Pub Date : 2020-10-01DOI: 10.4103/1941-8213.305993
Kanmani Murugesu, Premanandan Sivadasan, Michael Arvind, Wilson Wei Xin
Toxic megacolon is a dreaded complication of inflammatory bowel disease. Unfortunately, it is usually diagnosed late and, in cases of perforation, has a high mortality rate and is associated with a poor prognosis. We present a case of perforated toxic megacolon in a young woman with undiagnosed ulcerative colitis, highlighting the clinical course and outcome of this condition along with the need for prompt detection and intervention. It was difficult to manage this case in a district hospital because of the limited subspecialty support and resources.
{"title":"Perforated Toxic Megacolon: The Dreaded Complication in IBD","authors":"Kanmani Murugesu, Premanandan Sivadasan, Michael Arvind, Wilson Wei Xin","doi":"10.4103/1941-8213.305993","DOIUrl":"https://doi.org/10.4103/1941-8213.305993","url":null,"abstract":"Toxic megacolon is a dreaded complication of inflammatory bowel disease. Unfortunately, it is usually diagnosed late and, in cases of perforation, has a high mortality rate and is associated with a poor prognosis. We present a case of perforated toxic megacolon in a young woman with undiagnosed ulcerative colitis, highlighting the clinical course and outcome of this condition along with the need for prompt detection and intervention. It was difficult to manage this case in a district hospital because of the limited subspecialty support and resources.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43728675","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}
Pub Date : 2020-10-01DOI: 10.4103/1941-8213.305992
Maria Fuertes, S. Alcaide
We present the case of an 83-year-old woman that visited the emergency room of our hospital for correcting the transanal small bowel evisceration after a defecatory effort, without any history of rectal trauma. Emergency laparotomy was indicated, with the intraoperative finding of perforation in the anterior superior rectum, with a defect of approximately 3 cm. Due to the absence of fecaloid peritonitis, it was decided to perform a primary closure with double sutures. The patient evolved favorably.
{"title":"Spontaneous Rectal Perforation with Transanal Evisceration","authors":"Maria Fuertes, S. Alcaide","doi":"10.4103/1941-8213.305992","DOIUrl":"https://doi.org/10.4103/1941-8213.305992","url":null,"abstract":"We present the case of an 83-year-old woman that visited the emergency room of our hospital for correcting the transanal small bowel evisceration after a defecatory effort, without any history of rectal trauma. Emergency laparotomy was indicated, with the intraoperative finding of perforation in the anterior superior rectum, with a defect of approximately 3 cm. Due to the absence of fecaloid peritonitis, it was decided to perform a primary closure with double sutures. The patient evolved favorably.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45541931","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}
Pub Date : 2020-10-01DOI: 10.4103/1941-8213.305937
V. Nigam, Siddhartha Nigam
Background: Fistula-in-ano is known for its recurrence and other complications after surgery, especially in high fistulae cases. Use of a cutting seton is an accepted mode of treatment for high fistula-in-ano cases. Nigam′s modified Roeder′s knot (NMRK) makes the cutting seton adjustable. The aim of our study is to investigate the results of NMRK application in cutting seton in relation to reapplication, rethreading, postoperative inconvenience to the patient, and postoperative complications. Objectives: To determine whether the NMRK in cutting seton reduces the chances of seton reapplication and postoperative complications in high fistula-in-ano. Design: Squire---Quality Improvement Study. Setting: Patients admitted in various hospitals in Gurugram, Haryana, India. Materials, Methods, and Main Outcome Measures: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons between January 2001 and January 2019. Informed consent was obtained from each patient. The patients were evaluated for seton reapplication, inconvenience, recurrence, fecal incontinence, and other postoperative complications. Sample Size: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons Results: In our series, no patient suffered fecal incontinence. Three patients (3.75%) had gas incontinence, which gradually stopped within 2 weeks. Most of the setons took 4– 6 weeks to drop. The healing time was 6– 8 weeks for majority of the patients. Two patients (2.50%) developed recurrence after surgery. No patient required readmission or anesthesia for seton reapplication. Conclusion: If the cutting seton with the NMRK is retightened every week, then the drop time of the seton and the total healing time decrease, resulting in reduced incidence of inconvenience, pain, fecal incontinence, and recurrence. Rethreading or reapplication of seton is not required. Limitations: Our study includes only uncomplicated high fistula-in-ano cases. It also excludes complex fistulae, watercan perineum, and fistulae with inflammatory bowel disease or cancer. Conflict of Interest: None. Keywords: Cutting seton, fecal incontinence, fistula-in-ano, Nigam′s modified Roeder′s knot, recurrence
