Baseline Anal Sphincter Elastance May Predict Long-Term Outcomes of Sacral Neuromodulation for Fecal Incontinence.

Introduction: Anal acoustic reflectometry (AAR), a novel test of anal sphincter function, was shown to predict a successful trial phase of sacral neuromodulation (SNM) for fecal incontinence. This follow-up study aims to explore if AAR can also predict short- and long-term SNM outcomes at less than and more than 5 y, respectively.

Methods: Outcome data were reviewed from a prospectively managed database.

Anal sphincter function in rectal intussusception and high and low "take-off" external rectal prolapse-A prospective observational study.

Aim: Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low "take-off".

Methods: A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit.

Patient Satisfaction With Long-term Sacral Neuromodulation for Fecal Incontinence: Experience From a Single Tertiary Center.

Background: Sacral neuromodulation is an effective treatment for fecal incontinence in the long term. Efficacy is typically assessed using bowel diary, symptom severity, and quality-of-life questionnaires, and "success" is defined as more than 50% improvement in these measures. However, patient satisfaction may be a more meaningful and individualized measure of treatment efficacy.

A comparison of function lumen imaging probe measurements of anal sphincter function in fecal incontinence.

Background: The functional lumen imaging probe (FLIP) is a test of anal sphincter distensibility under evaluation by specialist centers. Two measurement protocols termed "stepwise" and "ramp" are used, risking a lack of standardization. This study aims to compare the performance of these protocols to establish if there are differences between them.

Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence.

Introduction: Faecal incontinence (FI) is a common condition with a significant impact on quality of life (QoL). Neuromodulation treatments delivered by members of the multidisciplinary team including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) are options for FI refractory to conservative management. The aim of this study was to assess whether a successful treatment with one neuromodulation modality corresponds with success in the other.

The Long-term Outcomes of Sacral Neuromodulation for Fecal Incontinence: A Single-Center Experience.

Background: Sacral neuromodulation is an effective treatment for fecal incontinence.

Objective: To assess the long-term outcomes of sacral neuromodulation and establish the outcomes of patients with inactive devices.

Design: This is an observational study of patients treated for >5 years.

Continuous vs stepwise anal acoustic reflectometry: An improved technique for physiological measurement of anal sphincter function?

Background: Anal acoustic reflectometry (AAR) is a technique for measuring the physiological profile of the anal canal, primarily the internal anal sphincter. Evaluation of a new continuous method, recently developed for the urethra, would enable its future application for investigation of rectal reflexes.

Methods: Patients aged 18 and over with fecal incontinence (FI) were included.

Methodologic Validation of a Faster Pelvic Floor Test: Two Randomized Studies in Anal Acoustic Reflectometry.

Background: Anal acoustic reflectometry investigates the opening and closing function of the anal canal using reflected sound waves to measure a cross-sectional area at different pressures. Anal acoustic reflectometry is reliable and repeatable, distinguishes between continence and incontinence and between subgroups of incontinence, correlates with symptom severity, and does not distort the anal canal during investigation.

Objective: The purpose of this study was to validate anal acoustic reflectometry methodology by asking 2 questions: can anal acoustic reflectometry be used alongside manometry (order study) and can anal acoustic reflectometry be performed faster (filling study).

The short-term effects of posterior tibial nerve stimulation on anorectal physiology in patients with faecal incontinence: a single centre experience.

Background: Posterior tibial nerve stimulation (PTNS) is a novel treatment for patients with faecal incontinence (FI) and may be effective in selected patients; however, its mechanism of action is unknown. We sought to determine the effects of PTNS on anorectal physiological parameters.

Methods: Fifty patients with FI underwent 30 min of PTNS treatment, weekly for 12 weeks.

Sacral nerve stimulation--hidden costs (uncovered).

Aim: The aim of this study is to determine the occurrence of surgical revision in a cohort of patients treated with sacral nerve stimulation (SNS) for faecal incontinence and constipation and to establish the types of procedures performed and indications for surgery.

Method: From the years 2002 to 2014, 125 patients were identified who had undergone permanent SNS therapy with 36 (28.8 %) patients requiring surgical intervention postimplantation.

Correlation of rectal tumor volumes with oncological outcomes for low rectal cancers: does tumor size matter?

