Techniques in Coloproctology最新文献

{"title":"Anal incontinence: encirclement with a new medical device.","authors":"J M Devesa, R Vicente, A Ballestero","doi":"10.1007/s10151-024-03100-4","DOIUrl":"10.1007/s10151-024-03100-4","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"72"},"PeriodicalIF":2.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal minimally invasive (TAMIS) mucosal resection with muscular plication for patients with obstructed defecation syndrome-A prospective pilot study.","authors":"K M Widmann, C Dawoud, D Gidl, S Riss","doi":"10.1007/s10151-024-03101-3","DOIUrl":"10.1007/s10151-024-03101-3","url":null,"abstract":"<p><strong>Background: </strong>Rectocele and intussusception are frequently observed during defecography as potential contributors to obstructed defecation syndrome (ODS). We aimed to describe our initial experience with transanal minimally invasive surgery (TAMIS) mucosectomy with muscular plication, as a novel surgical approach to treat patients with ODS.</p><p><strong>Methods: </strong>Conducted between August 2021 and October 2023 at the Medical University of Vienna, 11 patients (8 female) were prospectively enrolled and underwent TAMIS mucosectomy with circular mucosectomy and longitudinal muscular plication (internal Delorme's procedure). Functional outcome and quality of life were assessed by using standardized questionnaires pre- and postoperatively. The median follow up time was 16 months.</p><p><strong>Results: </strong>In defecography rectal intussusception could be observed in all patients and rectocele was found in nine patients (81.8%). The median age at the time of surgical procedure was 56 years (range 28-76 years). Neither intraoperative nor postoperative complications occurred. The median ODS score decreased from 16 to 11 points (p = 0.171), and four out of five patients (80%) with preexistent fecal incontinence reported improvement of their symptoms postoperatively (80%), though one patient had new onset of fecal incontinence symptoms. No significant changes could be demonstrated in terms of quality life by using the Short-Form Health Survey 12 (SF-12) survey.</p><p><strong>Conclusions: </strong>Our initial results showed that TAMIS mucosectomy is a safe technique, offering a viable alternative transanal approach for treating symptomatic ODS. Future studies with a larger sample size and a longer follow-up period should enhance the robustness of our preliminary findings.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"71"},"PeriodicalIF":2.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total fistula volume predicts surgical outcomes in complex perianal fistulizing Crohn's disease following fistula-tract laser closure: a single-center retrospective study.","authors":"D Cao, X Wang, Y Zhang, K Qian, N Yang, M Zhu, Y Li, G Wu, Z Cui","doi":"10.1007/s10151-024-03094-z","DOIUrl":"10.1007/s10151-024-03094-z","url":null,"abstract":"<p><strong>Backgrounds: </strong>This study aimed to identify risk factors influencing long-term treatment outcomes in patients with complex perianal fistulizing Crohn's disease (pfCD) following fistula-tract laser closure (FiLaC™).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from patients with complex pfCD who underwent FiLaC™ from January 2019 to December 2020, including demographics, pharmacological regimens, and preoperative MRI assessments. Follow-up monitored fistula outcomes such as healing, remission, failure, and recurrence.</p><p><strong>Results: </strong>Among 49 patients followed for an average of 60.0 months, 31 (63.3%) achieved fistula healing, 3 (6.1%) showed improvement, 3 (6.1%) had non-healing, and 12 (24.5%) experienced recurrence. Significant differences were found between healed and unhealed groups in total fistula volume (TFV), number of fistula tracts, and perianal Crohn's disease activity index (PDAI) (P = 0.036, P = 0.020, and P = 0.041, respectively). Multivariate regression analysis indicated TFV as a significant predictor of healing outcomes (P = 0.013). ROC analysis confirmed its predictive value for fistula healing in complex pfCD, with an area under the curve (AUC) of 0.729 (P = 0.008). The optimal threshold for TFV was 4.81 cm³, with a sensitivity of 61.1% and a specificity of 83.9%. The AUC for recurrence rates was 0.883 (P < 0.001), with sensitivity and specificity at 83.3% and 83.8%, respectively, using the same threshold for TFV. The Kaplan-Meier survival curve highlighted the predictive potential of TFV for fistula recurrence (P < 0.0001).</p><p><strong>Conclusions: </strong>TFV is an effective predictor of long-term outcomes in patients with complex pfCD following FiLaC™.