Techniques in Coloproctology最新文献

Background: Acute anal fissure is a common cause of severe pain in the anorectal region. The standard treatment is the topical application of a calcium channel blocker or glyceryl trinitrate. Despite acute anal fissure being a common proctologic condition, data on the healing rates and long-term outcomes remain scarce. This study aimed to evaluate data from our centre, with a special focus on long-term follow-up and recurrent disease.

Methods: All consecutive patients who presented with acute anal fissure between January 2016 and December 2016 were retrospectively identified. Patients were included if their clinical symptoms lasted for less than 6 weeks, secondary changes to fissure morphology were absent, and data from follow-up examinations were available. Clinical features, symptoms, therapy and long-term outcomes were evaluated.

Results: A total of 623 patients with a median age of 45 years were included; 342/623 patients were female (54.9%). The median follow-up period was 41 months (range 6 weeks-89 months), and 39.5% of the patients had a follow-up duration exceeding 5 years. Most fissures occurred in the 6 o'clock lithotomy position (63.7%), in the 12 o'clock position (21.0%), or in both (4.5%). In 67/623 patients, the fissure was in an atypical region (10.8%). In 439/623 patients, the fissure healed completely (70.5%). A total of 8.7% of the patients underwent fissurectomy, and 180/623 patients experienced recurrence (28.9%).

Conclusions: The management of acute anal fissure can be challenging because recurrence is common. Conservative management is successful in the majority of cases. Surgery is necessary only for a minority of patients.

Background: Magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) has significant advantages in the treatment of difficult lesions (Mortagy et al. in World J Gastroenterol 23:2883-2890, 2017). However, the main problem of MAG-ESD is that the placement of the magnetic anchor in vivo often requires the withdrawal and reinsertion of the endoscope, which prolongs the operation time (Zhang et al. in Tech Coloproctol 27:679-683, 2023). We introduced a novel technique, magnetic hydrogel-assisted ESD, and compared it with conventional ESD to explore its advantages and disadvantages.

Methods: We uniformly configured 0.5% sodium alginate (Sanchez-Ballester et al. in Carbohydr Polym 270:118399, 2021) (SA) solution, 1% CaCl₂ solution and nano-Fe₃O₄ (Chen et al. in Electromagn Biol Med 34:309-316, 2015) to produce a magnet hydrogel with ideal ratios. Fresh isolated porcine colons were used as a model; these were divided into a magnetic hydrogel-assisted ESD group and conventional ESD group to assess whether magnetic hydrogel-assisted ESD was feasible and advantageous.

Results: The median submucosal dissection time for magnetic hydrogel-assisted ESD (MHA-ESD) and conventional ESD was 15.13 min (IQR 11.21-19.05) and 17.89 min (IQR 13.74-22.04), respectively. The submucosal dissection time for MHA-ESD was significantly shorter compared to conventional ESD (P = 0.0368). Similarly, the submucosal dissection speed for MHA-ESD and conventional ESD was 74.81 mm²/min (IQR 72.18-80.39) and 60.86 mm²/min (IQR 58.96-67.77), respectively. The MHA-ESD group demonstrated a significantly faster submucosal dissection speed compared to the conventional ESD group (P < 0.001).

Conclusions: Compared with conventional ESD, MHA-ESD significantly accelerates the speed of submucosal dissection, effectively improves surgical efficiency, and enhances procedural convenience, thereby reducing the overall difficulty of ESD.

Purpose: To report the quality of life (QoL) and functional outcomes in patients with colorectal disease after receiving treatment in a multidisciplinary, nurse-led low anterior resection syndrome (LARS) outpatient clinic post surgery.

