Stephanie D. Talutis, U. Phatak, Angela H. Kuhnen, P. Rosenkranz, D. McAneny, J. Hall
Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary pathway of perioperative patient care. Objective: To evaluate the effect of an ERAS program on length-of-stay (LOS) among elective colorectal surgery patients at a safety-net hospital. Design: Retrospective chart review Setting: 500+ bed in a safety-net hospital. Patients and Methods: Retrospective review of elective colorectal surgery patients comparing those participating in an ERAS protocol to historical-control (HC) patients from the preceding year. Main Outcome Measures: The primary outcome was LOS. Secondary outcomes of interest included opioid utilization, fluid balance throughout the hospital stay, return of bowel function, 30-day complications emergency department visits, and readmissions. Sample Size: 193. Results: ERAS (n = 94) and HC groups (n = 99) were similar with regards to demographics and operations performed. ERAS patients had a longer operating room (OR) time (P = 0.010), however, OR fluid rates were lower for ERAS patients (P < 0.001) with more neutral fluid balance at discharge (closer to 0) (P = 0.006). ERAS patients received fewer opioids in the OR (P < 0.001) and throughout the hospital stay (P = 0.043). Median LOS was 4 days for both groups (P = 0.141) and no difference in 30-day emergency department (ED) visits, readmission, or complications. Conclusions: Benefits of ERAS may not be immediately evident post-implementation. Further study is needed regarding the maintenance of ERAS interventions over time and the impact on patient outcomes. Limitations: Single-center retrospective nature and surgeon turnover during this period. Conflict of Interest: None.
{"title":"Enhanced recovery after colorectal surgery: 1st year experience in a safety-net hospital","authors":"Stephanie D. Talutis, U. Phatak, Angela H. Kuhnen, P. Rosenkranz, D. McAneny, J. Hall","doi":"10.4103/wjcs.wjcs_7_20","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_7_20","url":null,"abstract":"Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary pathway of perioperative patient care. Objective: To evaluate the effect of an ERAS program on length-of-stay (LOS) among elective colorectal surgery patients at a safety-net hospital. Design: Retrospective chart review Setting: 500+ bed in a safety-net hospital. Patients and Methods: Retrospective review of elective colorectal surgery patients comparing those participating in an ERAS protocol to historical-control (HC) patients from the preceding year. Main Outcome Measures: The primary outcome was LOS. Secondary outcomes of interest included opioid utilization, fluid balance throughout the hospital stay, return of bowel function, 30-day complications emergency department visits, and readmissions. Sample Size: 193. Results: ERAS (n = 94) and HC groups (n = 99) were similar with regards to demographics and operations performed. ERAS patients had a longer operating room (OR) time (P = 0.010), however, OR fluid rates were lower for ERAS patients (P < 0.001) with more neutral fluid balance at discharge (closer to 0) (P = 0.006). ERAS patients received fewer opioids in the OR (P < 0.001) and throughout the hospital stay (P = 0.043). Median LOS was 4 days for both groups (P = 0.141) and no difference in 30-day emergency department (ED) visits, readmission, or complications. Conclusions: Benefits of ERAS may not be immediately evident post-implementation. Further study is needed regarding the maintenance of ERAS interventions over time and the impact on patient outcomes. Limitations: Single-center retrospective nature and surgeon turnover during this period. 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":"46387307","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}
Neuroendocrine carcinomas (NECs) are malignancies most often found in the colon, lung, pancreas, or thyroid. We describe a rare case of an NEC found in the anal canal of a 68-year-old woman. We also explore a list of differential diagnoses that should be considered in a patient presenting with a rectal mass. Pathological slides with staining for chromogranin, synaptophysin and CDX2 confirm the diagnosis. We are hopeful that this patient is responsive to neoadjuvant chemotherapy and radiation as to allow for a sphincter preserving surgery to ultimately lead to a better quality of life.
