Techniques in Coloproctology最新文献

Aim: This study aims to compare the clinical outcomes of patients treated for complex anal fistulas using standard laser fistula closure (FiLaC) versus FiLaC combined with an advancement flap (+FLAP).

Methods: A retrospective review was conducted on patients treated for complex anal fistulas between January 2022 and December 2023. Treatments included standard FiLaC and FiLaC combined with an advancement flap. Main outcome measures included operation duration, hospital stay, postoperative pain [Visual Analog Scale (VAS) score], complications, and success rate.

Results: A total of 47 patients were included in the study, with 25 in the standard FiLaC group and 22 in the +FLAP group. The +FLAP group had significantly longer operation times (29.7 ± 4.7 min versus 18.7 ± 4.0 min, p < 0.001) and hospital stays (16.2 ± 5.04 h versus 3.9 ± 2.3 h p < 0.001). Postoperative pain scores were similar between groups. The mean follow-up periods for the FILAC and +FLAP groups were 10.5 ± 3.5 months and 8.4 ± 4.0 months, respectively. The success rate was significantly higher in the +FLAP group (95.5% versus 72%, p = 0.03).

Conclusion: In this study, we found that, compared with FiLAC alone, combining FiLaC with an advancement flap may significantly improve primary success rates in the treatment of complex anal fistulas, and we believe this approach could be a valuable option for enhancing treatment outcomes in complex cases. The increased operation and hospital stay durations appear to be balanced by the higher success rates.

Background: This study aimed to evaluate and compare the safety and efficacy of artificial anal sphincters in clinical practice.

Methods: A systematic review of literatures on artificial anal sphincters in PubMed, MEDLINE, EMBASE, Web of Science, and the Cochrane Library was performed. The literature was reviewed three times by several independent investigators, resulting in the identification of 47 studies that met the inclusion criteria. The primary outcomes of interest included adverse events, incontinence assessment, quality of life assessment, and anorectal manometry.

Results: A total of 12 postoperative complications related to the implantation of the different artificial anal sphincters were reported. Four different incontinence rating scales and four quality of life scales were used to assess patients' fecal incontinence and improvement in quality of life. A total of 29 studies measured changes in patients' anorectal pressure before and after surgery.

Conclusions: In terms of safety, patients implanted with an artificial anal sphincter may develop complications such as pain, infection, defecation obstruction, and surgical revision. In terms of effectiveness, different artificial anal sphincters had significant effects on patients with fecal incontinence, but as a result of the insufficient sample size of the study, more relevant studies are needed for further validation in the future.

Aim: Colorectal cancer resection in the elderly may be associated with significant morbidity. This study aimed to assess perioperative morbidity in elderly patients undergoing colorectal cancer resection and to investigate risk factors for postoperative complications.

Materials and methods: Consecutive patients aged ≥ 75 years undergoing colorectal cancer resection with curative intent between January 2014 and December 2021 at our institution were included. We evaluated risk factors for postoperative complications, length of hospital stays (LOS), 30-day readmission, and 90-day mortality rates.

Results: A total of 843 patients underwent colorectal cancer resection during the study period, of whom 202 patients were 75 years or older. Advanced age was associated with postoperative complications (Clavien-Dindo score > 3b, p = 0.001). Sarcopenia, preoperative plasma albumin < 3.5 g/dL, and open and urgent surgery were significantly correlated with major complications (p = 0.015, p = 0.022, p = 0.003, and p < 0.001, respectively). LOS was longer in elderly patients with a modified 5-item Frailty Index (5-mFI) ≥ 2 and low preoperative serum albumin levels, as well as following open surgery (p = 0.006, p = 0.001 and p < 0.001, respectively). Sarcopenia and preoperative plasma albumin < 3.5 g/dL were predictors for 90-day mortality (p = 0.004 and p > 0.001).

Conclusion: Advanced age, sarcopenia, preoperative hypoalbuminemia, 5-mFI ≥ 2, and open or urgent surgery may serve as predictors for postoperative morbidity in the elderly population.

Objective: This study aimed to investigate the efficacy and safety of laparoscopic-assisted radical surgery for right hemicolonic cancer with a combined approach.

