Endoscopic placement of a covered stent to arrest bleeding from obstructing colorectal cancer
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 2, 2017 Category: Surgery Source Type: research

Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis
AbstractBackgroundMagnetic resonance defecography (MRD) allows for dynamic visualisation of the pelvic floor compartments when assessing for pelvic floor dysfunction. Additional benefits over traditional techniques are largely unknown. The aim of this study was to compare detection and miss rates of pelvic floor abnormalities with MRD versus clinical examination and traditional fluoroscopic techniques.MethodsA systematic review and meta-analysis was conducted in accordance with recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, Embase and the Cochrane Central Register of C...
Source: Techniques in Coloproctology - November 1, 2017 Category: Surgery Source Type: research

Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review
In this study, all published articles on these techniques were reviewed to determine efficacy, feasibility and safety.MethodsA systematic search of major databases was performed using defined terms. All studies reporting on experience of these techniques were included and outcomes (fistula healing and safety) evaluated.ResultsEighteen studies (VAAFT —12, FiLaC™—3, OTSC®—3) including 1245 patients were analysed. All were case series, and outcomes were heterogeneous with follow-up ranging from 6 to 69 months and short-term (
Source: Techniques in Coloproctology - October 29, 2017 Category: Surgery Source Type: research

Validation of an online risk calculator for the prediction of anastomotic leak after colon cancer surgery and preliminary exploration of artificial intelligence-based analytics
ConclusionsThe anastomotic leak risk calculator is significantly predictive of anastomotic leak after colon cancer resection. Wider investigation of artificial intelligence-based analytics for risk prediction is warranted. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 28, 2017 Category: Surgery Source Type: research

A prospective randomized trial on transanal hemorrhoidal dearterialization versus stapler hemorrhoidectomy: methodological issues that need to be clarified
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 28, 2017 Category: Surgery Source Type: research

High-dose versus low-dose botulinum toxin in anal fissure disease
ConclusionsIn this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 28, 2017 Category: Surgery Source Type: research

Scanning electron microscope imaging of pilonidal disease
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 25, 2017 Category: Surgery Source Type: research

Transanal total mesorectal excision with triangle rules: a road map to prevent injuries
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 24, 2017 Category: Surgery Source Type: research

Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): Could this be the solution we have been searching for?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 24, 2017 Category: Surgery Source Type: research

Treatment of obstructed defecation syndrome due to rectocele and rectal intussusception with a high volume stapler (TST STARR-plus)
AbstractBackgroundIn recent years, stapled transanal resection (STARR) has been adopted worldwide with convincing short-term results. However, due to the high recurrence rate and some major complications after STARR, there is still controversy about when the procedure is indicated. The aim of this study was to assess the safety, efficacy and feasibility of STARR performed with a new dedicated device for tailored transanal stapled surgery.MethodsAll the consecutive patients affected by obstructed defecation syndrome (ODS) due to rectocele or/and rectal intussusception, who underwent STARR with the TST STARR-Plus stapler, we...
Source: Techniques in Coloproctology - October 23, 2017 Category: Surgery Source Type: research

7th National Congress of the Italian Society of Colorectal Surgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 23, 2017 Category: Surgery Source Type: research

Healing of the perineal wound after proctectomy in Crohn ’s disease patients: only preoperative perineal sepsis predicts poor outcome
ConclusionsAfter proctectomy or proctocolectomy for CD, perineal wound healing is poor and poses a particular challenge for patients with preoperative perineal sepsis. These findings support a preoperative discussion regarding CD patients that examines potential outcomes and the consideration of measures such as the initial creation of defunctioning ostomy or control/drainage of local sepsis prior to proctectomy. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 12, 2017 Category: Surgery Source Type: research

Operative vectors, anatomic distortion, fluid dynamics and the inherent effects of pneumatic insufflation encountered during transanal total mesorectal excision
ConclusionsAlthough an invisible gas, CO2 insufflation with taTME produces markedly visible effects which are imposed upon the operative field. This can result in anatomic distortion and misperception of operative planes. Thus, practicing taTME surgeons should be cognizant of these effects. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 10, 2017 Category: Surgery Source Type: research

Laparoscopic left ureteral substitution using the cecal appendix after en - bloc rectosigmoidectomy: a case report and video demonstration
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 10, 2017 Category: Surgery Source Type: research

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: from novelty to routine in selected cases
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 21, 2017 Category: Surgery Source Type: research

Perineal rectosigmoidectomy combined with TAMIS rectopexy: a NOTES operation for rectal procidentia
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 21, 2017 Category: Surgery Source Type: research

It is not what it seems
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 21, 2017 Category: Surgery Source Type: research

