Surgical site infections following short-term radiotherapy and total mesorectal excision: results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery
Conclusions Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Prevention of surgical site infection: still an important challenge in colorectal surgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

The role of loose seton in the management of anal fistula: a multicenter study of 200 patients
Conclusions Recently, newer treatment modalities have been reported with enthusiasm. However, there remains a lack of strong statistical evidence of efficacy to support their use. Overall, loose seton placement remains a well-tolerated, pragmatic low-cost solution to this common and difficult condition as evident by our study. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

No observable difference in operative oncological outcomes between extra-levator versus standard abdominoperineal excision
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Randomized controlled trial comparing Moviprep ® and Phosphoral ® as bowel cleansing agents in patients undergoing colonoscopy
Conclusions Moviprep® and Phosphoral® provided equally efficient bowel cleansing in 90 % of patients, but Moviprep® provided a higher quality of cleansings graded as successful. The two agents were equally tolerated, and no difference was found in the related number of sick days. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Psycho-echo-biofeedback: a novel treatment for anismus—results of a prospective controlled study
Conclusions Psycho-echo-BFB is safe and inexpensive and allows all patients with anismus to relax PRM on straining. Previous anorectal surgery may be a negative predictor. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Intraoperative bleeding and haemostasis during pelvic surgery for locally advanced or recurrent rectal cancer: a prospective evaluation
Conclusions This patient group is at a high risk of intraoperative haemorrhage, and such patients are high consumers of blood products. Haemostatic adjunct use is often necessary to minimize blood loss. We describe our local algorithm to assist in the assessment and intraoperative management of these challenging cases. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Surgery for complex perineal fistula following rectal cancer treatment using biological mesh combined with gluteal perforator flap
Abstract Three patients with complex perineal fistula after extensive pelvic surgery and radiotherapy underwent surgical treatment combining a biological mesh for pelvic floor reconstruction and a unilateral superior gluteal artery perforator (SGAP) flap for filling of the perineal defect. All patients had both fecal and urinary diversion. Two fistulas originated from the small bowel, necessitating parenteral feeding, and one from the bladder. Symptoms included severe sacral pain and skin maceration. After laparotomy with complete debridement of the pelvic cavity, the pelvic floor was reconstructed by stitching a...
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Vertical rectus abdominis myocutaneous flap and quality of life following abdominoperineal excision for rectal cancer: a multi-institutional study
Conclusions This study is limited by its non-randomized retrospective design and relatively small sample size. A significant difference in patient QOL was not demonstrated between VRAM flap and primary perineal closure after APE for rectal cancer. Further studies in this area are warranted. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus
Conclusion Our meta-analysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered: open radical excision and primary midline closure should be abandoned. Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

The volume–outcome relationship in colorectal surgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Failure of sublesional infliximab injection for refractory parastomal pyoderma gangrenosum in a patient with Crohn’s disease
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - October 1, 2014 Category: Surgery Source Type: research

Comments to “Perianal injectable bulking agents as treatment for faecal incontinence in adults”
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 26, 2014 Category: Surgery Source Type: research

The Comfort Drain: a new device for treating complex anal fistula
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 26, 2014 Category: Surgery Source Type: research

5th Educational Meeting of the Italian Society of Colorectal Surgery (SICCR) “Fistulas”
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 25, 2014 Category: Surgery Source Type: research

The IXth Biennial Meeting of the Mediterranean Society of Coloproctology, May 22–23, 2014
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 25, 2014 Category: Surgery Source Type: research

Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial
Conclusions Recurrence rates did not differ significantly at 3-year follow-up and occurred in patients with index grade IV hemorrhoids. Chronic complications occurred only after hemorrhoidectomy. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 24, 2014 Category: Surgery Source Type: research

The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery
Abstract Background The aim of the present study was to evaluate the effects of preoperative nutritional status on the short-term outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery. Methods This prospective observational study included 149 patients who underwent elective resection of colorectal cancer with ERAS from January 2011 to January 2014 in a university hospital. Subjective global assessment (SGA) was used to determine preoperative nutritional status. Primary outcomes included the length of postoperative ...
Source: Techniques in Coloproctology - September 13, 2014 Category: Surgery Source Type: research

Experience with a new device for pathological assessment of colonic endoscopic submucosal dissection
Abstract Endoscopic submucosal dissection (ESD) is gaining popularity worldwide in the treatment of neoplastic lesions of the gastrointestinal tract. However, the experience in Western countries is quite limited and restricted to large or academic centers. Besides, this approach requires an optimal pathological assessment. The aim of this study was to report our experience with colonic ESD using a new device that allows complete handling of the resected specimens and especially of lateral margins, for pathological analysis. In a 1-year period, 14 patients (6 men, 8 women, age range 50–82 years) unde...
Source: Techniques in Coloproctology - September 12, 2014 Category: Surgery Source Type: research

