Annals of Coloproctology

Articles in E-pub version are posted online ahead of regular printed publication.

Original Articles

Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer: Victoria Weets, Hélène Meillat, Jacques Emmanuel Saadoun, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong; Received November 29, 2023 Accepted January 23, 2024 Published online September 20, 2024; DOI: https://doi.org/10.3393/ac.2023.00850.0121 [Epub ahead of print]

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Abstract PDF Supplementary Material: Purpose
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
Methods
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Results
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
Conclusion
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.

The impact of short-course total neoadjuvant therapy, long-course chemoradiotherapy, and upfront surgery on the technical difficulty of total mesorectal excision: an observational study with an intraoperative perspective: Cheryl Xi-Zi Chong, Frederick H. Koh, Hui-Lin Tan, Sharmini Su Sivarajah, Jia-Lin Ng, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Wen-Hsin Koo, Shuting Han, Si-Lin Koo, Connie Siew-Poh Yip, Fu-Qiang Wang, Fung-Joon Foo, Winson Jianhong Tan; Received December 27, 2023 Accepted March 31, 2024 Published online September 19, 2024; DOI: https://doi.org/10.3393/ac.2023.00899.0128 [Epub ahead of print]

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Abstract PDF Supplementary Material: Purpose
Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery.
Methods
Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to.
Results
The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01).
Conclusion
TNT does not appear to increase the surgical difficulty of TME.

Analysis of adenoma detection rate of colonoscopy among trainees: Young Min Song, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Bun Kim, Min Chul Kim, Myeong Jae Jin, Dae Kyung Sohn; Received March 10, 2023 Accepted July 20, 2023 Published online August 28, 2024; DOI: https://doi.org/10.3393/ac.2023.00199.0028 [Epub ahead of print]

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Abstract PDF Supplementary Material: Purpose
To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training.
Methods
ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined.
Results
The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606).
Conclusion
In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution: Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan; Received October 28, 2023 Accepted December 12, 2023 Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00738.0105 [Epub ahead of print]

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Abstract PDF: Purpose
In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution’s experiences.
Methods
Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.
Results
Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.
Conclusion
Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older: Byeo Lee Lim, In Ja Park, Jun-Soo Ro, Young Il Kim, Seok-Byung Lim, Chang Sik Yu; Received June 7, 2023 Accepted September 11, 2023 Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00367.0052 [Epub ahead of print]

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Abstract PDF: Purpose
The aim of this study was to examine the prognosis and associated risk factors, including adjuvant chemotherapy (CTx), in elderly patients with colon cancer.
Methods
This retrospective study included patients who underwent radical resection for colon cancer between January 2010 and December 2014 at Asan Medical Center. The effects of stage, risk factors, and chemotherapy on overall survival (OS) and recurrence-free survival (RFS) were compared in patients aged ≥70 and <70 years.
Results
Of 3,313 patients, 933 (28.1%) was aged ≥70 years. Of the 1,921 patients indicated for adjuvant CTx, 1,294 of 1,395 patients (92.8%) aged <70 years and 369 of 526 patients (70.2%) aged ≥70 years received adjuvant CTx. Old age (≥70 years) was independently associated with RFS in overall cohort. Among patients aged ≥70 years indicated for adjuvant CTx, the 5-year OS (81.6% vs. 50.4%, P<0.001) and RFS (82.9% vs. 67.4%, P=0.025) rates were significantly higher in those who did than did not receive adjuvant CTx. Additionally, adjuvant CTx was confirmed as independent risk factor of both OS and RFS in patients aged ≥70 years indicated for adjuvant CTx.
Conclusion
Old age was associated with poor RFS and adjuvant CTx had benefits in OS as well as RFS in elderly patients eligible for adjuvant CTx.

