Annals of Coloproctology

Technical tips

Transvaginal removal of rectal stromal tumor with Martius flap interposition: a feasible option for a large tumor at the anterior wall of the rectum: Weerapat Suwanthanma, Ploybutsara Kittiwetsakun, Samart Phuwapraisirisan, Pitichote Hiranyatheb; Ann Coloproctol. 2024;40(3):276-281. Published online June 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00556.0079

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Abstract PDF: Neoadjuvant imatinib treatment, followed by complete transvaginal removal, presents a feasible option for large rectal gastrointestinal tumors located on the anterior wall of the rectum and protruding into the vagina. The use of Martius flap interposition is convenient and can be employed to prevent rectovaginal fistula.

Technical tips

Introduction of extraperitoneal tunneling method: a way to secure the drain tube in the pelvic cavity after proctectomy: Sung Il Kang, Sohyun Kim, Jae Hwang Kim; Ann Coloproctol. 2024;40(2):182-185. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00073.0010

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Abstract PDF: The effectiveness of closed drainage tube insertion after low anterior resection has been controversial. We believe that drain tube displacement, which occurs up to 35% in real clinical practice, reduces the effectiveness of the drain tube. We report in this video a simple way to secure the drain tube in the pelvic cavity after low anterior resection and introduce a case that used the drain fixation method and treated anastomotic leakage without interventional procedure.

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience: Michael Jones, Brendan Moran, Richard John Heald, John Bunni; Ann Coloproctol. 2024;40(1):82-85. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00038.0005

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Abstract PDF: Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Minimally invasive surgery

Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection: Toan Duc Pham, Tomas Larach, Bushra Othman, Amrish Rajkomar, Alexander G. Heriot, Satish K. Warrier, Philip Smart; Ann Coloproctol. 2023;39(6):526-530. Published online December 19, 2023; DOI: https://doi.org/10.3393/ac.2022.00458.0065

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1 Web of Science
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Abstract PDF Supplementary Material

Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.

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Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management
Dheeraj Surya, Pankaj Gharde
Cureus.2024;[Epub] CrossRef

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

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Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

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Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Technical tip

Endoscopic transstomal stent insertion: a novel approach for a stenosed stoma in a challenging patient: Feras Aljarad, Ashutosh Gumber, Anne Marie McLeary, Kawan Shalli; Ann Coloproctol. 2023;39(4):357-361. Published online February 9, 2023; DOI: https://doi.org/10.3393/ac.2022.00962.0137

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Abstract PDF

Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.

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Application of a novel two-piece pouch in postoperative enterostomy in miniature Parma pigs
Yingjie Liu, Caiyan Xue, Jianyuan Wan, Meijiao Lin
Asian Journal of Surgery.2024;[Epub] CrossRef

Clinical outcomes with of the Contix Faecal Incontinence Management System: preliminary results: Moris Venturero, Reuma Yehuda-Margalit, Carla Maradey-Romero, Yael Corcos, Dan Carter, Marc Beer-Gabel; Ann Coloproctol. 2023;39(1):89-93. Published online December 6, 2022; DOI: https://doi.org/10.3393/ac.2022.00563.0080

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Abstract PDF

Fecal incontinence (FI) has a significant long-term impact on patient quality of life for which there is a range of medical and surgical management alternatives. We report the preliminary outcome using the ForConti Contix Faecal Incontinence Management System (FIMS) in FI patients who had failed conservative therapy and who were recruited at 2 tertiary institutions between September 2018 and September 2020. Comparative assessments were made before and after 2 week periods of treatment using bowel diaries and subjective Wexner and Faecal Incontinence Quality of Life scores. Of 17 patients enrolled, 11 completed an 8-week assessment with a significant fall in the average percentage of FI days reported from 84% before treatment to 16.8% at the first posttreatment assessment and down to 13.2% by the second assessment period. This finding correlated with a similar reduction in the total weekly number of episodes of frank FI, minor soiling, and fecal urgency reported by patients along with concomitant improvements in the Wexner scores. For those using the device, there was less concern about accidental bowel leakage, high rates of satisfaction, and minimal problems with the device. Initial results are encouraging warranting further study.

