Diseases of the Colon & Rectum最新文献

{"title":"Autologous Platelet-Rich Plasma in Complex Anal Fistula Treatment: Getting It Right? Promising Clinical Data From 90 Patients.","authors":"Christof Ihle, Thomas Hallgren, Antoni Zawadzki","doi":"10.1097/DCR.0000000000004179","DOIUrl":"10.1097/DCR.0000000000004179","url":null,"abstract":"<p><strong>Background: </strong>Further development of sphincter-preserving techniques in the treatment of complex anal fistula disease is required to improve patient outcomes.</p><p><strong>Objective: </strong>The objective of this study was to evaluate anal fistula closure achieved exclusively with autologous platelet-rich plasma in a large cohort of patients.</p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Settings: </strong>The study was conducted at a referral center for anal fistula disease in Sweden.</p><p><strong>Patients: </strong>The cohort consisted of 90 consecutive patients with complex anal fistulas at the referral center between October 2021 and June 2025. Patient ages ranged from 14 to 72 years. No patient group or fistula type was excluded.</p><p><strong>Interventions: </strong>The intervention treatment sequence included 1) clinical evaluation, including endoanal 3-dimensional ultrasonography, of fistula and incontinence at the surgical outpatient clinic; 2) outpatient surgery fistula examination under anesthesia, including endoanal 3-dimensional ultrasonography and seton placement; 3) outpatient surgery for fistula occlusion with autologous platelet-rich plasma after 3 months; 4) follow-up at the surgical outpatient clinic with clinical examination, endoanal 3-dimensional ultrasonography, and incontinence evaluation. Endoanal 3-dimensional ultrasonography has completely replaced MRI in this setting.</p><p><strong>Main outcome measures: </strong>The primary outcome was the closure rate, assessed both clinically and with endoanal 3-dimensional ultrasonography. Secondary outcomes were the complication rate, anal continence, and whether patient age has an effect on the healing rate.</p><p><strong>Results: </strong>Fistula healing was achieved in 57 patients (63%) after a single closure operation. Ten patients (11%) healed after a second closure operation, and a further 6 patients (7%) healed after a third procedure. We saw no complications or postoperative anal incontinence. Statistical analysis showed that age is a weak predictor of healing outcome in this dataset, because it lacked statistical significance.</p><p><strong>Limitations: </strong>This is a retrospective study, with no control group. All patient contacts and operations were performed by a single surgeon.</p><p><strong>Conclusions: </strong>The technique is relatively easy to learn, safe, and effective. Because of its very low destructiveness, it can easily be repeated until fistula closure is achieved. Sixty-three percent of patients had successful fistula closure after 1 operation. Eighty-one percent after 1 or 2 additional operations. These are very promising results in a difficult-to-treat patient group. See Video Abstract .</p><p><strong>Plasma autlogo rico en plaquetas en el tratamiento de fstulas anales complejas es la opcin correcta datos clnicos prometedores de pacientes: </strong>ANTECEDENTES:Es necesario seguir desarrollan","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"819-825"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Variation in Colorectal Peritoneal Cancer Index Threshold.","authors":"Mina Sarofim, Assad Zahid, David Morris","doi":"10.1097/DCR.0000000000004118","DOIUrl":"10.1097/DCR.0000000000004118","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"871"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Brooke Gurland","doi":"10.1097/DCR.0000000000004117","DOIUrl":"10.1097/DCR.0000000000004117","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"869"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor: Organ Preservation in Locally Advanced Rectal Cancer After Total Neoadjuvant Therapy With Endoscopic Submucosal Dissection.","authors":"Metincan Erkaya, Salih N Karahan, Emre Gorgun","doi":"10.1097/DCR.0000000000004115","DOIUrl":"10.1097/DCR.0000000000004115","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"867"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Approach for Total Proctocolectomy With Ileoanal Pouch Reconstruction for Familial Polyposis Coli.","authors":"Akash Mor, Ashwin Deouza, Avanish Saklani","doi":"10.1097/DCR.0000000000004093","DOIUrl":"10.1097/DCR.0000000000004093","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"856-857"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected Abstracts.","authors":"Carla F Justiniano, Warqaa Akram, Irena Gribovskaja-Rupp, Scott Dolejs","doi":"10.1097/DCR.0000000000004186","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004186","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"69 5","pages":"847-851"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Outcomes of Treatment Failure After Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases.","authors":"Varut Lohsiriwat, Romyen Jitmungngan, Worrawit Wanitsuwan, Siripong Sirikurnpiboon, Weeraput Chadbunchachai, Punnawat Chandrachamnong, Pornraksa Ovartchaiyapong","doi":"10.1097/DCR.0000000000004142","DOIUrl":"10.1097/DCR.0000000000004142","url":null,"abstract":"<p><strong>Background: </strong>Despite generally favorable outcomes of ligation of intersphincteric fistula tract for anal fistula, several patients experience persistent or recurrent disease.