{"title":"Nigam′s Modified Roeder′s Knot in Cutting Seton in High Fistula-in-ano Prevents Rethreading and Reapplication of Seton","authors":"V. Nigam, Siddhartha Nigam","doi":"10.4103/1941-8213.305937","DOIUrl":"https://doi.org/10.4103/1941-8213.305937","url":null,"abstract":"Background: Fistula-in-ano is known for its recurrence and other complications after surgery, especially in high fistulae cases. Use of a cutting seton is an accepted mode of treatment for high fistula-in-ano cases. Nigam′s modified Roeder′s knot (NMRK) makes the cutting seton adjustable. The aim of our study is to investigate the results of NMRK application in cutting seton in relation to reapplication, rethreading, postoperative inconvenience to the patient, and postoperative complications. Objectives: To determine whether the NMRK in cutting seton reduces the chances of seton reapplication and postoperative complications in high fistula-in-ano. Design: Squire---Quality Improvement Study. Setting: Patients admitted in various hospitals in Gurugram, Haryana, India. Materials, Methods, and Main Outcome Measures: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons between January 2001 and January 2019. Informed consent was obtained from each patient. The patients were evaluated for seton reapplication, inconvenience, recurrence, fecal incontinence, and other postoperative complications. Sample Size: Eighty high fistula-in-ano patients underwent fistulactomies using the NMRK in both the cutting and adjustable setons Results: In our series, no patient suffered fecal incontinence. Three patients (3.75%) had gas incontinence, which gradually stopped within 2 weeks. Most of the setons took 4– 6 weeks to drop. The healing time was 6– 8 weeks for majority of the patients. Two patients (2.50%) developed recurrence after surgery. No patient required readmission or anesthesia for seton reapplication. Conclusion: If the cutting seton with the NMRK is retightened every week, then the drop time of the seton and the total healing time decrease, resulting in reduced incidence of inconvenience, pain, fecal incontinence, and recurrence. Rethreading or reapplication of seton is not required. Limitations: Our study includes only uncomplicated high fistula-in-ano cases. It also excludes complex fistulae, watercan perineum, and fistulae with inflammatory bowel disease or cancer. Conflict of Interest: None. Keywords: Cutting seton, fecal incontinence, fistula-in-ano, Nigam′s modified Roeder′s knot, recurrence","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49439687","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}
Pub Date : 2020-10-01DOI: 10.4103/1941-8213.305888
Joseph C. H. Kong, Glen R Guerra, S. Prabhakaran, S. Warrier, A. Heriot
Background: Hartmann′s reversal is a major operation to restore colorectal continuity. Traditionally, an open Hartmann′s reversal (OHR) has been performed but there is a trend toward performing laparoscopic Hartmann′s reversal (LHR). With the increasing number of publications comparing these two, it is important to ascertain whether the benefits of LHR outweigh the risks. Objective: To compare LHR and OHR with respect to morbidity and mortality rates. Design: A systematic review and meta-analysis. Setting: The study was conducted at the Peter MacCallum Cancer Centre in Melbourne, Australia. Patients and Methods: A detailed systematic search was performed through PubMed, SCOPUS, TRIP, EMBASE, and ClinicalKey from 1990 to October 26, 2016. A review was undertaken in accordance with PRISMA guidelines. Main Outcome Measures: The primary outcome measure was 30-day morbidity. Secondary outcome measures included estimated intraoperative blood loss, conversion from laparoscopic to open approach, length of hospital stay, and 30-day mortality. Sample Size: Eighteen eligible studies were identified, comprising a total of 7824 patients: 1586 in the laparoscopic group and 6238 in the open group. Results: There was no statistical difference in mean operative time between the two groups. Overall morbidity was lower in the LHR group (16.8% vs 23.7%, P < 0.0001). Subgroup-analysis showed a higher risk of sepsis (6.5% vs 3.2%; P < 0.0001), wound infection (22.5% vs 12.6%; P < 0.0001), and ileus (13.4% vs 5.5%; P = 0.001) in the OHR group. Conclusion: LHR was associated with a lower morbidity rate and shorter hospital stay with an equivalent operative time. There is a moderate rate of conversion and appropriate case selection is important. Limitations: An absence of prospective or randomized trials comparing the two approaches for Hartmann′s reversal, contributing to selection bias in our study. It was difficult to combine patient characteristics data due to the heterogeneity in the reported parameters. Conflict of Interest: None.
