General Surgery Resuscitation Preference Documentation: A Quality Improvement Initiative.

Background/purpose: Documentation of resuscitation preferences is crucial for patients undergoing surgery. Unfortunately, this remains an area for improvement at many institutions. We conducted a quality improvement initiative to enhance documentation percentages by integrating perioperative resuscitation checks into the surgical workflow.

Double Duty: Complete Pathologic Response of Two Colonic Primaries with Mosaicism of a Novel Mutation to Neoadjuvant Pembrolizumab.

We present a fascinating case of a 57-year-old male with a novel mutation in MLH1 (), who presented with two synchronous colonic tumours, initially deemed unresectable, and experienced a complete pathological response on neoadjuvant pembrolizumab. Extensive genetic testing revealed post-zygotic mosaicism from the novel mutation.

Safety of Combination Biologic and Antirejection Therapy Post-Liver Transplantation in Patients With Inflammatory Bowel Disease.

Background: Patients with inflammatory bowel disease (IBD) post-liver transplant (LT) may have bowel inflammation requiring biologic therapy. We aimed to evaluate the safety of combination biologic and antirejection therapy in IBD patients after LT from a tertiary center case series and an updated literature review.

Methods: Inflammatory bowel disease patients undergoing LT between 1985 and 2018 and requiring combination biologic and antirejection therapy post-LT were identified from the London Health Sciences Transplant Registry (Ontario, Canada).

Long-term oncological outcomes following emergency resection of colon cancer.

Purpose: The relationship between emergency colon cancer resection and long-term oncological outcomes is not well understood. Our objective was to characterize the impact of emergency resection for colon cancer on disease-free and overall patient survival.

Methods: Data on patients undergoing resection for colon cancer from 2006 to 2015 were collected from a prospectively maintained clinical and administrative database.

Evaluating the impact of a resident research program in general surgery.

Background: Programs of resident research have been found to improve research productivity. However, evidence of the success of these programs is lacking in a Canadian context. The objective of this study was to evaluate the impact of the introduction of a formal program of resident research at a single Canadian academic centre.

Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis.

Background: Local resection for early rectal cancer is thought to be less invasive but oncologically inferior to radical resection.

Objective: The aim of this study was to compare local with radical resection in terms of oncologic control (survival and local recurrence), postoperative complications, and the need for a permanent stoma in adult patients with T1N0M0 rectal adenocarcinoma.

Data Sources: Data were retrieved from Medline, Embase, Central, www.

The use of "spin" in laparoscopic lower GI surgical trials with nonsignificant results: an assessment of reporting and interpretation of the primary outcomes.

Background: Spin has been defined as "specific reporting that could distort the interpretation of results and mislead readers."

Objective: The purpose of this study was to identify how frequently, and to what extent, "spin" occurs in laparoscopic lower GI surgical trials with nonsignificant results.

Data Sources: Publications were referenced in MEDLINE and EMBASE (1992-2012).

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors.

Background: To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors.

Methods: We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period.

Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis.

Background: This study aimed to determine the effect of local anesthesia administered before laparoscopic surgery (preemptive anesthesia) on postoperative pain.

Methods: The authors searched Medline, EMBase, and the Cochrane Central Register of Controlled Trials, as well as reference lists of textbooks and relevant articles. They contacted experts in the field of anesthesia and laparoscopic surgery for randomized controlled trials comparing preemptive administration of local anesthesia at the incision site or intraperitoneally with postoperative anesthesia administration or placebo.

The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection.

Objective: To determine the in-hospital mortality rates for patients undergoing colorectal resection for malignant or benign conditions, and to identify risk factors for in-hospital death, particularly the relationships with surgeon and hospital volume.

Background: Although there is strong evidence that complex cancer operations are best performed at specialized high-volume centers and by high-volume surgeons, the relationship between surgeon and hospital volume and perioperative outcomes is less well defined for more common procedures such as colorectal resections, particularly for benign diseases.

Methods: We obtained data from the Canadian Institute for Health Information Discharge Abstract Database on all adult patients who underwent colorectal resection between April 1, 2005 and March 31, 2006.

Reduced expression of basal and probiotic-inducible G-CSF in intestinal mononuclear cells is associated with inflammatory bowel disease.

Background: Granulocyte-colony stimulating factor (G-CSF) is a pleiotropic cytokine involved in the hematopoiesis of granulocytes, neuroprotection, and immunomodulation. Previously, we have shown that probiotic Lactobacillus rhamnosus GR-1 induces G-CSF production from bone marrow-derived macrophages. Whether this probiotic also induces G-CSF in intestinal mononuclear cells is unknown.

