Rodrigo Rezende Silva Cabral, Fernanda Biasi da Cunha, G. M. Nicollelli, Maria Cristina Sartor, Antonio Sergio Brener, Wagner Carignano Winter, Ygor Degraf, Lucas Schultz Zago, Larissa Machado e Silva Gomide
Introduction After the diagnosis of neoplasm of the middle and distal rectum, patients are often submitted to oncological treatment by neoadjuvant therapy. At the end of this treatment, those patients who show complete clinical response can choose, together with their physician, to adopt the watch-and-wait strategy; although it implies lower morbidity for the patient, this strategy is dependent on strict adherence to treatment follow-up for the early identification of any future local injury. Materials and Methods Survey of data from medical records and description, and discussion of case reports with a literature review in books and databases. Results We report the case of a 73-year-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum, Stage II (cT3bN0M0), who presented complete clinical response after undergoing treatment with neoadjuvant therapy.Together with the assistant team, the watch-and-wait strategy was chosen. During the follow-up, an endoscopic examination showed a vegetating at the proximal limit of the tumor scar. We chose to perform submucosal endoscopic dissection. The report of the anatomopathological examination evidenced a serrated adenoma with narrow margins free of neoplasia. Conclusion Patient adherence to cancer treatment using the watch-and-wait strategy is essential for the early identification of new local lesions. After resection of the lesion identified in the tumor scar site as a neoplasm-free lesion, it is consistent to think that this lesion would be the origin of the neoplasm, given the adenomatous origin.
导言：直肠中远端肿瘤确诊后，患者通常会接受新辅助治疗。治疗结束后，临床反应完全的患者可与医生一起选择采取观察-等待策略；虽然这意味着患者的发病率较低，但这一策略依赖于严格的治疗随访，以尽早发现任何未来的局部损伤。材料与方法 调查病历和描述中的数据，讨论病例报告以及书籍和数据库中的文献综述。结果 我们报告了一例 73 岁患者的病例，该患者被诊断为直肠中段中度分化腺癌 II 期（cT3bN0M0），在接受新辅助治疗后出现完全临床反应。在随访期间，内镜检查显示肿瘤疤痕近端有植物生长。我们选择进行粘膜下内镜剥离术。解剖病理检查报告显示，肿瘤为锯齿状腺瘤，边缘狭窄，无瘤变。结论 患者坚持采用观察和等待策略治疗癌症，对于早期发现新的局部病变至关重要。在切除肿瘤疤痕部位的病灶后，发现该病灶为无瘤病灶，考虑到该病灶为腺瘤性病灶，因此认为该病灶可能是肿瘤的起源。
{"title":"Vegetating Lesions that Appear in the Scar after Neoadjuvant Therapy for Rectal Tumors: Tumor Regrowth or Benign Neoplasm?","authors":"Rodrigo Rezende Silva Cabral, Fernanda Biasi da Cunha, G. M. Nicollelli, Maria Cristina Sartor, Antonio Sergio Brener, Wagner Carignano Winter, Ygor Degraf, Lucas Schultz Zago, Larissa Machado e Silva Gomide","doi":"10.1055/s-0044-1785211","DOIUrl":"https://doi.org/10.1055/s-0044-1785211","url":null,"abstract":"\u0000 Introduction After the diagnosis of neoplasm of the middle and distal rectum, patients are often submitted to oncological treatment by neoadjuvant therapy. At the end of this treatment, those patients who show complete clinical response can choose, together with their physician, to adopt the watch-and-wait strategy; although it implies lower morbidity for the patient, this strategy is dependent on strict adherence to treatment follow-up for the early identification of any future local injury.\u0000 Materials and Methods Survey of data from medical records and description, and discussion of case reports with a literature review in books and databases.\u0000 Results We report the case of a 73-year-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum, Stage II (cT3bN0M0), who presented complete clinical response after undergoing treatment with neoadjuvant therapy.Together with the assistant team, the watch-and-wait strategy was chosen. During the follow-up, an endoscopic examination showed a vegetating at the proximal limit of the tumor scar. We chose to perform submucosal endoscopic dissection. The report of the anatomopathological examination evidenced a serrated adenoma with narrow margins free of neoplasia.\u0000 Conclusion Patient adherence to cancer treatment using the watch-and-wait strategy is essential for the early identification of new local lesions. After resection of the lesion identified in the tumor scar site as a neoplasm-free lesion, it is consistent to think that this lesion would be the origin of the neoplasm, given the adenomatous origin.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francisco Duarte Cerqueira Gomes Girão Santos, Laura Elisabete Ribeiro Barbosa, João Paulo Meireles de Araújo Teixeira
Introduction Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases. Materials and Methods We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review. Results/Discussion Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation. Conclusion Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor.
