World journal of colorectal surgery最新文献

{"title":"Right versus left Colon cancer: Is there a difference in outcomes?","authors":"A. Plastiras, E. Iosif, G. Georgiou, A. Haji, Asif I Haq, S. Papagrigoriadis, J. Nunoo-Mensah","doi":"10.4103/WJCS.WJCS_31_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_31_18","url":null,"abstract":"Background: Colorectal cancer is a major healthcare problem due to its high prevalence and mortality rates. Objective: The objective of the study is to delineate the relationship between the location of the colon cancer and the outcomes. Design: This is a retrospective, single-center study including patients diagnosed with right and left colon cancer from January 2010 to December 2015. Setting: Patients with no rectal or synchronous metastatic disease were included in the study. Diagnosis was confirmed following a computed tomography and colonoscopy. Patients and Methods: Four hundred and seventy-five patients with colon cancer were included; 226 right-sided tumors (RCC) and 249 with left-sided colon cancer (LCC) underwent surgery. Main Outcome Measures: We compared right- and left-sided tumors in terms of epidemiological, histological, clinical, and perioperative characteristics, and we also attempted to determine whether there is a difference in the overall and per stage survival. Sample Size: Four hundred and seventy-five patients with colon cancer. Results: Patients with colon cancer were analyzed, 226 (47.5%) with RCC and 249 (52.4%) with LCC underwent surgery. Patients with RCC were more likely to be women, older, and with more comorbidities. Furthermore, RCC were more likely to be poorly differentiated (29.65%, P < 0.001) and more locally advanced at the time of diagnosis (P < 0.001). Controlling the differentiation for each stage, there was no statistical significant difference between left and right survival and recurrence (P > 0.05). When stratified according to tumor stage, Stage II LCC had better overall survival (odds ratio [OR], 1.694, 95% confidence interval [CI], 1.015, 2.827) and Stage III LCC had a better overall survival (OR, 1.403, 95% CI, 1.007, 2.143), disease-free survival (OR, 1.293, 95% CI, 1.011, 1.714), and less cancer-related deaths (OR, 0.282, 95% CI, 0.080, 1.000). Conclusions: Comparing similar stages, patients with LCC appear to have better oncological outcomes irrespective of tumor differentiation. Limitations: Single-center, retrospective study without excluding patients with hereditary cancers. Oncological biomarkers were not available in all patients, and further analysis was not performed.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49184150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the efficacy of biofeedback for chronic constipation using the constipation severity instrument and constipation-related quality of life measure","authors":"Y. Lan, Lillian G Jahan, M. Varma","doi":"10.4103/WJCS.WJCS_7_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_7_18","url":null,"abstract":"Background: Many studies have described using biofeedback to treat chronic constipation, but few reports have addressed its impact on quality of life (QOL). Objective: The aim was to evaluate the effect of biofeedback with a validated Constipation Severity Instrument (CSI) and Constipation-Related QOL (CRQOL) measure. Design: Prospectively collected data with retrospective analysis. Setting: Tertiary care academic center. Patients and Methods: Patients referred to the Center for Pelvic Physiology with chronic constipation and objective signs of pelvic floor dyssynergia, who received a complete course of biofeedback therapy and returned all of their questionnaires, were enrolled in the study. Questionnaires were given upon initial evaluation, immediately after the complete course of biofeedback, and 6 months later. Main Outcome Measures: Improvement of dyssynergia symptom and QOL by CSI and CRQOL. Sample Size: A total of 25 patients (20 females and 5 males) were included. Results: Overall, 75% of patients reported satisfactory symptom and QOL improvement. CSI total scores decreased after treatment (35.0 vs. 31.0, P = 0.06) and at 6-month follow-up (35.0 vs. 30.0, P = 0.05). Only the obstructive defecation (OD) subscale of CSI improved significantly after treatment (median 21.0 vs. 16.5, P < 0.01) and sustained to 6 months after therapy (median 21.0 vs. 18.5, P = 0.03). Statistically significant improvement was seen in the distress subscale of the CRQOL immediately after biofeedback (24.0 vs. 18.0, P = 0.02). Conclusions: This study demonstrated that the active effects of biofeedback in constipated patients were specific to OD symptoms and the distress subscale for QOL. CSI and CRQOL are both useful tools to evaluate the specific response of constipated patients after biofeedback therapy. Limitations: The study limitation was the small sample size due to difficulty in obtaining complete information in the enrolled patients.