Techniques in Coloproctology最新文献

{"title":"Correction: The role of ureteric indocyanine green fluorescence in colorectal surgery: a retrospective cohort study.","authors":"P Rogers, J Dourado, A Wignakumar, B Weiss, P Aeschbacher, Z Garoufalia, V Strassmann, S Emile, P Strzempek, S Wexner","doi":"10.1007/s10151-025-03112-8","DOIUrl":"10.1007/s10151-025-03112-8","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"62"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374940","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":"Patterns and predictors of postoperative complications and recurrence after ileocecal resection for Crohn's disease: a national multicenter longitudinal study.","authors":"A Soler-Silva, L Sánchez-Guillén, F Blanco-Antona, X Barber, M Millán","doi":"10.1007/s10151-024-03054-7","DOIUrl":"10.1007/s10151-024-03054-7","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) negatively impacts quality of life, and a high percentage of patients will need surgery. Ileocecal resection (ICR) is the most common abdominal procedure performed in CD. Postoperative complications are frequent, and recurrence is common. The main objectives of this study were to analyze risk factors (RF) for anastomotic leakage (AL) and recurrence after ICR, as well as quality of life (QoL) in CD in a sample of the Spanish population.</p><p><strong>Methods: </strong>A prospective, multicenter, observational study was designed, including all types of hospitals in Spain from 2018 to 2021. Demographic and medical-surgical characteristics, postoperative complications, hospital types by annual ICR volume, and quality of life (IBDQ-9) up to 1 year follow-up (OYF) were recorded and analyzed.</p><p><strong>Results: </strong>A total of 386 ICRs were recorded. At 60 days, there were 134 (36.4%) complications, 46 (11.91%) of which were major. A total of 23 (5.9%) AL were registered, and RF were Montreal A3 [OR 14.2, 95% CI (2.70-126), p = 0.005], Montreal p [OR 7.29, 95% CI (1.14-44.4), p = 0.029], and intensified adalimumab treatment [3.8, 95% CI (1.2-13.1), p = 0.026]. Recurrences at OYF were 67 (19%), and RF were history of neoplasia [OR 7.14, p = 0.01], Montreal B3 [OR 2.12, p = 0.02], and minimally invasive surgery (MIS) [OR 2.63, p = 0.02]. The mean difference in IBDQ-9 from baseline to 60 days was +1.72 (n = 177, p < 0.001) and to OYF +2.12 (n = 140, p < 0.001).</p><p><strong>Conclusions: </strong>The AL rate was 5.9%. Montreal A3, perianal disease, and intensified adalimumab were associated with a higher rate of AL. The recurrence rate was 17.6% (OYF). Prior neoplasia, Montreal B3, and MIS were associated with higher risk of recurrence. ICR improves quality of life at 60 days and is maintained 1 year after surgery.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"61"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374953","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":"Aesthetic benefit of single-port laparoscopic ileo-caecal resection for Crohn's disease: a comparative study.","authors":"A Antier, A Challine, M Collard, L V O'Connell, C Debove, N Chafai, J H Lefevre, Y Parc","doi":"10.1007/s10151-024-03067-2","DOIUrl":"10.1007/s10151-024-03067-2","url":null,"abstract":"<p><strong>Background: </strong>Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn's disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn's disease.</p><p><strong>Methods: </strong>This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia.</p><p><strong>Results: </strong>Two hundred and six patients were included (SPL, n = 65, 32%). Most patients were operated on for stricturing disease (64%). Conversion rate to laparotomy was 0% in the SPL group and 17.7% in the MPL group (p < 0.001). The complication rate was similar in both groups (SPL, 29.2%; MPL, 38.3%; p = 0.21) as was length of stay (5 days [4-7] in both groups). In total 124 (71%) responded to the questionnaire (MPL, n = 74, 67%; SPL, n = 50, 78%; p = 0.11). The SPL group scored better on the cosmesis scale (21.1 vs. 18.4, p < 0.001). In the SPL group, body image scale scores were better for patients with an intraumbilical incision (intraumbilical 5.2 (± 0.6) vs. periumbilical 6.4 (± 2), p = 0.04). After matching, body image scale scores were similar in both groups (SPL, 6; MPL, 6.4; p = 0.24), but cosmesis scale scores remained better in the SPL group (21.1 vs. 19.3, p = 0.03).</p><p><strong>Conclusion: </strong>Ileocolic resection for Crohn's disease with single-port laparoscopy has better cosmetic outcomes than with the multiport approach. Postoperative complications and long-term incisional hernia rate are similar. Routine use of an intraumbilical incision could improve cosmetics.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"59"},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191150","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":"Systematic review of the management options available for low anterior resection syndrome (LARS).","authors":"G Sharp, N Findlay, D Clark, J Hong","doi":"10.1007/s10151-024-03090-3","DOIUrl":"10.1007/s10151-024-03090-3","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer incidence is increasing. Low anterior resection is currently the gold standard surgical management. Postoperatively, patients may present with symptoms indicative of low anterior resection syndrome (LARS). LARS can be debilitating and is difficult to treat with low efficacy of treatment modalities. This systematic review aims to highlight the current evidence regarding LARS management.