Hubble trial: time to stick to basics for treatment of haemorrhoids?
Abstract The results of the Hubble trial, a randomised controlled trial comparing haemorrhoidal artery ligation with rubber band ligation for early-grade prolapsing haemorrhoids, are discussed. The difficulties in defining treatment success are debated along with the trial design highlighting the pitfalls of previous research. A finding that haemorrhoidal artery ligation is not necessarily superior to cheap alternatives has implications for current practice and future commissioning of surgeons. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 3, 2016 Category: Surgery Source Type: research

Transanal total mesorectal excision: dissection tips using ‘O’s and ‘triangles’
ConclusionUnderstanding and recognizing the described features which can be encountered in taTME surgery, a safe and accurate TME dissection can be facilitated. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2016 Category: Surgery Source Type: research

Do not snare rectal polyps
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 28, 2016 Category: Surgery Source Type: research

Splenic metastasis in colorectal cancer
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 27, 2016 Category: Surgery Source Type: research

Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas
ConclusionsOTSC® Proctology provides convincing results as first-line treatment for complex cryptoglandular fistulas. It is a safe, effective, minimally invasive, and sphincter-sparing procedure with postoperative pain comparable to other types of fistula surgery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 26, 2016 Category: Surgery Source Type: research

Commentary on “Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision”, published in BMC Cancer 2016 Jul 4;16(1):380. doi:10.1186/s12885-016-2428-5
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 26, 2016 Category: Surgery Source Type: research

“How long will I have my ACE?”: report of the pediatric colorectal club meeting, Prague June 11–13, 2016
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 24, 2016 Category: Surgery Source Type: research

Placement of a microdialysis catheter during laparoscopic rectal cancer surgery to assess anastomotic leak
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 23, 2016 Category: Surgery Source Type: research

A systematic review of the management of anal fistula in infants
Conclusions The majority of the studies reviewed evaluated surgical treatment of FIA. However, the few studies that employed conservative treatment reported complete resolution of FIA in most infants. Fistulotomy was the most commonly performed surgery for FIA and was associated with fewer complications, yet a higher recurrence rate than fistulectomy. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 23, 2016 Category: Surgery Source Type: research

Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study
AbstractBackgroundThe aim of the present study was to compare the feasibility, safety and efficacy of the through-the-scope (TTS) stent technique to that of the standard metallic stent technique for the management of malignant colorectal obstruction.MethodsFifty-two patients scheduled to receive stent insertion for the management of acute obstructive colorectal cancer were enrolled in our study and divided into a TTS stent group (n = 24) and a standard stent group (n = 28). The stent insertion procedure was performed under endoscopic and fluoroscopic guidance in all patients. The success rate, complicat...
Source: Techniques in Coloproctology - September 20, 2016 Category: Surgery Source Type: research

Laparoscopic ventral rectopexy in male patients with external rectal prolapse is associated with a high reoperation rate
ConclusionsLaparoscopic ventral rectopexy is a safe surgical procedure in male patients with external prolapse. However, a high overall reoperation rate was noticed due to recurrent rectal and residual mucosal prolapse. This suggests that the ventral rectopexy technique should be modified or combined with other abdominal or perineal methods when treating male rectal prolapse patients. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 19, 2016 Category: Surgery Source Type: research

Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprung ’s disease
AbstractFor the surgical treatment of Hirschsprung ’s disease, several surgical techniques are used to resect the distal aganglionic colon. Two frequently used techniques are the Duhamel procedure and the transanal endorectal pull-through procedure. During the ‘8th Pediatric Colorectal Course’ in Nijmegen, November 2015, a workshop was organiz ed to share experiences of both techniques by several experts in the field and to discuss (long term) outcomes. Specifically, the objective of the meeting was to discuss the main controversies in relation to the technical execution of both procedures in order to mak...
Source: Techniques in Coloproctology - September 14, 2016 Category: Surgery Source Type: research

Colonic prolapse after intersphincteric resection for very low rectal cancer: a report of 12 cases
ConclusionsWe believe surgery must be attempted in these patients who develop CP after ISR with CAA for very low rectal cancer in order to improve function and symptoms. A transanal approach with CP resection and new end-to-end anastomosis appeared to be safe and effective. Larger studies are needed to confirm our results. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 8, 2016 Category: Surgery Source Type: research

