Are two better than one? VALIFT: video-assisted ligation of the intersphincteric fistula tract —a combination of two minimally invasive techniques for treatment of transsphincteric perianal fistulas
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 8, 2019 Category: Surgery Source Type: research

Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani
ConclusionsMethylene-blue intradermal injection can result in a high symptom improvement rate with low recurrence rate for patients with idiopathic pruritus ani. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 7, 2019 Category: Surgery Source Type: research

Laparoscopic surgical repair of refractory chylous ascites after laparoscopic anterior resection
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 7, 2019 Category: Surgery Source Type: research

A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials
ConclusionsThe HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 6, 2019 Category: Surgery Source Type: research

Minimal open hemorrhoidectomy
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 6, 2019 Category: Surgery Source Type: research

Meta-analysis of the effect of perioperative intravenous lidocaine on return of gastrointestinal function after colorectal surgery
ConclusionsPerioperative IV lidocaine may improve recovery of gastrointestinal function after colorectal surgery. Large-scale effectiveness studies to measure effect size and evaluate optimum dose/duration are warranted. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 5, 2019 Category: Surgery Source Type: research

Gastroscope guidewire volvulus tube decompression
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 4, 2019 Category: Surgery Source Type: research

Antegrade impalement of the rectum by a foreign body: a case report of a successful transanal extraction using the transanal single port (TAMIS) technique
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 4, 2019 Category: Surgery Source Type: research

In search of the optimal operation for rectal prolapse: the saga continues …
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - February 4, 2019 Category: Surgery Source Type: research

Colorectal cancer in inflammatory bowel disease: review of the evidence
AbstractInflammatory bowel disease (IBD)-related colorectal cancer (CRC) is responsible for approximately 2% of the annual mortality from CRC overall, but 10 –15% of the annual deaths in IBD patients. IBD-related CRC patients are also affected at a younger age than sporadic CRC patients, and have a 5-year survival rate of 50%. Despite optimal medical treatment, the chronic inflammatory state inherent in IBD increases the risk for high-grade dysplasia a nd CRC, with additional input from genetic and environmental risk factors and the microbiome. Recognizing risk factors, implementing appropriate surveillance, and iden...
Source: Techniques in Coloproctology - January 30, 2019 Category: Surgery Source Type: research

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis
ConclusionsThe outpatient management of AD can reduce the rate of emergency hospitalizations. This setting is already part of the common clinical practice of many emergency departments, in which a standardized protocol is followed. The data reported suggest that this management is safe if associated with an accurate selection of patients (40%); but no subgroup analysis demonstrated significant differences between groups (such as comorbidities, previous episode, diabetes). The main limitations of the findings of the present review concern their applicability in common clinical practice as it was impossible to identify stric...
Source: Techniques in Coloproctology - January 25, 2019 Category: Surgery Source Type: research

Continuous intravenous lidocaine infusion for postoperative pain and recovery in adults
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 21, 2019 Category: Surgery Source Type: research

Robotic-assisted stereotactic real-time navigation: initial clinical experience and feasibility for rectal cancer surgery
ConclusionsThe combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 17, 2019 Category: Surgery Source Type: research

3D imaging and printing in pelvic colorectal cancer: ‘The New Kid on the Block’
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 17, 2019 Category: Surgery Source Type: research

Levator ani repair by transvaginal approach
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 17, 2019 Category: Surgery Source Type: research

Pyoderma gangrenosum as first manifestation of Crohn ’s disease
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 17, 2019 Category: Surgery Source Type: research

Pelvic floor rehabilitation for defecation disorders
AbstractPelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of  these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and ag...
Source: Techniques in Coloproctology - January 10, 2019 Category: Surgery Source Type: research

Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies
ConclusionsRobotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 8, 2019 Category: Surgery Source Type: research

Transperineal abdominoperineal resection synchronously assisted by laparoscopic approach for low rectal cancer directly invading the posterior wall of the vagina
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 4, 2019 Category: Surgery Source Type: research

Management of anoperineal lesions  in Crohn’s disease: a French National Society of Coloproctology national consensus
AbstractThe French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn ’s disease. Treatment strategies for acute abscesses, active fistulas (active denovo and still active under treatment), fistulas in remission, and rectovaginal fistulas are suggested. Recommendations have been graded following the international recommendations, and when absent, professional agreem ent has been established. For each situation, practical algorithms have been drawn. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 2, 2019 Category: Surgery Source Type: research