{"title":"Is Laparoscopic Hartmann′s Reversal a Safe Option? A Systematic Review and Meta-Analysis","authors":"Joseph C. H. Kong, Glen R Guerra, S. Prabhakaran, S. Warrier, A. Heriot","doi":"10.4103/1941-8213.305888","DOIUrl":"https://doi.org/10.4103/1941-8213.305888","url":null,"abstract":"Background: Hartmann′s reversal is a major operation to restore colorectal continuity. Traditionally, an open Hartmann′s reversal (OHR) has been performed but there is a trend toward performing laparoscopic Hartmann′s reversal (LHR). With the increasing number of publications comparing these two, it is important to ascertain whether the benefits of LHR outweigh the risks. Objective: To compare LHR and OHR with respect to morbidity and mortality rates. Design: A systematic review and meta-analysis. Setting: The study was conducted at the Peter MacCallum Cancer Centre in Melbourne, Australia. Patients and Methods: A detailed systematic search was performed through PubMed, SCOPUS, TRIP, EMBASE, and ClinicalKey from 1990 to October 26, 2016. A review was undertaken in accordance with PRISMA guidelines. Main Outcome Measures: The primary outcome measure was 30-day morbidity. Secondary outcome measures included estimated intraoperative blood loss, conversion from laparoscopic to open approach, length of hospital stay, and 30-day mortality. Sample Size: Eighteen eligible studies were identified, comprising a total of 7824 patients: 1586 in the laparoscopic group and 6238 in the open group. Results: There was no statistical difference in mean operative time between the two groups. Overall morbidity was lower in the LHR group (16.8% vs 23.7%, P < 0.0001). Subgroup-analysis showed a higher risk of sepsis (6.5% vs 3.2%; P < 0.0001), wound infection (22.5% vs 12.6%; P < 0.0001), and ileus (13.4% vs 5.5%; P = 0.001) in the OHR group. Conclusion: LHR was associated with a lower morbidity rate and shorter hospital stay with an equivalent operative time. There is a moderate rate of conversion and appropriate case selection is important. Limitations: An absence of prospective or randomized trials comparing the two approaches for Hartmann′s reversal, contributing to selection bias in our study. It was difficult to combine patient characteristics data due to the heterogeneity in the reported parameters. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48474859","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}
Background: Rectal cancer management has evolved from surgery to neoadjuvant radiotherapy to total chemoradiotherapy regimens. Magnetic resonance imaging (MRI) is the gold standard for staging; however, its role for assessing response to neoadjuvant therapy is less than clear. Objective: To assess the role of restaging MRI post neoadjuvant long-course chemoradiotherapy (NA CRT) for locoregionally advanced rectal cancer. Design: A retrospective audit of prospectively collected data. Setting: A tertiary hospital colorectal unit. Patients and Methods: Patients with locoregionally advanced rectal adenocarcinoma (T3/T4 and/or nodal disease), who underwent restaging pelvic MRI scans post-NA CRT were included. Medical records of relevant radiology and operative histopathology were reviewed. Main Outcome Measures: To determine whether restaging MRI altered subsequent patient management (compared to the initial plan as documented in the pretreatment colorectal multidisciplinary team meeting). Sample Size: Twenty-three patients with restaging MRI. Results: On diagnosis, 15 patients (65.2%) had American Joint Committee on Cancer (AJCC) stage-III disease; two patients had AJCC stage-II disease (8.7%), and five patients (21.7%) had AJCC stage-IV disease with limited metastases (curative intent to treatment). Three patients had a complete clinical response (cCR) post NA CRT. Fourteen tumors had downstaging (MRI tumor regression grade 2-3, 58.3%). In three patients (13.0%), restaging MRI altered patient management. Two of them had extensive disease that underwent significant downstaging, enabling avoidance of a pelvic exenteration; and one also had sufficient downstaging and was able to have a sphincter preserving operation as a result. Conclusions: MRI may have a role in patients with the extensive locoregional disease or in ultralow rectal cancers where it is unclear if sphincter preservation is possible. Limitations: Small sample size; additionally, “watch and wait” methods are not routinely practiced in this tertiary unit. Conflict of Interest: None.
