Diseases of the Colon & Rectum最新文献

{"title":"Comparison of Rubber Band Ligation and Hemorrhoidectomy in Patients With Symptomatic Hemorrhoids Grade III: A Multicenter, Open-Label, Randomized Controlled Noninferiority Trial.","authors":"Justin Y van Oostendorp, Lisette Dekker, Susan van Dieren, Ruben Veldkamp, Willem A Bemelman, Ingrid J M Han-Geurts","doi":"10.1097/DCR.0000000000003679","DOIUrl":"10.1097/DCR.0000000000003679","url":null,"abstract":"<p><strong>Background: </strong>The optimal management strategy for grade III hemorrhoids remains a subject of ongoing debate. Hemorrhoidectomy is the criterion standard, but rubber band ligation offers a less invasive outpatient alternative. Treatment variability persists due to a lack of consensus on the preferred strategy.</p><p><strong>Objective: </strong>To directly compare the effectiveness of rubber band ligation and hemorrhoidectomy in the treatment of grade III hemorrhoids.</p><p><strong>Design: </strong>Open-label, parallel-group, randomized controlled noninferiority trial.</p><p><strong>Settings: </strong>Multicenter study across 10 Dutch hospitals from October 2019 to September 2022.</p><p><strong>Patients: </strong>Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study. Exclusion criteria included prior rectal/anal surgery, more than 1 rubber band ligation/injection within the preceding 3 years, rectal radiation, preexisting sphincter injury, IBD, medical unfitness for surgery (ASA higher than 3), pregnancy, or hypercoagulability disorders.</p><p><strong>Interventions: </strong>Randomized 1:1 to rubber band ligation or hemorrhoidectomy, with up to 2 banding sessions allowed.</p><p><strong>Main outcome measures: </strong>Primary outcomes included 12-month health-related quality of life and recurrence rate. Secondary outcomes included complications, pain, work resumption, and patient-reported outcome measures.</p><p><strong>Results: </strong>Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy). Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%). Complication rates were comparable. Pain scores after hemorrhoidectomy were higher during the first week (visual analogue scale 4 vs 1; p = 0.002). Rubber band ligation group returned to work sooner (1 vs 9 days; p = 0.021). Patient-reported hemorrhoidal symptom scores favored hemorrhoidectomy.</p><p><strong>Limitations: </strong>The primary limitation of the study was its early termination due to funding constraints, resulting in a relatively small sample size and limited statistical power. Patient recruitment was hindered by significant treatment preferences and the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>Hemorrhoidectomy may benefit patients with grade III hemorrhoids in terms of quality of life, recurrence risk, and symptom burden, whereas rubber band ligation allows faster recovery with less pain. These findings can guide clinical decision-making. See Video Abstract .</p><p><strong>Clinical trial registration number: </strong>NCT04621695.</p><p><strong>Comparacin de la ligadura con banda elstica y la hemorroidectoma en pacientes con hemorroides sintomticas grado iii ensa","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"572-583"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequencing or Serendipity? Reevaluating the Role of Order in Colorectal Liver Metastasis Management.","authors":"Mufaddal K Kazi, Shraddha Patkar","doi":"10.1097/DCR.0000000000003696","DOIUrl":"10.1097/DCR.0000000000003696","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e210"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363868","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":"Refining Hemorrhoidectomy Outcomes: A Commentary on Micronized Purified Flavonoid Fraction Use and the MOST Trial Findings.","authors":"Songlin Zhang, Zehui Wang, Wei Yang","doi":"10.1097/DCR.0000000000003695","DOIUrl":"10.1097/DCR.0000000000003695","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e209"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363836","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":"Announcements.","authors":"","doi":"10.1097/01.dcr.0001111712.91101.65","DOIUrl":"https://doi.org/10.1097/01.dcr.0001111712.91101.65","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 5","pages":"e1031"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995742","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":"Colon and Rectal Surgery Regional Society Meetings.","authors":"","doi":"10.1097/01.dcr.0001111716.38074.e6","DOIUrl":"https://doi.org/10.1097/01.dcr.0001111716.38074.e6","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 5","pages":"e1032-e1033"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981657","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":"Excision of an Anal Leiomyoma.","authors":"Jonathan P Knowles, Benjamin J