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

Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception
ConclusionsThese data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 3, 2017 Category: Surgery Source Type: research

Confocal laser endomicroscopy in ulcerative colitis: beyond endoscopic assessment of disease activity
ConclusionsCLE might be a useful tool to determine inflammatory activity in UC. Fused crypts appeared to be a CLE marker of UC, while other abnormalities, like microvascular alteration and fluorescein leakage, have also been identified in patients with mucosal healing at endoscopy. Larger series are required to validate these results and the advantages of a CLE-based assessment of UC activity. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - July 3, 2017 Category: Surgery Source Type: research

High risk of lower urinary tract symptoms in patients with irritable bowel syndrome
ConclusionsOur study shows that IBS women have a similar risk of UTI compared to healthy women even if they complain more of LUTS, independently of IBS subtype and severity. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 24, 2017 Category: Surgery Source Type: research

Preservation of vaginal elasticity is essential for avoiding mesh complications after prolapse surgery
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 24, 2017 Category: Surgery Source Type: research

Assessing internet-based information used to aid patient decision-making about surgery for perianal Crohn ’s fistula
ConclusionsWe found no patient decision aids relating to surgery for pCD. The online sources relating to surgery for pCD are few, and their quality is poor, as seen in the low IPDAS and DISCERN scores. Less than half of the sources mentioned pCD-specific outcomes, and three sources were solely dedicated to providing information on pCD. Healthcare professionals should look to create a patient tool to assist decision-making in pCD. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 22, 2017 Category: Surgery Source Type: research

Prognostic factors affecting outcomes in fistulating perianal Crohn ’s disease: a systematic review
ConclusionsThis systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn ’s perianal fistulae is undertaken. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 20, 2017 Category: Surgery Source Type: research

The good, the bad and the ugly: rectal cancers in the twenty-first century
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 19, 2017 Category: Surgery Source Type: research

A preliminary study of the use of oral rehydration salts in decreasing ileostomy output
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 15, 2017 Category: Surgery Source Type: research

Incidental colorectal FDG uptake on PET/CT scan and lesions observed during subsequent colonoscopy: a systematic review
ConclusionsIncidental colorectal FDG uptake, as evaluated by subsequent colonoscopy, often reveals neoplastic lesions. Predominantly, lesions were located at the same location as FDG uptake. Further investigation is warranted before recommending that incidental colorectal FDG uptake should always result in referral to diagnostic colonoscopy. (Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 15, 2017 Category: Surgery Source Type: research

Authors ’ reply to: Prophylactic mesh to prevent parastomal hernia: a meta-analysis of randomized controlled studies (Tech Coloproctol (2017) 21:5–13)
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 15, 2017 Category: Surgery Source Type: research

Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review
AbstractAnal fistulas continue to be a problem for patients and surgeons alike despite scientific advances. While patient and anatomical characteristics are important to surgeons who are evaluating patients with anal fistulas, their development and persistence likely involves a multifaceted interaction of histological, microbiological, and molecular factors. Histological studies have shown that anal fistulas are variably epithelialized and are surrounded by dense collagen tissue with pockets of inflammatory cells. Yet, it remains unknown if or how histological differences impact fistula healing. The presence of a perianal ...
Source: Techniques in Coloproctology - June 15, 2017 Category: Surgery Source Type: research

The use of carbon dioxide insufflation to facilitate identification of intestinal injuries in patients undergoing cytoreductive surgery and intraperitoneal chemotherapy
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 14, 2017 Category: Surgery Source Type: research

Pelvic exenteration with en bloc resection of the pelvic sidewall and intraoperative electron beam radiotherapy with Mobetron ® for locally advanced rectal cancer
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 14, 2017 Category: Surgery Source Type: research

The Delorme technique in colostomy prolapse
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 14, 2017 Category: Surgery Source Type: research

Anal fistula surgery: what are the patients expecting from the surgeon?
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 8, 2017 Category: Surgery Source Type: research

Surgery beyond the visible light spectrum: theoretical and applied methods for localization of the male urethra during transanal total mesorectal excision
Abstract The risk of urethral injury during transanal total mesorectal excision (taTME) is delineated, and potential risk factors for iatrogenic transection are reviewed. A variety of applied and theoretical techniques can be used by surgeons to diminish the risk of injury in males undergoing this operation. Many of the approaches utilize non-optic media and wavelengths beyond the visible light spectrum which can enhance the surgeon ’s frame of reference. The aim of the present study was to assess the techniques and theoretical approaches to urethral localization during taTME. Future directions in surgical imaging ...
Source: Techniques in Coloproctology - June 6, 2017 Category: Surgery Source Type: research

Dynamic cystocolpoproctography to confirm the efficacy of laparoscopic rectopexy in the treatment of hedrocele associated with full-thickness rectal prolapse
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 6, 2017 Category: Surgery Source Type: research

Laparoscopic ventral rectopexy with percutaneous surgical system
(Source: Techniques in Coloproctology)
Source: Techniques in Coloproctology - June 6, 2017 Category: Surgery Source Type: research