Long-term outcome of laparoscopic rectopexy for full-thickness rectal prolapse
ConclusionsLaparoscopic rectopexy is a safe operation for full-thickness rectal prolapse. The durability of the repair diminished over time, particularly for patients operated on for recurrent prolapse. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 2, 2019 Category: Surgery Source Type: research

Gracilis muscle transposition for treatment of recurrent anovaginal, rectovaginal, rectourethral, and pouch –vaginal fistulas in patients with inflammatory bowel disease
ConclusionsGMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually  successful in almost 2/3 of patients. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - January 2, 2019 Category: Surgery Source Type: research

Distal purse-string suture technique for TaTME
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 22, 2018 Category: Surgery Source Type: research

Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis
ConclusionsPatients at high-risk for post-discharge events have different characteristics than those who develop VTE in-hospital. Identifying this specific subset of patients at highest risk for post-discharge VTE may allow for the selective use of prolonged thromboprophylaxis. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 19, 2018 Category: Surgery Source Type: research

Medium-term outcome of percutaneous tibial nerve stimulation in the treatment of fecal incontinence
AbstractIntroductionFecal incontinence (FI) is a multifactorial disease that affects patients ’ quality of life. The aim of this study was to evaluate the efficacy of posterior tibial nerve stimulation (PTNS) in the treatment of FI and to assess the medium-term results.MethodsA prospective cohort of patients with FI treated with PTNS between 2012 and 2014 was analysed. Endoluminal ultrasound and anorectal physiologic studies were performed in all patients. The efficacy of PTNS was assessed using a validated questionnaire (Cleveland Clinic Incontinence Score) at baseline, after treatment, and 2  years later. The ...
Source: Techniques in Coloproctology - December 18, 2018 Category: Surgery Source Type: research

The effect of proctoring on the learning curve of  transanal minimally invasive surgery for local excision of rectal neoplasms
AbstractBackgroundThe current method of choice for local resection of benign and selected malignant rectal tumors is transanal endoscopic microsurgery. Transanal minimally invasive surgery (TAMIS) yields similar oncological results and better patient reported outcomes when compared to transanal endoscopic micro surgery. However, due to the technical complexity of TAMIS, a significant learning curve has been suggested. Data on the surgical learning curve are limited. The aim of our study was to investigate surgeon specific learning curves for TAMIS procedures for the local excision of selected rectal tumors, and analyze the...
Source: Techniques in Coloproctology - December 17, 2018 Category: Surgery Source Type: research

Oncologic results of conventional laparoscopic TME: is the intramesorectal plane really acceptable?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 17, 2018 Category: Surgery Source Type: research

Optimal processing of ESD specimens to avoid pathological artifacts
ConclusionsSpecific devices including cellulose support and adequate sampling blocks can be helpful to perform accurate histological assessment of ESD specimens after en bloc ESD for precancerous/neoplastic gastrointestinal lesions, with complete analysis of the status of the margins and the entirely en bloc evaluation of the lesion. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 17, 2018 Category: Surgery Source Type: research

Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse
AbstractRectal prolapse, rectal procidentia, “complete” prolapse or “third-degree” prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominan ce among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electro...
Source: Techniques in Coloproctology - December 15, 2018 Category: Surgery Source Type: research

Risk of postoperative morbidity in patients having bowel resection for colonic Crohn ’s disease
AbstractBackgroundThe aim of the present multicenter study was to analyze the incidence and risk factors associated with postoperative morbidity in patients  who had colorectal resection for colonic Crohn’s disease.MethodsConsecutive patients undergoing colorectal resection for colonic Crohn ’s disease at seven surgical units in 1992–2017 were included. Exclusion criteria were: proctectomy for perianal disease, surgery for cancer, previous colectomies, surgery before 1998. Abdominal colectomy and proctocolectomy were defined as extended resections; all other operations were classifi ed as segmental r...
Source: Techniques in Coloproctology - December 12, 2018 Category: Surgery Source Type: research

TAMIS J-pouch excision
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 12, 2018 Category: Surgery Source Type: research

Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents
ConclusionsThis is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 11, 2018 Category: Surgery Source Type: research