Methods: We conducted a retrospective review of clinical data from 102 patients who underwent laparoscopic-assisted radical right hemicolectomy for right hemicolonic cancer at the Department of General Surgery, Zhujiang Hospital, Southern Medical University, between January 2021 and September 2023. All patients received preoperative diagnoses of right hemicolonic cancer via CT and e-colonoscopy. Patients were categorized into two groups based on the surgical approach: the combined approach group (n = 51) and the traditional approach group (n = 51). Perioperative outcomes and follow-up data were compared between the two groups.

Results: A total of 102 patients were included in the statistical criteria. Comparison of baseline data between the two groups showed no statistically significant differences (all p > 0.05). Compared with the traditional access group, the surgical stem-oriented combined access group had a shorter operative time [(180.69 ± 47.484) min vs. (226.18 ± 45.884) min, t = - 4.920, p < 0.001] and less intraoperative blood loss [(89.71 ± 79.350) ml vs. (149.31 ± 104.633) ml. Z = - 3.370, p = 0.001.

Conclusions: Surgical stem-oriented modified combined approach laparoscopic radical right hemicolectomy for right hemicolonic cancer is safe and feasible and has the advantages of low surgical difficulty, shortened operative time, reduced intraoperative bleeding, and accelerated postoperative recovery. In addition, the combined approach may be more agreeable for beginners to master, and the procedure may be easier to promote and popularize.

Trial registration: ClinicalTrials.gov (2024-KY-026-01).

Background: Laser hemorrhoidoplasty (LHP) has emerged as a novel, minimally invasive technique for managing symptomatic hemorrhoids, gaining popularity among clinicians. Despite its increasing adoption, significant variations exist in the application of LHP across different practices.

Purpose: The aim of these recommendations was to spell out some basic principles and recommendations for performing a standard LHP procedure.

Methods: The Recommendation Development Group (RDG) consisting of surgeons with experience in LHP were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above.

Results: The RDG developed 21 recommendations that were voted upon by 49 panelists. Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus.

Conclusion: The RDP offers a comprehensive suite of guidelines to enhance the safety and efficacy of standard LHP procedures. Out of 21 detailed recommendations, 16 reached strong consensus, collectively addressing the full spectrum of LHP procedures-from laser settings and preoperative preparations to perioperative strategies and postoperative care. This coherent framework is anticipated not only to standardize but also to refine the LHP technique across the board, thereby elevating the management of symptomatic hemorrhoidal disease.

Background: Since the ileal pouch anal anastomosis (IPAA) was first described, anorectal manometry (ARM) has been used to study its physiology and function. Few studies have investigated if preoperative ARM can predict pouch function.

Methods: Pubmed, EMBASE, and the Cochrane Library databases were systematically searched. Papers detailing preoperative ARM results and postoperative functional outcomes of patients with IPAA were included. Meta-analysis with meta-regression was performed, assessing the relationship between preoperative manometric results and objective postoperative functional outcomes including frequency, seepage, pad usage and medications, and functional scoring systems including Wexner Incontinence and Oresland Scores.

Results: Results from 31 studies were analysed. Mean resting pressure (MRP) decreased significantly (- 23.16 mmHg, 95% CI - 27.98 to - 18.35, p < 0.01) after pouch formation but before ileostomy reversal, with subsequent minor increase (3.51 mmHg, 95% CI 0.93 to 6.09, p = 0.01) by 6 months after reversal of ileostomy. Pooled bowel frequency was 5.4 per 24 h (4.90-5.91), day and night-time soiling, incontinence, and pad usage rates were 16% (9-24%), 26% (19-33%), 12% (4-20%), and 21% (13-30%) respectively. Pooled Oresland and Wexner Scores were 3.81 (2.92-4.70) and 3.45 (2.71-4.19). A significant association between preoperative MRP and Wexner Score was observed (p < 0.001). As a result of risk of bias, study heterogeneity, and variation in manometry systems, certainty of evidence was low or very low.

Conclusion: Preoperative predictors of function inform patient and clinician decision-making. Further investigations into the association between preoperative MRP and Wexner Score using modern ARM techniques are warranted.

Background: Pelvic exenterations are now established as a standard of care for locally advanced and recurrent rectal cancer. Traditionally, these radical and complex operations have been performed via an open approach, but with the increasing expertise in robotic-assisted surgery (RAS), there is scope to perform such cases robotically. This study compares outcomes from open and RAS pelvic exenterations.

