Perineal wound healing following ileoanal pouch excision.

Introduction: There is paucity of information relating to perineal wound healing when pouch failure after ileal pouch anal anastomosis necessitates pouch excision (PE). The aim of this study is to evaluate perineal healing and factors associated with the development of persistent perineal sinus (PPS) after PE.

Methods: Perineal wound-related outcomes for patients who underwent PE from 1985-2009 were evaluated by type of closure (extrasphincteric, intersphincteric, and sphincter-preserving (SP)) and other factors (presence of Crohn's disease (CD) and/or perineal fistulae).

Risk and location of cancer in patients with preoperative colitis-associated dysplasia undergoing proctocolectomy.

Objective: To evaluate the influence of preoperative dysplasia grade, appearance, and site on risk and location of cancer in patients with colitis.

Background: The ability to predict the presence and location of cancer in colitis patients with dysplasia is essential to facilitate recommendations regarding the necessity and type of surgery.

Methods: Ulcerative and indeterminate colitis patients who underwent proctocolectomy for dysplasia were retrospectively selected.

Dysplasia associated with Crohn's colitis: segmental colectomy or more extended resection?

Background And Objective: There is limited data on the appropriate management of dysplasia in Crohn's colitis. An evidence-based surgical strategy is provided.

Methods: Patients with a pathologic diagnosis of dysplasia in Crohn's colitis from 1987 to 2009 were identified.

Influence of neoadjuvant radiotherapy on anastomotic leak after restorative resection for rectal cancer.

Purpose: This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.

Methods: From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (-RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment.

Preoperative hypoalbuminemia is associated with adverse outcomes after ileoanal pouch surgery.

Background: This study examines the association between preoperative albumin and ileoanal pouch (IPAA) outcomes and the utility of serum albumin in the decision to perform a staged IPAA with an initial subtotal colectomy.

Methods: From 2001-2009, patients were identified from an institutional pouch database and albumin values were extracted from the clinic data repository. Hypoalbuminemic (albumin <3.

Is adjuvant chemotherapy really needed after curative surgery for rectal cancer patients who are node-negative after neoadjuvant chemoradiotherapy?

Purpose: Adjuvant chemotherapy is currently offered, as standard, after curative resection for patients with rectal cancer who receive neoadjuvant chemoradiation (NCRT). We postulate that adjuvant chemotherapy adds minimal oncologic benefit for patients who undergo total mesorectal excision who are node-negative after neoadjuvant chemoradiation.

Methods: From a prospective, institutional cancer database, rectal cancer patients who completed neoadjuvant chemoradiation and curative surgery (2000-2008) and were node-negative on final pathology were identified.

Key attributes of a modern surgical trainer: perspectives from consultants and trainees in the United kingdom.

Objective: This study identifies key attributes of a modern surgical trainer as defined by individual trainees and consultant training faculty members.

Design: Using a collaborative inquiry process, we conducted focus groups and semistructured interviews with 32 trainees and 10 consultant trainers in general surgery. This study was undertaken in a single postgraduate deanery in the United Kingdom.

The role of primary surgical procedure in maintaining intestinal continuity for patients with Crohn's colitis.

Objective: This study evaluates surgical procedures for Crohn's colitis. The risk of recurrence and how it interacts with future avoidance of permanent stoma and quality of life (QoL) is studied.

Background: Segmental and subtotal colectomy are widely used surgical options in isolated Crohn's colitis.

Factors associated with ileoanal pouch failure in patients developing early or late pouch-related fistula.

Background: The natural history of a pouch-related fistula in terms of timing of its development and its impact on pouch survival is poorly defined.

Objective: This study aimed to evaluate factors associated with the time of onset of ileoanal pouch-related fistulas and predictors of pouch failure after the development of fistulas.

Design: This study is an evaluation of prospectively collected data from a cohort of patients with pouch-related fistulas.

Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials.

Purpose: This study was designed to determine whether conventional hemorrhoidectomy or stapled hemorrhoidopexy is superior for the management of hemorrhoids.

Methods: A systematic review of all randomized trials comparing conventional hemorrhoidectomy with stapled hemorrhoidopexy was performed. MEDLINE, EMBASE, and Cochrane Library databases were searched using the terms "hemorrhoid*" or "haemorrhoid*" and "stapl*.

Managing haemorrhoids.

Increased understanding of the anatomy of haemorrhoids has led to the development of new procedures to treat them. Among the surgical options for intractable prolapsed haemorrhoids, formal haemorrhoidectomy now competes with stapled haemorrhoidopexy, which is less painful and allows a shorter convalescence but may have a higher recurrence rate and needs further long term evaluation

Heterotopic pancreas in the spleen: malignant degeneration to mucinous cystadenocarcinoma.

We report the clinicopathological findings of a patient who presented with a primary splenic cystic tumour arising from heterotopic pancreatic tissue. The pancreas was normal on radiological and intraoperative examination. Histological analysis of the specimen demonstrated a mucinous cystadenocarcinoma with remnants of normal pancreatic tissue within the substance of the spleen.