Colonic hypereosinophilia in ulcerative colitis may help to predict the failure of steroid therapy
AbstractBackgroundAlthough glucocorticosteroids (GS) and mesalazine are effective and widely employed to treat moderate-to-severe ulcerative colitis (UC), information regarding the factors responsible for response to such therapy is still scarce. One of these factors is thought to be an increased number of mucosal eosinophils. The aim of our study was to determine whether the presence of hypereosinophilia in colonic mucosa of UC patients might influence the short-term response to l treatment with GS and mesasalazine.MethodsClinical, endoscopic, and pathologic data from patients with a recent diagnosis of moderate UC, who h...
Source: Techniques in Coloproctology - December 10, 2018 Category: Surgery Source Type: research

Anal Fistula Laser Closure: the length of fistula is the Achilles ’ heel
AbstractBackgroundLaser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing.MethodsA retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470  nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of f...
Source: Techniques in Coloproctology - December 8, 2018 Category: Surgery Source Type: research

Novel technique for stomal isolation after extensive abdominal wall soft tissue loss
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 8, 2018 Category: Surgery Source Type: research

CO 2 embolism can complicate transanal total mesorectal excision
ConclusionsDuring taTME, rare CO2 emboli may occur in the setting of venous bleeding during pneumopelvis, causing sudden, transient cardiovascular instability. Immediate recognition of rapid decrease in ETCO2, SpO2, and BP should be followed by desufflation of pneumopelvis, patient positioning in Trendelenburg and left lateral decubitus, and hemodynamic support. Increased awareness of this potential complication and maintaining a high index of suspicion will lead to preparedness of the anesthesia and surgery teams. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 6, 2018 Category: Surgery Source Type: research

Management of retrorectal hematoma after stapled transanal rectal resection for prolapsed hemorrhoids associated with occult rectal prolapse and obstructed defecation syndrome
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 6, 2018 Category: Surgery Source Type: research

Management of some extra-peritoneal rectal injuries without fecal diversion may be feasible, but high-quality evidence is still needed
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 6, 2018 Category: Surgery Source Type: research

Application of a linear stapler to the laparoscopic treatment of gastrocolic fistula in patients with Crohn ’s disease
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 5, 2018 Category: Surgery Source Type: research

Fasciocutaneous lotus petal flap in the treatment of chronic pouch-vaginal fistula in ulcerative colitis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 3, 2018 Category: Surgery Source Type: research

Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer
ConclusionsPelvic exenteration remains a major operation associated with significant morbidity and mortality. Despite advances in preoperative assessment and staging, R1 resection rates remain high. There is also a high degree of variability of reporting outcomes and standardisation of this process would aid comparison of results between centres and drive forward research in this area. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - December 1, 2018 Category: Surgery Source Type: research

7th Educational Meeting “Anal fistula: news and dilemmas” Rome, 20 November, 2018
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 30, 2018 Category: Surgery Source Type: research

Transanal extended rectal surgery with lateral pelvic lymph node dissection
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 27, 2018 Category: Surgery Source Type: research

Pubovisceral muscle and anal sphincter defects in women with fecal or urinary incontinence after vaginal delivery
AbstractBackgroundVaginal delivery is the most frequent cause of direct anal sphincter trauma as well as pelvic floor muscle defects in women with corresponding signs and symptoms. The aim of the present study was to identify anatomical and functional abnormalities of the anal canal and pelvic floor in women who had had a vaginal delivery and determine the relationship between such abnormalities and the symptoms and severity of fecal incontinence (FI).MethodsConsecutive female patients with symptoms of fecal and/or urinary incontinence were recruited through the colorectal and gynecological outpatient clinics at two large ...
Source: Techniques in Coloproctology - November 26, 2018 Category: Surgery Source Type: research

TAMIS repair of a rectal stenosis not treatable by endoscopy
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 26, 2018 Category: Surgery Source Type: research

Gastrointestinal stromal tumor with skeinoid fibers: an unusual presentation
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 24, 2018 Category: Surgery Source Type: research

Novel use of argon plasma coagulation (APC)  in the treatment of high output small bowel mucous fistula
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 21, 2018 Category: Surgery Source Type: research

Perforated sigmoid diverticulitis: Hartmann ’s procedure or resection with primary anastomosis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 20, 2018 Category: Surgery Source Type: research

Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery
ConclusionsOur data suggest that laparoscopic colorectal surgery may be associated with a lower risk of iatrogenic splenic injury, and that most splenic injuries can be managed with spleen-preserving approaches. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 20, 2018 Category: Surgery Source Type: research

Technique of air-leak testing of ileocolic anastomosis
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - November 19, 2018 Category: Surgery Source Type: research