Current Challenges for Education and Training in Transanal Surgery.

Transanal endoscopic microsurgery (TEM) is a technique that was introduced in the 1980s for improved exposure to upper rectal polyps. This technique, though initially difficult to master due to new skill acquisition for surgeons, has spared many patients proctectomy. There are many benign indications for transanal endoscopic surgery which has led to in vivo operating room training with fewer undesirable effects to the patient.

Pediatric Colorectal Surgery: A Collaborative Approach From a Single Institution.

Background: Inflammatory bowel disease encompasses relapsing gastrointestinal disorders commonly presenting in pediatric patients, with 25% of diagnoses made before age 20 and 4% before age 5. Considering the need for life-long surgical follow-up, a collaborative system involving both pediatric and colorectal surgeons could improve overall patient experiences. We hypothesized that cases performed in collaboration with both pediatric and adult colorectal surgeons may lead to better outcomes.

Outcome Comparison of Single-port Versus Multiport Versus Under Direct View Completion Proctectomy With Ileal-Pouch Anal Anastomosis for Patients With Ulcerative Colitis.

Purpose: Whether the reported theoretical benefits of single-port laparoscopic (SPL) approach can be converted to superior clinical outcomes is still unknown for ulcerative colitis (UC) patients undergoing second-stage proctectomy. This study aimed to compare the short-term postoperative and long-term pouch-related functional outcomes of SPL, multiport laparoscopic (MPL), and direct view (DV) completion proctectomy with ileal-pouch anal anastomosis (CP/IPAA).

Materials And Methods: Patients who underwent either SPL, MPL, or under DV CP/IPAA for UC between August 2009 and August 2014 were identified from an institutional review board-approved, prospectively maintained institutional database and reviewed.

Case-Matched Comparison of Long-Term Functional and Quality of Life Outcomes Following Laparoscopic Versus Open Ileal Pouch-Anal Anastomosis.

Background: Laparoscopic ileal pouch-anal anastomosis (IPAA) is associated with recovery benefits when compared with open IPAA. There is limited data on long-term quality of life and functional outcomes, which this study aimed to assess.

Methods: An IRB-approved, prospectively maintained database was queried to identify patients undergoing laparoscopic IPAA (L), case-matched with open IPAA (O) based on age ± 5 years, gender, body mass index (BMI) ± 5 kg/m, diagnosis, date of surgery ± 3 years, stapled/handsewn anastomosis, omission of diverting loop ileostomy and length of follow-up ± 3 years.

Nomogram-Derived Prediction of Postoperative Ileus after Colectomy: An Assessment from Nationwide Procedure-Targeted Cohort.

Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database.

Does stoma site specimen extraction increase postoperative ileostomy complication rates?

Background: Minimizing incisions has the potential to decrease hernia formation and wound complications following laparoscopic surgery. It is currently unknown if using the stoma site for specimen extraction affects outcomes. This study aims to evaluate the impact of stoma site extraction on postoperative complication rates in laparoscopic colorectal surgery.

Clinically Node Negative, Pathologically Node Positive Rectal Cancer Patients Who Did Not Receive Neoadjuvant Therapy.

Purpose: Neoadjuvant chemoradiotherapy is the preferred standard of care for clinical stages II-III rectal cancer. It is uncertain whether clinically node negative (cN-) tumors found to be pathologically stage III could be optimally treated with surgery alone and avoid adjuvant treatments. The aim of our study was to define the outcomes of such patients.

Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort.

Background: Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database.

Methods: Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned).

Robotic, laparoscopic, and open colectomy: a case-matched comparison from the ACS-NSQIP.

Background: This study aimed to compare perioperative outcomes of patients undergoing robotic, laparoscopic, and open colectomy using a procedure-targeted database.

Methods: Retrospective review of patients undergoing elective colectomy in 2013 was conducted using the procedure-targeted database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Robotic, laparoscopic, and open groups were matched (1:1:1) based on age, gender, body mass index, surgical procedure, diagnosis and ASA classification.

Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution.

Background: Previous work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA.

Methods: Perioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs.

Comparison of Short-term Outcomes After Laparoscopic Versus Open Hartmann Reversal: A Case-matched Study.

Purpose: The aim of this study is to compare short-term outcomes of laparoscopic versus open Hartmann reversal.

Materials And Methods: Patients who underwent Hartmann reversal between January 2005 and September 2014 were identified and matched for age, sex, body mass index, American Society of Anesthesiologists score, and creation of diverting ileostomy to open counterparts. Patient characteristics and postoperative outcomes (30 d) were evaluated.

Impact of the Specific Extraction-Site Location on the Risk of Incisional Hernia After Laparoscopic Colorectal Resection.

Background: The impact of the specific incision used for specimen extraction during laparoscopic colorectal surgery on incisional hernia rates relative to other contributing factors remains unclear.

Objective: This study aimed to assess the relationship between extraction-site location and incisional hernia after laparoscopic colorectal surgery.

Design: This was a retrospective cohort study (January 2000 through December 2011).

Impact of tumor location on lymph node metastasis in T1 colorectal cancer.

Purpose: Data evaluating the risk of lymph node metastasis depending upon the location of the primary tumor are limited in patients with T1 colorectal cancer. We aimed to evaluate the impact of tumor location on lymph node metastasis in T1 colorectal cancer.