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"70"},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and usefulness of the elongation of ileocolic pedicle with extended ileal resection on secure anastomosis after laparoscopic restorative proctocolectomy: a retrospective observational study.","authors":"Tatsuya Manabe, Yusuke Mizuuchi, Keiichiro Okuyama, Shin Takesue, Takaaki Fujimoto, Futoshi Tanaka, Masafumi Nakamura, Hirokazu Noshiro","doi":"10.1007/s10151-024-03091-2","DOIUrl":"https://doi.org/10.1007/s10151-024-03091-2","url":null,"abstract":"<p><strong>Purpose: </strong>Tension-free ileal pouch-anal anastomosis (IPAA) in restorative proctocolectomy (RPC) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) is important for avoiding anastomotic complications. We have employed the elongation of ileocolic pedicle (ICP) with extended ileal resection as one of the mesenteric-lengthening techniques. In this study, we examined the feasibility and usefulness of our mesenteric-lengthening technique.</p><p><strong>Methods: </strong>This retrospective study enrolled 60 patients for whom laparoscopic RPC with IPAA was electively planned for UC and FAP from January 2009 to December 2022. In 41 patients (\"conventional group\"), the ileum was cut flush to the cecum without ileal resection, and in 19 patients (\"experimental group\"), the elongation of the ICP with extended ileal resection was conducted. The short-term outcomes were compared between the two groups, and the risk factor for anastomotic complications was examined.</p><p><strong>Results: </strong>The preoperative and intraoperative parameters did not differ between the two groups. However, the incidence of anastomosis-related complications (ARCs) was significantly lower in the experimental group than in the conventional group (0.0% versus 14.6%, respectively; p = 0.027). Univariate analysis demonstrated that the elongation of the ICP with extended ileal resection was significantly correlated with ARCs (p = 0.027 and p = 0.030, respectively), although multivariate analysis did not show the independent factors.</p><p><strong>Conclusion: </strong>The lengthening technique using the elongation of the ICP with extended ileal resection is feasible and safe, and might be one choice for secure IPAA during the laparoscopic approach for RPC.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"66"},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of laparoscopic ventral rectopexy for full-thickness rectal prolapse: the PEXITY study.","authors":"M Barra, B Trilling, G Mastronicola, P-Y Sage, A Roudier, A Foote, F Tidadini, J Fournier, J-L Faucheron","doi":"10.1007/s10151-024-03104-0","DOIUrl":"10.1007/s10151-024-03104-0","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic ventral mesh rectopexy (LVR) has gained increasing acceptance for the treatment of patients with a full-thickness rectal prolapse (RP), but literature on follow-up of at least 10 years is scarce. We studied recurrence rate, long-term functional results and quality of life in patients who had LVR for RP more than 12 years ago.</p><p><strong>Method: </strong>The study population consisted of patients who could be contacted among the 175 who had undergone LVR for RP and whose short- and medium-term outcomes were published in 2012. We studied the long-term recurrence rate (Kaplan-Meier), functional outcome (Wexner and ODS scores), quality of life (EuroQol) and satisfaction of the patient through clinical examination(s), specific scores and questionnaires.</p><p><strong>Results: </strong>Of the 175 patients, 14 patients had exclusion criteria, 57 had died, and 42 were lost to follow-up, leaving 62 patients for analysis. Seventeen patients presented with a recurrence (10.5%) at the 10-year follow-up. The only statistically significant risk factor for recurrence was recurrent RP (HR = 11.5 (2.54-52.2), P = 0.002). The median faecal incontinence score was 4 (0-10) and significantly worse in patients who had a recurrence [12 (7-13) vs 3 (0-9); P = 0.016]. The median obstructive defaecation score was 6 (3-12). The median quality of life score was 7 (6-8). Most patients who presented with a recurrence said they would undergo the operation again and recommended it, as would patients with no recurrence.</p><p><strong>Conclusion: </strong>LVR for RP is a safe and efficient technique with sustainable long-term results that shows long-term efficacy at > 10 years after the operation.