{"title":"Ileostomy: Early and Late Complications","authors":"Francisco Duarte Cerqueira Gomes Girão Santos, Laura Elisabete Ribeiro Barbosa, João Paulo Meireles de Araújo Teixeira","doi":"10.1055/s-0044-1779603","DOIUrl":"https://doi.org/10.1055/s-0044-1779603","url":null,"abstract":"\u0000 Introduction Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases.\u0000 Materials and Methods We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review.\u0000 Results/Discussion Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation.\u0000 Conclusion Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"513 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omar Vergara-Fernández, E. Ruiz-Muñoz, Danilo Tueme-de la Peña, Héctor E. Bravo-Ávila, Alejandro Hoyos-Torres, N. Salgado-Nesme
Objective To identify if there is an association between pelvic entry and pelvic outlet diameters with increased positive circumferential resection margin (CRM) in rectal cancer. Introduction Positive CRM in rectal cancer is a major predictor for local and distant recurrence. Pelvic diameters may be related to the difficulty of dissection, as well as intrinsic tumor characteristics such as tumor size, location, distance from the anal margin, and T stage, which may compromise the integrity of the mesorectum and circumferential margin involvement. Methods A retrospective review of the patient's medical records who underwent surgical resection of rectal adenocarcinoma from January 2012 to June 2022 was performed. The patient's preoperative staging, operative characteristics, and histopathologic outcomes were gathered from the medical records. Preoperative MRI scanning was done in all patients. MRI pelvimetry was done by two observers. CRM involvement was recorded as stated in the pathology report. Pelvimetry variables were dichotomized according to their mean values for correlation analysis. The odds ratio (OR) was calculated from a binary logistics regression model to assess the relation between the positive CRM and the independent variables. Results A total of 78 patients were included in this study. A positive CRM was reported in 10 patients (12.8%). BMI >27.4 + 6.6 (p = 0.02), positive extramural vascular invasion (p = 0.027), positive CRM by MRI scanning (p = 0.004), and anal sphincter involvement (p = 0.03) were associated with positive CRM. Pelvimetry values were not associated with a positive CRM. Conclusion No association was found between the pelvic diameters measured by MRI pelvimetry with a positive CRM.
{"title":"Pelvic Diameter is not Associated with Positive Circumferential Resection Margin in Rectal Cancer: Retrospective Analysis of 78 Cases","authors":"Omar Vergara-Fernández, E. Ruiz-Muñoz, Danilo Tueme-de la Peña, Héctor E. Bravo-Ávila, Alejandro Hoyos-Torres, N. Salgado-Nesme","doi":"10.1055/s-0044-1782152","DOIUrl":"https://doi.org/10.1055/s-0044-1782152","url":null,"abstract":"\u0000 Objective To identify if there is an association between pelvic entry and pelvic outlet diameters with increased positive circumferential resection margin (CRM) in rectal cancer.\u0000 Introduction Positive CRM in rectal cancer is a major predictor for local and distant recurrence. Pelvic diameters may be related to the difficulty of dissection, as well as intrinsic tumor characteristics such as tumor size, location, distance from the anal margin, and T stage, which may compromise the integrity of the mesorectum and circumferential margin involvement.\u0000 Methods A retrospective review of the patient's medical records who underwent surgical resection of rectal adenocarcinoma from January 2012 to June 2022 was performed. The patient's preoperative staging, operative characteristics, and histopathologic outcomes were gathered from the medical records. Preoperative MRI scanning was done in all patients. MRI pelvimetry was done by two observers. CRM involvement was recorded as stated in the pathology report. Pelvimetry variables were dichotomized according to their mean values for correlation analysis. The odds ratio (OR) was calculated from a binary logistics regression model to assess the relation between the positive CRM and the independent variables.