Methods: A retrospective observational study was conducted that included all patients with colorectal disease referred to the LARS outpatient clinic at VieCuri Medical Centre between January 2021 and December 2024. A standardized treatment protocol was implemented, complemented by a nurse-led component that enabled early symptom detection and provided accessible, intensive patient contact and follow-up. The structured five-phase protocol ranges from preoperative counseling and conservative management to multidisciplinary care and, if necessary, invasive interventions. Bowel function and quality of life were assessed pre- and post-treatment using validated instruments, including the LARS score, Wexner score, and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C29 questionnaires.

Results: A total of 96 patients were included. Median LARS scores decreased from 38.0 to 13.0 (p < 0.001), with 76% of patients transitioning from major to no LARS. Wexner scores improved from 11.0 to 2.0 (p < 0.001), and global QoL increased from 66.7 to 83.3 (p < 0.001). Pharmacological treatment was administered to 93% of patients, most commonly psyllium and loperamide. In addition, 85% were referred to a dietitian, 50% to pelvic floor physiotherapy, and 26% to a psychologist or sexologist. Transanal irrigation was introduced in 14% of cases. Only one patient required sacral neuromodulation, and one opted for a permanent stoma. The median follow-up consisted of three in-person and three telephone consultations per patient.

Conclusions: A multidisciplinary, nurse-led LARS clinic significantly improved bowel function and QoL in patients with colorectal cancer (CRC). These findings support the implementation of structured, individualized care pathways for LARS management.

Background: For many surgeons performing laparoscopic colectomies, splenic flexure mobilization (SFM) remains one of the most technically challenging phases. To resolve challenges in laparoscopic SFM, we utilized Artisential^®, a line of articulated laparoscopic instruments (ALI), to gain more freedom in traction and enlarge the visualized working space. We developed a study to demonstrate how Artisential^® allowed for a more efficient usage of surgical space during splenic flexure mobilization without surgical quality.

Methods: This study consisted of two parts. First was a comparative analysis of dead space shown on screen during surgery with and without Artisential^® usage. Video recordings of nine consecutive laparoscopic low anterior resections (LAR) performed by a single surgeon using an Artisential^® grasper in the left (nondominant) hand were chosen as the experimental group. Among 43 LAR cases performed by the same surgeon in the previous year without the Artisential^®, 9 cases most similar to the control were chosen by propensity score matching (PSM) of sex, age, distance from the anal verge, and preoperative chemoradiotherapy status. We compared the two groups in terms of average operation duration, postoperative complication severity, and the number of lymph nodes harvested.

Results: Using an Artisential^® grasper for traction for splenic flexure mobilization during laparoscopic low anterior resections increased screen visualization by 11.8% compared with using conventional laparoscopic graspers. Length of operation, severity of postoperative complications, and number of harvested lymph nodes were comparable in both modalities.

Conclusions: Angulated traction was utilized for splenic flexure mobilization in laparoscopic low anterior resections using a grasper from Artisential^®, a line of articulated laparoscopic instruments. The surgeon was able to create a significantly larger working field and better exposure of target structures. This implementation did not affect operation time, recovery, or specimen integrity.

Background: Preoperative stoma site marking by a wound, ostomy, and continence nurse (WOCN) or colorectal surgeons significantly reduces stoma-related complications. Limited access to WOCNs or colorectal surgeons, especially in rural or emergency settings, remains a barrier to optimal care. This study evaluated the feasibility and spatial accuracy of a novel telemedicine-based protocol for stoma site marking before colorectal surgery in settings with limited specialist access. The primary outcome was the spatial distance between the in-person and virtual markings. Accuracy was classified as exact same point, within < 1 cm, 1-2 cm, or > 2 cm.

Methods: This prospective observational pilot study was planned in a tertiary academic medical center. Healthy adult volunteers with no prior abdominal surgery were enrolled in the study. Each participant underwent two independent stoma markings: one by an in-person WOCN and another by a different WOCN using standardized patient photographs taken in standing, sitting, supine, and bending positions, with an acetate grid for anatomical calibration.