Carcinoma arising in enteric diversion or rectal neobladder for bladder exstrophy
AbstractBladder exstrophy is a rare malformation. Ureteral diversion, such as ureterosigmoidostomy or a neorectal bladder, has been described. When the patients reach adulthood, cancer may arise in these reconstructions. Our aim was to perform a systematic review (all languages) of the published literature on neoplasia after urinary diversion and suggested management in cases of cancer. PubMed and Cochrane library were searched for relevant articles published within the last 20  years. All identified articles were reviewed for inclusion. Carcinoma occurring in the bladder and unreconstructed exstrophy were excluded...
Source: Techniques in Coloproctology - September 3, 2016 Category: Surgery Source Type: research

Repair of a colonoscopic perforation of the rectum with transanal endoscopic microsurgery
AbstractIatrogenic colonic perforations are relatively uncommon but serious complications of diagnostic and therapeutic colonoscopies. Transanal endoscopic microsurgery (TEM) is an useful approach to the rectum and may be used for repair of a rectal perforation during colonoscopy. A 56-year-old male had an iatrogenic perforation of the rectum during a routine follow-up colonoscopy repaired by TEM with an uneventful and rapid recovery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 29, 2016 Category: Surgery Source Type: research

Intestinal obstruction following a hemorrhoid laser procedure (HeLP)
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 29, 2016 Category: Surgery Source Type: research

Compression versus hand-sewn and stapled anastomosis in colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
This study aimed to compare the anastomotic leak rates in patients undergoing compression anastomoses versus hand-sewn or stapled anastomoses. Randomized controlled trials (RCTs) comparing outcomes of compression versus conventional (hand-sewn and stapled) colorectal anastomosis were collected from MEDLINE, Embase and the Cochrane Library. The quality of the RCTs and the potential risk of bias were assessed. Pooled odds ratios (OR) were calculated for categorical outcomes and weighted mean differences for continuous data. Ten RCTs were included, comprising 1969 patients (752 sutured, 225 stapled, and 992 compression anasto...
Source: Techniques in Coloproctology - August 23, 2016 Category: Surgery Source Type: research

Perirectal myxoid pseudocyst removed by transanal endoscopic microsurgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 23, 2016 Category: Surgery Source Type: research

From misbelieve to proofs in transanal irrigation for functional bowel problems
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 22, 2016 Category: Surgery Source Type: research

Authors ’ reply to the letter of De Nardi and Giamundo
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 22, 2016 Category: Surgery Source Type: research

Superior mesenteric artery stenting and colonic resection for colonic cancer with severe visceral arterial stenosis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 19, 2016 Category: Surgery Source Type: research

Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study
AbstractBackgroundVentral rectopexy to the promontory has become one of the most strongly advocated surgical treatments for patients with full-thickness rectal prolapse and deep enterocele. Despite its challenges, laparoscopic ventral rectopexy with or without robotic assistance for selected patients can be performed with relatively minimal patient trauma thus creating the potential for same-day discharge. The aim of this prospective case –controlled study was to assess the feasibility, safety, and cost of day case robotic ventral rectopexy compared with routine day case laparoscopic ventral rectopexy.MethodsBetween ...
Source: Techniques in Coloproctology - August 17, 2016 Category: Surgery Source Type: research

Efficacy of fibrin glue therapy for abscess-associated enteric fistulas
AbstractBackgroundAbdominal abscess that result from bowel injury may require treatment with percutaneous drainage. In some cases, an abscess-associated fistula develops between the injured bowel and the drainage catheter. Fistulas that fail to resolve may require surgery; however, fibrin glue therapy (FGT) may be a suitable alternative.MethodsWe retrospectively identified patients undergoing FGT for an abscess-associated enteric fistula between 2004 and 2015. Success was defined as closure of the fistula tract without need for additional intervention. A multivariable logistic regression analysis was utilized to identify f...
Source: Techniques in Coloproctology - August 13, 2016 Category: Surgery Source Type: research