{"title":"The role of restaging MRI post neoadjuvant therapy for locoregionally advanced rectal cancer","authors":"A. D. Di Re, Raymond Lee, James T. Toh","doi":"10.4103/WJCS.WJCS_11_20","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_11_20","url":null,"abstract":"Background: Rectal cancer management has evolved from surgery to neoadjuvant radiotherapy to total chemoradiotherapy regimens. Magnetic resonance imaging (MRI) is the gold standard for staging; however, its role for assessing response to neoadjuvant therapy is less than clear. Objective: To assess the role of restaging MRI post neoadjuvant long-course chemoradiotherapy (NA CRT) for locoregionally advanced rectal cancer. Design: A retrospective audit of prospectively collected data. Setting: A tertiary hospital colorectal unit. Patients and Methods: Patients with locoregionally advanced rectal adenocarcinoma (T3/T4 and/or nodal disease), who underwent restaging pelvic MRI scans post-NA CRT were included. Medical records of relevant radiology and operative histopathology were reviewed. Main Outcome Measures: To determine whether restaging MRI altered subsequent patient management (compared to the initial plan as documented in the pretreatment colorectal multidisciplinary team meeting). Sample Size: Twenty-three patients with restaging MRI. Results: On diagnosis, 15 patients (65.2%) had American Joint Committee on Cancer (AJCC) stage-III disease; two patients had AJCC stage-II disease (8.7%), and five patients (21.7%) had AJCC stage-IV disease with limited metastases (curative intent to treatment). Three patients had a complete clinical response (cCR) post NA CRT. Fourteen tumors had downstaging (MRI tumor regression grade 2-3, 58.3%). In three patients (13.0%), restaging MRI altered patient management. Two of them had extensive disease that underwent significant downstaging, enabling avoidance of a pelvic exenteration; and one also had sufficient downstaging and was able to have a sphincter preserving operation as a result. Conclusions: MRI may have a role in patients with the extensive locoregional disease or in ultralow rectal cancers where it is unclear if sphincter preservation is possible. Limitations: Small sample size; additionally, “watch and wait” methods are not routinely practiced in this tertiary unit. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46305099","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}
Immune checkpoint inhibitors (ICI) have dramatically improved survival outcomes for multiple malignancies. High-grade, steroid-refractory ICI colitis is a challenging, life-threatening complication that requires urgent hospitalization and treatment. Vedolizumab shows great potential as a gastrointestinal specific treatment option for ICI colitis but its use currently lacks any prospective trial evidence base. This report documents a case of steroid-refractory, pembrolizumab-induced colitis managed with vedolizumab in a male with previously diagnosed stage-IIIb lung adenocarcinoma. The report raises the possibility of an increased risk of colonic metastasis with vedolizumab use and the potential need for closer monitoring and surveillance in patients with a history of active or recent malignancy. Additionally, this case demonstrates the need for consideration of concomitant Cytomegalovirus and Clostridium difficile infection in this patient population. Clear surgical referral and management guidelines must be considered as the increased utilization of ICI continues.
{"title":"Colonic lung cancer metastasis in vedolizumab-treated immune checkpoint inhibitor colitis","authors":"Sean S Davis, M. Watson, H. Takhar, F. Reid","doi":"10.4103/WJCS.WJCS_8_20","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_8_20","url":null,"abstract":"Immune checkpoint inhibitors (ICI) have dramatically improved survival outcomes for multiple malignancies. High-grade, steroid-refractory ICI colitis is a challenging, life-threatening complication that requires urgent hospitalization and treatment. Vedolizumab shows great potential as a gastrointestinal specific treatment option for ICI colitis but its use currently lacks any prospective trial evidence base. This report documents a case of steroid-refractory, pembrolizumab-induced colitis managed with vedolizumab in a male with previously diagnosed stage-IIIb lung adenocarcinoma. The report raises the possibility of an increased risk of colonic metastasis with vedolizumab use and the potential need for closer monitoring and surveillance in patients with a history of active or recent malignancy. Additionally, this case demonstrates the need for consideration of concomitant Cytomegalovirus and Clostridium difficile infection in this patient population. Clear surgical referral and management guidelines must be considered as the increased utilization of ICI continues.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41629032","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}
Eosinophilic gastroenteritis is a rare inflammatory disease of one or more segments of the gastrointestinal tract. Clinical features vary depending on the site and layer of involvement. We present a case of a 61-year-old female with malignant colonic obstruction and several months of abdominal discomfort, nausea, and altered bowel habits. She had a colonic stent as a bridge to her definitive surgery. She continued to have diarrhea and abdominal discomfort until her definitive surgery. Interestingly, histopathology showed colonic cancer with segments of eosinophilic colitis. This is a unique case given the rarity of eosinophilic gastroenteritis and its potential predisposition to neoplastic disease. We review the clinical and pathological features of eosinophilic gastroenteritis and the possible linkage with colorectal cancer.