Results: A total of 876 paired stoma site markings were obtained from 247 volunteers. Exact concordance between virtual and in-person markings was observed in 19.3% of cases. An additional 39.2% of virtual markings were located within 1 cm of the reference point, and 22.1% were within 1-2 cm. The remaining 19.4% deviated by more than 2 cm from the in-person marking. Overall, 80.6% of virtual markings fell within 2 cm of the in-person reference, demonstrating a high level of spatial concordance between the two methods.

Conclusions: A standardized virtual stoma site marking protocol demonstrated high concordance with in-person assessment. This telemedicine-based strategy may be a feasible alternative in settings lacking colorectal specialists and could help optimize perioperative stoma care. The main limitations are inclusion of healthy volunteers rather than surgical patients. Real-world application and clinical outcome impact remain to be validated.

Objective: This study compares the clinical benefits of double-tube end ileostomy versus traditional end ileostomy in patients undergoing low anterior resection for rectal cancer.

Methods: A retrospective analysis was conducted on 65 patients who underwent laparoscopic radical rectal cancer surgery with preventive ileostomy between March 2022 and December 2024 at the First Affiliated Hospital of Anhui Medical University. Among these, 47 patients received traditional ileostomy, while 18 patients underwent double-tube ileostomy. The clinical characteristics and follow-up outcomes of the two groups were compared.

Results: Both groups showed no significant differences in intraoperative blood loss, postoperative bowel function recovery, or complication rates (P > 0.05). However, the double-tube ileostomy group had superior outcomes: average stoma creation time was 25.39 ± 2.85 min, postoperative hospital stays averaged 8.89 ± 2.30 days, and total hospitalization costs were 57,796.50 ± 5306.30 RMB, all significantly lower than in the traditional ileostomy group (P < 0.01). Complications were fewer in the double-tube group, with only one case of type A anastomotic leakage (5.56%) and no long-term complications following successful tube removal. By contrast, the traditional group had 4 cases of leakage (8.51%), and 16 patients experienced long-term complications, with only 40 (85.11%) achieving successful stoma closures. Furthermore, patients in the traditional group reported higher SCL-90 scores for somatization and sleep and eating problems (P < 0.05), indicating significant differences between the groups.

Conclusion: Double-tube end ileostomy offers a safe and effective alternative to traditional methods, with shorter operative times, fewer secondary surgeries, and reduced physiological, psychological, and financial burdens on patients.

Background: Enhanced recovery after surgery (ERAS) protocols and multimodal prehabilitation are interventions used to improve outcomes after surgery. However, their integration is not well studied and is a subject of ongoing debate. The aim of the study was to evaluate the effectiveness of multimodal prehabilitation within ERAS for elderly patients undergoing elective colorectal surgery.

Methods: Studies that used prehabilitation modalities, such as exercise, nutrition, psychology, and spirituality, compared with two control groups-ERAS alone or ERAS with postoperative rehabilitation-were systematically reviewed and reported according to the PRISMA guidelines. Meta-analysis was performed on outcomes such as length of stay (LOS), 6-min walk test (6MWT), postoperative complications, and quality of Life (QOL) using a random effects model.

Results: Six studies with low risk of bias and good quality were selected. These included 547 patients with an age range of 65-78 years in the intervention group (n = 277) and of 66-82 years in the control group (n = 270). All studies exclusively included patients with colorectal cancer. Statistically significant difference was observed for 6MWT and MD of 18.3800 m (95% CI 1.5147-35.2453; p = 0.0404) with an I² statistic of 3.7% (p = 0.3741), indicating low heterogeneity among studies. However, a statistically significant difference was not found for LOS, postoperative complications, or QOL. No difference was found in subgroup analysis for different study designs or control groups.

Conclusion: Although multimodal prehabilitation in ERAS for elderly patients undergoing elective colorectal surgery has limited clinical use, potential remains for targeted and optimized interventions. Further research is needed to consolidate evidence in selected patient populations.