A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique
AbstractBackgroundTissue-selecting technique (TST) is a novel stapled hemorrhoidectomy technique which targets the hemorrhoids, leaving uninvolved mucosal bridges intact and avoiding circumferential circular stapling. The aim of this study was to compare the short-term outcomes of TST and transanal hemorrhoidal dearterialization (THD).MethodsPatients presenting with symptomatic hemorrhoids were recruited. Patients were randomized into two groups: (1) TST and (2) THD. Patient demographics, perioperative data, postoperative pain scores, recurrence and patient satisfaction scores were evaluated. Patients with acute thrombosed...
Source: Techniques in Coloproctology - September 20, 2017 Category: Surgery Source Type: research

Anoperineal lesions in Crohn ’s disease: French recommendations for clinical practice
AbstractBackgroundAnoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn ’s disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn’s disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie...
Source: Techniques in Coloproctology - September 19, 2017 Category: Surgery Source Type: research

Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery
ConclusionsThe DaVinci Xi dual-console platform is a safe and effective platform for training junior surgeons. The dual-console system has the potential to alter surgical training pathways. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 19, 2017 Category: Surgery Source Type: research

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern
AbstractBackgroundEarly detection of anastomotic leakage (AL) after colorectal surgery followed by timely reintervention is of crucial importance. The aim of this study was to investigate the accuracy of computed tomography (CT) imaging for AL and the effects of delay in reintervention after a false-negative CT.MethodsAll files from patients who had colorectal surgery with primary anastomoses between 2009 and 2014 were reviewed. The predictive value of CT scanning for AL was determined and correlated with short-term postoperative patient outcomes. In addition, factors predictive of false-negative scans were assessed.Result...
Source: Techniques in Coloproctology - September 19, 2017 Category: Surgery Source Type: research

Fine-tuning indications for laparoscopic ventral mesh rectopexy
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 13, 2017 Category: Surgery Source Type: research

Erratum to: One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer
AbstractUnfortunately, one of the author name was wrongly published in the original publication. The complete correct name should read as follows “Beatriz Camargo Azevedo”. The original article was updated. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 13, 2017 Category: Surgery Source Type: research

A systematic review of transabdominal levator division during abdominoperineal excision of the rectum (APER)
ConclusionsTransabdominal division of the levators during APER is feasible and reproducible, with acceptable perioperative and good early oncological outcomes. Further comparative studies are needed. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 11, 2017 Category: Surgery Source Type: research

Treatment of chronic anal fissure with sacral neuromodulation: a pilot study
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 11, 2017 Category: Surgery Source Type: research

The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures
ConclusionsThe unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 11, 2017 Category: Surgery Source Type: research

Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: potential pitfalls of a multicentre observational study
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 11, 2017 Category: Surgery Source Type: research

Is it time for one-step nucleic acid amplification (OSNA) in colorectal cancer? A systematic review and meta-analysis
AbstractBackgroundLymph node metastasis (LNM) is prognostic in colorectal cancer (CRC). However, evaluation by routine haematoxylin and eosin histology (HE) limits nodal examination and is subjective. Missed LNMs from tissue allocation bias (TAB) might under-stage disease, leading to under-treatment. One-step nucleic acid amplification (OSNA) for CK19 messenger ribonucleic acid (mRNA), a marker of LNM, analyses the whole node. The aim of the present systematic review and meta-analysis was to assess recent studies on OSNA versus HE and its implications for CRC staging and treatment.MethodsDatabases including OVID, Medline a...
Source: Techniques in Coloproctology - September 8, 2017 Category: Surgery Source Type: research

Percutaneous embolization of a colonic fistula using n-butyl-2 cyanoacrylate (Histoacryl ® )
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 8, 2017 Category: Surgery Source Type: research

Reviewers should have known better
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 8, 2017 Category: Surgery Source Type: research

Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience
ConclusionsRVMR is a feasible, safe and effective option for the treatment of rectal prolapse, with low short-term morbidity and mortality. Multicenter and long-term studies are needed to better assess the benefits of this procedure. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 4, 2017 Category: Surgery Source Type: research

Three steps and a join: a simple guide to right- and left-sided medial to lateral laparoscopic colorectal surgery
ConclusionsThis step-by-step instructional video and procedural guide provides a simple and standardised approach which may be incorporated into a training pathway for laparoscopic right- and left-sided colorectal surgery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 4, 2017 Category: Surgery Source Type: research

Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases
AbstractBackgroundIndications for transanal endoscopic microsurgery (TEM) have been extended to technically challenging tumors, which may be associated with an increased risk of peritoneal perforation (PP). The aim of the present study was to investigate the occurrence, management and outcome of PP in patients having TEM.MethodsAll the patients who had TEM for rectal adenoma or adenocarcinoma in our unit were included. Patients in whom PP occurred (Group A) were compared to those without PP (Group B).ResultsFrom 2007 to 2015, 194 TEM (116 men, median age 66 [range 21 –100] years) were divided into Groups A (n =&...
Source: Techniques in Coloproctology - September 4, 2017 Category: Surgery Source Type: research