{"title":"A mass in the anal canal found to be poorly differentiated small-cell neuroendocrine carcinoma","authors":"M. Gates, N. Shah, I. Saeed","doi":"10.4103/wjcs.wjcs_26_19","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_26_19","url":null,"abstract":"Neuroendocrine carcinomas (NECs) are malignancies most often found in the colon, lung, pancreas, or thyroid. We describe a rare case of an NEC found in the anal canal of a 68-year-old woman. We also explore a list of differential diagnoses that should be considered in a patient presenting with a rectal mass. Pathological slides with staining for chromogranin, synaptophysin and CDX2 confirm the diagnosis. We are hopeful that this patient is responsive to neoadjuvant chemotherapy and radiation as to allow for a sphincter preserving surgery to ultimately lead to a better quality of life.","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":"43869797","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}
Perianal mucinous adenocarcinoma (PMA) is a rare gastrointestinal malignancy that occurs in patients with a long-standing history of recurrent perirectal abscesses or a chronic fistula. We present a unique case of PMA, which began as a rectal abscess and progressed to PMA with a skip lesion present all the way up in the mid-rectal region. This is the first case in which PMA presented with skip lesions as opposed to a continuous lesion, and presented without fistulas and recurrent abscesses history but just a 4-day history of perianal burning, itching, and tingling. CT imaging, MRIs, and PET scans were done for the diagnosis of PMA. A discussion of the National Comprehensive Cancer Network (NCCN) guidelines on using radiation therapy followed by an abdominoperineal resection with inguinal node dissection for the management and treatment of PMA is reported. Sharing the presentation of PMA with multimodality specialty groups and tumor boards helps develop various diagnostic and therapeutic approaches for PMA, as well as enhances our understanding of this rare malignant entity.
{"title":"Skip lesions in perianal mucinous adenocarcinoma","authors":"N. Shah, M. Gates, I. Saeed","doi":"10.4103/wjcs.wjcs_1_20","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_1_20","url":null,"abstract":"Perianal mucinous adenocarcinoma (PMA) is a rare gastrointestinal malignancy that occurs in patients with a long-standing history of recurrent perirectal abscesses or a chronic fistula. We present a unique case of PMA, which began as a rectal abscess and progressed to PMA with a skip lesion present all the way up in the mid-rectal region. This is the first case in which PMA presented with skip lesions as opposed to a continuous lesion, and presented without fistulas and recurrent abscesses history but just a 4-day history of perianal burning, itching, and tingling. CT imaging, MRIs, and PET scans were done for the diagnosis of PMA. A discussion of the National Comprehensive Cancer Network (NCCN) guidelines on using radiation therapy followed by an abdominoperineal resection with inguinal node dissection for the management and treatment of PMA is reported. Sharing the presentation of PMA with multimodality specialty groups and tumor boards helps develop various diagnostic and therapeutic approaches for PMA, as well as enhances our understanding of this rare malignant entity.","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":"46910736","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}
Granular cell tumors (GCTs) are typically benign tumors of neuronal origin that stain positive for S-100. They traditionally occur in the skin and subcutaneous tissue with gastrointestinal tumor sites, such as the colon, being rare. On colonoscopy, they appear as a well-circumscribed, yellow, submucosal lesion. Biopsy prior to endoscopic or surgical removal can be inconclusive due to the submucosal nature of the lesion. Although GCTs are rarely malignant, they can metastasize with a high mortality rate. Endoscopic resection has been described as an appropriate treatment for tumors up to 5 cm in diameter. We present the case of a 19-year-old male who experienced a 60-pound weight loss, which was initially attributed to depression. On clinical examination, a GCT was found in his ascending colon.