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43375696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colon and rectal surgery for inflammatory bowel disease patients on vedolizumab: Preliminary surgical outcomes","authors":"S. Stringfield, Lisa A. Parry, S. Ramamoorthy, S. Eisenstein","doi":"10.4103/1941-8213.240252","DOIUrl":"https://doi.org/10.4103/1941-8213.240252","url":null,"abstract":"Background and Objectives: Vedolizumab is an antagonist of leukocyte trafficking that targets gut α4β7 integrins and is efficacious in inflammatory bowel disease (IBD). Studies investigating postoperative complications in patients on this medication have not been performed. The objective of this study is to identify rates and types of postoperative complications experienced in patients with IBD who have undergone surgery following treatment with vedolizumab. Patients and Methods: This was a retrospective review of the electronic medical record of patients with IBD who underwent perianal or abdominal surgery, June 2014–March 2016, at the University of California San Diego Medical Center. Main outcome measures were rates and types of postoperative complications. Results: Patients were divided into three treatment groups: vedolizumab, other biologics, and no biologics. Twenty-nine patients on vedolizumab underwent forty operations that fit study criteria. Fifteen of 26 abdominal operations experienced a postoperative complication, for a complication rate of 57.7%. The most common complication was infectious (34.6%). Anastomotic leak rate was 16.7% and mortality rate was 7.7%. Complication rates in patients on vedolizumab were higher than rates in other patients with IBD. One of 14 perianal operations experienced an infectious complication (7%). Readmission rate in abdominal patients on vedolizumab was higher than the other categories (31% vs. 7% and 10%, P = 0.01). Conclusions: We observed high rates of postoperative complications in patients on vedolizumab who underwent abdominal surgery. Rates were higher than published outcomes as well as outcomes for other IBD patients at our institution. Studies including larger numbers of patients must be performed to further investigate this issue.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47211415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#Colorectalsurgery: Connecting colorectal surgeons around the world","authors":"S. Emile, H. Elfeki","doi":"10.4103/1941-8213.240256","DOIUrl":"https://doi.org/10.4103/1941-8213.240256","url":null,"abstract":"","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42961461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back to basics – The importance of enterostomal therapy education for general surgery residents","authors":"John J. Tackett, Annabelle L. Fonseca, W. Longo","doi":"10.4103/1941-8213.240253","DOIUrl":"https://doi.org/10.4103/1941-8213.240253","url":null,"abstract":"Background and Objectives: General surgery residents' perceived knowledge base and comfort with intestinal stomas and enterostomal therapy are profiled through a national survey. Subjects and Methods: General surgery residents were surveyed to explore the existence of formal didactics and training in ostomy creation and stomal care, to examine the residents' perceived knowledge base of clinical indications for enterostomal care approaches, and to elicit the residents' comfort with performing enterostomal surgeries and managing complications. Results: A total of 734 US residents were surveyed. 218 respondents completed the survey (30%): 40% Northeast, 22% Midwest, 22% South, 16% West, and 82% with direct university affiliation. Only 12% experienced formal enterostomal therapy training and only 15% attended related lectures. Most (86%) routinely worked with enterostomal therapists. Only 11% of chiefs felt “very confident” in their knowledge base of clinical indications for enterostomal care, and 61% felt “very comfortable” with surgical procedures of ostomy creation and closure. Merely 4% of all residents felt “very comfortable” dealing with common ostomy complications. Conclusions: In an era of surgical subspecialization and advanced nursing practice in enterostomal therapy, general surgery residents lack confidence in their knowledge base and comfort when approaching enterostomal therapy and stomal complications. US resident education should be reformed to enhance training in these fundamental principles essential to general surgery practice.