</p><p><strong>Objective: </strong>This study aimed to identify patterns of treatment failure after ligation of intersphincteric fistula tract and evaluate subsequent outcomes.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Setting: </strong>Five university hospitals in Thailand.</p><p><strong>Patients: </strong>Patients diagnosed with persistent or recurrent cryptoglandular anal fistula after ligation of intersphincteric fistula tract between 2012 and 2020 were included.</p><p><strong>Main outcome measures: </strong>Fistula characteristics, patterns of treatment failure, and outcomes of subsequent management were analyzed.</p><p><strong>Results: </strong>A total of 200 patients were included, of whom 12.5% had persistent fistulas and 87.5% had recurrence. Median time to recurrence was 6 months (range, 1-48). Most treatment failures (n = 186; 93%) occurred within 1 year after surgery. Six distinct patterns of treatment failure were identified. The most common was type 1 (I-E, tract running from the previous internal opening [I] to an external opening [E], known as an original fistula: n = 116; 58%), followed by type 2 (I-L, tract running from the previous internal opening [I] to an unhealed intersphincteric wound [L], known as an intersphincteric fistula: n = 56; 28%). Type 1 failure was effectively treated by redo ligation of intersphincteric fistula tract with an 87% success rate. Overall, the healing rate was 90.5%, with a median follow-up period of 18 months (range, 12-38).</p><p><strong>Limitations: </strong>Exclusion of noncryptoglandular fistulas may limit generalizability. The retrospective multicenter design and surgeon-dependent decision-making may have introduced selection bias and heterogeneity in surgical technique.</p><p><strong>Conclusions: </strong>Most treatment failures occurred within 1 year after ligation of intersphincteric fistula tract. Understanding the 6 distinct failure patterns enables more appropriate surgical decision-making. The majority represented either recurrence of the original tract or persistence within the intersphincteric space. See Video Abstract .</p><p><strong>Patrones y resultados del fracaso del tratamiento tras la ligadura del tracto fistuloso intersfinteriano en la fstula anal criptoglandular anlisis de casos de fracaso de la ligadura del tracto fistuloso intersfinteriano: </strong>ANTECEDENTES:A pesar de los resultados generalmente favorables de la ligadura del tracto fistuloso intersfinteriano para la fístula anal, varios pacientes experimentan una enfermedad persistente o recurrente.Objetivo:El objetivo de este estudio fue identificar los patrones de fracaso del tratamiento tras la ligadura del tracto fistuloso intersfinteriano y evaluar sus resultados.DISEÑO:Estudio retrospecti","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"801-808"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Results of Open Excisional Hemorrhoidectomy Combined With 3% Polidocanol Foam Sclerotherapy in Patients With Grade IV Hemorrhoidal Disease: A Randomized Controlled Open-Label Single-Center Study.","authors":"Xiangyi Yin, Jiaqi Jiang, Biao Liang, Dan Gan, Yuchang Lu, Jiachun Ni, Zhenyi Wang, Gaetano Gallo","doi":"10.1097/DCR.0000000000004147","DOIUrl":"10.1097/DCR.0000000000004147","url":null,"abstract":"<p><strong>Background: </strong>The Milligan-Morgan hemorrhoidectomy remains the criterion standard for grade IV hemorrhoidal disease. However, postoperative pain, bleeding, and prolonged recovery persist as challenges. Sclerotherapy shows promise but lacks evidence in grade IV hemorrhoidal disease management.</p><p><strong>Objective: </strong>This study evaluated the efficacy and safety of open excisional hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy) combined with 3% polidocanol foam sclerotherapy in patients with grade IV hemorrhoidal disease.</p><p><strong>Design: </strong>A randomized, open-label, single-center clinical trial.</p><p><strong>Settings: </strong>Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.</p><p><strong>Patients: </strong>Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups.</p><p><strong>Interventions: </strong>The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy; the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy.</p><p><strong>Main outcome measures: </strong>The primary outcome was the time to return to daily activities. Secondary outcomes included Hemorrhoidal Disease Symptom Score, Vaizey Incontinence scores, visual analog scale score, Short Health Scale for Hemorrhoidal Disease scores, postoperative bleeding grade, usage of analgesics, and satisfaction.