Golas","doi":"10.1097/DCR.0000000000003598","DOIUrl":"10.1097/DCR.0000000000003598","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e203"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Perspective on Outcome Following Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques.","authors":"Arielle E Kanters","doi":"10.1097/DCR.0000000000003711","DOIUrl":"10.1097/DCR.0000000000003711","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"530"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472310","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":"Kono-S.","authors":"Robert J Kucejko, Sachin Vaid, Dimitra Theodoropoulos","doi":"10.1097/DCR.0000000000003672","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003672","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 5","pages":"509"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987790","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":"Bridging Gaps to Improve Care Models for Patients at Risk for Anal Dysplasia and Cancer: A Call to Action.","authors":"Stacy M Ranson, Linnette M Arroyo-Roldan, Elizabeth C Wick, Valentina Robila, Bridget N Fahy, Emily B Rivet","doi":"10.1097/DCR.0000000000003582","DOIUrl":"10.1097/DCR.0000000000003582","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"499-502"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390502","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":"National Trends in Hospital Admissions, Interventions, and Outcomes for Early-Onset (Age <50 years) Diverticulitis From 2005 to 2020.","authors":"Shineui Kim, Oh Jin Kwon, Nikhil L Chervu, Saad Mallick, Konmal Ali, Peyman Benharash, Alexander T Hawkins, Hanjoo Lee, Aimal Khan","doi":"10.1097/DCR.0000000000003668","DOIUrl":"10.1097/DCR.0000000000003668","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Little is known about the burden and outcomes of diverticulitis in patients younger than 50 years. This knowledge gap hinders the development of effective management strategies and preventive measures for this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to analyze national trends in hospitalizations, interventions, and outcomes for early-onset diverticulitis (age younger than 50 years) in comparison to standard-onset diverticulitis (age 50 years or older) cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings: &lt;/strong&gt;A survey-weighted, national sample extracted from the National Inpatient Sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;All adults (18 years or older) hospitalized for diverticulitis between 2005 and 2020 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;National trends in the proportions of early-onset versus standard-onset diverticulitis were found to be related, along with the rates of colectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 2005 to 2020, 5,239,735 patients were nonelectively hospitalized for diverticulitis. Of them, 837,195 (16.0%) were early onset. During the study period, the proportion of the early-onset cohort admitted for complicated diverticulitis significantly increased from 18.5% to 28.2% (nonparametric trend &lt; 0.001). In addition, there was a decline in the proportion of early-onset diverticulitis patients needing a colectomy (34.7%-20.3%, nonparametric trend &lt; 0.001), with a corresponding increase in the proportion of patients needing interventional radiology intervention (12.7%-28.6%, nonparametric trend &lt; 0.001). Compared to standard-onset diverticulitis, early-onset diverticulitis was associated with decreased odds of mortality (adjusted OR 0.18; 95% CI, 0.16-0.20; p &lt; 0.001) as well as decreased length of stay (β -0.28 days; 95% CI, -0.32 to -0.24; p &lt; 0.001) and hospitalization costs (β -$1900; 95% CI, -$2100 to -$1800; p &lt; 0.001). In addition, early-onset diverticulitis was associated with increased odds of colectomy (adjusted OR 1.29; 95% CI, 1.26-1.31) and percutaneous drainage (adjusted OR 1.58; 95% CI, 1.53-1.62).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective data collection. Lack of granular clinical data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There has been a significant increase in the proportion of complicated diverticulitis-related admissions among patients younger than 50 years. Patients with early-onset diverticulitis were more likely to undergo colectomy or percutaneous drainage than those with standard-onset (at age 50 years or older) diverticulitis. Additional research is needed to determine the cause of these trends and identify public health policies aimed at potentially preventing the increasing burden of diverticulitis among younger populations. See Video Abstract .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Tendencias nacionales en admisiones hospitalarias, intervenciones y resultados en casos de diverticulitis precoz eda","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"562-571"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188451","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}