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44665003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of prone jackknife position in ambulatory anorectal surgery","authors":"F. Cheema, Sabair Lee, Marcus Zebrower, J. Poggio","doi":"10.4103/1941-8213.240255","DOIUrl":"https://doi.org/10.4103/1941-8213.240255","url":null,"abstract":"Background and Objectives: The objectives of this study were to determine morbidity and mortality rates of ambulatory anorectal surgeries in prone jackknife position. Patients and Methods: Retrospective chart analysis on 210 patients undergoing ambulatory anorectal surgery in the prone jackknife position. The primary endpoint studied was mortality and complication rates. Other factors analyzed were age, sex, clinical diagnosis, procedure, past medical history, American Society of Anesthesiologists physical status classification, current smoking status, mean pre- and post-operative mean arterial pressure (MAP), mean minimum intraoperative MAP, minimum intraoperative O2saturation, estimated blood loss, fluids given, anesthesia duration, antibiotic administration, and days to discharge and whether there were any readmissions within 30 days. To assess significant differences between pre-, intra-, and post-operative mean arterial pressure, one-way ANOVA was used. Results: There was no mortality within 30 days of surgery. Complication rate was 3.3% with urinary retention being the most common, comprising 42% of all complications. Thirty-day readmission rate from surgery was 1%. Mean pre- and post-operative MAP was 88.4 ± 11.4 and 90.6 ± 11.9, respectively. Mean minimum intraoperative MAP and O2saturation was 70.6 ± 9.5 and 98.7% ± 1.6%, respectively. Mean minimum intraoperative MAP was significantly decreased compared to mean pre- and post-operative MAP (P < 0.05). Conclusion: Prone jackknife position supports the chest while relaxing the abdomen by flexing at the hips. In ambulatory anorectal surgeries under general anesthesia, given the hemodynamic stability and lack of intra- and post-operative complications, prone jackknife position is a noninferior alternative to supine or lithotomy position.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49260813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucosal advancement flap for fistula-in-ano: A single-institution experience","authors":"Y. Kaneko, D. Lam, J. Keck, R. Woods","doi":"10.4103/1941-8213.240254","DOIUrl":"https://doi.org/10.4103/1941-8213.240254","url":null,"abstract":"Background and Objective: Mucosal advancement flap (MAF) is a well-described definitive treatment for complex fistula-in-ano, with high healing rates ranging from 37 to 87% for cryptoglandular fistula, but with mild incontinence rates of up to 35%. There is a paucity of Australian data to support the efficacy and complication rates of MAF, nor predictive factors for success. Patients and Methods: This was a retrospective study, with ethical approval granted by St. Vincent's Hospital Melbourne (SVHM) Quality and Risk Unit. Patients who underwent MAF at SVHM and St Vincent's Private Hospital Fitzroy from 2011 to 2015 were included in the study; all data were collected from patient medical records. Results: A total of 65 patients were treated with MAF during the study period. Fistula etiology was cryptoglandular in 82%, anovaginal in 11%, and perianal Crohn's disease in 7% of patients. Overall success rates for MAF were 66% for cryptoglandular fistula, 14% for anovaginal fistula, and 40% for Crohn's fistula. Excluding anovaginal fistulae, the success rate of MAF was 74% for males and 57% for females. MAF performed for an anterior internal opening was associated with a success rate of 65% versus 56% for a posterior internal opening. Postoperative fecal incontinence rate was 6%. Five of the patients with failed MAF underwent a second sphincter-preserving procedure; none of these were successful. Conclusion: This study supports the use of MAF for the treatment of complex fistula-in-ano, with a success rate compatible with existing literature and a low incontinence rate.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45878581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PELVIC FLOOR SYMPTOMS AND QUALITY OF LIFE ANALYSES IN WOMEN UNDERGOING SURGERY FOR RECTAL PROLPASE.","authors":"Dr Ellington,&nbsp;M Mann,&nbsp;Cb Bowling,&nbsp;Er Drelichman,&nbsp;Wj Greer,&nbsp;Jm Szychowski,&nbsp;He Richter","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Characterize pelvic floor symptom distress and impact, sexual function and quality of life in women who underwent rectal prolapse surgery.</p><p><strong>Methods: </strong>Subjects undergoing rectal prolapse surgery from 2004-2009 completed questionnaires including the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Prolapse/Urinary Incontinence Sexual Questionnaire. Baseline demographic, medical, and surgical characteristics were extracted by chart review. Demographic and clinic outcomes of women undergoing transperineal and abdominal approaches were compared. Wilcoxon rank-sum test was used for continuous variables and Fisher's exact test for categorical measures.</p><p><strong>Results: </strong>45 were identified; two deceased at follow-up. 28/43 subjects (65.1%) responded to the questionnaires. Mean time from original procedure was 3.9 ± 3.1 years. No differences in median total Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and subscale scores, and Prolapse/Urinary Incontinence Sexual Questionnaire scores in women undergoing open rectopexy versus transperineal proctectomy were seen (all p>0.05). 