomy. Cooper et al. proposed a radiological classification based on prolapse ‘take-off’ level on defecating proctography (DPG), hypothesising that high take-off (HTO) and low take-off (LTO) phenotypes may respond differently to abdominal versus perineal repair. This hypothesis has not previously been tested in a clinical cohort.
Methods
A retrospective observational cohort study was performed across three hospitals over 12 years (2012–2024). Patients undergoing laparoscopic ventral mesh rectopexy (VMR), as first standardised by D'Hoore et al. [3] or Delorme's procedure with DPG-defined take-off were included. Outcomes were compared between procedures, matched versus unmatched surgery, and HTO versus LTO. The primary end-point was anatomical recurrence. Secondary end-points included radiological findings and symptom profiles by phenotype.
Results
Of 108 patients, 71 (52 VMR, 19 Delorme's) had evaluable DPG and were included in phenotype analysis (HTO, n = 28; LTO, n = 43). Overall recurrence was 15.5%. Recurrence was lower after VMR than Delorme's (13.5% vs. 21.1%, p = 0.47) and in matched versus unmatched surgery (12.8% vs. 20.8%, p = 0.53), though not statistically significant. Within VMR, recurrence was lower in HTO than LTO (8.3% vs. 17.9%). HTO was significantly associated with enterocele (71.4% vs. 44.2%, p = 0.030) and greater perineal discomfort (85.7% vs. 55.8%, p = 0.010), whereas LTO more frequently presented with incontinence/urgency.
Conclusion
This first clinical validation of the high/low take-off concept demonstrates phenotype-specific differences in radiology, symptoms, and surgical outcomes. Tailoring surgery to prolapse phenotype may reduce recurrence and guide personalised operative planning. Prospective, multicentre studies with quality-of-life outcomes are warranted.
背景：全层直肠脱垂（FTRP）是异质性的，尽管解剖结构相似，但其结果却不同。Cooper等人提出了一种基于排便直肠造影（DPG）脱垂“起飞”水平的放射学分类，假设高起飞（HTO）和低起飞（LTO）表型对腹部和会阴修复的反应可能不同。这一假设此前尚未在临床队列中得到验证。方法：回顾性观察队列研究在三家医院进行了12年（2012-2024）。接受腹腔镜腹侧网状直肠固定术（VMR）的患者，首先由D'Hoore等人标准化，b[3]或Delorme的手术与dpg定义的起飞。结果比较了手术过程、匹配手术与不匹配手术、HTO与LTO。主要终点为解剖性复发。次要终点包括放射学表现和表型的症状概况。结果：108例患者中，71例（52例VMR， 19例Delorme’s）具有可评估的DPG，并纳入表型分析（HTO, n = 28； LTO, n = 43）。总复发率为15.5%。VMR术后复发率低于Delorme术后（13.5% vs. 21.1%, p = 0.47），匹配手术vs.不匹配手术（12.8% vs. 20.8%, p = 0.53），但无统计学意义。在VMR中，HTO的复发率低于LTO （8.3% vs. 17.9%）。HTO与小肠膨出（71.4%比44.2%,p = 0.030）和会阴不适（85.7%比55.8%,p = 0.010）显著相关，而LTO更常表现为尿失禁/尿急。结论：高/低起飞概念的首次临床验证证明了放射学、症状和手术结果的表型特异性差异。根据脱垂表型定制手术可以减少复发并指导个性化的手术计划。具有生活质量结果的前瞻性、多中心研究是有必要的。
{"title":"High versus low take-off rectal prolapse: Outcomes of tailored surgery","authors":"Mohit Satish Gupta, Usman Mateen, Nicola Davies, Andrew Clarke","doi":"10.1111/codi.70330","DOIUrl":"10.1111/codi.70330","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Full-thickness rectal prolapse (FTRP) is heterogeneous, with outcomes varying despite similar anatomy. Cooper et al. proposed a radiological classification based on prolapse ‘take-off’ level on defecating proctography (DPG), hypothesising that high take-off (HTO) and low take-off (LTO) phenotypes may respond differently to abdominal versus perineal repair. This hypothesis has not previously been tested in a clinical cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective observational cohort study was performed across three hospitals over 12 years (2012–2024). Patients undergoing laparoscopic ventral mesh rectopexy (VMR), as first standardised by D'Hoore et al. [3] or Delorme's procedure with DPG-defined take-off were included. Outcomes were compared between procedures, matched versus unmatched surgery, and HTO versus LTO. The primary end-point was anatomical recurrence. Secondary end-points included radiological findings and symptom profiles by phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 108 patients, 71 (52 VMR, 19 Delorme's) had evaluable DPG and were included in phenotype analysis (HTO, <i>n</i> = 28; LTO, <i>n</i> = 43). Overall recurrence was 15.5%. Recurrence was lower after VMR than Delorme's (13.5% vs. 21.1%, <i>p</i> = 0.47) and in matched versus unmatched surgery (12.8% vs. 20.8%, <i>p</i> = 0.53), though not statistically significant. Within VMR, recurrence was lower in HTO than LTO (8.3% vs. 17.9%). HTO was significantly associated with enterocele (71.4% vs. 44.2%, <i>p</i> = 0.030) and greater perineal discomfort (85.7% vs. 55.8%, <i>p</i> = 0.010), whereas LTO more frequently presented with incontinence/urgency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This first clinical validation of the high/low take-off concept demonstrates phenotype-specific differences in radiology, symptoms, and surgical outcomes. Tailoring surgery to prolapse phenotype may reduce recurrence and guide personalised operative planning. Prospective, multicentre studies with quality-of-life outcomes are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 12","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707538","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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