Background: Anastomotic leakage (AL) remains a major complication after rectal cancer surgery. Although various techniques have been proposed to reduce its incidence, the effectiveness of transanal tube (TA) placement remains controversial. This study aimed to evaluate whether combining indocyanine green (ICG) fluorescence angiography with TA placement reduces the risk of AL after rectal cancer surgery.

Methods: A retrospective analysis, including patients who underwent rectal resection with primary anastomosis for rectal cancer, was performed. In all cases, anastomotic perfusion was assessed intraoperatively using ICG fluorescence angiography. Patients were categorized into two groups on the basis of postoperative TA placement: TA group and non-TA group. The primary outcome was the incidence of AL. Multivariate logistic regression and subgroup analyses based on tumor location were performed.

Results: The TA group demonstrated a significantly lower incidence of AL compared with the control group (5% versus 18%, p = 0.02). Multivariate analysis identified male sex as a risk factor and TA placement as a protective factor for AL. Subgroup analysis revealed that TA placement was particularly effective in patients with middle rectal cancer.

Conclusions: The placement of a TA may offer additional benefit in reducing the risk of AL after rectal cancer surgery when adequate perfusion is confirmed using ICG fluorescence imaging, particularly in cases of middle rectal cancer.

Introduction: Anastomotic leakage (AL) is a serious complication after rectal cancer resection, often mitigated by diverting loop ileostomy. However, outlet obstruction remains a significant concern, potentially prolonging hospitalization and requiring reintervention. While surgical risk factors have been explored, patient-specific anatomical factors are less well understood. This study aimed to identify patient-related risk factors for outlet obstruction and evaluate a preventive surgical modification in high-risk patients undergoing laparoscopic and robotic rectal cancer surgeries.

Methods: This retrospective study included 318 patients who underwent laparoscopic or robotic rectal resection with a diverting loop ileostomy. Risk factors were assessed in a control cohort (April 2015-February 2020), followed by a modified ileostomy technique in a validation cohort (March 2020-December 2024).

Results: Increased rectus abdominis muscle thickness (TAM) and larger visceral fat area (AVF) were independent risk factors for outlet obstruction (p = 0.037 and p = 0.041, respectively). Patients with both factors had the highest incidence (52.6%). The modified technique significantly reduced obstruction among high-risk patients (p = 0.003) without increasing parastomal hernia rates.

Conclusions: TAM and AVF are independent predictors of outlet obstruction. A tailored fascial modification reduced obstruction in high-risk patients, supporting the value of preoperative anatomical assessment in surgical planning.

Background and aims: Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a recognized limitation of colorectal ESD (C-ESD) associated with morbidity, additional costs, and prolonged admission. Reliable closure of C-ESD defects can decrease the incidence of PEECS. We introduce a novel mucomuscular closure technique that involves direct closure of the muscularis propria using through-the-scope clips (TTSC). We evaluate the feasibility and efficacy of the modified closure technique in prevention of post-C-ESD PEECS.

Methods: We conducted a prospective cohort study of consecutive C-ESDs at a single tertiary center between January 2017 and October 2023. Patients who underwent C-ESD with mucomuscular closure or conventional closure with TTSC were enrolled. The primary outcome was the incidence and clinical outcome of PEECS. Secondary outcomes were rates of complete defect closure and severe adverse events (SAEs).

Results: A total of 764 patients were included in this study. The incidence of PEECS was significantly lower in the mucomuscular closure group versus conventional closure group (2.5% versus 15.0%, P < 0.001). No SAEs occurred in mucomuscular closure group, whereas two patients had delayed perforation, and two had delayed bleeding in the conventional closure group. In mucomuscular closure group, there was no difference in PEECS occurrence between complete closure (5/218, 2.3%) and partial closure (3/105, 2.9%). No TTSC-related perforation occurred in the process of defect closure.

Conclusions: Mucomuscular closure with TTSC in C-ESDs is effective in preventing PEECS and other postoperative complications.