Reviews

Colorectal screening following appendectomy in adult patients: a systematic review: Francesco Esposito, Marco Del Prete, Matilde Magri, Fanny Dufour, Alexandre Cortes; Received August 16, 2023 Accepted November 5, 2023 Published online August 1, 2024; DOI: https://doi.org/10.3393/ac.2023.00528.0075 [Epub ahead of print]

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Abstract PDF: Purpose
Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.
Methods
A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.
Results
Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography–colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.
Conclusion
Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.

Tolerance to and postoperative outcomes with early oral feeding following elective bowel surgery: a systematic review with meta-analysis: Lord Mvoula, Evelyn Irizarry; Received July 17, 2023 Accepted November 21, 2023 Published online July 31, 2024; DOI: https://doi.org/10.3393/ac.2023.00472.0067 [Epub ahead of print]

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Abstract PDF: Purpose
Advancements in gastrointestinal surgery have directed attention toward optimizing recovery, including through the use of feeding methods that reduce prolonged postoperative hospital stays, complications, and mortality, among other undesirable outcomes. This study’s primary goals were to identify current peer-reviewed literature reporting the postoperative outcomes of elective bowel surgery and to evaluate the clinical evidence of patients’ tolerance to oral feeding following elective bowel surgery.
Methods
An exhaustive literature search was conducted via PubMed and Scopus. The search results were screened for potential articles, and articles were assessed for eligibility based on prespecified eligibility criteria. The data were synthesized, and the results were reported and discussed thematically.
Results
The database search yielded 1,667 articles, from which 18 randomized controlled trials were chosen for inclusion in this study. This study included 874 early oral feeding (EOF) patients, 865 traditional oral feeding patients, and 91 patients whose postoperative care was unspecified. Data synthesis was done, and meta-analyses were conducted. The results showed that EOF patients required a significantly shorter time to tolerate a solid diet and had shorter hospital stays. In addition, bowel function was restored earlier in EOF groups.
Conclusion
The results show good tolerance to EOF, shorter hospitalizations, and faster restoration of bowel function, suggesting that EOF after elective bowel surgery is relatively safe. However, further studies with similar baseline conditions should be conducted to verify these results.

Video

Tips and tricks for transluminal specimen extraction and extra-abdominal sigmoid colon resection: Vladimir Balaban, Mikhail Mutyk, Kamil Abumuslimov, Mikhail Klochkov, Ivan Mishchenko, Petr Tsarkov; Received October 2, 2023 Accepted November 27, 2023 Published online July 11, 2024; DOI: https://doi.org/10.3393/ac.2023.00689.0098 [Epub ahead of print]

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Abstract PDF Supplementary Material: The purpose of this video is to demonstrate how to achieve adequate length and blood supply of the proximal colon for a perineal pull-through procedure, without splenic flexure mobilization during natural orifice specimen extraction. Key steps of the procedure include lateral mobilization of the colon, D3 lymph node dissection, preservation of the left colic artery, low ligation of the inferior mesenteric vein, ligation and washout of the distal bowel lumen, extra-abdominally proximal resection of sigmoid colon, purse-string sutures on the distal sigmoid colon, and an air leak test. Transluminal specimen extraction with extra-abdominal resection was found to be a cost-effective procedure with good cosmetic effects. Tension-free anastomosis was achieved by preservation of the left colic artery and low ligation of the inferior mesenteric vein. The purse-string sutures were placed on the proximal and distal bowel to avoid crossing the staples line. Transluminal specimen extraction with extra-abdominal resection required minimal manipulation intra-abdominally in comparison with other natural orifice specimen extraction techniques.