Methods: This retrospective observational study includes all pelvic exenterations for locally advanced or recurrent colorectal cancers performed in a single centre between September 2018 and September 2023. Cases were grouped into open or RAS surgery and classified in terms of operative extent and complexity. The primary outcome was resection margin status. Secondary outcomes were postoperative morbidity, length of stay and blood loss.

Results: Thirty-three patients were included. Nineteen (57.6%) cases utilised an open technique, and 14 (42.4%) used RAS. Patient characteristics and operative complexity were equivalent between groups. R0 rate (63.1% vs 71.4%, p = 0.719), median haemoglobin drop (19 (11-30) g/L vs 13 (5-26) g/L, p = 0.208) and postoperative morbidity (18/19 (94.7%) vs 9/14 (64.3%), p = 0.062) were equivalent. Length of stay (16.0 days (8-25) vs 9.5 days (6-16), p = 0.047) was shorter in the RAS group.

Conclusions: Short-term surgical and histopathological outcomes are equivalent in this small cohort of patients. This study suggests that RAS may be a safe and effective method for performing pelvic exenterations for colorectal malignancies. Larger-scale and robustly designed prospective studies are required to confirm these preliminary findings and report on long-term oncological outcomes.

Introduction: In the past 30 years, minimally invasive surgery (MIS) has made remarkable progress and has become the standard of care in colorectal cancer treatment. The implementation of new techniques or platforms is, therefore, a challenge for surgical teams. This study aims to analyze the experience in the implementation of minimally invasive surgery in the colorectal unit in a specialized colorectal cancer center. We will report and compare the clinical outcomes of the patients submitted to the different surgical approaches, reflecting the importance of surgical training in the laparoscopic and robotic field for the reduction of surgical complications and improve short-term outcomes.

Methods: This study involved a retrospective analysis of data collected from a prospectively maintained database at the colorectal unit of Champalimaud Foundation between 2012 and 2023. Data were collected as part of routine clinical documentation and included variables on patient's demographics, staging, short-term outcomes, and follow-up.

Results: A total of 661 patients treated at the Champalimaud Foundation between 2012 and 2023 were included, of which 389 (59%) had colon and 272 (41%) rectal cancer. Most of the patients underwent elective surgery, with a minimally invasive approach performed in 91% of cases. A complete resection (R0) was achieved in 95.1% (619) of the procedures with a pathology report staging 64.5% (409) of tumors as pT3-4. Eleven percent (70) of patients had complications classified as Clavien-Dindo (CD) ≥ 3.

Conclusion: This study supports the safety of the implementation of minimally invasive surgery in colorectal cancer care, with improvement in postoperative outcomes and surgical quality, supporting the importance of surgical training and specialized teams.

Background: Transanal irrigation (TAI) effectively addresses fecal incontinence and improves quality of life in individuals with spina bifida. Given the scarcity of follow-up studies lasting > 5 years and reports of numerous TAI discontinuations, we assessed the enduring effectiveness and impact of TAI > 10 years after its initiation on the quality of life in individuals with spina bifida.

Methods: We recruited individuals with spina bifida enrolled in a bowel management program who initiated TAI in 2010 and participated in 4-month and 3-year follow-up studies at a spina bifida clinic. Raw data on bowel-related characteristics at baseline and after 4 months and 3 years of TAI were collected, and new survey-based demographic information, bowel-related characteristics, and the Fecal Incontinence Quality of Life scale scores were analyzed alongside extant datasets.

Results: Among 34 participants (age, mean [standard deviation] 17.7 [3.2] years), the mean follow-up was 11.8 (0.3) years; 21 participants persistently used TAI (persistent users), 12 discontinued TAI (discontinued users), and 1 used TAI and antegrade continence enema at the time of analysis. The fecal incontinence rate among persistent users decreased from 76.2% at baseline to 14.3% at the time of analysis; 11 (91.7%) discontinued users had fecal incontinence before TAI initiation, and the majority of discontinued users (66.7%) discontinued TAI because of improved bowel function. The fecal incontinence rate and quality of life did not differ significantly between discontinued users and persistent users.

Conclusions: TAI effectively alleviated fecal incontinence among persistent users. One-third of users discontinued TAI but had improved fecal continence. We recommend periodic bowel function evaluation in TAI users and to reevaluate the necessity for TAI maintenance.