Purposes: Several reports have described a relationship between tumor volume and oncological outcomes for certain cancers. There is paucity of similar data for rectal cancer. We conducted this study to establish whether tumor volume, mesorectal volume, and the tumor volume to mesorectal volume ratio (TV/MRV), evaluated by magnetic resonance imaging (MRI), affect the oncological outcomes of patients with rectal cancer.

Baseline quality of life factors predict long term survival after elective resection for colorectal cancer.

Background: Studies have shown an association between baseline quality of life (Qol) and survival in advanced cancers. The aim of this study was to investigate their predictive value in long term survival after elective colorectal cancer resection.

Methods: A consecutive series of patients undergoing elective colorectal cancer surgery for nonmetastatic disease were recruited in 2003/04.

Outcomes associated with resident involvement in partial colectomy.

Background: Surgical cases that include trainees are associated with worse outcomes in comparison with those that include attending surgeons alone.

Objective: This study aimed to identify whether resident involvement in partial colectomy was associated with worse outcomes when evaluated by surgical approach and resident experience.

Design: This is a retrospective study using the National Surgical Quality Improvement Program database.

Visceral obesity and colorectal cancer: are we missing the boat with BMI?

Introduction: Compared to subcutaneous fat, visceral fat is more metabolically active, leading to chronic inflammation and tumorigenesis. The aim of this study is to describe the effect of visceral obesity on colorectal cancer outcomes using computed tomography (CT) imaging to measure visceral fat.

Materials And Methods: We conducted a retrospective chart review of patients who underwent surgical resection for colorectal cancer.

Tobacco smoking and postoperative outcomes after colorectal surgery.

Objective: The aim of this study was to delineate the impact of smoking on postoperative outcomes after colorectal resection for malignant and benign processes.

Background: Studies to date have implicated smoking as a risk factor for increased postoperative complications. However, there is a paucity of data on the effects of smoking after colorectal surgery and in particular for malignant compared with benign processes.

Gastrointestinal surgery in adult patients with cystic fibrosis.

Objective: Gastrointestinal conditions requiring surgical intervention are becoming increasingly frequent in adults with cystic fibrosis (CF) as life expectancy increases. In addition, patients with CF are at risk of specific gastrointestinal complications associated with their disease. This includes distal intestinal obstruction syndrome (DIOS), which may affect up to 15% of patients, and can present diagnostic and therapeutic challenges.

Recognizing risk: bowel resection in the chronic renal failure population.

Background: There is a paucity of quality data on the effects of chronic kidney disease in abdominal surgery. The aim of this study was to define the risk and outcome predictors of bowel resection in stage 5 chronic kidney disease using a large national clinical database.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from years 2005-2010 for major bowel resection in dialysis-dependent patients.

Evaluation of the impact of implementing the prone jackknife position for the perineal phase of abdominoperineal excision of the rectum.

Background: Abdominoperineal excision of rectum has been associated with poor oncological specimens and high local recurrence rates in comparison with restorative surgery. The role of recent changes in operative position has yet to be evaluated.

Objectives: This study aimed to determine whether a change in the perineal phase from the Lloyd-Davies position to the prone jackknife position might improve excision margins and oncological outcomes.

Sacral neuromodulation for the management of severe constipation: development of a constipation treatment protocol.

Background: Constipation is a common multifactorial gastrointestinal symptom with quality of life implications. Sacral neuromodulation has been used in the management of severe constipation with mixed results. The aim of this study was to review our experience of sacral neuromodulation as a treatment for chronic constipation and develop a chronic constipation management protocol.

Management of a difficult malignant tracheoesophageal fistula.

Malignant tracheoesophageal fistula is a pre terminal condition in oesophageal cancer and is associated with significant patient distress. Various treatment options have been described and the general consensus is to use stents to cover them and relieve patient symptoms. We describe a case in which a modified Wilson-Cook prosthesis was successfully used to palliate tracheoesophageal fistula in a markedly dilated oesophagus.

Mesorectal grades predict recurrences after curative resection for rectal cancer.

Purpose: Local recurrence after curative excision for rectal cancer is frequently regarded as a failure of surgery. The macroscopic quality of the excised mesorectum after total mesorectal excision has been proposed as a means of assessment of the adequacy of surgery. This study was designed to determine the utility of mesorectal grading in prediction of local and overall recurrence after curative surgery.