International Journal of Colorectal Disease最新文献

Purpose: Postoperative ileus(POI) occurs in 10-19% of colorectal surgeries. The identification of patients at-risk for POI is a key for nasogastric tube(NGT) placement. Point-of-care ultrasound(POCUS) has shown potential in predicting POI by assessing gastric volume, but its role has never been explored. The aim was to evaluate the association between the ratio of gastric volume on postoperative day (POD)2/POD0, measured by Point-of-care ultrasound(POCUS), and the risk of vomiting, postoperative ileus(POI) and the need for nasogastric tube(NGT) insertion after colorectal surgery.

Methods: This prospective monocentric study included 112 patients who underwent colorectal resection with or without anastomosis between August 2020 and April 2023. Gastric volume was measured using POCUS at POD0 and POD2. The primary outcome was the ratio of POD2/POD0. Area under the ROC curve based on multivariate model was estimated for the prediction of the need for NGT insertion was calculated.

Results: Among the 112 patients included in the study, 22 had postoperative nausea (19.6%), 16 experimented POI (14.3%) and 13 needed postoperative NGT insertion(11.6%). A larger POD2/POD0 ratio was significantly associated with nausea, POI and postoperative NGT insertion. In multivariate analysis, the POD2/POD0 ratio was an independent factor associated with the risk of postoperative nausea and postoperative NGT insertion. Finally, the POD2/POD0 ratio predicted the risk for postoperative NGT insertion with an area under ROC curve at 0.79(95%CI:0.67-0.91).

Conclusion: POCUS of the gastric volume is a promising tool to select patient requiring NGT insertion after colorectal surgery.

Clinical trial registry: NCT04461067.

Background: This study aimed to evaluate the learning curve of robotic intracorporeal single-stapling anastomosis (RiSSA) using risk-adjusted cumulative sum (RA-CUSUM) analysis based on standardized procedural intervals.

Methods: We retrospectively analyzed 36 consecutive patients who underwent robotic left-sided colorectal resection with RiSSA by a single surgeon. Eight intraoperative timepoints were annotated from surgical videos to define two composite metrics: pure RiSSA interval and total purse-string suture time. RA-CUSUM analysis was applied to assess technical proficiency over time.

Results: The RA-CUSUM curve showed an inflection point at case 17 for the pure RiSSA interval and at case 11 for purse-string suture time, indicating earlier acquisition of suture skills compared to overall procedural fluency. Two Clavien-Dindo grade ≥ III complications occurred in the late phase, including one anastomotic leak (5.3%, 1/19), whereas no major complications were observed during the early phase, although the limited sample size precludes any definitive safety interpretation. Technical metrics, including console time, pure RiSSA interval, and total purse-string suture duration, significantly improved after the inflection point.

Conclusions: In this single-surgeon cohort, RiSSA demonstrated a definable learning trajectory, with technical efficiency stabilizing after approximately 17 cases. The occurrence of major complications after the learning phase highlights that technical proficiency does not eliminate procedural risks. The pure RiSSA interval offers a reproducible metric to evaluate anastomotic proficiency and could support skill assessment frameworks in robotic colorectal procedures. Studies involving multiple surgeons and institutions are warranted to determine the generalizability of these findings.

Purpose: The incidence of colorectal cancer (CRC) is increasing in individuals aged < 50 years of age. This study aimed to examine whether high-frequency follow-up after CRC surgery reduces 5-year overall mortality, cancer-specific mortality and recurrence in patients with CRC aged ≤ 50 years.

Methods: The COLOFOL trial performed between 2006 and 2010 was used to analyse patients randomised to high-frequency (computed tomography [CT] of the abdomen and thorax and a carcinoembryonic antigen [CEA] test at 6, 12, 18, 24 and 36 months) versus low-frequency (CT and CEA at 12 and 36 months) follow-up after curative CRC surgery. Intention-to-treat and per-protocol analyses were performed to study the primary outcomes (5-year overall mortality and cancer-specific mortality) and the secondary outcome (CRC recurrence), comparing the age groups ≤ 50, 51-70 and > 70 years.

Results: In total, 2,509 patients were included in the intention-to-treat analysis with 183, 1,714 and 612 patients aged ≤ 50, 51-70 and > 70 years, respectively. The 5-year overall mortality risk for patients aged ≤ 50 was 8.3% in the high-frequency group compared with 8.4% in the low-frequency group (risk difference 0.2% [95% CI, - 8.0; 8.3]). The cancer-specific mortality risk for patients aged ≤ 50 years was 7.1% in the high-frequency group compared with 7.4% in the low-frequency group (risk difference, 0.3% [95% CI, - 7.4; 8.0]). The cancer-specific recurrence risk for patients aged ≤ 50 years was 12.9% in the high-frequency group compared with 21.0% in the low-frequency group (risk difference 8.1% [95% CI, - 2.6; 18.7]).

Conclusion: Among individuals aged ≤ 50 years with stage II-III CRC, there was no reduction in overall mortality, cancer-specific mortality and cancer-specific recurrence with more intensive follow-up using CT and CEA.