{"title":"Granular cell tumor of the colon presenting as profound weight loss","authors":"Sarah E. Diaz, J. Hain, S. Hans","doi":"10.4103/wjcs.wjcs_14_19","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_14_19","url":null,"abstract":"Granular cell tumors (GCTs) are typically benign tumors of neuronal origin that stain positive for S-100. They traditionally occur in the skin and subcutaneous tissue with gastrointestinal tumor sites, such as the colon, being rare. On colonoscopy, they appear as a well-circumscribed, yellow, submucosal lesion. Biopsy prior to endoscopic or surgical removal can be inconclusive due to the submucosal nature of the lesion. Although GCTs are rarely malignant, they can metastasize with a high mortality rate. Endoscopic resection has been described as an appropriate treatment for tumors up to 5 cm in diameter. We present the case of a 19-year-old male who experienced a 60-pound weight loss, which was initially attributed to depression. On clinical examination, a GCT was found in his ascending colon.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42097506","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}
Pranav Mandovra, Vishakha Kalikar, P. Bajaj, R. Patankar
Background: Stapled hemorrhoidopexy gained popularity due to low postoperative pain. Few patients still complain of postoperative anal pain. Methylene blue (MB) in caudal and epidural anesthesia gives long-term pain relief and has also been used to treat intractable pruritus ani. Objective: Evaluate the role of local infiltration of the MB as an analgesic in the procedure for prolapse and hemorrhoids (PPH) surgery. Design: Prospective observational study. Setting: Tertiary health care center. Patients and Methods: Patients with grade-III hemorrhoids were included and were divided into two groups: A and B. Group A received a perianal injection of 2 mL of 1% MB with 10 mL of 25% bupivacaine. Group B received a perianal injection of 2 mL of normal saline with 10 mL of 25% bupivacaine. Main Outcome Measures: Patients were followed up prospectively for pain, hospital stay, and complications. Results were noted and compared between the two groups. Sample Size: 50 patients. Results: Group A had significantly lower pain scores on day 3 (mean ± SD 2.08 ± 1.08) and day 7 (mean ± SD 0.64 ± 0.95) as compared to the pain scores on day 3 (mean ± SD 3.92 ± 1.35) (P-value = 0.000) and day 7 (mean ± SD 2.40 ± 1.0) (P-value = 0.000) in group B. Pain scores within first 24 h and day 21 post-surgery were not statistically significant between groups A and B (P-value = 0.286 and 0.19, respectively). Group B required a significantly higher number of both injectable and oral analgesics (mean + SD 4.03 + 0.94) as compared to group A patients (mean + SD 1.97 + 0.81) (P-value = 0.001). 4% of the patients in group B had prolonged hospital stay due to severe pain. Patients in group A also had a significant reduction in their requirement of analgesics. None of the patients who received MB had any local or systemic allergic reactions. Conclusion: Local infiltration of MB may be used as an effective analgesic in PPH patients without any increase in morbidity. Limitations: Single-center study with a small sample size. Conflict of Interest: None.
{"title":"Role of local infiltration of methylene blue as an analgesic in stapled hemorrhoidopexy: A prospective study","authors":"Pranav Mandovra, Vishakha Kalikar, P. Bajaj, R. Patankar","doi":"10.4103/wjcs.wjcs_20_19","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_20_19","url":null,"abstract":"Background: Stapled hemorrhoidopexy gained popularity due to low postoperative pain. Few patients still complain of postoperative anal pain. Methylene blue (MB) in caudal and epidural anesthesia gives long-term pain relief and has also been used to treat intractable pruritus ani. Objective: Evaluate the role of local infiltration of the MB as an analgesic in the procedure for prolapse and hemorrhoids (PPH) surgery. Design: Prospective observational study. Setting: Tertiary health care center. Patients and Methods: Patients with grade-III hemorrhoids were included and were divided into two groups: A and B. Group A received a perianal injection of 2 mL of 1% MB with 10 mL of 25% bupivacaine. Group B received a perianal injection of 2 mL of normal saline with 10 mL of 25% bupivacaine. Main Outcome Measures: Patients were followed up prospectively for pain, hospital stay, and complications. Results were noted and compared between the two groups. Sample Size: 50 patients. Results: Group A had significantly lower pain scores on day 3 (mean ± SD 2.08 ± 1.08) and day 7 (mean ± SD 0.64 ± 0.95) as compared to the pain scores on day 3 (mean ± SD 3.92 ± 1.35) (P-value = 0.000) and day 7 (mean ± SD 2.40 ± 1.0) (P-value = 0.000) in group B. Pain scores within first 24 h and day 21 post-surgery were not statistically significant between groups A and B (P-value = 0.286 and 0.19, respectively). Group B required a significantly higher number of both injectable and oral analgesics (mean + SD 4.03 + 0.94) as compared to group A patients (mean + SD 1.97 + 0.81) (P-value = 0.001). 