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Novel Nonablative Radiofrequency Approach for the Treatment of Anal Incontinence: A Phase 1 Clinical Trial
Patrícia Lordêlo, Juliana Barros, Claudia Liony, Cristiane Maria Carvalho C Dias, Janine Ferreira, Priscila G Januário, Luana N Matos, Camila O Muniz, Laizza S Silva, Cristina Brasil
Cureus.2023;[Epub] CrossRef

Malignant disease, Rectal cancer,Minimally invasive surgery

Single-port robot-assisted abdominoperineal resection: a case review of the first four experiences: Moon Suk Choi, Seong Hyeon Yun, Jung Kyong Shin, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2022;38(1):88-92. Published online October 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00395.0056

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5 Web of Science
5 Citations

Abstract PDF

Recently, abdominoperineal resection (APR) using a robot has been demonstrated in other studies. However, there has been no report on APR for rectal cancer using the single-port robot (SPR) platform. In response to this research gap, we described the clinical experience of APR using a SPR. From April 2019 to March 2020, APR using a SPR platform was performed in a total of 4 patients. Three patients had a transumbilical approach, and 1 patient had a transstoma site approach. The average operation time was 307 minutes, and the patient docking time to the SPR platform was 133.5 minutes. There were no complications during the operation, and no laparoscopy or open conversion. No reoperation occurred within 30 days. Mild postoperative complications occurred in 2 patients. We found that APR has safety and feasibility in surgery using an SPR platform. There was no intraoperative event and severe postoperative complications.

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Single-incision laparoscopic total extraperitoneal inguinal-hernia repair using the new articulating instruments: A video vignette
Chul Seung Lee, Gwan Chul Lee, Choon Sik Chung, Dong Keun Lee
Asian Journal of Surgery.2024; 47(8): 3586. CrossRef
Single-incision robotic colorectal surgery with the da Vinci SP® surgical system: initial results of 50 cases
H. S. Kim, B.-Y. Oh, C. Cheong, M. H. Park, S. S. Chung, R.-A. Lee, K. H. Kim, G. T. Noh
Techniques in Coloproctology.2023; 27(7): 589. CrossRef
Short-term outcomes of single-incision robotic colectomy versus conventional multiport laparoscopic colectomy for colon cancer
Ho Seung Kim, Bo-Young Oh, Soon Sup Chung, Ryung-Ah Lee, Gyoung Tae Noh
Journal of Robotic Surgery.2023; 17(5): 2351. CrossRef
Short-term outcomes of da Vinci SP versus Xi for colon cancer surgery: a propensity-score matching analysis of multicenter cohorts
Jin-Min Jung, Young Il Kim, Yong Sik Yoon, Songsoo Yang, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Journal of Robotic Surgery.2023; 17(6): 2911. CrossRef
Surgical Techniques for Transanal Local Excision for Early Rectal Cancer
Gyoung Tae Noh
The Ewha Medical Journal.2023;[Epub] CrossRef

Benign GI diease,Rare disease & stoma,Surgical technique

Endoscopic Removal of a Fecalith or Fecomucolith in a Rectal Stump or Pouch: Evie Yeap, Ratheesraj Ratinam, Asiri Arachchi, James Lim, Yeng Kwang Tay, Zeev Duieb; Ann Coloproctol. 2021;37(5):346-348. Published online August 25, 2021; DOI: https://doi.org/10.3393/ac.2021.00206.0029

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Abstract PDF: Fecaliths or fecomucoliths can form in rectal stumps after a Hartmann procedure or in a coloneovaginal conduit. They can cause significant distress to the patient by causing symptoms such as discharge and odor. We describe a novel and effective method of endoscopic obliteration and removal where other techniques such as removal during examination under anesthesia or serial enemas have failed. By using a combination of hydrodissection with a saline injector gun and biopsy forceps and a polypectomy snare to break down the fecomucolith or fecalith, this troublesome problem can be resolved endoscopically. Successful removal of the fecalith/fecomucolith and resolution of the symptoms for the patients were achieved. No complications are reported. We describe an effective and novel method for endoscopic removal of fecaliths and fecomucoliths.

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