{"title":"Eosinophilic gastroenteritis in the setting of colorectal neoplasia","authors":"Y. Koo, J. Oo, S. Ng","doi":"10.4103/WJCS.WJCS_5_20","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_5_20","url":null,"abstract":"Eosinophilic gastroenteritis is a rare inflammatory disease of one or more segments of the gastrointestinal tract. Clinical features vary depending on the site and layer of involvement. We present a case of a 61-year-old female with malignant colonic obstruction and several months of abdominal discomfort, nausea, and altered bowel habits. She had a colonic stent as a bridge to her definitive surgery. She continued to have diarrhea and abdominal discomfort until her definitive surgery. Interestingly, histopathology showed colonic cancer with segments of eosinophilic colitis. This is a unique case given the rarity of eosinophilic gastroenteritis and its potential predisposition to neoplastic disease. We review the clinical and pathological features of eosinophilic gastroenteritis and the possible linkage with colorectal cancer.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45358502","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}
Reem A. Alharbi, Moneera Binsaleem, O. Alamodi, A. Alkhamis, B. Alshaban, N. Alhassan, Sara Albastaki, K. Alkhayal, O. Alobeed, A. Zubaidi, Khalid A Alresini, S. Alhomoud, S. Alasari, Alaa S. Abduljabbar, Nasser Alsanea
The coronavirus disease 2019 (COVID-19) pandemic has vastly impacted normal day-to-day surgical practice throughout the world. It is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The treatment of colorectal diseases in the presence of COVID-19 infections must be reconsidered. An expert's panel from the Saudi Chapter and Gulf Cooperation Council Countries Chapter under the umbrella of the Saudi Society of Colon and Rectal Surgery was assembled. The panel identified the key questions and systematically reviewed all reports around the impact of COVID-19 on colorectal cancer treatment, emergency surgery, surgical technique, endoscopy, and operating room protocols. Using the grading of recommendations assessment, development, and evaluation (GRADE) methodology and the evidence-to-decision framework, the strength of recommendations and the quality of evidence were determined by the panel. The panel recommends a thorough review of current surgical practice in the field of colorectal diseases to minimize the impact of COVID-19. Lack of clinical trials and local regional data in the area of colorectal diseases during the COVID-19 pandemic are marked as limitations of this study.
{"title":"Saudi Society Of Colon And Rectal Surgery (SSCRS) Position statement on colorectal surgery and endoscopy during the COVID-19 pandemic","authors":"Reem A. Alharbi, Moneera Binsaleem, O. Alamodi, A. Alkhamis, B. Alshaban, N. Alhassan, Sara Albastaki, K. Alkhayal, O. Alobeed, A. Zubaidi, Khalid A Alresini, S. Alhomoud, S. Alasari, Alaa S. Abduljabbar, Nasser Alsanea","doi":"10.4103/WJCS.WJCS_30_20","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_30_20","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic has vastly impacted normal day-to-day surgical practice throughout the world. It is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The treatment of colorectal diseases in the presence of COVID-19 infections must be reconsidered. An expert's panel from the Saudi Chapter and Gulf Cooperation Council Countries Chapter under the umbrella of the Saudi Society of Colon and Rectal Surgery was assembled. The panel identified the key questions and systematically reviewed all reports around the impact of COVID-19 on colorectal cancer treatment, emergency surgery, surgical technique, endoscopy, and operating room protocols. Using the grading of recommendations assessment, development, and evaluation (GRADE) methodology and the evidence-to-decision framework, the strength of recommendations and the quality of evidence were determined by the panel. The panel recommends a thorough review of current surgical practice in the field of colorectal diseases to minimize the impact of COVID-19. Lack of clinical trials and local regional data in the area of colorectal diseases during the COVID-19 pandemic are marked as limitations of this study.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42798945","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}