4% of the patients in group B had prolonged hospital stay due to severe pain. Patients in group A also had a significant reduction in their requirement of analgesics. None of the patients who received MB had any local or systemic allergic reactions. Conclusion: Local infiltration of MB may be used as an effective analgesic in PPH patients without any increase in morbidity. Limitations: Single-center study with a small sample size. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42781008","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}
Michelle L Cooper, Cu-Tai Lu, H. Puhalla, H. Nabi, M. Papen
Background: The utility of routine outpatient colonoscopy after the conservative management of complicated and uncomplicated colonic diverticulitis has become questionable. Recent literature suggests this time-honored practice after uncomplicated diverticulitis is to be of little benefit, although uncertainty still persists regarding complicated diverticulitis. Objective: We analysed the rates of benign and malignant pathology identified on colonoscopy after conservatively managed uncomplicated and complicated diverticulitis in a hospital where such colonoscopies have been routine practice. Design: A retrospective cohort study was conducted. Setting: Gold Coast Hospital, Southport, Queensland, Australia. Patients and Methods: All patients who were admitted to the Gold Coast Hospital, Southport, Queensland, Australia, between June 2007 and June 2010 diagnosed with acute uncomplicated and complicated diverticulitis were included in the study. The patients were followed up and colonoscopy reports and histology results obtained. Main Outcome Measures: Benign and malignant pathology post uncomplicated and complicated diverticulitis. Sample Size: 144 patients were eligible for inclusion. Results: Between June 2007 and June 2010, 1073 patients were hospitalized with an admission diagnosis coding for diverticulitis. Of these, 144 patients had a computed tomography (CT) which confirmed the diagnosis of acute diverticulitis. Complete colonoscopy and histology data were obtained for 107 of these patients. Of these, 32 patients (29.91%) had pathology found at colonoscopy. One patient (0.9%) was found to have adenocarcinoma of the colon. Conclusion: Colonoscopy follow-up for acute diverticulitis has remained acceptable in many units to exclude alternate colonic pathology. However, recent literature has questioned the utility of this practice. This study – in keeping with this growing body of international literature – found the rate of synchronous/alternative pathology to be comparable to that of asymptomatic patient populations. Routine colonoscopies after uncomplicated colonic diverticulitis confidently diagnosed with a CT scan, therefore, cannot be justified. Limitations: Retrospective nature and sample size. Conflict of Interest: None.
{"title":"The need for routine colonoscopy after acute diverticulitis revisited","authors":"Michelle L Cooper, Cu-Tai Lu, H. Puhalla, H. Nabi, M. Papen","doi":"10.4103/wjcs.wjcs_34_18","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_34_18","url":null,"abstract":"Background: The utility of routine outpatient colonoscopy after the conservative management of complicated and uncomplicated colonic diverticulitis has become questionable. Recent literature suggests this time-honored practice after uncomplicated diverticulitis is to be of little benefit, although uncertainty still persists regarding complicated diverticulitis. Objective: We analysed the rates of benign and malignant pathology identified on colonoscopy after conservatively managed uncomplicated and complicated diverticulitis in a hospital where such colonoscopies have been routine practice. Design: A retrospective cohort study was conducted. Setting: Gold Coast Hospital, Southport, Queensland, Australia. Patients and Methods: All patients who were admitted to the Gold Coast Hospital, Southport, Queensland, Australia, between June 2007 and June 2010 diagnosed with acute uncomplicated and complicated diverticulitis were included in the study. The patients were followed up and colonoscopy reports and histology results obtained. Main Outcome Measures: Benign and malignant pathology post uncomplicated and complicated diverticulitis. Sample Size: 144 patients were eligible for inclusion. Results: Between June 2007 and June 2010, 1073 patients were hospitalized with an admission diagnosis coding for diverticulitis. Of these, 144 patients had a computed tomography (CT) which confirmed the diagnosis of acute diverticulitis. Complete colonoscopy and histology data were obtained