Skin bridge loop ileostomy: technical details
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Partial prolapsectomy and fixation proctomucopexy: a novel minimally invasive procedure
Abstract A novel minimally invasive procedure for the management of anterior external and posterior internal mucosal prolapse is described. The operation, carried out via a transanal route, consists of a partial prolapsectomy and a mucosal proctopexy. Out of six patients, one had severe postoperative bleeding and one had a recurrence of internal prolapse and obstructed defecation. Three patients had pelvic floor rehabilitation for associated dysfunctions. The advantage of the operation is that a circumferential anastomosis is avoided, thus decreasing the risk of dehiscence, and only a short sphincter dilation is ...
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Incision-less reversal of Hartmann’s procedure
This study presents our experience of this approach using the glove port and standard laparoscopic instrumentation. Between October 2010 and October 2013, 14 patients [median age 62 years (range 42–83 years); median body mass index 25.2 kg/m2 (range 22.7–34.9) kg/m2] underwent attempted single-port (via colostomy site) reversal of Hartmann’s. All but one patient had had a laparotomy for their primary surgery. The glove port was used with a camera and two working ports. Additional remote access was needed in 3 (21 %) patients [1 × 5 mm port (two patients); 2&nb...
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Rectovaginal fistula: a new technique and preliminary results using collagen matrix biomesh
Conclusions Our technique shows promising results. A local and simple technique with acceptable closure and morbidity rates, like our local repair with biomesh, would be ideal as a first step in treating RVFs. Long-term results are needed. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Use of self-retaining barbed suture for rectal wall closure in transanal endoscopic microsurgery
Conclusions Barbed sutures display the same bursting pressure as monofilament sutures and their use for rectal wall closure seems feasible. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Surgical treatment of recurrent prolapse after stapled haemorrhoidopexy
Conclusions This technique is a promising alternative after failed stapled haemorrhoidopexy. Morbidity is low. The procedure may effectively treat associated symptoms. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages II and III colon cancer: long-term oncologic outcomes in 168 patients
Conclusions Standardization of laparoscopic CME and D3 lymphadenectomy is expedient. The technique is associated with acceptable morbidity and provides excellent oncologic outcomes for stage II and stage III colon cancer. A longer follow-up is needed to validate the enhancement of oncological outcome related to this surgical concept. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Comparison of hospital costs for single-port and conventional laparoscopic colorectal resection: a case-matched study
Abstract Background Whether single-port laparoscopic (SPL) colorectal resection is cost-effective in comparison to conventional laparoscopy remains unclear. The aim of this study is to compare hospital costs for single-port versus conventional laparoscopic colorectal resections. Methods Patients with available cost data who underwent (SPL) colorectal resection between December 2007 and December 2010 were matched with conventional (multiport) laparoscopic (CL) counterparts for age, gender, American Society of Anesthesiologists score, body mass inde...
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Complete mesocolic excision
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

The prognostic value of lymph node ratio and updated TNM classification in rectal cancer patients with adequate versus inadequate lymph node dissection
Abstract Background The aim of this study was to clarify whether the lymph node ratio (LNR) is superior to the updated TNM classification regarding the prognosis of stage III rectal cancer patients who have not undergone neoadjuvant therapy. The TNM system is based on the absolute number of lymph nodes involved, and the LNR takes into account involved and examined nodes. Methods In 237 patients with stage III rectal cancer, we evaluated prognostic factors for 5-year overall survival (OS), disease-free survival (DFS), and risk of distant metastases...
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy
Abstract Recent developments in colonic surgery generate exciting opportunities for surgeons and trainees. In the first instance, the anatomy of the entire mesenteric organ has been clarified and greatly simplified. No longer is it regarded as fragmented and complex. Rather it is continuous from duodenojejunal flexure to mesorectum, spanning the gastrointestinal tract between. Recent histologic findings have demonstrated that although apposed to the retroperitoneum, the mesenteric organ is separated from this via Toldt’s fascia. These fundamentally important observations underpin the principles of complete ...
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Close, but no cigar
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

Reply to correspondence on: Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse by H. A. Formijne Jonkers et al.
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research

To clip or not to clip? Invited comment on Wilhelm et al.: Use of self-retaining barbed suture for rectal wall closure in transanal endoscopic microsurgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - September 1, 2014 Category: Surgery Source Type: research