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"68"},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersphincteric resection for low-lying rectal cancer: analysis of risk factors and establishment of a preoperative assessment system for postoperative anal function.","authors":"L Lin, Y Wang, Y Cai, Y Lei, W Chen, G Liu","doi":"10.1007/s10151-024-03109-9","DOIUrl":"10.1007/s10151-024-03109-9","url":null,"abstract":"<p><strong>Purpose: </strong>In recent years, intersphincteric resection has increasingly become a viable alternative to abdominoperineal resection due to its significant preservation of the anus. Previous studies have indicated that intersphincteric resection has provides comparable oncological outcomes to APR, but anal incontinence remains a common postoperative complication. we reassessed identify preoperatively controllable and measurable risk factors that may affect anal function following intersphincteric resection, and to attempt to construct a preoperative risk assessment system for anal function after intersphincteric resection, thereby standardizing intersphincteric resection treatment for low rectal cancer.</p><p><strong>Materials and methods: </strong>This single-center retrospective study included 51 patients who underwent intersphincteric resection surgery between January 2018 and March 2023 and maintained autonomous defecation for one year or more were selected. Using Independent samples t-test, rank-sum test, Fisher's exact test, and linear regression, we analyzed anal function at 12 months postoperatively and the clinical factors influencing it. Construction of a postoperative fecal incontinence risk assessment scale for ISR based on standardized coefficients in multifactorial linear regression.</p><p><strong>Results: </strong>Age, clinical T stage, preoperative puborectalis muscle thickness, and preoperative chemoradiotherapy were identified as independent factors affecting postoperative anal function.</p><p><strong>Conclusions: </strong>Older age, higher clinical T stage, thinner preoperative puborectalis muscle thickness, and preoperative chemoradiotherapy are associated with poorer postoperative anal function. Patients with 0-1 high-risk factors can be recommended for intersphincteric resection treatment; those with 3 high-risk factors should not undergo intersphincteric resection; and patients with 2 high-risk factors should have a thorough discussion regarding the potential risks before a cautious surgical decision is made.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"69"},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal repair of anastomotic leakage after oncologic low anterior resection: a prospective cohort.","authors":"W Lossius, T Stornes, T E Bernstein, A Wibe","doi":"10.1007/s10151-024-03103-1","DOIUrl":"10.1007/s10151-024-03103-1","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage is a common complication after low anterior resection for rectal cancer, often resulting in a permanent stoma. This study aimed to evaluate the effectiveness of early detection, sepsis control, and transanal repair in managing anastomotic leakage.</p><p><strong>Methods: </strong>In this prospective cohort study conducted from January 2018 to June 2022 at a Norwegian university hospital, patients undergoing resectional surgery for rectal cancer were assessed for anastomotic leaks. Early detection involved CT with rectal contrast and flexible endoscopy. Repair eligibility required involvement of less than half the anastomotic circumference and no ischemia or retraction of the colon. The cavity outside the anastomotic defect was cleaned using a catheter for intermittent irrigation or endoluminal vacuum therapy. A diverting stoma was created, and a transabdominal pelvic drain was inserted if not already present. Once sepsis was controlled and the cavity was clean, the defect was sutured using a transanal minimally invasive surgery access platform or an open transanal technique, based on anastomosis level. Healing was confirmed via computed tomography (CT) with rectal contrast and rigid proctoscopy before reversing diverting stomas, and again at 12 months. A supplementary video demonstrates the technique.</p><p><strong>Results: </strong>Of 22 identified anastomotic leaks, 11 underwent transanal repair, resulting in healed anastomosis for nine patients and restored bowel continuity for eight. Among these, five reported major low anterior resection syndrome. Median hospital stay was 20 days, with no 90-day mortality.</p><p><strong>Conclusions: </strong>This anastomosis-preserving approach for treating anastomotic leakage shows promise, potentially preserving bowel function and reducing permanent stoma rates.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"67"},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal interventions for low anterior resection syndrome: Bayesian network meta-analysis of randomized controlled trials.","authors":"M Yu, Y Liu, N Li, J Xu, H Zhang, F Li, H Chen, B Li","doi":"10.1007/s10151-024-03099-8","DOIUrl":"10.1007/s10151-024-03099-8","url":null,"abstract":"<p><strong>Background: </strong>The optimal intervention for managing low anterior resection syndrome (LARS) remains uncertain. This Bayesian network meta-analysis was conducted to compare and rank the effectiveness of various interventions on LARS.