Background: Obstructive defecation syndrome (ODS) is a common and poorly understood cause of constipation. Stapled transanal rectal resection (STARR) is one of the surgical options for ODS. Objectives: This study evaluates short-term and long-term functional outcomes following STARR for ODS patients and predictive factors determining the outcome of the surgery. Design: Retrospective analysis of prospectively collected data. Setting: This study was conducted in the colorectal unit of a tertiary hospital in Mumbai, India. Patients and Methods: Patients who underwent STARR surgery for ODS from January 2009 to January 2013 were evaluated. Patients were periodically followed up for 5 years. Main Outcome Measures: Longo scores and patient satisfaction were periodically evaluated in the 5-year follow-up. Sample Size: 204 patients. Results: 204 patients (M:F = 133:71, mean age 54.2 years) were evaluated. The mean preoperative Longo score was 23.2 ± 4.1. The mean operative time was 40 min and the median hospital stay was 2.1 days. On follow-up at 3 months symptoms improved in 92% patients, at 12 months symptoms persisted or recurred in 15% patients. Mean Longo scores at 12 months, 3 years, and 5 years follow-up was 7.14, 10.25, and 16.41 respectively. Patient satisfaction rate showed a declining trend in relation to time. ODS recurrence was observed in 41 (20%) patients and 78 (38%) patients at the end of 3 years and 5 years, respectively. Conclusions: STARR for ODS is a safe surgical procedure with minimal complications and good short-term functional results but fails in maintaining long-term efficacy of its results. Proper patient selection is extremely important for good functional outcomes. Limitations: Single-center study of retrospective nature with limited sample size. Conflict of Interest: None.
{"title":"Clinical outcomes of stapled transanal rectal resection (STARR) for obstructed defecation syndrome: Is STARR really a star on long-term follow-up?","authors":"Pranav Mandovra, Vishakha Kalikar, R. Patankar","doi":"10.4103/WJCS.WJCS_6_20","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_6_20","url":null,"abstract":"Background: Obstructive defecation syndrome (ODS) is a common and poorly understood cause of constipation. Stapled transanal rectal resection (STARR) is one of the surgical options for ODS. Objectives: This study evaluates short-term and long-term functional outcomes following STARR for ODS patients and predictive factors determining the outcome of the surgery. Design: Retrospective analysis of prospectively collected data. Setting: This study was conducted in the colorectal unit of a tertiary hospital in Mumbai, India. Patients and Methods: Patients who underwent STARR surgery for ODS from January 2009 to January 2013 were evaluated. Patients were periodically followed up for 5 years. Main Outcome Measures: Longo scores and patient satisfaction were periodically evaluated in the 5-year follow-up. Sample Size: 204 patients. Results: 204 patients (M:F = 133:71, mean age 54.2 years) were evaluated. The mean preoperative Longo score was 23.2 ± 4.1. The mean operative time was 40 min and the median hospital stay was 2.1 days. On follow-up at 3 months symptoms improved in 92% patients, at 12 months symptoms persisted or recurred in 15% patients. Mean Longo scores at 12 months, 3 years, and 5 years follow-up was 7.14, 10.25, and 16.41 respectively. Patient satisfaction rate showed a declining trend in relation to time. ODS recurrence was observed in 41 (20%) patients and 78 (38%) patients at the end of 3 years and 5 years, respectively. Conclusions: STARR for ODS is a safe surgical procedure with minimal complications and good short-term functional results but fails in maintaining long-term efficacy of its results. Proper patient selection is extremely important for good functional outcomes. Limitations: Single-center study of retrospective nature with limited sample size. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47215208","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}
Milton Mui, Joseph C. H. Kong, Glen R Guerra, A. Heriot
Background: Major advances in the management of locally advanced rectal cancer has led to controversies and varying clinical practices among colorectal surgeons, such as patient selection for neoadjuvant therapy and preferred regimen for neoadjuvant therapy. In addition, the role of restaging scans post-neoadjuvant therapy is still poorly established. Objectives: To examine current practice in the preoperative management of locally advanced rectal cancer in Australasia and determine the value of restaging magnetic resonance imaging (MRI). Design: Cross-sectional study (survey). Setting: Specialist colorectal surgeons in Australia and New Zealand. Participants and Methods: A web-based survey was distributed to the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members between December 2016 and February 2017. Information on demographics, imaging modalities used for staging, indications and choice of neoadjuvant therapy, as well as utility and perceived value of restaging MRI after neoadjuvant therapy was collected. Respondents were given hypothetical scenarios to assess their management decisions based on the findings of restaging MRI scans. Sample Size: 225. Main Outcome Measures: Preferred