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The aim of this study is to assess the feasibility, short-term complication rates and clinical outcomes, including voiding dysfunction, from a prospective database of discoid resection performed in two tertiary referral centers.
Trends in surgical rates for Crohn's disease (CD) in the biologic era are controversial. We aim to assess modern trends in the formation rates of surgical stomas.
Organ-preserving local excision (LE) by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly less morbidity with acceptable oncological outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK.
Inflammatory markers such as serum C-reactive protein (CRP) are used as routine markers to detect anastomotic leakage following colorectal surgery. However, CRP is characterized by a relatively low predictive value, emphasizing the need for the development of novel diagnostic approaches. Volatile organic compounds (VOCs) are gaseous metabolic products deriving from all conceivable bodily excrements and reflect (alterations in) the patient's physical status. Therefore, VOCs are increasingly considered as pot...
In patients with a previous history of rectal anastomotic leakage (AL), the surgical indications and timing for closure of a diverting stoma closure have to be carefully judged. Even if AL has apparently healed before stoma closure, re-leakage may occur after closure. The aim of this study was to determine the incidence and risk factors for recurrent anastomotic leakage following stoma closure. We also examined the treatment strategies aimed to minimize the risk of recurrent anastomotic leakage.
Frailty is defined as a decrease in physiologic reserve with increased risk of morbidity following significant physiological stressors. This study examines the predictive power of 5-item modified frailty index (5-mFI) in predicting outcomes in colorectal surgery patients.
Although the data on minimally invasive right hemicolectomy in an elective setting have progressively been increasing, minimally invasive approaches are seldom preferred in a non-elective setting (1). As would be expected, a minimally invasive approach to an obstructing colon cancer can be challenging because of the limited working space in the abdomen. For patients with an obstructing right or transverse colon cancer, a right or extended right hemicolectomy with primary ileocolic anastomosis has been recom...
Abdominoperineal resection (APR) often results in a perineal defect, which is associated with a high rate of perineal wound problems . Obliteration of the dead space by tissue flaps may decrease the incidence of wound failure . This article is protected by copyright. All rights reserved.
Significant recent changes in management of locally advanced rectal cancer include preoperative staging, use of extended neoadjuvant therapies, and minimally invasive surgery (MIS). This study was aimed at characterizing those changes and associated short-term outcomes.
Laparoscopic right hemicolectomy with complete mesocolic excision (CME) is a very challenging procedure. It is known to have a long learning curve . The benefit of a robotic platform has been shown in rectal cancer surgery [2-4]. The aim of this video is to demonstrate the benefits of our three-trocar technique with the use of Senhance robotic platform that may reduce surgical risks, learning curve and operative time. This article is protected by copyright. All rights reserved.
There has been limited focus on female sexuality after treatment for colorectal cancer. Aim of this study was to investigate long-term female sexual dysfunction in disease-free colorectal cancer survivors in the Danish population.
Minimally invasive surgery for pilonidal sinus disease has gained increasing popularity owing to its advantages of minimal pain and scar, quick healing, and expedited recovery. Injection of fibrin glue and phenol solution has been described as minimally invasive methods for treatment of pilonidal sinus. This report describes the injection of a new sealant, the thrombin gelatin matrix, as a novel approach of treatment of pilonidal sinus disease. The new sealant, in presence of raw bleeding surface, starts th...
In this video, we demonstrate the Altemeier's Procedure (perineal rectosigmoidectomy) in an 85-year-old woman with long-standing faecal incontinence secondary to a full thickness rectal prolapse. This was carried out under general anaesthesia with the patient placed in lithotomy. Exposure was facilitated using a Long Star retractor (CooperSurgical Inc., Trumbull, Connecticut, USA). The prolapsed rectum was fully everted and a circumferential electrocautery incision was made approximately 1-2 cm distal to th...
Prospective cohort study to determine the intrinsic non-modifiable factors influencing length of stay (LOS) in unselected consecutive patients undergoing elective colorectal surgery within an enhanced recovery pathway (ERP).
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC). The most common type of IPAA is a J-pouch. If despite all other mobilization maneuvers, inadequate mesenteric reach prevents a tension free anastomosis with J-pouch, a good alternative is S-pouch creation, which can provide an additional 2 to 4 cm of length (1). This article is protected by copyright. All rights reserved.
Splenic flexure colon cancer (SFC) is relatively rare. It accounts for 2% to 5% of all colorectal cancers  and for this reason there is still no consensus about its surgical management. The controversy is mainly focused on the extent of the resection, about the surgical approach to be adopted and on the type of anastomosis to be performed. In the literature different approaches have been proposed, varying from a right extended colectomy, to a left super-extended resection, with or without splenectomy and...
Transanal endoscopic microsurgery is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open. The aim of this study was to determine if closure of the defect created during full thickness excision of rectal lesions with transanal endoscopic microsurgery leads to less postoperative pain when compa...
Low anterior resection syndrome (LARS) can affect up to 70% of all patients with rectal cancer. In the last two decades, sacral nerve stimulation (SNS) has emerged as an effective treatment for faecal incontinence. There is some encouraging literature on the use of SNS in patients with LARS. The purpose of this review is to provide an up to date review on the utility of SNS on LARS.
Anovaginal fistulas are abnormal tracts that connect the vagina with the lower gastrointestinal tract. They result most frequently from obstetric trauma following a failed repair of a third or fourth degree laceration of the perineum, from episiotomy infection or from unrecognized injury at the time of vaginal delivery. Fistulas that occur below the dentate line are called anovaginal fistulas or low fistulas. This article is protected by copyright. All rights reserved.
The aim of this study was to assess the value of PET/CT and sentinel lymph node biopsy (SLN), in staging inguinal lymph nodes in anal cancer patients and to determine if the results of the two methods could be of prognostic value.
Dear Editor, We present a case of a 72-year old man (BMI: 26,5) diagnosed with a histologically proven adenocarcinoma of the splenic flexure, without any other comordibities. The video demonstrates the robotic approach with DaVinci Xi (Intuitive Surgical, Sunnyvale, USA) platform to a splenic flexure resection. After the placement of the robotic arms and the robotic docking, the procedure began with the detachment of the coloepiploic ligament and mobilization of the splenic flexure, using the Monopolar Caut...
Since 1921, when the French surgeon Hartmann first described his eponymous procedure, it remains popular among surgeons and is preferred in left-sided colonic resections where performing a primary anastomosis would be considered to have a high risk for leakage [1,2]. However, a major second operation is required to restore intestinal continuity. Almost one-third of the patients do not undergo a second operation for multiple reasons including the relatively high morbidity and mortality rates and associated p...
We clearly demonstrate that colonoscopic decompression followed by snare-assisted side-hole tube placement is an effectively temporary treatment for sigmoid volvulus. This article is protected by copyright. All rights reserved.
Intestinal malrotation (IM) is defined as a congenital incomplete rotation and fixation of the gastrointestinal tract. It is frequently asymptomatic and it is diagnosed incidentally during radiological tests. In these cases, surgery is a challenge for surgeons due to the intraoperative anatomical alterations observed. Moreover, an anomalous intestinal vascularization can be associated, so the development of new technologies to assess the anastomotic blood supply during surgery can be determinant to improve ...
In this video, we clearly demonstrate that large lower rectal adenoma can be removed safely by transanal approach and Thunderbeat tissue management system is an appropriate device for submucosal dissection and hemostasis. This article is protected by copyright. All rights reserved.