Methods: Patients who underwent an oncologic resection with curative intent for T1 adenocarcinoma of the colon and rectum between January 1997 and October 2014 were assessed.

Case-matched Comparison of Robotic Versus Laparoscopic Proctectomy for Inflammatory Bowel Disease.

The present study reports an early institutional experience with robotic proctectomy (RP) and outcome comparison with laparoscopic proctectomy (LP) in patients with inflammatory bowel disease (IBD). Patients who underwent either RP or LP during proctocolectomy for IBD between January 2010 and June 2014 were matched (1:1) and reviewed. Twenty-one patients undergoing RP fulfilled the study criteria and were matched with an equal number of patients who had LP.

Considering Value in Rectal Cancer Surgery: An Analysis of Costs and Outcomes Based on the Open, Laparoscopic, and Robotic Approach for Proctectomy.

Objective: The aim of the study was to compare value (outcomes/costs) of proctectomy in patients with rectal cancer by 3 approaches: open, laparoscopic, and robotic.

Background: The role of minimally invasive proctectomy in rectal cancer is controversial. In the era of value-based medicine, costs must be considered along with outcomes.

Comparison of straight vs hand-assisted laparoscopic colectomy: an assessment from the NSQIP procedure-targeted cohort.

Background: The perioperative outcomes of patients who underwent straight laparoscopic (LAP) vs hand-assisted laparoscopic (HALS) surgery were compared using a recently released procedure-targeted database.

Methods: The 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database was used and patients were classified into 2 groups according to the final surgical approach: LAP vs HALS. Demographics, comorbidities, and 30-day outcomes were compared.

Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?

Background: Laparoscopic sigmoidectomy for diverticulitis is widely accepted, using either endolinear staplers or traditional linear staplers under direct vision through the extraction site to transect the rectum. The aim of this study was to assess modifiable factors affecting perioperative morbidity after elective laparoscopic sigmoidectomy for diverticulitis.

Methods: Potential associations between perioperative morbidity and demographic, disease-related, and treatment-related factors were assessed on all consecutive patients included in a prospectively collected database undergoing elective laparoscopic sigmoidectomy for diverticulitis between 1992 and 2013.

Case-matched Comparison of Robotic Versus Laparoscopic Colorectal Surgery: Initial Institutional Experience.

Robotic colorectal surgery is an emerging technique. In this study, we aimed to compare outcomes of robotic colorectal operations to laparoscopy. Patients undergoing robotic colorectal surgery between November 2010 and July 2013 were case matched to laparoscopic counterparts based on diagnosis and operation type.

Hand-Assisted versus Straight-Laparoscopic versus Open Proctosigmoidectomy for Treatment of Sigmoid and Rectal Cancer: A Case-Matched Study of 100 Patients.

To assess the efficacy of laparoscopic proctosigmoidectomy for cancer treatment, 25 patients who underwent hand-assisted laparoscopic resection during the study period (9/2006 - 7/2012) were matched to 25 straight-laparoscopic and 50 open-surgery cases. The patients who underwent hand-assisted resection had higher rates of preoperative cardiac disease and hypertension than did the straight-laparoscopy and open-surgery groups. Straight-laparoscopic surgery seems to provide faster convalescence compared with open surgery and hand-assisted laparoscopic surgery.

Laparoscopic IPAA is not associated with decreased rates of incisional hernia and small-bowel obstruction when compared with open technique: long-term follow-up of a case-matched study.

Background: There are scant data on the presumed reduction of small-bowel obstruction and incisional hernia rates associated with laparoscopic IPAA.

Objective: The aim of this study was to compare long-term outcomes after open vs laparoscopic IPAA based on a previous study from our institution.

Design: This was a retrospective cohort study (from January 1992 through December 2007).

Severe adverse outcomes of endoscopic perforations in patients with and without IBD.

Background: Endoscopy-associated perforation (EAP) is a dreaded adverse event with significant morbidity and even mortality. Whether EAP in patients with inflammatory bowel disease (IBD) is associated with worse outcomes is not known. We aimed to assess the frequency of perforations in patients undergoing lower gastrointestinal (GI) endoscopies and compare the risk factors and perforation-associated complications (PAC) in patients with IBD with those without IBD.

Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database.

Background: Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database.

Methods: Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes.

Impact of previous midline laparotomy on the outcomes of laparoscopic intestinal resections: a case-matched study.

The effectiveness of laparoscopic intestinal resection in patients with previous midline laparotomy (PML) is controversial. The aim of this study was to assess the feasibility of laparoscopic surgery and identify possible factors associated with postoperative outcomes in patients with PML. Patients with PML (at least an infraumbilical incision or longer) undergoing elective laparoscopic intestinal resection between 1997 and 2011 were case matched with patients without PML undergoing laparoscopic surgery based on age, gender, body mass index, ASA score, surgical procedure, and diagnosis.

Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy.

Background: Obese patients pose additional operative technical difficulties, and it is unclear if the outcomes of single-port colorectal surgery are equivalent to those of conventional laparoscopy in such patients. The aim of this study was to compare perioperative variables and short-term outcomes of single-port versus conventional laparoscopy in obese patients undergoing colorectal surgery.

Patients And Methods: Obese patients (BMI ≥ 30 kg/m(2)) undergoing single-port laparoscopic colorectal resections between March 2009 and September 2012 were case matched 1:1 with obese counterparts undergoing conventional (multi-port) laparoscopic surgery based on diagnosis and operation type.