</p><p><strong>Methods: </strong>Systematic review of Medline, Cochrane and Embase used the following terms: \"low anterior resection syndrome\" AND \"management\", \"low anterior resection syndrome\" AND \"treatment\". Articles that focus solely of low anterior resection syndrome management in patients > 18 years were included. Bias risk was assessed via the Newcastle-Ottawa quality assessment scale for cohort studies and the JBI critical appraisal tool for randomized controlled trials. Due to heterogeneity of methodology, no statistical analysis was performed.</p><p><strong>Results: </strong>Thirty-eight articles with a total of 1914 patients were included in this review. Ninety-five per cent underwent surgery for malignancy. Treatment options included pharmacology, pelvic floor rehabilitation (PFR), transanal irrigation (TAI), sacral nerve modulation (SNM), percutaneous tibial nerve stimulation (PTNS) and \"treatment programs\" starting from the least invasive procedures escalating to more invasive treatments upon failure. The most common published medical therapies report Ramoestron use; however, studies are low impact. PFR showed significant improvement in LARS mostly in those with symptoms of faecal incontinence. However, long-term outcomes are inconsistent. TAI supplies pseudo-continence with its greatest benefit reported in those with incomplete evacuation. TAI has significant short-term effects on LARS but little long-term effect. TAI is also associated with a significant drop-out rate. SNM's hypothesised benefit is extrapolated from non-LARS associated FI. Results show improvements in FI but a high rate of explantation. PTNS evidence suggests little if any significant LARS improvement. A single \"stepwise programme\" study reported that 77 per cent did not progress further than diet and medication. Little evidence suggests benefit regarding diet or acupuncture.</p><p><strong>Discussion: </strong>There is no consensus as to the optimal treatment strategy for LARS. LARS is multifactorial and requires sensitive discussion between patient and surgeon to address the most prominent symptom. It requires physical and psychological input. No single treatment option provides superior results. Treatment is based on symptom control and patient acceptance.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"58"},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191209","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":"Surgical anatomy of lateral lymph node dissection: landmarks and areas of dissection in minimally invasive surgery.","authors":"T Yamaguchi, T Akiyoshi","doi":"10.1007/s10151-024-03078-z","DOIUrl":"10.1007/s10151-024-03078-z","url":null,"abstract":"<p><p>Lateral lymph node dissection (LLND) for rectal cancer is a vital procedure to achieve en bloc removal of metastatic lateral lymph nodes with surrounding fat tissues, guided by precise anatomical landmarks. The anatomy of the lateral compartment, however, is not straightforward for the majority of surgeons. Inadequate knowledge of the vascular and neural anatomy may increase the risk of intraoperative complications such as bleeding, nerve injury and incomplete lymph node dissection. Minimally invasive surgery provides enhanced visualization of the surgical anatomy in the lateral compartment. Comprehensive knowledge of surgical anatomy is indispensable for successful LLND, and  simplifying the anatomy into the planes makes the procedure accessible for surgeons. This article  presents anatomical landmarks essential for standardizing the step-by-step procedures of LLND and review the literature. i.e., for safe implementation of the procedures.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"60"},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191204","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":"Comparing answers of ChatGPT and Google Gemini to common questions on benign anal conditions.","authors":"C M Maron, S H Emile, N Horesh, M R Freund, G Pellino, S D Wexner","doi":"10.1007/s10151-024-03096-x","DOIUrl":"10.1007/s10151-024-03096-x","url":null,"abstract":"<p><strong>Introduction: </strong>Chatbots have been increasingly used as a source of patient education. This study aimed to compare the answers of ChatGPT-4 and Google Gemini to common questions on benign anal conditions in terms of appropriateness, comprehensiveness, and language level.</p><p><strong>Methods: </strong>Each chatbot was asked a set of 30 questions on hemorrhoidal disease, anal fissures, and anal fistulas. The responses were assessed for appropriateness, comprehensiveness, and reference provision. The assessments were made by three subject experts who were unaware of the name of the chatbots. The language level of the chatbot answers was assessed using the Flesch-Kincaid Reading Ease score and grade level.</p><p><strong>Results: </strong>Overall, the answers provided by both models were appropriate and comprehensive. The answers of Google Gemini were more appropriate, comprehensive, and supported by references compared with the answers of ChatGPT. In addition, the agreement among the assessors on the appropriateness of Google Gemini answers was higher, attesting to a higher consistency. ChatGPT had a significantly higher Flesh-Kincaid grade level than Google Gemini (12.3 versus 10.6, p = 0.015), but a similar median Flesh-Kincaid Ease score.</p><p><strong>Conclusions: </strong>The answers of Google Gemini to questions on common benign anal conditions were more appropriate and comprehensive, and more often supported with references, than the answers of ChatGPT. The answers of both chatbots were at grade levels higher than the 6th grade level, which may be difficult for nonmedical individuals to comprehend.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"57"},"PeriodicalIF":2.