Original Articles

The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results: Shrivats Mishra, Dileep S. Thakur, Uday Somashekar, Amrendra Verma, Dhananjay Sharma; Received November 22, 2022 Accepted January 1, 2023 Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.01018.0145 [Epub ahead of print]

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Abstract PDF

Purpose
Many methods have been used to treat complex fistulas, but no single technique has been considered standard. Damage to the sphincter may sometimes be unavoidable, and incontinence may be an important cause of morbidity. This study aimed to validate the results of transanal opening of the intersphincteric space (TROPIS), as a technique that avoids damaging the anal sphincter, in patients with complex fistula in ano.
Methods
A prospective study was conducted among 35 consecutive patients with complex fistula in ano. After a preoperative magnetic resonance fistulogram, TROPIS was performed in all patients. The St. Mark’s incontinence score was assessed preoperatively and postoperatively at 3 months.
Results
The tracts were intersphincteric in 16 patients, transsphincteric in 10, extrasphincteric in 2, and horseshoe in 3. Four patients had recurrent tracts (3 transsphincteric and 1 intersphincteric). A defined follow-up schedule was used. Curettage was done if postoperative pus drainage from the wound was noted. The fistula healed in 29 patients (82.89%) following TROPIS. The remaining 6 patients received curettage, with healing in 3 (overall healing rate, 91.4%). Patients who received curettage were followed for 3 months, and the outcome was labeled as healed or failed. The mean preoperative incontinence score was 0. One patient developed incontinence to gas postoperatively in week 2, but there was no significant change in the scores at 3 months postoperatively. The mean postoperative incontinence score was 0.02.
Conclusion
TROPIS is an effective method for the treatment of complex fistula in ano, with minimal risk for incontinence.

Citations

Citations to this article as recorded by

Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024;[Epub] CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template (SMART): An interdisciplinary Delphi consensus
Iwona Sudoł-Szopińska, Pankaj Garg, Anders Mellgren, Antonino Spinelli, Stephanie Breukink, Francesca Iacobellis, Małgorzata Kołodziejczak, Przemysław Ciesielski, Jenssen Christian, Giulio Aniello Santoro
World Journal of Gastrointestinal Surgery.2024; 16(10): 3288. CrossRef

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review: Julianna Seo, Ishith Seth, Dilshad Dooreemeah, Chun Hin Angus Lee; Received November 11, 2022 Accepted January 9, 2023 Published online March 2, 2023; DOI: https://doi.org/10.3393/ac.2022.00976.0139 [Epub ahead of print]

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Abstract PDF Supplementary Material: Purpose
Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction.
Methods
PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients’ demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient.
Results
Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality.
Conclusion
This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Protective loop ileostomy or colostomy? a risk evaluation of all common complications: Yi-Wen Yang, Sheng-Chieh Huang, Hou-Hsuan Cheng, Shih-Ching Chang, Jeng-Kai Jiang, Huann-Sheng Wang, Chun-Chi Lin, Hung-Hsin Lin, Yuan-Tzu Lan; Received September 23, 2022 Accepted December 15, 2022 Published online January 27, 2023; DOI: https://doi.org/10.3393/ac.2022.00710.0101 [Epub ahead of print]

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Abstract PDF

Purpose
Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice.
Methods
Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared.
Results
There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female sex, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542).
Conclusion
We suggest avoiding colostomy in patients who are female and potential prolong diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

Citations

Citations to this article as recorded by

Uso de ileostomía derivativa en cáncer de ovario. Revisión de la literatura
Franco Rafael Ruiz-Echeverría, Pedro Hernando Calderón-Quiroz, Juliana Rendón-Hernández
Revista Colombiana de Cirugía.2024;[Epub] CrossRef
Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer
Shilai Yang, Gang Tang, Yudi Zhang, Zhengqiang Wei, Donglin Du
International Journal of Colorectal Disease.2024;[Epub] CrossRef
The Role of Colon in Isolated Intestinal Transplantation: Description of 4 Cases
Pierpaolo Di Cocco, Giulia Bencini, Alessandro Martinino, Egor Petrochenkov, Stepan Akshelyan, Kentaro Yoshikawa, Mario Spaggiari, Jorge Almario-Alvarez, Ivo Tzvetanov, Enrico Benedetti, Gaetano Gallo
International Journal of Surgical Oncology.2024;[Epub] CrossRef