for 107 of these patients. Of these, 32 patients (29.91%) had pathology found at colonoscopy. One patient (0.9%) was found to have adenocarcinoma of the colon. Conclusion: Colonoscopy follow-up for acute diverticulitis has remained acceptable in many units to exclude alternate colonic pathology. However, recent literature has questioned the utility of this practice. This study – in keeping with this growing body of international literature – found the rate of synchronous/alternative pathology to be comparable to that of asymptomatic patient populations. Routine colonoscopies after uncomplicated colonic diverticulitis confidently diagnosed with a CT scan, therefore, cannot be justified. Limitations: Retrospective nature and sample size. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42964766","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: Crohn's disease causes recurrent and complex perianal fistulas. Although the prevalence of it is up to 30%, the common cause of perianal fistula is thought to be the crypto-glandular theory. Surgeons send perianal fistula specimens for histopathological analysis; however, it is unclear whether such practices should be performed routinely. Objective: Evaluating the utility of routine histopathology on perianal fistula specimens during surgery to exclude the diagnosis of Crohn's disease. Design: Multicenter retrospective study was conducted from January 2012 to October 2018 on patients who underwent surgery for perianal fistula and specimen sent for histology. Setting: Metropolitan tertiary referral center in Melbourne, Australia. Patients and Methods: 105 patients who underwent 124 anal fistula procedures and their perianal fistula specimens sent for histopathological analysis were selected from the medical database. Medical and pathology reports were analyzed and data were reviewed by a second author for consistency. Sample Size: 105 patients, 124 procedures. Main Outcome Measures: Histopathological results suspicious for Crohn's disease and endoscopic examination results to confirm Crohn's disease. Results: 41 together, 124 perianal fistula specimens were collected from 105 patients. The male to female ratio was 2.9:1 and the average age was 43.6 years. Nonspecific inflammation was seen in 121 (97.5%) specimens. Three specimens had granulomatous inflammation of which, only two (1.6%) had Crohn's disease confirmed on endoscopic biopsy of the terminal ileum. In 15 patients with Crohn's disease, none of the 19 specimens sent for histology demonstrated histopathological features of Crohn's disease. Conclusion: Routine histopathological analyses of perianal fistula specimens provide limited clinical value. Clinicians should selectively send specimens for histopathological analysis to limit the use of resources. Limitations: Retrospective study. Not all perianal fistula specimens were routinely sent for the analysis. Data prior to 2012 was not collected as we are limited by an electronic database which was commenced in 2012. Conflict of Interest: None.
{"title":"Is routine pathological analysis of perianal fistula specimen necessary in diagnosis of crohn's disease?","authors":"S. Lau, Casey Yu, S. Ng, R. Chandra","doi":"10.4103/wjcs.wjcs_25_19","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_25_19","url":null,"abstract":"Background: Crohn's disease causes recurrent and complex perianal fistulas. Although the prevalence of it is up to 30%, the common cause of perianal fistula is thought to be the crypto-glandular theory. Surgeons send perianal fistula specimens for histopathological analysis; however, it is unclear whether such practices should be performed routinely. Objective: Evaluating the utility of routine histopathology on perianal fistula specimens during surgery to exclude the diagnosis of Crohn's disease. Design: Multicenter retrospective study was conducted from January 2012 to October 2018 on patients who underwent surgery for perianal fistula and specimen sent for histology. Setting: Metropolitan tertiary referral center in Melbourne, Australia. Patients and Methods: 105 patients who underwent 124 anal fistula procedures and their perianal fistula specimens sent for histopathological analysis were selected from the medical database. Medical and pathology reports were analyzed and data were reviewed by a second author for consistency. Sample Size: 105 patients, 124 procedures. Main Outcome Measures: Histopathological results suspicious for Crohn's disease and endoscopic examination results to confirm Crohn's disease. Results: 41 together, 124 perianal fistula specimens were collected from 105 patients. The male to female ratio was 2.9:1 and the average age was 43.6 years. Nonspecific inflammation was seen in 121 (97.5%) specimens. Three specimens had granulomatous inflammation of which, only two (1.6%) had Crohn's disease confirmed on endoscopic biopsy of the terminal ileum. In 15 patients with Crohn's disease, none of the 19 specimens sent for histology demonstrated histopathological features of Crohn's disease. Conclusion: Routine histopathological analyses of perianal fistula specimens provide limited clinical value. Clinicians should selectively send specimens for histopathological analysis to limit the use of resources. Limitations: Retrospective study. Not all perianal fistula specimens were routinely sent for the analysis. Data prior to 2012 was not collected as we are limited by an electronic database which was commenced in 2012. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43862683","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}