</p><p><strong>Results: </strong>The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs 25.06 ± 7.85 days; 95% CI, -11.27 to -0.29 days; p  = 0.04), reduced postoperative bleeding (0-3 scale; estimate -0.45; 95% CI, -0.72 to -0.16; p  = 0.002), lower analgesic use (0-3 scale; estimate -0.38; 95% CI, -0.66 to -0.09; p  = 0.009), and improved symptom scores at 1 to 2 months (Z -2.52 and -2.11, p  < 0.05). Median satisfaction scores were 10 versus 9.5 ( p  = 0.12). No adverse events occurred.</p><p><strong>Limitations: </strong>Small sample size, nonblinded, single-center design, and short follow-up period.</p><p><strong>Conclusions: </strong>Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy significantly enhanced postoperative recovery, reduced complications, and demonstrated comparable patient satisfaction. Long-term follow-up is warranted to validate sustained efficacy. See Video Abstract.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry: ChiCTR2400087552.</p><p><strong>Resultados preliminares de la hemorroidectoma abierta combinada con escleroterapia con espuma de polidocanol al en pacientes con enfermedad hemorroidal de grado iv estudio aleatorizado, controlado, abierto y unicntrico: </strong>ANTECEDENTES:La hemorroidectomía de Milligan-Morgan sigue siendo el tratamien","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"809-818"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Anal Fistula in Crohn's Disease With Platelet-Rich Plasma: Long-term Results.","authors":"María Luisa Reyes Díaz, Fátima Hinojosa Ramírez, Rocío Olmo Santiago, Irene M Ramallo Solís, Rosa M Jiménez Rodríguez, José Pintor Tortolero, Ana M García Cabrera, Jorge M Vázquez Monchul, Fernando de la Portilla de Juan","doi":"10.1097/DCR.0000000000004185","DOIUrl":"10.1097/DCR.0000000000004185","url":null,"abstract":"<p><strong>Background: </strong>Approximately 90% of patients with anal fistulas secondary to Crohn's disease require surgical intervention. An ideal technique that achieves high cure rates with minimal complications and low recurrence has yet to be established. In other medical disciplines, platelet-rich plasma has demonstrated regenerative and healing properties, offering new therapeutic possibilities.</p><p><strong>Objective: </strong>This study aimed to evaluate the 5-year healing rate in patients with anal fistulas associated with Crohn's disease after treatment with platelet-rich plasma.</p><p><strong>Design: </strong>This prospective observational study was conducted between 2011 and 2022. Patients with Crohn's disease and perianal fistulas who met the inclusion criteria were treated with platelet-rich plasma. Follow-up assessments were performed at 1, 3, 6, 12, 36, and 60 months.</p><p><strong>Settings: </strong>A single tertiary referral center.</p><p><strong>Patients: </strong>Data from eligible patients with Crohn's disease-associated anal fistulas were analyzed.</p><p><strong>Main outcome measures: </strong>Primary outcomes included fistula healing and recurrence rates, continence status, and complications.</p><p><strong>Results: </strong>A total of 42 patients (45.2% men, 54.8% women; mean age 38.6 ± 11.9 years) were included. Of all patients, 97.6% were receiving active treatment for Crohn's disease. All procedures were performed on an outpatient basis. Transsphincteric fistulas accounted for 80.9% of cases, 95.2% of which were recurrent. The median time to recurrence was 55 ± 8 months (95% CI, 38-72). Follow-up was completed by 40, 24, and 19 patients at 1, 3, and 5 years, respectively. Mild complications occurred in 23.8% of patients, and continence was preserved in all but 1 patient. Kaplan-Meier analysis revealed recurrence-free healing of 83.5% at 1 year, 52.5% at 3 years, and 43.8% at 5 years.</p><p><strong>Limitations: </strong>Single-center design and the predominance of transsphincteric fistulas among the cases.</p><p><strong>Conclusions: </strong>Platelet-rich plasma treatment for anal fistulas in Crohn's disease patients is safe, feasible in an outpatient setting, and associated with high healing rates and low recurrence. See Video Abstract .</p><p><strong>Tratamiento de la fstula anal en la enfermedad de crohn con plasma rico en plaquetas resultados a largo plazo: </strong>ANTECEDENTES:Aproximadamente el 90 % de los pacientes con fístulas anales secundarias a la enfermedad de Crohn requieren intervención quirúrgica. Aún no se ha establecido una técnica ideal que logre altas tasas de curación con mínimas complicaciones y baja recurrencia. En otras disciplinas médicas, el plasma rico en plaquetas ha demostrado propiedades regenerativas y curativas, lo que ofrece nuevas posibilidades terapéuticas.Objetivo:El objetivo de este estudio fue evaluar la tasa de cicatrización a 5 años en pacientes con fístulas anales debidas a la ","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"792-800"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr. Bob: A Forgotten Giant Amongst Proctologists.","authors":"Charles H Knowles","doi":"10.1097/DCR.0000000000004121","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004121","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}