26 (60%) participants answered the Prolapse/Urinary Incontinence Sexual Questionnaire, nine reported sexual activity within the last month. All underwent abdominal procedures.</p><p><strong>Conclusion: </strong>There are few colorectal or other pelvic floor symptoms after rectal prolapse repair. Robust prospective studies are needed to more fully characterize and understand issues associated with rectal prolapse surgery in women.</p>","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219513/pdf/nihms567599.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32799989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subsequent Adenomas of Ileal Pouch and Anorectal Segment after Prophylactic Surgery for Familial Adenomatous Polyposis.","authors":"A E M'Koma,&nbsp;A J Herline,&nbsp;S E Adunyah","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Familial adenomatous polyposis (FAP) is an autosomally dominant disease characterized by the early development of colorectal adenomas and carcinoma in untreated patients. Patients with FAP may develop rectal cancer at their initial presentation (primary) or after prophylactic surgery (secondary). Controversies exist regarding which surgical procedure represents the best first-line treatment. The options for FAP are ileorectal anastomosis (IRA) or a restorative proctocolectomy (RPC) with either a handsewn or a stapled ileal pouch-anal anastomosis (IPAA), with or without mucosectomy. The purpose of these surgeries is to stop progression to an adenoma-cancer sequence by eradicating the colon, a disease prone organ. Unfortunately, these surgical procedures, which excise the entire colon and rectum while maintaining transanal fecal continence, do not guarantee that patients still won't develop adenomas. Based on the available literature, we therefore reviewed reported incidences of pouch-related adenomas that occurred post prophylactic surgery for FAP. The review consists of a collection of case, descriptive, prospective and retrospective reports.</p><p><strong>Objectives: </strong>To provide available data on the natural history of subsequent adenomas after prophylactic surgery (by type) for FAP.</p><p><strong>Methods: </strong>A review was conducted of existing case, descriptive, prospective and retrospective reports for patients undergoing prophylactic surgery for FAP (1975 - August, 2013). In each case, the adenomas were clearly diagnosed in one of the following: the ileal pouch mucosa (above the ileorectal anastomosis), within the anorectal segment (ARS) below the ileorectal anastomosis, or in the afferent ileal loop.</p><p><strong>Results: </strong>A total of 515 (36%) patients with pouch-related adenomas have been reported. Two hundred and eleven (211) patients had adenomas in the ileal pouch mucosa, 295 had them in the ARS and in 9 were in the afferent ileal loop. Patients with pouch adenomas without dysplasia or cancer were either endoscopically polypectomized or were treated with a coagulation modality using either a Nd:Yag laser or argon plasma coagulation (as indicated). Patients with dysplastic pouch adenomas or pouch adenomas with cancer had their pouch excised (pouchectomy).</p><p><strong>Conclusion: </strong>In patients with FAP treated with IRA or RPC with IPAA, the formation of adenomas in the pouch-body mucosa or ARS/anastomosis and in the afferent ileal loop is apparent. Because of risks for adenoma recurrence, a life time endoscopic pouch-surveillance is warranted.</p>","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012278/pdf/nihms-575932.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32333996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LOCAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN MANAGEMENT OF ANAL FISSURE","authors":"G. Ellabban, galal elkazaz, emad hokam","doi":"10.5580/240a","DOIUrl":"https://doi.org/10.5580/240a","url":null,"abstract":"Introduction: Anal fissure is a common benign condition that can cause severe anal pain after defecation and bleeding. Symptoms from fissure cause considerable morbidity and reduction in quality of life. The aim of treatment is to reduce anal hvpertonia, which may improve anodermal blood flow and heal the fissure. Aim of the work: This study aimed to evaluate the effectiveness of local glyceryl trinitrate (GTN) versus surgical lateral internal sphincterotomy in the management of acute and chronic anal fissure. Patients and methods: In our present study we compared topical application of GTN on lipsomal base with the surgical procedure i.e. internal lateral sphincterotomy and according to the method of treatment the patients were divided into two groups; group 1 which included 40 patients with anal fissure and agreed to have the medical treatment with topical GTN 0.2% applied to the anoderm twice daily. Group 2 also included 40 patients and treated with lateral internal","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70819102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}