{"title":"Fistula to the Neovagina After Gender-Affirming Surgery: Understanding, Management, and Postoperative Care.","authors":"Arielle E Kanters","doi":"10.1055/s-0045-1804521","DOIUrl":"10.1055/s-0045-1804521","url":null,"abstract":"<p><p>Gender-affirming surgery (GAS) represents a significant step for many transgender individuals, facilitating alignment of physical anatomy with gender identity. With the growing availability of gender-affirming surgical care, it is essential that we are prepared to discuss and manage postoperative complications. Multidisciplinary care is warranted in the setting of both rectal injury as well as the development of a rectovaginal fistula. By understanding the intricacies of fistula formation and employing effective repair techniques, healthcare providers can significantly improve outcomes for patients facing this challenging complication.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"420-426"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrent Rectal Prolapse.","authors":"Leon Naar, Vipul Sheth, Brooke Gurland","doi":"10.1055/s-0045-1804524","DOIUrl":"10.1055/s-0045-1804524","url":null,"abstract":"<p><p>Surgical correction is the primary treatment of external rectal prolapse. The likelihood that rectal prolapse will return is reported to be between 5 and 40% depending on a combination of technical and patient factors. In this review, we will present patient features as well as technical factors during index repair that have been shown to place patients at higher risk of recurrence. Subsequently, we will present the available data regarding the management of recurrent rectal prolapse and our approach in the care of patients with recurrence.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"384-391"},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"History of the Treatment of Rectal Prolapse.","authors":"Rebecca Spivak, Katherine Hu","doi":"10.1055/s-0045-1804512","DOIUrl":"10.1055/s-0045-1804512","url":null,"abstract":"<p><p>Rectal prolapse is the intussusception of the rectum, resulting in its full-thickness protrusion out of the anus. Approximately 0.5% of the general population is affected by this condition, with a higher occurrence in women and the elderly. While benign, rectal prolapse can be debilitating, as it can cause pain, bleeding, mucus discharge, and fecal incontinence. The earliest documented records of rectal prolapse date back to Ancient Egypt (1500-1200 BC), describing laxatives and topical therapeutics for the treatment of an anus turned inside out. Many techniques were devised to hold the reduced prolapsed rectum in place, ranging from cords to the use of bandages. Surgical cauterization of the anal sphincter to prevent recurrent prolapse began as early as 6 BC in India, a practice that continued into the 1800s. Advances in fundamental understanding of the anatomy of the colon, rectum, and anus in the 19th and early 20th centuries paved the way for modern surgical approaches. The 20th century saw the development of procedures proposed by surgeons such as Delorme, Moschowitz, Ripstein, and Altemeier. The emergence of the laparoscopic rectopexy in 1992 and subsequent use of robotic-assisted techniques in the early 2000s marked the transition to modern rectal prolapse surgeries, improving both precision and outcomes. The overall management of rectal prolapse has evolved significantly from ancient remedies to the surgeries known today, yet some fundamental similarities remain consistent between today's outlook and what was documented centuries ago. Understanding the historical evolution of the diagnosis and treatment of rectal prolapse provides insight into the contemporary management of the disorder.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"363-368"},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Rahman, Shannon L Wallace, Anna R Spivak, Vanessa A Hortian
{"title":"Ways to Repair Multicompartment Prolapse: Decision-Making and Surgical Approach.","authors":"Sara Rahman, Shannon L Wallace, Anna R Spivak, Vanessa A Hortian","doi":"10.1055/s-0045-1804514","DOIUrl":"10.1055/s-0045-1804514","url":null,"abstract":"<p><p>Multicompartment pelvic organ prolapse (POP) occurs when multiple pelvic organs herniate through the pelvic floor, impacting quality of life and daily function. Concomitant POP and rectal prolapse are common but often underrecognized. A multidisciplinary approach involving urology, urogynecology, and colorectal surgery is essential for comprehensive care and improved outcomes. Concurrent surgeries are increasingly performed, allowing patients to address both conditions in a single operation without heightened complication rates. Treatment for rectal and vaginal prolapse can be achieved through robotic, laparoscopic, open abdominal, or vaginal/perineal approaches. Surgical selection is guided by patient comorbidities, treatment goals, the choice of mesh versus native tissue repair, and the surgeon's experience. This article presents five different approaches to illustrate the nuances of combined surgical approaches, offering insights into optimizing the treatment of multicompartment POP.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"375-383"},"PeriodicalIF":1.