Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution
Conclusions Robotic transanal surgery for local excision, transanal total mesorectal excision, and repair of fistulae is feasible, although these new approaches represent a work-in-progress. Improvement in platform design will likely facilitate the ability to perform more complex procedures. Further research with robotic transanal approaches is necessary to determine whether or not this approach can provide patients with significant benefit. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 24, 2015 Category: Surgery Source Type: research

Tying up loose ends
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 24, 2015 Category: Surgery Source Type: research

Palliation of a gastrocolic fistula secondary to colon cancer with a covered colonic stent using a simultaneous dual-scope approach
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 24, 2015 Category: Surgery Source Type: research

Postoperative complications after reconstructive surgery for cloacal malformations: a systematic review
Abstract The repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative complication seen after cloacal repair as reported in the literature. A systematic literature search was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Eight records were eligible for this study which were qualitatively analyzed according to the Rangel score. Ove...
Source: Techniques in Coloproctology - February 21, 2015 Category: Surgery Source Type: research

Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below—a preliminary report
This report describes our initial experience with a hybrid laparoscopic and transanal endoscopic technique for TME in low rectal cancer. Methods Between December 2012 and October 2013, we identified patients with rectal cancer 
Source: Techniques in Coloproctology - February 21, 2015 Category: Surgery Source Type: research

Laparoscopic-assisted extralevator abdominoperineal excision using a parastomal prophylactic mesh and a biological mesh for pelvic floor reconstruction
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 20, 2015 Category: Surgery Source Type: research

Colonic transit in the empty colon after defunctioning ileostomy: Do we really know what happens?
Conclusions Colonic transit may be abolished by the presence of diverting ileostomy. It should now be established whether clearance of the left colon alone, using enemas, is sufficient for patients undergoing low anterior resection, thus avoiding the morbidity associated with oral MBP. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 20, 2015 Category: Surgery Source Type: research

Assessment of a novel, full-thickness incisional biopsy model to restage rectal tumours after neoadjuvant chemoradiotherapy: results of an ex vivo pilot study
Conclusion This prospective data demonstrates that incisional biopsy is not suitable as a stand-alone method to restage rectal cancer after CRT. Alternate or complementary means of restaging are needed. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 17, 2015 Category: Surgery Source Type: research

A pull-through delayed “high” coloanal anastomosis: new tricks to refresh an old procedure
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 14, 2015 Category: Surgery Source Type: research

The 113th Annual Meeting of the American Society of Colon and Rectal Surgeons
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 12, 2015 Category: Surgery Source Type: research

Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience
Conclusions THD is a same-day procedure for the treatment of hemorrhoidal disease that is safe and effective, and offers the potential for immediate return to normal activity. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 31, 2015 Category: Surgery Source Type: research

Erratum to: Is the lateralization distance important in terms in patients undergoing the modified Limberg flap procedure for treatment of pilonidal sinus?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 24, 2015 Category: Surgery Source Type: research

Hemorrhoidopexy with the HemorPex System
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 23, 2015 Category: Surgery Source Type: research

Re: Staying on Target—reply to comments by Loyal et al.
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 23, 2015 Category: Surgery Source Type: research

European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations
Abstract The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Peña, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an ano...
Source: Techniques in Coloproctology - January 22, 2015 Category: Surgery Source Type: research

Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 14, 2015 Category: Surgery Source Type: research

Is the porcelain throne to blame?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 13, 2015 Category: Surgery Source Type: research

Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases
Abstract Background Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome and/or faecal incontinence. Very few reports exist on the use of biologic mesh for LVR. The aim of our study was to report the complication and recurrence rate of our first 100 cases of LVR for symptomatic internal rectal prolapse and/or rectocele using a porcine dermal collagen mesh. Methods Prospectively collected data on LVR for inter...
Source: Techniques in Coloproctology - January 11, 2015 Category: Surgery Source Type: research

Robotic-assisted strictureplasty for Crohn’s disease
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 8, 2015 Category: Surgery Source Type: research

Transanal total mesorectal excision: full steam ahead
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 6, 2015 Category: Surgery Source Type: research

Predictive factors for inadequate colon preparation before colonoscopy
Abstract Background It could be helpful to ascertain which patients are at risk of poor bowel preparation prior to performing sedated colonoscopy. The aim of the present study was to identify the predictive factors for poor colon preparation prior to colonoscopy. Methods A prospective study was performed at Kaohsiung Chang Gung Memorial Hospital, Taiwan, from September 2011 to May 2013. Patient characteristics, food consumed within 2 days of colonoscopy, volume of polyethylene glycol (PEG) solution, interval between completing PEG and examination, n...
Source: Techniques in Coloproctology - January 6, 2015 Category: Surgery Source Type: research