\u0000 Results A total of 78 patients were included in this study. A positive CRM was reported in 10 patients (12.8%). BMI >27.4 + 6.6 (p = 0.02), positive extramural vascular invasion (p = 0.027), positive CRM by MRI scanning (p = 0.004), and anal sphincter involvement (p = 0.03) were associated with positive CRM. Pelvimetry values were not associated with a positive CRM.\u0000 Conclusion No association was found between the pelvic diameters measured by MRI pelvimetry with a positive CRM.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"203 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Portuguese Society of Coloproctology (SPCP) – Leap Forward by Looking Back","authors":"Nuno José Gomes Rama","doi":"10.1055/s-0043-1777059","DOIUrl":"https://doi.org/10.1055/s-0043-1777059","url":null,"abstract":"","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"1 1","pages":"e243 - e244"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139232543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Mauricio Londoño Estrada, Cristiane Koizimi Martos Fernandes, Marina Barbarela Grisolia de Oliveira, Gustavo Moreira Costa de Souza, Paulo Rocha França-Neto, Fábio Lopes de Queiroz, Antônio Lacerda-Filho
Abstract Introduction Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF.
{"title":"Injection of Freshly Collected Adipose Tissue for the treatment Complex Cryptoglandular Anal Fistula: Case Report","authors":"Daniel Mauricio Londoño Estrada, Cristiane Koizimi Martos Fernandes, Marina Barbarela Grisolia de Oliveira, Gustavo Moreira Costa de Souza, Paulo Rocha França-Neto, Fábio Lopes de Queiroz, Antônio Lacerda-Filho","doi":"10.1055/s-0043-1773784","DOIUrl":"https://doi.org/10.1055/s-0043-1773784","url":null,"abstract":"Abstract Introduction Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hugo Samartine Junior, Lucas Rosasco Mazzini, Daniel Ferreira Paiva, Nicole Goldenberg Levy, Lauro Igor Silva, José Luís Braga de Aquino, Elisa Donalisio Teixeira Mendes
Abstract Introduction Scientific studies in Brazil grew around 10.7% compared to previous years. However, the level of quality of evidence has been decreasing. The aim in our study is to examine the meeting abstracts of the Brazilian congress of coloproctology and analyze the level of evidence in trends and variables. Methods A descriptive bibliometric study, working with secondary data to review scientific abstracts in the annals of the coloproctology congress from 2015 to 2019. Results A total of 1756 abstracts of the Brazilian Congress of Coloproctology were analyzed for 5 years (2015-2019). There was a higher trend of abstracts presented with lower levels of evidence (level of evidence 5: 52.3% and 3: 30%), being the majority composed of case reports (49.4%) and retrospective studies (30.4%). The last two years analyzed (2018: 55.2% and 2019: 59.3%) had a predominance above average of case reports. From 2017 to 2019 there was a significant decrease in the number of level 2 evidence studies (18.10%,11.80% and 5.50%), while the number of studies with level 5 evidence showed an increase (45.60%, 56.60% and 61.40%). Statistical analysis occurred in only 17%, with an important decrease for the last two years (2018: 13.6%; 2019: 12.1%). Conclusions Although the data of this study is from the Brazilian coloproctology point of view, they are important for the global scientific community, as they allow a quantitative evaluation of the relative contribution from the level of evidence of Brazilian coloproctology researchers to the scientific scenario.
