Diseases of the Colon & Rectum最新文献

{"title":"Reply.","authors":"Fabio S Kawaguti, Cintia M S Kimura, Daniel T Rezende","doi":"10.1097/DCR.0000000000004045","DOIUrl":"10.1097/DCR.0000000000004045","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"269"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid Video-Assisted Fistula Treatment With Seton Tie for Management of Fistula-in-Ano: Results of a Novel Technique.","authors":"Tarun Mittal, Anmol Ahuja, Ashish Dey, Vinod K Malik, Shresth Manglik, Tanushree B Nahata","doi":"10.1097/DCR.0000000000004004","DOIUrl":"10.1097/DCR.0000000000004004","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive treatment has shown variable success rates (67%-82%) with persistent challenges in effectively managing the internal opening of transsphincteric fistulas.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of hybrid video-assisted anal fistula treatment combined with silk cutting seton tie for managing transsphincteric anal fistulas.</p><p><strong>Design: </strong>Retrospective evaluation of prospectively collected data from December 2021 to January 2024.</p><p><strong>Settings: </strong>Single-center study with all procedures performed by a single surgeon.</p><p><strong>Patients: </strong>A total of 63 patients with transsphincteric anal fistula underwent the procedure during the study period. Two patients were lost to follow-up, and 61 patients (47 men and 14 women) were included in the final analysis. The mean age was 42.3 ± 13.8 years. The mean fistula tract length was 3.9 ± 1.2 cm. Exclusion criteria included multiple openings, IBD, tuberculosis, and preexisting incontinence.</p><p><strong>Interventions: </strong>The hybrid technique involved identifying the internal opening using diluted hydrogen peroxide injection under fistuloscopy, followed by placement of a 1-0 silk seton around the internal opening. The fistula tract was fulgurated using monopolar diathermy and curetted.</p><p><strong>Main outcome measures: </strong>Primary healing rate at 16 weeks, median healing time, recurrence at 1-year follow-up, and complications were the main outcome measures.</p><p><strong>Results: </strong>Primary healing was achieved in 55 patients (90%) within 16 weeks, with a median healing time of 5 weeks. Seton expulsion occurred spontaneously in 39 patients (63.9%) at a median of 4 weeks. Six patients had persistent wounds, with 4 healing by 20 weeks and 2 requiring fistulectomy. At 1-year follow-up, 4 patients (6.6%) experienced recurrence, and the overall failure rate was 9.8%.</p><p><strong>Limitations: </strong>Retrospective design, short follow-up, small sample size, single-surgeon experience, and inclusion limited to transsphincteric fistulas.</p><p><strong>Conclusions: </strong>Hybrid video-assisted anal fistula treatment with seton tie is a minimally invasive and effective approach for transsphincteric fistula-in-ano, as it offers low recurrence, minimal morbidity, and faster recovery. See Video Abstract .</p><p><strong>Tratamiento hbrido asistido por vdeo de la fstula con ligadura de seton para el manejo de la fstula anal resultados de una tcnica novedosa: </strong>ANTECEDENTES:El tratamiento mínimamente invasivo ha mostrado tasas de éxito variables (67-82 %) con retos persistentes en el manejo eficaz de la abertura interna de las fístulas transesfinterianas.OBJETIVO:Evaluar la eficacia y la seguridad del tratamiento híbrido de la fístula anal asistido por vídeo combinado con la ligadura con setón de seda para el manejo de las fístulas anales transesfinterianas.DISEÑO:Evaluaci","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"218-225"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transsacrococcygeal (Kraske) Approach: A Reappraisal.","authors":"Pornraksa Ovartchaiyapong, Woramin Riansuwan","doi":"10.1097/DCR.0000000000003911","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003911","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"69 2","pages":"266"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circumferential Rectal Cancer Is a Risk Factor for Stricture Formation and Restaging Uncertainties After Neoadjuvant Therapy.","authors":"James G Connolly, James C McCullum, Cody Munroe, Racquel S Gaetani, Jonathan T Bliggenstorfer, Julia T Saraidaridis, Angela H Kuhnen, Peter W Marcello, David A Kleiman, Jonathan S Abelson","doi":"10.1097/DCR.0000000000004015","DOIUrl":"10.1097/DCR.0000000000004015","url":null,"abstract":"<p><strong>Background: </strong>Circumferential rectal tumors treated with total neoadjuvant therapy have the potential to develop into a stricture. These strictures can make assessment of clinical response challenging and are considered a contraindication to nonoperative management according to the National Comprehensive Cancer Network guidelines. However, the incidence of stricture formation and its likelihood of harboring occult residual disease remains poorly understood.