Background: Anastomotic leakage (AL) is a severe complication after rectal cancer surgery. This network meta-analysis (NMA) compares reinforced suturing (RS), transanal drainage tube (TDT), and no additional intervention (NRT) for AL prevention.

Methods: An NMA was conducted according to PRISMA-NMA guidelines. PubMed, Web of Science, and Embase were searched for randomized controlled trials and observational studies comparing RS, TDT, or NRT in adults undergoing anterior resection for rectal cancer, with AL as the primary outcome. Secondary outcomes included Grade C AL, stricture, bleeding, ileus, and wound infection.

Results: 16 studies (3 RCTs, 11 RNCTs, and 2 PNCTs; n = 4562) were included. For overall AL incidence, both RS (OR 0.32, 95% CrI 0.16-0.62) and TDT (OR 0.47, 95% CrI 0.33-0.63) significantly reduced AL vs. NRT. RS ranked highest (SUCRA 0.93). Although RS had the highest SUCRA for overall AL, the RS-TDT contrast was not statistically significant(OR 1.44, 95% CrI 0.68-3.09), so ranking should not be over-interpreted as proof of superiority. For Grade C AL, RS significantly reduced risk versus both TDT (OR 5.01, 95% CrI 1.33-28.67) and NRT (OR 0.10, 95% CrI 0.02-0.32; SUCRA 0.99). No significant differences were found among interventions for anastomotic bleeding, ileus, or wound infection. TDT showed a trend toward reduced anastomotic stricture risk (SUCRA 0.73), but the effect was not statistically significant (TDT vs. NRT: OR 0.68, 95% CrI 0.19-2.27). Sensitivity analysis restricted to larger studies (≥ 100 patients/group) confirmed the robustness of primary outcomes.

Conclusions: Both RS and TDT were associated with a reduction in overall AL risk compared to NRT. Network estimates suggested that RS may be more effective than TDT in preventing the more severe Grade C AL; however, this finding is based on indirect comparisons with wide credible intervals and requires confirmation in future head-to-head trials. The choice of intervention may therefore depend on patient risk profile and clinical context.

Background: Haemorrhoids are one of the most frequently encountered benign anorectal conditions that negatively impact patients' quality of life. Excisional haemorrhoidectomy (closed or open) is a surgical procedure reserved for the treatment of third- and fourth-degree haemorrhoids, with considerable post-procedure pain reported. The aim of this study was to clarify the association between post operative metronidazole use (both oral and topical) and post-haemorrhoidectomy pain scores through systematic review and meta-analysis of randomised controlled trials (RCTs).

Methods: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Prospective registration was performed on PROSPERO (CRD42024580928). A systematic review was performed for RCTs reporting post-haemorrhoidectomy pain scores between patients who received metronidazole and patients who received placebo. Meta-analysis was performed using RevMan version 5.4.

Results: Seventeen RCTs including 1297 participants were eligible for inclusion. Metronidazole administration was associated with significantly lower post-operative visual analogue scores (VAS) on day 1 (-1.18, p < 0.00001), day 2 (-1.15, p = 0.003), day 3 (-0.86, p < 0.00001), and day 7 post-operatively with a mean pain score difference of -1.72 (95% CI -2.27 to -1.18) (p < 0.00001). A significant difference in pain scores was seen on day 3 favouring topical metronidazole in comparison to the oral route (1.38, 95% CI [0.44, 2.32], p = 0.004).

Conclusion: This review synthesises the best available evidence to support the use of metronidazole to reduce pain after excisional haemorrhoidectomy. While both oral and topical forms appear to be beneficial, topical administration appears to have a more effective analgesic effect from post-operative day 3.

Introduction: Low anterior resection syndrome (LARS) is a common complication following sphincter-sparing rectal cancer surgery, affecting 30-80% of patients and significantly reducing quality of life. Treatment options such as pelvic floor physiotherapy, transanal irrigation and sacral neuromodulation are available, yet the optimal treatment sequence and their overall efficacy remain uncertain. This study aims to assess the effectiveness of an integrative management pathway, including preoperative physiotherapy, for the prevention and treatment of LARS at our institution.

Methods: This cohort study will include patients undergoing low anterior resection for rectal cancer at Fribourg Cantonal Hospital over 24 months; patient's inclusion will start on February 2026. Preoperative assessment includes LARS and EQ-5D questionnaires, and anal manometry to establish baseline functional status. Postoperative LARS and EQ-5D scores will be collected at six weeks. Based on LARS severity, patients will follow a progressive treatment pathway consisting of physiotherapy, transanal irrigation, and sacral neuromodulation. Questionnaires will be repeated after each treatment stage to assess symptom progression and quality of life. Statistical analysis will include Wilcoxon Mann-Whitney tests for score comparisons and logistic regression for identifying risk factors such as neoadjuvant therapy, tumor location, and anastomotic technique.

Results: We hypothesize that this integrative approach will lead to a significant reduction in LARS severity and improvement in quality of life compared to retrospective data collected in 2022.