{"title":"Assessing the Level of Evidence of Presented Studies at the Brazilian Congress of Coloproctology","authors":"Hugo Samartine Junior, Lucas Rosasco Mazzini, Daniel Ferreira Paiva, Nicole Goldenberg Levy, Lauro Igor Silva, José Luís Braga de Aquino, Elisa Donalisio Teixeira Mendes","doi":"10.1055/s-0043-1772782","DOIUrl":"https://doi.org/10.1055/s-0043-1772782","url":null,"abstract":"Abstract Introduction Scientific studies in Brazil grew around 10.7% compared to previous years. However, the level of quality of evidence has been decreasing. The aim in our study is to examine the meeting abstracts of the Brazilian congress of coloproctology and analyze the level of evidence in trends and variables. Methods A descriptive bibliometric study, working with secondary data to review scientific abstracts in the annals of the coloproctology congress from 2015 to 2019. Results A total of 1756 abstracts of the Brazilian Congress of Coloproctology were analyzed for 5 years (2015-2019). There was a higher trend of abstracts presented with lower levels of evidence (level of evidence 5: 52.3% and 3: 30%), being the majority composed of case reports (49.4%) and retrospective studies (30.4%). The last two years analyzed (2018: 55.2% and 2019: 59.3%) had a predominance above average of case reports. From 2017 to 2019 there was a significant decrease in the number of level 2 evidence studies (18.10%,11.80% and 5.50%), while the number of studies with level 5 evidence showed an increase (45.60%, 56.60% and 61.40%). Statistical analysis occurred in only 17%, with an important decrease for the last two years (2018: 13.6%; 2019: 12.1%). Conclusions Although the data of this study is from the Brazilian coloproctology point of view, they are important for the global scientific community, as they allow a quantitative evaluation of the relative contribution from the level of evidence of Brazilian coloproctology researchers to the scientific scenario.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"129 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali
Abstract Background Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers.
{"title":"Eight Years Experience of Transanal Endoscopic Microsurgery","authors":"Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali","doi":"10.1055/s-0043-1774736","DOIUrl":"https://doi.org/10.1055/s-0043-1774736","url":null,"abstract":"Abstract Background Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"10 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henrique Perobelli Schlenstein, Gabriel Thiago da Silva, Gabriella Catharino Caliman, Izabella Dias Muniz de Andrade, Marina Silva Rodrigues, Matheus Vitoretti, Renato Migliore, João Kleber de Almeida Gentile
Abstract Introduction Distension of the rectum wall and subsequent momentary relaxation of the internal anal sphincter (IAS) trigger a reflex called the rectoanal inhibitory reflex (RAIR). This same rectal distension causes a reflex contraction of the external anal sphincter (EAS), responsible for conscious continence called rectoanal excitatory reflex (RAER). This set of reflexes are named sampling reflex. Objectives The sampling reflex is necessary to initiate defecation or flatulence. The objective of this study is to evaluate the sampling reflex and its practical applicability as a manometric marker of the main defecation disorders. Methodology This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) items. The development method consisted of searching for articles in the research platforms BVS, PubMed, Cochrane Library, SciELO and ScienceDirect and for the selection of articles the Rayyan Platform was used. The articles resulting from the search strategies were added to the platform and five collaborators were invited for the blind selection. Finally, 6 articles were included in the final review. Results An intact sampling reflex allows the individual to facilitate discrimination between flatus and stool and to choose whether to discharge or retain rectal contents. On the other hand, an impaired sampling reflex can predispose an individual to incontinence. Therefore, it was observed that patients with defecation disorders had an impaired sampling reflex, since it was found that constipated patients have incomplete opening of the IAS, lower amplitude of RAIR and increase of RAER. Most incontinent patients present a failure in the recruitment of the EAS, a decrease in the RAER and an increase in the RAIR, in duration and amplitude. Conclusion The improvement of high-resolution anorectal manometric techniques was essential for understanding the pathophysiology of defecation disorders, as well as the physiological understanding and importance of RAIR and RAER.