Benefits and risks of diverting stoma creation during rectal cancer surgery: Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki; Received May 22, 2022 Accepted October 9, 2022 Published online December 5, 2022; DOI: https://doi.org/10.3393/ac.2022.00353.0050 [Epub ahead of print]

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4 Citations

Abstract PDF

Purpose
A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared.
Results
The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group.
Conclusion
Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Citations

Citations to this article as recorded by

The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
Journal of Personalized Medicine.2024; 14(1): 121. CrossRef
Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multicentre retrospective study
Scott MacDonald, Li‐Siang Wong, Hwei Jene Ng, Claire Hastings, Immogen Ross, Tara Quasim, Susan Moug
Colorectal Disease.2024; 26(5): 994. CrossRef
Nomogram for predicting the probability of rectal anastomotic re-leakage after stoma closure: a retrospective study
Yuegang Li, Gang Hu, Jinzhu Zhang, Wenlong Qiu, Shiwen Mei, Xishan Wang, Jianqiang Tang
BMC Cancer.2024;[Epub] CrossRef
Effect of intraoperative anastomotic reinforcement suture on the prevention of anastomotic leakage of double-stapling anastomosis for laparoscopic rectal cancer: a systematic review and meta-analysis
Chaoyang Wang, Xiaolong Li, Hao Lin, Jiahua Ju, Haibao Zhang, Yongjiang Yu
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef

Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire: Tuong-Anh Mai-Phan, Vu Quang Pham; Received July 24, 2022 Accepted August 26, 2022 Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00514.0073 [Epub ahead of print]

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1 Citations

Abstract PDF

Purpose
The aim of this study was to validate the low anterior resection syndrome (LARS) score questionnaire in the Vietnamese language among Vietnamese patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
The LARS score questionnaire was translated from English into Vietnamese and then back-translated as recommended internationally. From January 2018 to December 2020, 93 patients who underwent sphincter-preserving surgery completed the Vietnamese version of the LARS score questionnaire together with an anchored question assessing the influence of bowel function on quality of life (QoL). To validate test-retest reliability, patients were requested to answer the LARS score questionnaire twice.
Results
Ninety-three patients completed the LARS score questionnaire, of whom 89 responded twice. The patients who responded twice were included in the analysis of test-retest reliability. Fifty-eight patients had a “major” LARS score. The LARS score was able to discriminate between patients who were obese and those who were not (P<0.001) and between the low anterior resection and anterior resection procedures (P<0.001). Age and sex were not associated with higher LARS scores (P=0.975). There was a perfect fit between the QoL category question and the LARS score in 56.2% of cases, and a moderate fit was found in 42.7% of cases, showing reasonable convergent validity. The test-retest reliability of 89 patients showed a high intraclass correlation coefficient.
Conclusion
The Vietnamese version of the LARS score questionnaire is a valid tool for measuring LARS.

Citations

Citations to this article as recorded by

Major Low Anterior Resection Syndrome (LARS) and Quality of Life in Patients With Low Rectal Cancer: A Preoperative Survey Using LARS Score and European Organisation for Research and Treatment of Cancer’s 30-Item Core Quality of Life Questionnaire
Ly Huu Phu, Ho Tat Bang, Nguyen Viet Binh, Hoang Danh Tan, Ung Van Viet, Nguyen Trung Tin
Cureus.2023;[Epub] CrossRef

Annual long-term functional outcomes after transanal repair for symptomatic rectocele: Akira Tsunoda, Hiroshi Kusanagi; Received April 22, 2022 Accepted July 7, 2022 Published online November 15, 2022; DOI: https://doi.org/10.3393/ac.2022.00283.0040 [Epub ahead of print]