</p><p><strong>Objective: </strong>To investigate which patients with locally advanced rectal cancer are at risk for stricture formation after total neoadjuvant therapy and assess residual tumor at the time of surgery.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single tertiary care center.</p><p><strong>Patients: </strong>Patients with stage II or III rectal cancer who underwent total neoadjuvant therapy with curative intent surgery were included.</p><p><strong>Main outcome measures: </strong>The rate of stricture formation after total neoadjuvant therapy and pathologic complete response rate after proctectomy at the primary tumor site.</p><p><strong>Intervention: </strong>Total neoadjuvant therapy.</p><p><strong>Results: </strong>Of the 69 patients included in the analysis, 18 patients (26%) had a circumferential rectal tumor. Four of these 18 patients (22%) developed a stricture at the primary tumor site. No other patients in the study developed a stricture. All 4 patients with a posttreatment rectal stricture underwent proctectomy due to the concern for residual disease within the stricture despite complete response on endoscopy and MRI. Three of the 4 stricture patients (75%) had residual primary disease on final surgical pathology. Fourteen patients with circumferential tumors did not develop a stricture but underwent a proctectomy for incomplete response. Eleven of 14 patients (79%) had a pathologic incomplete response.</p><p><strong>Limitations: </strong>Limited sample size.</p><p><strong>Conclusions: </strong>Seventy-five percent of these patients with a stricture had residual disease on surgical pathology despite classic findings of complete clinical response. This study highlights the inherent difficulty in pursuing nonoperative management in this patient population. See Video Abstract .</p><p><strong>El cncer rectal circunferencial es un factor de riesgo para la formacin de estenosis y la incertidumbre en la reevaluacin tras la terapia neoadyuvante: </strong>ANTECEDENTES:Los tumores rectales circunferenciales tratados con terapia neoadyuvante total pueden desarrollar estenosis. Estas estenosis pueden dificultar la evaluación de la respuesta clínica y se consideran una contraindicación para el tratamiento no quirúrgico según las directrices de la Red Nacional Integral del Cáncer. Sin embargo, la incidencia de la formación de estenosis y la probabilidad de que alberguen enfermedad residual oculta siguen sin conocerse bien.OBJET","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"181-190"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperactive Intestinal Peaks Observed Within Hours After Colorectal Surgery Identify Patients Who Develop Postoperative Ileus.","authors":"Luca Stocchi, Steve Axelrod, Lindsay A Axelrod, Anand R Navalgund","doi":"10.1097/DCR.0000000000004031","DOIUrl":"10.1097/DCR.0000000000004031","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of postoperative ileus remains difficult.</p><p><strong>Objective: </strong>To determine whether myoelectric activity recorded by a noninvasive, wireless patch system correlated with the onset of postoperative ileus/bowel dysfunction.</p><p><strong>Design: </strong>Single-arm, prospective study. The surgeon was blinded to myoelectric bowel activity until study completion.</p><p><strong>Settings: </strong>Single surgeon, tertiary referral center.</p><p><strong>Patients: </strong>Consecutive adult patients undergoing abdominal colorectal surgery.</p><p><strong>Interventions: </strong>Three wireless patches acquiring myoelectrical GI activity were placed on the abdomen after surgery and removed before hospital discharge/reoperation. All patients followed an enterprise-specific enhanced recovery protocol.</p><p><strong>Main outcome measures: </strong>Ileus (nausea, vomiting, abdominal distention requiring nasogastric tube placement) or bowel dysfunction (similar symptoms without nasogastric tube needed) detected clinically within 30 postoperative days. Daily gut activity prints (histograms of the frequencies of all peaks detected in 10-minute time windows) were created for each patient for every 4-hour period after surgery, and activity was averaged and plotted for each group. Peaks in the 8 to 12 cycles per minute range were assigned to intestinal activity, and the energy under the peaks was summed through day 1, day 2, and day 3 and compared among patients.