Interobserver variability amongst gastrointestinal pathologists in assessing prognostic parameters of malignant colorectal polyps: a cause for concern
ConclusionsNone of the staging systems used is suitable for all polyp types or has good reproducibility. There is an urgent need to make pathologists ’ assessment of MCRPs easier and more reproducible. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 13, 2016 Category: Surgery Source Type: research

Surgical timing after chemoradiotherapy for rectal cancer, analysis of technique (STARRCAT): results of a feasibility multi-centre randomized controlled trial
ConclusionsThe feasibility of measurement of operative performance of rectal cancer surgery as an endpoint was confirmed in this exploratory study. Recruitment of sufficient numbers of patients represented a challenge, and a proportion of patients did not proceed to resection surgery. These results suggest that interval after CRT may not substantially impact upon surgical technical performance. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 10, 2016 Category: Surgery Source Type: research

A blueprint for robotic navigation: pre-clinical simulation for transanal total mesorectal excision (taTME)
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - August 10, 2016 Category: Surgery Source Type: research

The iLappSurgery taTME app: a modern adjunct to the teaching of surgical techniques
AbstractApplication-based technology has emerged as a method of modern information communication, and this has been applied towards surgical training and education. It allows surgeons the ability to obtain portable and instant access to information that is otherwise difficult to deliver. The iLappSurgery Foundation has recently launched the transanal total mesorectal excision educational application (taTME app) which provides a useful adjunct, especially for surgeons interested in mastery of the taTME technique and its principles. The article provides a detailed review of the application, which has achieved a large user-ba...
Source: Techniques in Coloproctology - August 8, 2016 Category: Surgery Source Type: research

Recurrent volvulus of cecorectal anastomosis after subtotal colectomy: technical implications of an unusual complication
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 25, 2016 Category: Surgery Source Type: research

Biofeedback treatment of chronic constipation: myths and misconceptions
Abstract Chronic constipation is a prevalent disorder with considerable impact on healthcare costs and quality of life. Most patients would respond to conservative measures in primary care. Patients with refractory constipation are commonly referred to dedicated centers for appropriate investigations and management. After testing, three main subtypes of constipation are commonly identified: normal colon transit, slow transit, and functional defecation disorders. The etiology of functional defecation disorders is consistent with maladaptive behavior, and biofeedback therapy has been considered a valuable treatment option. ...
Source: Techniques in Coloproctology - July 22, 2016 Category: Surgery Source Type: research

Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis
Conclusions Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 22, 2016 Category: Surgery Source Type: research

30-day mortality after elective colorectal surgery can reasonably be predicted
Abstract Background The aim of the present study was to develop a clinically relevant, accurate and usable risk assessment scoring system solely for colorectal cancer patients undergoing elective resection. Methods All colorectal resections for colorectal cancer 2006–2012 were identified from the American College of Surgeons Quality Improvement Program. Independent risk factors for 30-day mortality after elective surgery were identified using univariable and multivariable logistic regression. A points-calculator based on factors most strongly a...
Source: Techniques in Coloproctology - July 15, 2016 Category: Surgery Source Type: research

Results of the Gore Bio-A fistula plug implantation in the treatment of anal fistula: a multicentre study
Conclusions Synthetic plugs may be an alternative to bioprosthetic fistula plugs in the treatment of transsphincteric anal fistulas. This method might have better success rates than treatment with bioprosthetic fistula plugs. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 14, 2016 Category: Surgery Source Type: research

Pro-inflammatory cytokines in cryptoglandular anal fistulas
Conclusions IL-1β is expressed in the large majority of cryptoglandular anal fistulas, as well as several other pro-inflammatory cytokines. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 11, 2016 Category: Surgery Source Type: research

Results of long-term retrograde rectal cleansing in patients with constipation or fecal incontinence
Conclusions RC is a moderately effective long-term alternative in patients who do not respond to medical therapy and biofeedback exercises. There is a high dropout rate in the first months, but a moderate rate of continuation in the period hereafter. No predictive factors for continuation were found in medical history or function tests. Those who continued RC performed better on the SF-36 subscale energy/fatigue. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 5, 2016 Category: Surgery Source Type: research

The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer
Conclusions Our results suggest that after ELAPE the application of a negative pressure system to the perineal wound closed with biologic mesh may reduce perineal wound complications and may reduce the need for major perineal reconstruction. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 5, 2016 Category: Surgery Source Type: research