A. Khalil, Essam Ebeid, T. Ahmed, Karim Elneklawy, M. Nada
Background: Neuro-modulation of the pelvic nerves is an effective and promising modality for treating fecal incontinence. Direct sacral nerve stimulation is the most popular for neuro-modulation although it is technically demanding. Percutaneous and transcutaneous posterior tibial nerve stimulations are relatively newer approaches for neuro-modulation and they carry the advantage of being cheaper and less invasive. There is not much published data about the transcutaneous approach and in this study, we are describing our experience with this technique. Objective: This study was conducted to describe and determine the efficacy of percutaneous posterior tibial nerve stimulation in the treatment of fecal incontinence. Design: A prospective descriptive study. Setting: The colorectal clinic in the hospital was prepared with the required equipment. The authors funded all procedures performed and the patients paid no extra charges. Patients and Methods: Our study included 15 patients with fecal incontinence visiting the colorectal clinic in Ain Shams University Hospital. All patients received 12 sessions of electric stimulation, 3 sessions per week for 40 minutes each. Main Outcome Measures: Sample Size Wexner score and the short term effect of the treatment. Sample Size: 15 patients. Results: The study included 11 females and 4 males, 2 patients were excluded from the results. The results showed that there was improvement in mean Wexner score for these patients from 13 before the treatment to 8 after finishing the treatment course. Reassessment after 6 months of treatment revealed no deterioration in their continence. Conclusion: We found that transcutaneous posterior tibial nerve stimulation is an effective, cheap, and tolerable method for treating fecal incontinence. However, long-term follow up is required on larger group of patients to adopt this technique. Limitations: Small sample size, short course follow up.Conflict of Interest: None.
{"title":"Transcutaneous posterior tibial nerve stimulation for fecal incontinence: New hope revisited","authors":"A. Khalil, Essam Ebeid, T. Ahmed, Karim Elneklawy, M. Nada","doi":"10.4103/WJCS.WJCS_24_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_24_19","url":null,"abstract":"Background: Neuro-modulation of the pelvic nerves is an effective and promising modality for treating fecal incontinence. Direct sacral nerve stimulation is the most popular for neuro-modulation although it is technically demanding. Percutaneous and transcutaneous posterior tibial nerve stimulations are relatively newer approaches for neuro-modulation and they carry the advantage of being cheaper and less invasive. There is not much published data about the transcutaneous approach and in this study, we are describing our experience with this technique. Objective: This study was conducted to describe and determine the efficacy of percutaneous posterior tibial nerve stimulation in the treatment of fecal incontinence. Design: A prospective descriptive study. Setting: The colorectal clinic in the hospital was prepared with the required equipment. The authors funded all procedures performed and the patients paid no extra charges. Patients and Methods: Our study included 15 patients with fecal incontinence visiting the colorectal clinic in Ain Shams University Hospital. All patients received 12 sessions of electric stimulation, 3 sessions per week for 40 minutes each. Main Outcome Measures: Sample Size Wexner score and the short term effect of the treatment. Sample Size: 15 patients. Results: The study included 11 females and 4 males, 2 patients were excluded from the results. The results showed that there was improvement in mean Wexner score for these patients from 13 before the treatment to 8 after finishing the treatment course. Reassessment after 6 months of treatment revealed no deterioration in their continence. Conclusion: We found that transcutaneous posterior tibial nerve stimulation is an effective, cheap, and tolerable method for treating fecal incontinence. However, long-term follow up is required on larger group of patients to adopt this technique. Limitations: Small sample size, short course follow up.Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46389310","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}