</p><p><strong>Results: </strong>Patch application on 46 enrolled cases undergoing abdominal colorectal surgery (open in 17, robotic in 11, laparoscopic in 18) was not associated with any adverse events. Hyperactive intestinal activity was significantly higher in 12 patients who developed postoperative ileus/bowel dysfunction within 16 hours postoperatively ( p = 0.041), with a more pronounced difference at 20 and 24 hours ( p = 0.016 and p = 0.013, respectively).</p><p><strong>Limitations: </strong>Data were collected blindly during standard postoperative care; therefore, the integration of technology into clinical practice remains to be tested.</p><p><strong>Conclusions: </strong>Noninvasive measurement of intestinal myoelectrical activity allowed early identification of postoperative ileus/bowel dysfunction. Future studies will assess the possible advantages deriving from the integration of this system into clinical practice. See Video Abstract .</p><p><strong>Los picos intestinales hiperactivos observados pocas horas despus de la ciruga colorrectal identifican a los pacientes que desarrollan leo posoperatorio: </strong>ANTECEDENTES:El reconocimiento precoz del íleo posoperatorio sigue siendo difícil.OBJETIVO:Determinar si la actividad mioeléctrica registrada por un sistema de parches inalámbricos no invasivos se correlacionaba con la aparición de íleo posoperatorio/disfunción intestinal.DISEÑO:Estudio prospectivo de un solo grupo. El cirujano ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"245-255"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Donut and the Hole: A Colorectal Surgeon's Musings on Optimism and Pessimism.","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003953","DOIUrl":"10.1097/DCR.0000000000003953","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"155-157"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Outcomes After Elective Versus Emergency Resection for Right-Sided Colon Cancer\": Toward a Bridge-to-Surgery Approach.","authors":"Kenza Koliaï, Rabah Bouzouagh, Nessma K Lardjane, Taous Merabti, Fella Dabouz, Chafik Bouzid","doi":"10.1097/DCR.0000000000004040","DOIUrl":"10.1097/DCR.0000000000004040","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"270"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Risk Factors for Stricture After Endoscopic Submucosal Dissection of Large Rectal Neoplasms\".","authors":"Miao Yu, Jinmei Zou","doi":"10.1097/DCR.0000000000004044","DOIUrl":"10.1097/DCR.0000000000004044","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"268"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory Analysis of Urinary and Sexual Dysfunction in Patients With Low Anterior Resection Syndrome Undergoing Sacral Neuromodulation: Insights From the SANLARS Trial.","authors":"Franco Marinello, Pere Planellas, Domenico Fraccalvieri, Nuria Ortega-Torrecilla, Julia Gil, Esther Kreisler, Gianluca Pellino, Eloy Espín-Basany","doi":"10.1097/DCR.0000000000004050","DOIUrl":"10.1097/DCR.0000000000004050","url":null,"abstract":"<p><strong>Background: </strong>Limited evidence is available on the effects of sacral neuromodulation on concomitant nondigestive symptoms of low anterior resection syndrome.</p><p><strong>Objective: </strong>To assess the impact of sacral neuromodulation on urinary and sexual dysfunction in patients with low anterior resection syndrome.</p><p><strong>Design: </strong>Secondary analysis of a randomized, double-blinded, 2-phased, controlled, multicenter crossover trial (NCT02517853).</p><p><strong>Settings: </strong>Three tertiary hospitals.</p><p><strong>Patients: </strong>Patients with major low anterior resection syndrome 12 months after transit reconstruction after rectal resection who had failed conservative treatment.</p><p><strong>Interventions: </strong>Patients underwent an advanced test phase of stimulation for 3 weeks and received a pulse generator implant if a 50% reduction in a low anterior resection syndrome score was achieved. These patients entered the randomized phase in which the generator was left active or inactive for 4 weeks. After a 2-week washout, the sequence was changed. After the crossover, all generators were left activated.</p><p><strong>Main outcome measures: </strong>Improvement of urinary and sexual dysfunction as assessed with validated questionnaires.