Pouch-related fistula and intraoperative tricks to prevent it
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 3, 2015 Category: Surgery Source Type: research

Triple procedure for complex anal fistula
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 1, 2015 Category: Surgery Source Type: research

Anal sphincteroplasty and gracilis muscle transposition using transvaginal access in a patient with fecal incontinence
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 1, 2015 Category: Surgery Source Type: research

Laparoscopic en bloc excision of gastrointestinal stromal tumors of the rectum after neoadjuvant imatinib therapy: anteriorly extended intersphincteric resection combined with partial resection of the prostate
Abstract We herein present a novel technique for laparoscopic en bloc excision involving anteriorly extended intersphincteric resection with partial resection of the posterior lobe of the prostate for large rectal gastrointestinal stromal tumors (GISTs). The sequence of neoadjuvant imatinib therapy and this less invasive surgery for marginally resectable rectal GISTs has the potential to obviate the need for urinary reconstruction and permanent stomas without jeopardizing the tumor margin status. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 31, 2014 Category: Surgery Source Type: research

Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a definitive treatment? Retrospective analysis of 63 cases
Conclusions Laparoscopic peritoneal lavage for perforated diverticulitis can be considered a safe and effective alternative to traditional surgical resection, and using this approach, most elective colon resection might be avoided. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 30, 2014 Category: Surgery Source Type: research

R0 resection, not surgical technique, is the key consideration in pelvic exenteration surgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 28, 2014 Category: Surgery Source Type: research

Pudendal nerve exposure and preservation in low rectal surgery by using transvaginal access
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 24, 2014 Category: Surgery Source Type: research

Propensity adjusted appraisal of the surgical strategy for appendiceal carcinoids
Conclusions Right hemicolectomy did not seem to confer any survival advantage on patients with appendiceal carcinoids with a diameter>2 cm. For this reason, tumor size should not be considered an absolute indication for right hemicolectomy. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 5, 2014 Category: Surgery Source Type: research

Is the lateralization distance important in terms in patients undergoing the modified Limberg flap procedure for treatment of pilonidal sinus?
Conclusions No statistically significant differences in early complications or recurrence rates were found between the two different lateralization distances in the modified Limberg flap procedure. Therefore, we conclude that 1-cm lateralization of the lower part of the incision is sufficient. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 1, 2014 Category: Surgery Source Type: research

Objective assessment of technique in laparoscopic colorectal surgery: What are the existing tools?
Abstract Assessment can improve the effectiveness of surgical training and enable valid judgments of competence. Laparoscopic colon resection surgery is now taught within surgical residency programs, and assessment tools are increasingly used to stimulate formative feedback and enhance learning. Formal assessment of technical performance in laparoscopic colon resection has been successfully applied at the specialist level in the English “LAPCO” National Training Program. Objective assessment tools need to be developed for training and assessment in laparoscopic rectal cancer resection surgery. Simulati...
Source: Techniques in Coloproctology - November 27, 2014 Category: Surgery Source Type: research

Prevention of recurrent small bowel obstruction resulting from pelvic adhesions in patients who have previously undergone abdominoperineal excision of the rectum
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 26, 2014 Category: Surgery Source Type: research

Surgical site events in colorectal surgery: prevention is better than cure
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 26, 2014 Category: Surgery Source Type: research

AirSeal system insufflator to maintain a stable pneumorectum during TAMIS
Abstract Transanal minimally invasive surgery (TAMIS) is typically used for treating intraluminal rectal tumors. Other applications have recently been described. We here present the use of TAMIS as a tool to treat a chronic anastomotic fistula after restorative rectal resection. A new insufflation device expected to solve the problem of maintaining a stable pneumorectum is described. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 26, 2014 Category: Surgery Source Type: research

Ligation anopexy versus hemorrhoidectomy in the treatment of second- and third-degree hemorrhoids
Conclusions LA is safe, and as effective as CH in the treatment of grade II and grade III hemorrhoids, with shorter operative times, earlier mobilization, and lower postoperative pain scores. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 24, 2014 Category: Surgery Source Type: research

Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess
Conclusions Selected patients with diverticular abscess can be initially treated with antibiotics without adverse consequences on their outcomes. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 23, 2014 Category: Surgery Source Type: research

Erratum to: Quality of patient information on the internet for the treatment of anal fistula and anal fissure
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 20, 2014 Category: Surgery Source Type: research

Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center
Conclusions HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 19, 2014 Category: Surgery Source Type: research

“Sandwich technique” with bridging, a modification of negative pressure wound therapy for anal fistulas
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 18, 2014 Category: Surgery Source Type: research

Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT)
Abstract Background Ligation of intersphincteric fistula tract (LIFT) is a relatively new technique in the treatment of complex anorectal fistulas. As it spares the anal sphincter, rates of post-operative incontinence may be lower when compared to conventional treatment. To date, there have not been enough reports of long-term fistula recurrence rates. We performed a long-term follow-up study of 75 patients who underwent LIFT following seton drainage and partial fistulotomy. Methods Only patients with complex cryptogenic anorectal fistulas were inclu...
Source: Techniques in Coloproctology - November 17, 2014 Category: Surgery Source Type: research

Outcome and prognostic factors of local recurrent rectal cancer: a pooled analysis of 150 patients
Conclusions Resection for LRRC results in improved survival. Other than the well-known prognostic factors R0 resection and OS, PET scan has an independent impact both on OS and R0 resection. It should therefore be included in routine clinical practice when staging LRRC. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 10, 2014 Category: Surgery Source Type: research

Extralevator versus standard abdominoperineal excision for rectal cancer
Conclusions We found low rates of positive CRM after APE compared with the literature. ELAPE did not reduce these rates, and although the local recurrence rate was lower, this did not reach statistical significance. ELAPE has significantly reduced the rate of intraoperative bowel perforation and can optimize low rectal cancer surgery in selected patients. We found no significant differences between the two procedures regarding wound-related complications. A tailored approach and a larger trial with longer follow-up are needed to evaluate long-term results. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 10, 2014 Category: Surgery Source Type: research

Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence
Abstract Achieving a clear distal or circumferential resection margins with laparoscopic total mesorectal excision (TME) may be laborious, especially in obese males and when operating on advanced distal rectal tumors with a poor response to neoadjuvant treatment. Transanal (TaTME) is a new natural orifice translumenal endoscopic surgery modality in which the rectum is mobilized transanally using endoscopic techniques with or without laparoscopic assistance. We conducted a comprehensive systematic review of publications on this new technique in PubMed and Embase databases from January, 2008, to July, 2014. Experime...
Source: Techniques in Coloproctology - November 9, 2014 Category: Surgery Source Type: research

Abnormalities in collagen composition may contribute to the pathogenesis of hemorrhoids: morphometric analysis
Abstract Purpose While hemorrhoidal disease is common, its etiology remains unclear. It has been postulated that disturbances in collagen lead to reduced connective tissue stability, and in turn to the development of hemorrhoidal disease. We aimed to compare the quality and quantity of collagen in patients with hemorrhoidal disease versus normal controls. Methods Specimens from 57 patients with grade III or IV internal hemorrhoids undergoing hemorrhoidectomy between 2006 and 2011 were evaluated. Samples from 20 human cadavers without hemorrhoidal disease...
Source: Techniques in Coloproctology - November 9, 2014 Category: Surgery Source Type: research

Long-term evaluation of bulking agents for the treatment of fecal incontinence: clinical outcomes and ultrasound evidence
Conclusions In the long term, perianally injected bulking agents seem to lose effectiveness. The ultrasound assessment suggests that the process of resorption is almost complete, and the implants are no longer effective in treating incontinence. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 9, 2014 Category: Surgery Source Type: research

Extended lateral pelvic sidewall excision (ELSiE): an approach to optimize complete resection rates in locally advanced or recurrent anorectal cancer involving the pelvic sidewall
Conclusions Patients with locally advanced and recurrent cancer involving the lateral pelvic sidewall may be rendered suitable for potentially curative radical resection with a modification in the approach to the lateral pelvic sidewall. Our pilot series seems to indicate that our novel technique (ELSiE) is feasible, safe and yields high rates of complete pathological resection. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 8, 2014 Category: Surgery Source Type: research

One-third of patients fail to return to work 1 year after surgery for colorectal cancer
Abstract Background Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery. Method Questionnaires were created and dispatched to 204 patients who had undergone surgery with curative intent for colorectal cancer, in 2011–2012, in a single teaching h...
Source: Techniques in Coloproctology - November 8, 2014 Category: Surgery Source Type: research

Malignant melanoma metastasis to the colon: a curable lesion
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 8, 2014 Category: Surgery Source Type: research

A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery
Abstract Background Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. Methods Patients with non-metastasize...
Source: Techniques in Coloproctology - November 8, 2014 Category: Surgery Source Type: research

Results of sacral nerve neuromodulation for double incontinence in adults
Abstract Faecal incontinence and urinary incontinence are common and often associated. Sacral neurostimulation is a validated technique for treating each of these two types of incontinence, taken separately. The purpose of this study was to review the literature on the results of this treatment for double incontinence. A literature search was conducted using MEDLINE, PubMed, EMBASE and the Cochrane Library using the keywords “faecal incontinence”, “anal incontinence”, “urinary incontinence”, “urgency”, “urinary disorder”, “neurostimulation”, &...
Source: Techniques in Coloproctology - November 8, 2014 Category: Surgery Source Type: research