M. Abbas, M. Shalabi, D. Gopalan, Princess Bianzon, F. Georgopoulos
Background: Propofol anesthesia for endoscopic procedures has gained wide acceptance among physicians and patients. Much debate remains though whether propofol can be safely administered by non-anesthesiologists. Objective: To compare the procedural outcome of patients undergoing colonoscopy with Propofol target-controlled infusion administered by anesthesiologists vs. non-anesthesiologists. Design: A retrospective review. Setting: A private community hospital in Dubai, United Arab Emirates. Patients and Methods: All consecutive patients (age > 13 years, with American Society of Anesthesiologists class I-II and no other contraindications to administration of sedation by non-anesthesiologists) who underwent colonoscopy between January 1, 2017 and September 30, 2017. In the initial part of the study, propofol was administered by an anesthesiologist until the endoscopists were trained to provide propofol anesthesia via targeted-controlled infusion [TCI] by syringe pump. Intraprocedural data was collected in a prospective registry. Statistical analysis was performed using Chi square and student t test. Main Outcome Measures: Cecal intubation rate, procedural time, procedural-related complications, and polypectomy/biopsy rate. Sample Size: 347 patients. Results: Group 1 [anesthesiologists] 84 patients, Group 2 [endoscopists] 263 patients. Mean age was 44.8 and 46.9 years in Group 1 and 2, respectively (P = 0.17). There was no difference in gender distribution. The mean procedural time was 21 minutes in both groups (P = 0.93). The cecal intubation rate was similar [92.9% in Group 1 vs. 94.3% in Group 2, P = 0.40). No difference in procedural-related complications was noted between groups, with 1 patient in Group 2 sustaining endoscopic perforation during balloon dilation of a near obstructing anastomotic stricture. Except for the patient with endoscopic perforation, no patient required advanced airway management. Conclusions: Propofol can be safely administered by endoscopists using target-controlled infusion. Similar total procedural time and cecal intubation rate can be achieved without increased risk of procedural-related complications. Limitations: Retrospective review, community-based hospital, elective cases, small cohort size. Conflict of Interest: None.
{"title":"Propofol administration by anesthesiologists versus endoscopists during colonoscopy: Does it make a difference?","authors":"M. Abbas, M. Shalabi, D. Gopalan, Princess Bianzon, F. Georgopoulos","doi":"10.4103/WJCS.WJCS_23_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_23_19","url":null,"abstract":"Background: Propofol anesthesia for endoscopic procedures has gained wide acceptance among physicians and patients. Much debate remains though whether propofol can be safely administered by non-anesthesiologists. Objective: To compare the procedural outcome of patients undergoing colonoscopy with Propofol target-controlled infusion administered by anesthesiologists vs. non-anesthesiologists. Design: A retrospective review. Setting: A private community hospital in Dubai, United Arab Emirates. Patients and Methods: All consecutive patients (age > 13 years, with American Society of Anesthesiologists class I-II and no other contraindications to administration of sedation by non-anesthesiologists) who underwent colonoscopy between January 1, 2017 and September 30, 2017. In the initial part of the study, propofol was administered by an anesthesiologist until the endoscopists were trained to provide propofol anesthesia via targeted-controlled infusion [TCI] by syringe pump. Intraprocedural data was collected in a prospective registry. Statistical analysis was performed using Chi square and student t test. Main Outcome Measures: Cecal intubation rate, procedural time, procedural-related complications, and polypectomy/biopsy rate. Sample Size: 347 patients. Results: Group 1 [anesthesiologists] 84 patients, Group 2 [endoscopists] 263 patients. Mean age was 44.8 and 46.9 years in Group 1 and 2, respectively (P = 0.17). There was no difference in gender distribution. The mean procedural time was 21 minutes in both groups (P = 0.93). The cecal intubation rate was similar [92.9% in Group 1 vs. 94.3% in Group 2, P = 0.40). No difference in procedural-related complications was noted between groups, with 1 patient in Group 2 sustaining endoscopic perforation during balloon dilation of a near obstructing anastomotic stricture. Except for the patient with endoscopic perforation, no patient required advanced airway management. Conclusions: Propofol can be safely administered by endoscopists using target-controlled infusion. Similar total procedural time and cecal intubation rate can be achieved without increased risk of procedural-related complications. Limitations: Retrospective review, community-based hospital, elective cases, small cohort size. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49242153","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}