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Collaboration Commentary: Breaking Down the Role of Pelvic Health Physical Therapy in Colorectal Care.","authors":"Julia Barten","doi":"10.1055/s-0045-1804526","DOIUrl":"10.1055/s-0045-1804526","url":null,"abstract":"<p><p>Pelvic health treatment demands an understanding of multiple pelvic subspecialties to adequately address. While there are many providers who identify as pelvic health physical therapists, not all are sufficiently able to manage bowel dysfunction. There is a limited number of certified pelvic health specialists within the United States. The goal of this clinical commentary is to break down the role pelvic health physical therapy (PHPT) plays in treatment for colorectal care. The \"background\" provides insight into the physical therapy (PT) education process and pelvic health specialization. The \"methods\" discuss PHPT treatment including patient education, examination techniques, value of tests and images, as well as common colorectal conditions. A table summarizes possible findings and treatment considerations for common colorectal conditions, methods for optimizing pelvic floor muscles (PFMs) are discussed, and pelvic devices are explained. The \"results\" of referring patients and expectation for goals is reviewed along with a \"discussion\" of room for improvement and \"conclusion\" of important takeaways. The depth of the vast subjects covered shall only be briefly summarized in this clinical commentary with the hope that it provides context, explanations, recommendations, and leads to future discussions and research that includes PHPT.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"392-401"},"PeriodicalIF":1.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Low Anterior Resection Syndrome, Role of SNM?","authors":"Franco Marinello","doi":"10.1055/s-0045-1804527","DOIUrl":"10.1055/s-0045-1804527","url":null,"abstract":"<p><p>Low anterior resection syndrome (LARS) includes all bowel dysfunctions after rectal cancer surgery, causing significant damage to survivors' quality of life. Among different therapeutical approaches, sacral neuromodulation (SNM) has become an interesting technique to palliate LARS symptoms. This article highlights the pathophysiology of LARS, describing the most important aspects of SNM in this scenario.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"417-419"},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Updates on Pelvic Floor Disorders: Evaluation and Management.","authors":"Anna R Spivak","doi":"10.1055/s-0045-1804511","DOIUrl":"10.1055/s-0045-1804511","url":null,"abstract":"","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"361-362"},"PeriodicalIF":1.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reflections on 30 Years of Taking Care of Patients with Pelvic Floor Disorders.","authors":"Tracy L Hull","doi":"10.1055/s-0045-1804522","DOIUrl":"10.1055/s-0045-1804522","url":null,"abstract":"<p><p>Over the past three decades care of patients with pelvic floor disorders has changed dramatically. Fecal incontinence surgery that initially was repair or encircling the anal sphincter now is treated as a first line with sacral nerve stimulation. Rectal prolapse surgery has benefited from minimally invasive approaches and an abdominal approach is considered even in older frail individuals. Medication for constipation has dramatically helped more patients avoid surgery. A multidisciplinary approach with surgeons operating during the same anesthesia on the middle/anterior pelvis and posterior pelvis is common. Evaluation of outcomes and patient-reported outcomes are the norm. We have come a long way toward care of this group of patients, but we still have huge steps to achieve to optimize care as we look toward the next 30 years.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"427-431"},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna K Gernand, Darrielle L Allen, Stephen E Lupe, Madison L Simons
{"title":"The Role of Psychologists in Treating Pelvic Pain Conditions.","authors":"Anna K Gernand, Darrielle L Allen, Stephen E Lupe, Madison L Simons","doi":"10.1055/s-0045-1804499","DOIUrl":"10.1055/s-0045-1804499","url":null,"abstract":"<p><p>Patients with pelvic floor disorders may experience a wide range of symptoms affecting one or more compartments of the pelvic floor (anterior/urinary, apical/reproductive, and posterior/gastrointestinal). Disorders affecting the pelvic organs (e.g., endometriosis, IBS), nerves, and supportive musculature (e.g., pelvic floor dysfunction, muscle trauma) often co-occur. As a result, individuals with one or more of these conditions may fluctuate between or simultaneously experience symptoms such as pelvic pain, urinary frequency/urgency/incontinence, sexual dysfunction, and gastrointestinal problems. This multifaceted range of symptoms results in the need for interdisciplinary team-based approaches to tailor treatment. Given the negative impact pelvic floor symptoms can have on quality of life and mental health which in turn can \"turn up the dial\" on the severity of symptoms, psychologists play an integral role in optimizing care for the whole patient. The rationale for and role of the psychologist in treating gastrointestinal and urogynecological symptoms will therefore initially be discussed according to symptom cluster after which the scope for a transdiagnostic treatment approach will be explored.</p>","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"402-410"},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anna R. Spivak, DO, FACS, FASCRS.","authors":"Scott R Steele","doi":"10.1055/s-0045-1804510","DOIUrl":"10.1055/s-0045-1804510","url":null,"abstract":"","PeriodicalId":48754,"journal":{"name":"Clinics in Colon and Rectal Surgery","volume":"38 6","pages":"359-360"},"PeriodicalIF":1.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}