Conclusions: This study protocole aims to refine postoperative management of LARS through a structured, evidence-based protocol, to identify modifiable risk factors, and to enhance overall patient outcomes following rectal cancer surgery.

Background: Caecal volvulus is a rare condition with an unknown prevalence, particularly in paediatric patients. Predisposing factors include fixation anomalies of the colon (with or without malrotation) and significant intestinal distension due to conditions such as chronic constipation, post-operative ileus, Hirschsprung disease (HD), or paediatric intestinal pseudo-obstruction (PIPO). African degenerative leiomyopathy (ADL) is a regional variant of visceral myopathy characterised by a fibrotic "tiger-striped" degeneration of the muscular layers of the colon, which causes PIPO. It is endemic to Sub-Saharan Africa and is associated with poor outcomes. To our knowledge, this is the first case in which a caecal volvulus led to the diagnosis of ADL.

Case presentation: An 11-year-old female, previously healthy, presented with a 2-day history of abdominal distension, bilious vomiting, and constipation. Abdominal radiography and a computed tomography (CT) scan were suggestive of a colonic volvulus. Endoscopic reduction was unsuccessful, and exploratory laparotomy revealed a caecal volvulus. A limited right hemicolectomy and end ileostomy were performed. Histology revealed the typical myopathic changes with "tiger-striped" fibrosis and atrophy. Postoperatively, she experienced recurrent episodes of bowel pseudo-obstruction. A full-thickness rectal biopsy confirmed the presence of ganglion cells, excluding HD and further supporting the diagnosis of ADL. The patient, unfortunately, died 6 months later due to abdominal compartment syndrome.

Conclusions: ADL is a rare and often fatal condition associated with intermittent bowel obstruction and systemic complications, including cardiac and urologic abnormalities. In paediatric patients, caecal volvulus should prompt consideration of PIPO as an underlying diagnosis.

Purpose: Crohn's disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuration is still debated. This systematic review and meta-analysis aimed to evaluate the impact of different anastomotic techniques on early endoscopic recurrence following ileocolonic resection for CD.

Methods: A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6-12 months were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types.

Results: Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = -1.96, p = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions.

Conclusions: Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.

Background: Inflammatory bowel disease (IBD) is an intestinal inflammatory disease of unknown etiology. Depression and anxiety are prevalent mental symptoms associated with IBD. Although numerous studies have explored the potential relationship between IBD and these psychological conditions, a bibliometric analysis on this topic has yet to be conducted.

Methods: We screened 420 relevant articles from the Web of Science Core Collection (WoSCC) database from 2010 to 2024 and analyzed them using software such as CiteSpace, VOSviewer, Pajek, and Tableau.

Results: The USA (98 papers), the University of Manitoba (24 papers), Inflammatory Bowel Diseases (56 papers), and Charles N. Bernstein (20 papers) were the most productive country, institution, journal, and author, respectively. High-frequency keywords in this field include "quality-of-life," "symptoms," "prevalence," "comorbidity," "association," "therapy," and "management." Additionally, emerging research frontiers encompass topics such as "mouse model," "remission," "disorder," and "gut microbiota."

Conclusions: Over the past 14 years, there has been a notable increase in research focused on depression and anxiety associated with inflammatory bowel disease. Key areas such as "mouse models," "remission," "disorder," and "gut microbiota" are poised to become focal points of future investigations. These findings may offer new avenues for researchers to explore.

Background: To evaluate the functional, short-term oncologic and clinical outcomes of robotic rectal resection using the Hugo™ RAS (Robotic-assisted surgery) system compared with those of conventional laparoscopic surgery.

Methods: This retrospective cohort study was based on a prospectively maintained database. Baseline demographics, perioperative variables, postoperative complications (Clavien‒Dindo), and both functional (LARS score, pain, urinary and sexual function) and oncologic outcomes were compared. Functional outcomes were assessed at one, three and six months postoperatively.

Results: A total of 40 consecutive patients with rectal cancer who underwent surgery were included. 25 patients underwent laparoscopic resections and the remaining 15 patients received robotic resections using the Hugo™ RAS system. Baseline characteristics were comparable between the groups. At the six-month follow-up compared to the laparoscopic group, the robotic group had significantly lower mean LARS scores (19.2 vs. 9.8; p = 0.008), a greater proportion without LARS (53% vs. 85%; p = ns), and lower pain levels (not significant pain: 71% vs. 93%; p = 0.019). Male patients who underwent robotic surgery had significantly better sexual function at 6 months (p = 0.045). No statistically significant differences were found in terms of complications, but differences in anastomotic leakage (12% vs. 0%), paralytic ileus (16% vs. 6.7%) or Clavien‒Dindo 3-5 (24% vs. 13.4%) were clinically significant in favour of the robotic group.

Conclusion: Robotic surgery with the Hugo™ RAS system is a feasible and safe alternative to conventional laparoscopic resection for rectal cancer, achieving comparable short-term oncologic outcomes while providing improved functional recovery. Ethics Committee of the General University Hospital of Elche (PI 60/2024).

Clinicaltrials id: NCT06512480.