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1 Citations

Abstract PDF

Purpose
This study was performed to assess the long-term annual functional outcomes and quality of life (QOL) after transanal rectocele repair.
Methods
We evaluated retrospectively collected data from patients who underwent transanal repair for symptomatic rectocele between February 2012 and December 2018. The Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI), and several QOL questionnaires (e.g., the Patient Assessment of Constipation-QOL [PAC-QOL], Fecal Incontinence QOL, and the 36-Item Short Form Survey [SF-36]) were administered before surgery and annually after surgery. Additionally, physiological assessments and defecography were performed before and after surgery. Substantial symptom improvement, indicated by at least a 50% reduction in the CSS or FISI score, was evaluated postoperatively. All postoperative follow-up results were compared with the preoperative data.
Results
Thirty-two patients were included in the study. The median follow-up period was 5 years (range, 0.5−7 years). Postoperative defecography showed that the rectocele size significantly decreased (P<0.0001). However, the physiological assessment did not reveal postoperative changes. The CSS score 1 year after surgery was significantly lower than the preoperative score (P<0.0001) and remained significantly low until the long-term follow-up. Constipation improved by more than 80% 2 to 5 years postoperatively, and fecal incontinence improved in 2/3 of the patients after 5 years. The PAC-QOL scores significantly improved (all P<0.05) over time until the 3-year and long-term follow-ups, and 6 of the 8 SF-36 scores significantly improved at specific points postoperatively.
Conclusion
Transanal rectocele repair provides long-term improvement for constipation and constipation-specific QOL.

Citations

Citations to this article as recorded by

Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size
Akira Tsunoda, Tomoko Takahashi, Satoshi Matsuda, Hiroshi Kusanagi
International Journal of Colorectal Disease.2023;[Epub] CrossRef

Benign bowel disease

Implications of bacteriological study in complicated and uncomplicated acute appendicitis: Sorin Cimpean, Alberto Gonzalez Barranquero, Ion Surdeanu, Benjamin Cadiere, Guy-Bernard Cadiere; Received February 28, 2022 Accepted July 7, 2022 Published online November 10, 2022; DOI: https://doi.org/10.3393/ac.2022.00157.0022 [Epub ahead of print]

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2 Citations

Abstract PDF

Purpose
Bacteriological sample in the presence of intra-abdominal free fluid is necessary to adapt the antibiotherapy and to prevent the development of resistance. The aim was to evaluate the differences between uncomplicated acute appendicitis (UAA) and complicated acute appendicitis (CAA) in terms of bacterial culture results and antibiotic resistance, and to evaluate the factors linked with CAA.
Methods
We performed a single-center, retrospective observational study of all consecutive patients who presented with appendicular peritonitis and underwent emergent surgery in a tertiary referral hospital in Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance, and postoperative outcomes of 268 patients were analyzed. UAA was considered catarrhal or phlegmonous inflammation of the appendix. CAA was considered gangrenous or perforated appendicitis.
Results
Positive microbiological cultures were significantly higher in the CAA group (68.2% vs. 53.4%). The most frequently isolated bacteria in UAA and CAA cultures were Escherichia coli (37.9% and 48.6%, respectively). Most observed resistances were against ampicillin (28.9% and 21.7%) and amoxicillin/clavulanic acid (16.4% and 10.5%) in UAA and CAA, respectively. A higher Charlson Comorbidity Index, an elevated white blood cell count, an open procedure, and the need for drainage were linked to CAA. Culture results, group of bacterial isolation, and most common isolated bacteria were not related to CAA.
Conclusion
CAA presented a higher rate of positive cultures with increased identification of gram-negative bacteria. Bacterial culture from the peritoneal liquid does not reveal relevant differences in terms of antibiotic resistance.

Citations

Citations to this article as recorded by

Causative microbes and antibiotic susceptibility of acute appendicitis in adults and children
Chia-Hsiang Yu, Chia-Ning Chang, Chih-Chien Wang
Pediatrics & Neonatology.2024; 65(2): 159. CrossRef
The role of intraoperative swab during appendectomy in patients with uncomplicated and complicated appendicitis
Bruno Leonardo Bancke Laverde, Matthias Maak, Melanie Langheinrich, Stephan Kersting, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann, Maximilian Brunner
International Journal of Colorectal Disease.2023;[Epub] CrossRef

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