Evaluation of a progressive algorithmic approach for the treatment of unresectable colon polyps using colon conservation techniques.

Background: The majority of endoscopically unresectable colon polyps (EUCP) are treated by segmental colectomy. However, up to 90% of EUCP do not harbor malignancy, making colectomy an unnecessary procedure. To minimize unnecessary segmental colectomy, we established a progressive treatment algorithm utilizing colon conservation techniques (CCT).

Adjuvant Chemotherapy Does Not Improve Recurrence-Free Survival in Patients With Stage 2 or Stage 3 Rectal Cancer After Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision.

Background: Current guidelines for locally advanced stage 2/3 rectal cancer recommend neoadjuvant chemoradiotherapy followed by total mesorectal excision and adjuvant chemotherapy. The oncologic benefit of adjuvant chemotherapy has not been consistently demonstrated.

Objective: The purpose of this study was to evaluate disease recurrence and survival in patients with rectal cancer who received adjuvant chemotherapy after chemoradiotherapy and total mesorectal excision.

Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens.

Background And Objectives: Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection.

Methods: This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability.

Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients.

Background: Given the significant perioperative risks and costs of total mesorectal excision, minimally invasive transanal surgical approaches have grown in popularity for early rectal cancer and rectal polyps. This article discusses a transanal robotic surgery technique to perform full-thickness resections of benign and malignant rectal neoplasms.

Objective: The purpose of this study was to describe an initial experience with robotic transanal minimally invasive surgery.

Expectant management surveillance for patients at risk for invasive squamous cell carcinoma of the anus: a large US healthcare system experience.

Purpose: To determine the impact of expectant management surveillance for patients at risk for squamous cell carcinoma of the anus (SCCA).

Methods: Adult patients at risk for anal cancer, specifically those with human immunodeficiency virus (HIV) or known human papilloma virus (HPV) infections (anal dysplasia, anogenital warts, cervical dysplasia, or cervical cancer), underwent expectant management surveillance with targeted therapy of only grossly abnormal or symptomatic anoderm lesions. A retrospective analysis investigated the SCCA incidence in these surveilled populations and in the general population patients without known HIV or HPV infection.

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse.

Background: Pelvic organ prolapse is prevalent among women with rectal prolapse.

Objective: This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair.

Design: A retrospective cohort.

Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection.

Purpose: The aim of this study is to assess the incidence of incisional ventral hernia and small bowel obstruction following laparoscopic and open colorectal resection.

Methods: A retrospective review was performed of a large database comprising 13 hospitals, serving 3.6 million patients in Southern California.

Preoperative versus postoperative radiotherapy for rectal cancer in a decision analysis and outcome prediction model.

Purpose: Reduction of local recurrences has been achieved by radiotherapy, but also by improved surgical technique (total mesorectal excision). Radiotherapy has adverse effects and cannot exceed local dose limits. Neoadjuvant radiotherapy may result in overtreatment.

Surgical excision of extensive anal condylomata not associated with risk of anal stenosis.

Introduction: Surgical treatment of extensive and confluent anal condylomata results in large open wounds, which in other contexts of anorectal surgery (e.g., hemorrhoidectomy), have been associated with a relevant risk of stricture formation.

Morbidity of ostomy takedown.

Purpose: Creation of a temporary ostomy is a surgical tool to divert stool from a more distal area of concern (anastomosis, inflammation, etc). To provide a true benefit, the morbidity/mortality from the ostomy takedown itself should be minimal. The aim of our study was therefore to evaluate our own experience and determine the complications and mortality of stoma closure in relation to the type and location of the respective ostomy.

Teaching palliative care and end-of-life issues: a core curriculum for surgical residents.

Background: Most surgical training programs have no curriculum to teach palliative care. Programs designed for nonsurgical specialties often do not meet the unique needs of surgeons. With 80-hour workweek limitations on in-hospital teaching, new methods are needed to efficiently teach surgical residents about these problems.

Minimally invasive tension-free inguinal hernia repair.

With a growing understanding of abdominal wall mechanics and improving surgical technology, inguinal herniorrhaphy has undergone significant advancements in the past 100 years. As primary repair through an anterior approach gave way to the "tension-free" Lichtenstein technique in the later part of the 20th century, hernia recurrence rates fell dramatically. With this fall in recurrence rates, other postoperative factors became the measure of herniorrhaphy technique quality.