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) addressing interventions for LARS were extracted from six electronic databases until September 2023. A network meta-analysis was performed using a Bayesian random-effects and consistency model. The results were presented as mean differences (MDs) with credible interval (CrI) or standardized mean differences (SMDs) with CrI.</p><p><strong>Results: </strong>A total of 11 RCTs were included. In the short term (≤ 6 months), transanal irrigation (TAI) had significant positive impacts on overall LARS symptoms (MD (95% CrI) -14.13 (-20.11, -7.83)) and the severity of bowel incontinence (SMD (95% CrI) -1.34 (-1.97, -0.71)) compared with the control group. Pelvic floor rehabilitation (PFR) also exhibited significant improvements in bowel incontinence as compared with the control group (SMD (95% CrI) -0.56 (-0.88, -0.23)). TAI was ranked highest for reducing LARS symptoms, followed by PFR, and percutaneous tibial nerve stimulation (PTNS). In the long term (> 6 months), the results indicated that TAI was most likely to rank first, followed by PTNS, and PFR; however, no significant differences were observed.</p><p><strong>Conclusions: </strong>In the short term, TAI was identified as the most effective treatment for managing LARS, followed by PFR. Both TAI and PTNS demonstrated promising potential in enhancing bowel function over the long term. Further trials are needed to confirm these findings.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"64"},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety of biologic OviTex mesh in ventral mesh rectopexy: a prospective pilot study.","authors":"M A Boom, E M van der Schans, N A T Wijffels, P M Verheijen, E C J Consten","doi":"10.1007/s10151-024-03097-w","DOIUrl":"10.1007/s10151-024-03097-w","url":null,"abstract":"<p><strong>Background: </strong>Minimal-invasive ventral mesh rectopexy (VMR) is a widely accepted treatment for patients suffering from rectal prolapse. The type of mesh used in VMR remains a subject of debate. Currently, the most applied implant is a polypropylene mesh. The aim of the present pilot study was to determine the ease of use, feasibility, and safety of OviTex PGA mesh, a biologic mesh, in VMR.</p><p><strong>Methods: </strong>Consecutive patients who underwent VMR for internal or external rectal prolapse were included in a prospective non-randomised pilot study in two centers. Preoperative and postoperative evaluation (90 days and 6 months) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. The primary objectives were to monitor the perioperative technical end result and the postoperative complication rate.</p><p><strong>Results: </strong>Sixteen patients underwent VMR with an OviTex PGA implant. All operations were completed successfully and without intraoperative complications. The mean ODS and FISI score was significantly decreased after 6-months follow-up. No graft-related complications (GRC) occurred. Two patients developed a recurrent prolapse within 6 months.</p><p><strong>Conclusion: </strong>Robotic correction of rectal prolapse using an OviTex mesh is a safe, minimally invasive, technically feasible treatment. However, further research is warranted to evaluate the potential added value of OviTex compared to polypropylene mesh on a larger scale. Long-term follow-up is essential to assess the durability of the procedure and monitor the occurrence of any new symptoms.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"65"},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical navigation for lateral pelvic lymph node dissection in rectal cancer.","authors":"K Ochiai, S Ishihara","doi":"10.1007/s10151-024-03084-1","DOIUrl":"https://doi.org/10.1007/s10151-024-03084-1","url":null,"abstract":"<p><p>Lateral pelvic lymph node dissection (LPLND) provides oncologic benefits in patients with rectal cancer who have enlarged lateral nodes. However, anatomical complexity in the lateral pelvis makes the procedure technically challenging,  which may lead to  increased intraoperative blood loss, prolonged operative time, postoperative complications and incomplete lymph node dissection. To address such technical  challenges, various surgical navigation tools have been developed. In this up-to-date narrative review, we summarize the current evidence on surgical navigation for LPLND and discuss their advantages,  limitations and future perspectives.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"63"},"PeriodicalIF":2.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}