From TATA to NOTES, how taTME fits into the evolutionary surgical tree
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 5, 2016 Category: Surgery Source Type: research

Is ileal pouch –anal anastomosis after Whipple procedure doable?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 1, 2016 Category: Surgery Source Type: research

Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis
Abstract Colorectal cancer is one of the most common cancers worldwide. However, it is unclear what influence body mass index (BMI) has on colorectal cancer prognosis. We conducted a systematic review and meta-analysis of observational studies to examine the association of BMI with colorectal cancer outcomes. We searched MEDLINE and EMBASE databases from inception to February 2015 and references of identified articles. We selected observational studies that reported all-cause mortality, colorectal cancer-specific mortality, recurrence and disease-free survival according to BMI category. Random-effects meta-analyse...
Source: Techniques in Coloproctology - June 24, 2016 Category: Surgery Source Type: research

A comprehensive physical therapy approach including visceral manipulation after failed biofeedback therapy for constipation
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 24, 2016 Category: Surgery Source Type: research

Robotic partial intersphincteric resection with colonic J-pouch anal anastomosis for a very low rectal cancer
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 22, 2016 Category: Surgery Source Type: research

Utilization of the TAMIS technique for trans-stomal excision of a colonic neoplasm: a video demonstration
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 21, 2016 Category: Surgery Source Type: research

The 115th Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 16, 2016 Category: Surgery Source Type: research

Drainage of a complicated high perianal abscess: a bilateral ilioinguinal approach
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 7, 2016 Category: Surgery Source Type: research

Twisting in the wind: intracorporeal ileocolic anastomosis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 6, 2016 Category: Surgery Source Type: research

Enhanced recovery after surgery (ERAS) pathway vs traditional care in laparoscopic rectal resection: a single-center experience
Conclusions The introduction of the ERAS protocol in laparoscopic rectal resection led to a reduction in primary and total length of hospital stay without an increase in morbidity or readmission rates when compared to traditional care. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 4, 2016 Category: Surgery Source Type: research

Shedding light on the dark side of microscopic colitis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - May 30, 2016 Category: Surgery Source Type: research

A radiological and pathological assessment of ileocolic pedicle length as a predictor of lymph node retrieval following right hemicolectomy for caecal cancer
Abstract Background In colon cancer, the number of harvested lymph nodes is critical for pathological staging. It has been proposed that the more central the mesenteric vascular ligation, the greater the nodal yield. The aim of the current study was to determine the association of radiological and pathological ileocolic pedicle length on nodal harvest following right hemicolectomy for caecal cancer. Methods A series of 50 patients undergoing right hemicolectomy for adenocarcinoma underwent specimen evaluation. Preoperative computed tomography images were...
Source: Techniques in Coloproctology - May 26, 2016 Category: Surgery Source Type: research

Treatment of irritable bowel syndrome with a novel colonic irrigation system: a pilot study
Abstract Background Medical treatments for irritable bowel syndrome (IBS) are often disappointing. A colonic irrigation system, the Ashong colonic irrigation apparatus (ACIA), was designed as a patient-administered device for defecation disorders. This pilot study evaluated the efficacy and safety of ACIA for IBS. Methods Eighteen patients, 12 with constipation-dominant IBS (IBS-C) and 6 with diarrhea-dominant IBS (IBS-D) group, were studied. Patients were randomized into treatments of 1–4 weeks. Colonic irrigation was performed twice daily fo...
Source: Techniques in Coloproctology - May 19, 2016 Category: Surgery Source Type: research

Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery
Abstract Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nuances of transanal total mesorectal excision as learned during the course of its clinical application and international teaching, so as to rapidly communicate and share important insights with other surgeons who are in the early adoption phase of this approa...
Source: Techniques in Coloproctology - May 17, 2016 Category: Surgery Source Type: research

Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National Surgical Quality Improvement Program
Conclusions Older age, baseline dyspnea, smoking, and the use of muscle flap were associated with higher risk of wound dehiscence following APR. Patients with wound dehiscence had a higher rate of readmission and need for reoperation, and an increased risk of 30-day mortality. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - May 17, 2016 Category: Surgery Source Type: research