{"title":"Sampling Reflex as a New Manometric Marker in the Diagnosis of Defecation Disorders - Systematic Review","authors":"Henrique Perobelli Schlenstein, Gabriel Thiago da Silva, Gabriella Catharino Caliman, Izabella Dias Muniz de Andrade, Marina Silva Rodrigues, Matheus Vitoretti, Renato Migliore, João Kleber de Almeida Gentile","doi":"10.1055/s-0043-1773800","DOIUrl":"https://doi.org/10.1055/s-0043-1773800","url":null,"abstract":"Abstract Introduction Distension of the rectum wall and subsequent momentary relaxation of the internal anal sphincter (IAS) trigger a reflex called the rectoanal inhibitory reflex (RAIR). This same rectal distension causes a reflex contraction of the external anal sphincter (EAS), responsible for conscious continence called rectoanal excitatory reflex (RAER). This set of reflexes are named sampling reflex. Objectives The sampling reflex is necessary to initiate defecation or flatulence. The objective of this study is to evaluate the sampling reflex and its practical applicability as a manometric marker of the main defecation disorders. Methodology This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) items. The development method consisted of searching for articles in the research platforms BVS, PubMed, Cochrane Library, SciELO and ScienceDirect and for the selection of articles the Rayyan Platform was used. The articles resulting from the search strategies were added to the platform and five collaborators were invited for the blind selection. Finally, 6 articles were included in the final review. Results An intact sampling reflex allows the individual to facilitate discrimination between flatus and stool and to choose whether to discharge or retain rectal contents. On the other hand, an impaired sampling reflex can predispose an individual to incontinence. Therefore, it was observed that patients with defecation disorders had an impaired sampling reflex, since it was found that constipated patients have incomplete opening of the IAS, lower amplitude of RAIR and increase of RAER. Most incontinent patients present a failure in the recruitment of the EAS, a decrease in the RAER and an increase in the RAIR, in duration and amplitude. Conclusion The improvement of high-resolution anorectal manometric techniques was essential for understanding the pathophysiology of defecation disorders, as well as the physiological understanding and importance of RAIR and RAER.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"372 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135393605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo P. Smalbroek, Inger-Lise Schuffel, Teus J. Weijs, Lea M. Dijksman, Floris B. Poelmann, Niels A.T. Wijffels, Djamila Boerma, Anke B. Smits
Abstract Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed.
{"title":"Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review","authors":"Bo P. Smalbroek, Inger-Lise Schuffel, Teus J. Weijs, Lea M. Dijksman, Floris B. Poelmann, Niels A.T. Wijffels, Djamila Boerma, Anke B. Smits","doi":"10.1055/s-0043-1773783","DOIUrl":"https://doi.org/10.1055/s-0043-1773783","url":null,"abstract":"Abstract Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135393919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas. Material and Methods There were 60 patients with complex fistulae involving the sphincter, with 56 male and 4 female, mean age 40.6 years, operated by fistulectomy and primary sphincter repair over a period of 7 years. Patients were followed up for 6months for any complications, recurrence, and incontinence. Results The majority of patients (50, 83.3%) had complete wound healing in 2 weeks, while 4 (6.6%) patients had hematoma and superficial wound dehiscence, which were managed conservatively and healed in 4 weeks. There was one recurrence. All patients had good continence postoperatively, except for mild fecal incontinence (FI, score 3), seen in 6 (10%) patients. However, all these patients regained continence within 6 weeks. Conclusions Primary reconstruction of anal sphincter with fistulectomy is a safe option for complex fistula-in-ano.
{"title":"Cutting of Sphincter in Fistulectomy with Primary Closure in Complex Fistula-in-Ano: Is it Feasible?","authors":"Amrendra Verma, Reena Kothari, Dhananjaya Sharma, Pawan Agarwal","doi":"10.1055/s-0043-1774726","DOIUrl":"https://doi.org/10.1055/s-0043-1774726","url":null,"abstract":"Abstract Introduction Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas. Material and Methods There were 60 patients with complex fistulae involving the sphincter, with 56 male and 4 female, mean age 40.6 years, operated by fistulectomy and primary sphincter repair over a period of 7 years. Patients were followed up for 6months for any complications, recurrence, and incontinence. Results The majority of patients (50, 83.3%) had complete wound healing in 2 weeks, while 4 (6.6%) patients had hematoma and superficial wound dehiscence, which were managed conservatively and healed in 4 weeks. There was one recurrence. All patients had good continence postoperatively, except for mild fecal incontinence (FI, score 3), seen in 6 (10%) patients. However, all these patients regained continence within 6 weeks. Conclusions Primary reconstruction of anal sphincter with fistulectomy is a safe option for complex fistula-in-ano.","PeriodicalId":15408,"journal":{"name":"Journal of Coloproctology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135393600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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