imaging modalities for staging and restaging of rectal cancer post-neoadjuvant therapy; indications and preferred regimen for neoadjuvant therapy; and utility and perceived value of restaging scans, particularly MRI, Results: Sixty-two (27.6%) CSSANZ members responded. Main neoadjuvant therapy indications included advanced T3 tumors (80.7% for T3c; 83.9% for T3d), T4 tumors (87.1%), nodal metastases (69.4% for N1; 77.4% for N2), and an involved circumferential resection margin (CRM) (95.2%). Long-course chemoradiotherapy was preferred for neoadjuvant therapy (80.6%). The preferred initial-stage imaging modalities were MRI (100%) and computed tomography of chest, abdomen, and pelvis (CT-CAP) (100%). Fifty-six (90.3%) respondents would perform restaging scans post neoadjuvant therapy in selected patients. An involved CRM was frequently identified as a feature on restaging MRI which may affect management (78.6%), with extramural venous invasion (EMVI) (7.1%) or tumor regression grading (TRG) (26.8%) rated less significant. Conclusion: Preoperative management of locally advanced rectal cancer in Australasia is generally consistent with current guidelines. Restaging MRI after neoadjuvant therapy undoubtedly has a role for guiding patient management, but larger prospective studies are warranted to firmly establish their place in daily clinical practice. Limitations: Poor response rate, leading to a small sample size; study population limited to colorectal surgeons in Australasia; and difficult to assess how restaging scans may change management plan. Conflict of Interest: None.
{"title":"Preoperative management of locally advanced rectal cancer and the role of restaging MRI: An australasian perspective","authors":"Milton Mui, Joseph C. H. Kong, Glen R Guerra, A. Heriot","doi":"10.4103/wjcs.wjcs_9_20","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_9_20","url":null,"abstract":"Background: Major advances in the management of locally advanced rectal cancer has led to controversies and varying clinical practices among colorectal surgeons, such as patient selection for neoadjuvant therapy and preferred regimen for neoadjuvant therapy. In addition, the role of restaging scans post-neoadjuvant therapy is still poorly established. Objectives: To examine current practice in the preoperative management of locally advanced rectal cancer in Australasia and determine the value of restaging magnetic resonance imaging (MRI). Design: Cross-sectional study (survey). Setting: Specialist colorectal surgeons in Australia and New Zealand. Participants and Methods: A web-based survey was distributed to the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members between December 2016 and February 2017. Information on demographics, imaging modalities used for staging, indications and choice of neoadjuvant therapy, as well as utility and perceived value of restaging MRI after neoadjuvant therapy was collected. Respondents were given hypothetical scenarios to assess their management decisions based on the findings of restaging MRI scans. Sample Size: 225. Main Outcome Measures: Preferred imaging modalities for staging and restaging of rectal cancer post-neoadjuvant therapy; indications and preferred regimen for neoadjuvant therapy; and utility and perceived value of restaging scans, particularly MRI, Results: Sixty-two (27.6%) CSSANZ members responded. Main neoadjuvant therapy indications included advanced T3 tumors (80.7% for T3c; 83.9% for T3d), T4 tumors (87.1%), nodal metastases (69.4% for N1; 77.4% for N2), and an involved circumferential resection margin (CRM) (95.2%). Long-course chemoradiotherapy was preferred for neoadjuvant therapy (80.6%). The preferred initial-stage imaging modalities were MRI (100%) and computed tomography of chest, abdomen, and pelvis (CT-CAP) (100%). Fifty-six (90.3%) respondents would perform restaging scans post neoadjuvant therapy in selected patients. An involved CRM was frequently identified as a feature on restaging MRI which may affect management (78.6%), with extramural venous invasion (EMVI) (7.1%) or tumor regression grading (TRG) (26.8%) rated less significant. Conclusion: Preoperative management of locally advanced rectal cancer in Australasia is generally consistent with current guidelines. Restaging MRI after neoadjuvant therapy undoubtedly has a role for guiding patient management, but larger prospective studies are warranted to firmly establish their place in daily clinical practice. Limitations: Poor response rate, leading to a small sample size; study population limited to colorectal surgeons in Australasia; and difficult to assess how restaging scans may change management plan. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45741724","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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