R. Dutta, Sujitesh Saha, M. Saha, Abhimanyu Basu, Soumen Das, D. Saha
Background: Comprising nearly 30% of all colorectal cancers, rectal cancer continues to be a significant medical and social problem. Abdominiperineal resection (APR) remains the procedure of choice for patients with rectal carcinoma. An alternative to APR is abdominosacral resection (ASR). Objective: We aim to assess the various modes of presentation, demographic profiles, and histopathological characteristics of tumors, and evaluate the efficacy of ASR over APR in terms of exposure, operating time, bleeding, etc., especially in the perineal/sacral part of the procedure. Design: This was a prospective observational study.Setting: This study was conducted at a superspeciality government hospital in eastern India. Patients and Methods: Patients diagnosed with low rectal carcinoma were included in the study. Two groups were formed using a stratified model of sampling theory; one group underwent APR while the other ASR. Main Outcome Measures: For patients with low rectal cancer, ASR is a feasible approach with reduced bleeding, lesser operating time in the perineal/sacral part of dissection, better exposure, and good oncological outcome.Sample Size: Thirty participants were included in the study. Results: Of the total study participants, 63% were males and 36% females. Patients in their 30s and 40s were the most commonly affected age group. Per-rectal bleeding was the most common presentation. The most common histological tumor encountered was well-differentiated adenocarcinoma. The mean operating time and mean blood loss with regards to the perineal/sacral part of the dissection was less in ASR than that in APR. In addition, the exposure was better in ASR. Ninety-three percent of the patients undergoing ASR had total mesorectal excision. Conclusion: ASR is a feasible approach for low rectal carcinoma and performs better in certain aspects than APR. Limitations: This study had a short duration and included less number of patients. Conflict of Interest: None.
{"title":"Abdominosacral resection versus abdominoperineal resection in patients with low rectal carcinoma in terms of exposure/operating time/bleeding","authors":"R. Dutta, Sujitesh Saha, M. Saha, Abhimanyu Basu, Soumen Das, D. Saha","doi":"10.4103/WJCS.WJCS_2_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_2_19","url":null,"abstract":"Background: Comprising nearly 30% of all colorectal cancers, rectal cancer continues to be a significant medical and social problem. Abdominiperineal resection (APR) remains the procedure of choice for patients with rectal carcinoma. An alternative to APR is abdominosacral resection (ASR). Objective: We aim to assess the various modes of presentation, demographic profiles, and histopathological characteristics of tumors, and evaluate the efficacy of ASR over APR in terms of exposure, operating time, bleeding, etc., especially in the perineal/sacral part of the procedure. Design: This was a prospective observational study.Setting: This study was conducted at a superspeciality government hospital in eastern India. Patients and Methods: Patients diagnosed with low rectal carcinoma were included in the study. Two groups were formed using a stratified model of sampling theory; one group underwent APR while the other ASR. Main Outcome Measures: For patients with low rectal cancer, ASR is a feasible approach with reduced bleeding, lesser operating time in the perineal/sacral part of dissection, better exposure, and good oncological outcome.Sample Size: Thirty participants were included in the study. Results: Of the total study participants, 63% were males and 36% females. Patients in their 30s and 40s were the most commonly affected age group. Per-rectal bleeding was the most common presentation. The most common histological tumor encountered was well-differentiated adenocarcinoma. The mean operating time and mean blood loss with regards to the perineal/sacral part of the dissection was less in ASR than that in APR. In addition, the exposure was better in ASR. Ninety-three percent of the patients undergoing ASR had total mesorectal excision. Conclusion: ASR is a feasible approach for low rectal carcinoma and performs better in certain aspects than APR. Limitations: This study had a short duration and included less number of patients. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47893210","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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