</p><p><strong>Results: </strong>Data for 35 patients were analyzed. The International Consultation on Incontinence Questionnaire-Short Form for urinary incontinence score at baseline (5.09 ± 6.48) decreased by 46% (p = 0.002) and 35% (p = 0.023) at 6- and 12-month follow-up. The proportion of patients with several urine leaks per day decreased from 17.1% to 5.7% (baseline vs 12-month follow-up, p = 0.001). High confidence in keeping an erection increased from 0 to 13.6% (baseline vs 12-month follow-up, p = 0.002). Improvement in sexual function in the 7 female patients who reported being sexually active was less apparent. The Female Sexual Function Index score at baseline, 6-, and 12-month follow-up were 15.84 ± 3.17, 18.03 ± 1.44 (p = 0.433), and 16.53 ± 2.61 (p = 0.7).</p><p><strong>Limitations: </strong>This is a secondary analysis of a randomized trial, which could be underpowered for the current aim.</p><p><strong>Conclusions: </strong>Neuromodulation seemed to ameliorate urinary dysfunction associated with low anterior resection syndrome. See Video Abstract.</p><p><strong>Anlisis exploratorio de la disfuncin urinaria y sexual en pacientes con sndrome de reseccin anterior baja sometidos a neuromodulacin sacra conclusiones del ensayo sanlars: </strong>ANTECEDENTES:Existen pocas pruebas disponibles sobre los efectos de la neuromodulación sacra en los síntomas no digestivos concomitantes del síndrome de resección anterior baja.OBJETIVO:Evaluar el impacto de la neuromodulación sacra en la disfunción urinaria y sexual en pacientes con síndrome de resección anterior baja.DISEÑO:Análisis secundario de un ensayo cruzado aleatorizado, doble ciego, en dos fases, controla","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"69 2","pages":"226-234"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Outcomes of Treatment Failure after Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases.","authors":"Varut Lohsiriwat, Romyen Jitmungngan, Worrawit Wanitsuwan, Siripong Sirikurnpiboon, Weeraput Chadbunchachai, Punnawat Chandrachamnong, Pornraksa Ovartchaiyapong","doi":"10.1097/DCR.0000000000004142","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004142","url":null,"abstract":"<p><strong>Background: </strong>Despite generally favorable outcomes of ligation of intersphincteric fistula tract for anal fistula, several patients experience persistent or recurrent disease.</p><p><strong>Objective: </strong>This study aimed to identify patterns of treatment failure after ligation of intersphincteric fistula tract and evaluate their outcomes.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Setting: </strong>Five university hospitals in Thailand.</p><p><strong>Patients: </strong>Those diagnosed with persistent or recurrent cryptoglandular anal fistula after ligation of intersphincteric fistula tract between 2012 and 2020.</p><p><strong>Main outcome measures: </strong>Fistula characteristics, patterns of treatment failure and outcomes of subsequent management were analyzed.</p><p><strong>Results: </strong>A total of 200 patients were included, of whom 12.5% had persistent fistulas and 87.5% had recurrence. Median time to recurrence was 6 months (range, 1-48). Most treatment failures (n = 186, 93%) occurred within one year after surgery. Six distinct patterns of treatment failure were identified. The most common was type 1 (I-E, tract running from the previous internal opening (I) to an external opening (E) - known as an original fistula: n=116, 58%), followed by type 2 (I-L, tract running from the previous internal opening (I) to an unhealed intersphincteric wound - known as an intersphincteric fistula: n = 56, 28%). Type 1 failure was effectively treated by redo- ligation of intersphincteric fistula tract with an 87% success rate. Overall, the healing rate was 90.5% - with a median follow-up period of 18 months (range, 12-38).</p><p><strong>Limitations: </strong>Exclusion of non-cryptoglandular fistulas may limit generalizability. The retrospective multicenter design and surgeon-dependent decision-making may have introduced selection bias and heterogeneity in surgical technique.</p><p><strong>Conclusions: </strong>Most treatment failures occurred within one year after ligation of intersphincteric fistula tract. Understanding the six distinct failure patterns enables more appropriate surgical decision-making. The majority represented either recurrence of the original tract or persistence within the intersphincteric space. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}