Response to the letter “Reviewers should have known better” by Mahir Gachabayov
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 4, 2017 Category: Surgery Source Type: research

A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids
AbstractBackgroundThe aim of the present study was to compare short- and medium-term results of transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM) versus hemorrhoidectomy using an ultrasonic scalpel (US) for third-degree hemorrhoids.MethodsForty-four patients were randomly assigned to undergo either DM or US. The patients were followed up at 1, 2, 3  months at our clinic, and by telephone interview when the study was completed in May 2017. The primary endpoint was postoperative pain with quality of life, length of stay, return to normal activities, and incontinence among secondary endpoints.Res...
Source: Techniques in Coloproctology - September 4, 2017 Category: Surgery Source Type: research

Using fluorescence lymphangiography to define the ileocolic mesentery: proof of concept for the watershed area using real-time imaging
AbstractRecent advances in mesenteric science have demonstrated that the mesentery is a continuous structure with a ‘watershed’ area at the mesenteric apex between the right colon and terminal ileum, where lymphatic flow can proceed either proximally or distally. With this new understanding of the anatomy, functional features are emerging, which can have an impact on surgical management. Fluorescence lymphang iography or lymphoscintigraphy with indocyanine green allows real-time visualization of lymphatic channels, which highlights sentinel lymph nodes and may facilitate identification of the ideal margins for ...
Source: Techniques in Coloproctology - August 29, 2017 Category: Surgery Source Type: research

Factors associated with hospital readmission following diverting ileostomy creation
ConclusionsDehydration associated with diverting ileostomy creation was relevant as an individual cause of readmission, but its overall incidence was relatively rare. Dedicated strategies to prevent dehydration should be directed to patients who received chemoradiotherapy and/or laparoscopic surgery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 17, 2017 Category: Surgery Source Type: research

One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer
ConclusionsHistopathological analysis with 1-level step section is insufficient to determine complete tumor eradication. The 3-level sections methodology revealed residual tumor cells in patients initially classified as ypT0. Further studies with larger sample size are required to verify the clinical relevance of these residual tumor cells. Caution should continue to be applied to watch and wait strategies following nCRT. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 17, 2017 Category: Surgery Source Type: research

A systematic review and meta-analysis of the treatment of anal fissure
ConclusionsLIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE qua...
Source: Techniques in Coloproctology - August 9, 2017 Category: Surgery Source Type: research

There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes
ConclusionsLaparoscopic surgery for rectal cancer is associated with similar short-term and long-term oncologic outcomes compared to open surgery. The oncologic quality of extracted specimens seems comparable regardless of the approach used. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 9, 2017 Category: Surgery Source Type: research

Imaging the pelvic floor
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 3, 2017 Category: Surgery Source Type: research

Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: Is videodefecography still the test of choice after 50 years?
ConclusionsMR defecography could become the imaging test of choice for evaluating obstructed defecation syndrome. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 28, 2017 Category: Surgery Source Type: research

Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study
ConclusionThis protocol is the first prospective trial that investigates the role of both local excision and watch and wait approaches in patients treated with neoadjuvant therapy for rectal cancer. The trial is registered at clinicaltrials.gov (NCT02710812). (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 28, 2017 Category: Surgery Source Type: research

Looking for the Good, Bad and the Ugly rectal cancers of the twenty-first century … or “How to avoid tears when peeling onions”
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 28, 2017 Category: Surgery Source Type: research

Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study
ConclusionsIn the medial approach for laparoscopic mobilization of the splenic flexure, when only one of the arches is present, the avascular area is an extensive and secure territory. If the artery of Moskowitz is present, the area is nonexistent and this would contraindicate the approach due to risk of iatrogenic bleeding. A radiological preoperatory study could be essential for accurate and safe surgery in this area. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 27, 2017 Category: Surgery Source Type: research

The 116th Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 27, 2017 Category: Surgery Source Type: research

Robotic transanal surgery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study
ConclusionsSPS robotic transanal surgery represents an exciting new option for transanal surgery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 14, 2017 Category: Surgery Source Type: research

Mobile applications for colorectal surgery journals: Do we really need them?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 14, 2017 Category: Surgery Source Type: research

Transitional health care for patients with Hirschsprung disease and anorectal malformations
ConclusionsThe transitional outpatient clinic provides care adapted to the needs and wishes of adult HD and ARM patients. It is a novel addition to quality of care of patients with complex congenital disorders. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 3, 2017 Category: Surgery Source Type: research

Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?
Conclusions Both modalities can be used as a method to assess pelvic floor dysfunction. The EDF using 3D anorectal and endovaginal approaches showed advantages in identification of the anal sphincters and pubodefects (partial or total). There was good correlation between the two techniques, and a TLUS rectocele classification based on size that corresponds to the established classification using EDF was established. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 3, 2017 Category: Surgery Source Type: research