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043316","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":"Robotic-assisted total proctocolectomy with ileal pouch-anal anastomosis in familial adenomatous polyposis: a step-by-step approach for surgeons advancing to expertise.","authors":"S Jearanai, T Limvorapitak","doi":"10.1007/s10151-024-03107-x","DOIUrl":"10.1007/s10151-024-03107-x","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034514","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":"Who is a candidate at the initial presentation? Prediction of positive lateral lymph node and survival after dissection.","authors":"Y Lee","doi":"10.1007/s10151-024-03079-y","DOIUrl":"10.1007/s10151-024-03079-y","url":null,"abstract":"<p><p>Metastatic lateral pelvic lymph node (LPN) in rectal cancer has a significant clinical impact on the prognosis and treatment strategies. But there are still debates regarding prediction of lateral pelvic lymph node metastasis and its oncological impact. This review explores the evidence for predicting lateral pelvic lymph node metastasis and survival in locally advanced rectal cancer. Until now many studies have reported that magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are considered as essential tools for predicting metastatic LPN, with MRI-based size criteria, particularly the short-axis diameter of LPN. But several studies have reported that the addition of tumor location or artificial intelligence (AI) can further enhance diagnostic accuracy. Western practices focus more on neoadjuvant chemoradiation (nCRT), while Eastern countries focus more on lateral pelvic lymph node dissection (LPND). LPND has been shown to reduce lateral local recurrence (LLR) rates compared to total mesorectal excision (TME) alone, particularly in patients with enlarged LPNs, but its impact on overall survival is uncertain. The decision to perform LPND should be individualized according to LPN size and response to nCRT; and through selective LPND based on those criteria, patients could achieve a balance between the benefit of local control and the risk of surgical complications from LPND, such as sexual and urinary dysfunction.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"52"},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025585","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":"Positive lateral lymph node turned negative after neoadjuvant therapy-surgery or observation?","authors":"E G M van Geffen, M Kusters","doi":"10.1007/s10151-024-03080-5","DOIUrl":"10.1007/s10151-024-03080-5","url":null,"abstract":"<p><p>Since the adoption of neoadjuvant chemoradiation and total mesorectal excision as the standard in rectal cancer care, there has been marked improvement in the local recurrence rates. In this context, restaging magnetic resonance imaging (MRI) plays a key role in the assessment of tumor response, occasionally enabling organ-sparing approaches. However, the role of restaging MRI in evaluating lateral lymph nodes remains limited. Most studies suggest a high risk of lateral local recurrence regardless of a decrease in lymph node size on restaging MRI. Therefore, it is recommended that clinical decisions should rely on the primary MRI scan. Watchful waiting may be appropriate only in cases of a clinical complete response with substantial downsizing of lateral lymph nodes (≤ 4.0 mm). Notably, some lateral lymph nodes may enlarge during follow-up despite complete tumor response, in which case, lateral lymph node dissection can be considered while preserving the rectum. Thus, continuous surveillance of lateral lymph nodes is essential during watchful waiting. Restaging MRI may hold greater importance for smaller lymph nodes (5.0-6.9 mm), as those with persistent malignant features on imaging carry a 13% risk of lateral recurrence at 4 years. Understanding these risks is critical when engaging in shared decision-making with the patient.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"53"},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025564","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":"The oncologic benefits of lateral lymph node dissection after neoadjuvant therapy - local control or survival?","authors":"T Sammour","doi":"10.1007/s10151-024-03082-3","DOIUrl":"10.1007/s10151-024-03082-3","url":null,"abstract":"<p><p>Lateral pelvic lymph node dissection (LPLND) for rectal adenocarcinoma is an established treatment modality for selected patients with abnormal lateral pelvic lymph nodes on magnetic resonance imaging (MRI) imaging. The goal of this treatment is to achieve a true R0 resection, including lymphadenectomy, with the aim of improving patient oncological outcome, potentially at the expense of surgical and functional complications. However, there remain several areas of controversy resulting from a distinct lack of clarity regarding effective patient selection, lymph node size criteria, the role and extent of routine neoadjuvant treatment versus surgery alone in selected cases, the impact on patient survival metrics and whether the existing data are even valid in the era of total neoadjuvant therapy (TNT). Furthermore, the lack of widely disseminated surgical standardisation and expertise in performing this procedure potentially contributes to the lack of utilisation in certain countries and regions. In this narrative review, we summarize the current state of the literature and attempt to answer the question of what oncological benefits there are, if any, from LPLND after neoadjuvant therapy in rectal cancer, and whether these justify the risks and potential need for inter-hospital transfer.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"51"},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025571","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}