Mesenteric angiography for the localization and treatment of acute lower gastrointestinal bleeding.

Background: There is limited evidence regarding the effectiveness and complications of mesenteric angiography in the diagnosis and management of acute lower gastrointestinal bleeding (ALGIB). Our objective was to determine the complications and outcomes of mesenteric angiography in patients with ALGIB and to identify predictors of a positive result at angiography.

Methods: We identified and reviewed the records of all patients who underwent mesenteric angiography for ALGIB at our institution during a 10-year period.

CUSUM analysis of J-pouch surgery reflects no learning curve after board certification.

Objective: To investigate changes in morbidity and mortality associated with ileal J-pouch surgery performed during the first 3 years of a single surgeon's practice to determine the presence or absence of a learning curve after fellowship training.

Methods: From July 2002 to July 2005, an observational study of postoperative outcomes was undertaken, in which 30-day and inhospital morbidity and mortality were assessed. A total of 37 patients (17 women and 20 men) underwent the surgery; their average age was 32 (range 16-51) years.

Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery.

Purpose: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with internal hemorrhoids.

Methods: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months.

Correlating the Fecal Incontinence Quality-of-Life Score and the SF-36 to a proposed Ostomy Function Index in patients with a stoma.

Quality of life is affected by the creation of a stoma. To assess the validity of the Ostomy Function Index in patients with a stoma, a prospective survey was conducted from July 2000 to September 2001 among patients participating in local United Ostomy Association chapters (N = 99; 55 with a colostomy and 44 with an ileostomy). The Short Form 36 general health survey, Fecal Incontinence Quality of Life Scale, and the proposed Cleveland Clinic Florida Ostomy Function Index were used to assess general health and stoma function in patients with an ostomy.

Colorectal cancer screening: do we practice what we preach?

Objective: Compliance rates for colorectal cancer screening have been reported as low, and ignorance is the most common factor sighted to explain this. The aim of this study was to determine screening compliance among colorectal surgeons assumed to be educated of the risks of colorectal cancer.

Methods: A postal survey was distributed to the members of the American Society of Colon and Rectal Surgeons.

Is the quality of life better in patients with colostomy than patients with fecal incontience?

Background: A colostomy offers definitive treatment for individuals with fecal incontinence (FI). Patients and physicians remain apprehensive regarding this option because the quality of life (QOL) with a colostomy is presumably worse than living with FI. The aim of this study, therefore, was to compare the QOL of colostomy patients to patients with FI.

Horseshoe abscesses and fistulas: how are we doing?

Background: Various surgical treatments exist for horseshoe abscesses and fistulae, including posterior midline sphincterotomy, catheter drainage, cutting and draining setons, and advancement flaps. The aim of this study was to evaluate the long-term results of patients treated for these complex anorectal problems.

Methods: A retrospective review was undertaken of patients with a diagnosis of horseshoe abscess, horseshoe fistula, postanal space abscess, or postanal space fistula from 1990 to 2001.

Small bowel transit does not correlate with outcome of surgery in patients with colonic inertia.

Colonic inertia is a motility disorder that may involve dysfunction of the entire intestinal tract. The aim of this study was to assess whether small bowel transit time is associated with the outcome of total abdominal colectomy in patients with colonic inertia. A retrospective review of the medical records of patients who underwent total abdominal colectomy for colonic inertia was performed to identify those individuals who had a preoperative small bowel transit study.

Not all inflammation in the right lower quadrant is appendicitis: a case report of Escherichia coli O157:H7 with a review of the literature.

Although significant work has been presented on this subject in pediatric, infectious disease, and epidemiologic literature, there is a noteworthy lack of information on Escherichia coli O157:H7 in any surgical journals. As this disease can present with signs and symptoms often ascribed to the acute abdomen, it is imperative that the general surgeon, pediatric surgeon, and colorectal surgeon are all familiar with this infection and its clinical ramifications. A case report followed by a review of the literature is presented.

Attainment of continence with J-pouch and artificial bowel sphincter for concomitant imperforate anus and familial adenomatous polyposis: report of a case.

Numerous proven surgical therapies now exist to compensate for loss of anal sphincter function or loss of rectal reservoir capacity. Fecal incontinence that results from the combined loss of rectal reservoir and anal sphincter tone remains a surgical challenge. This case describes what may be the first successful treatment of a patient with imperforate anus and familial adenomatous polyposis using an ileal J-pouch and artificial bowel sphincter.

Colorectal cancer screening: do they practice what they preach?

Introduction: Compliance for voluntary colorectal cancer (CRC) screening reported by the American Society of Colon and Rectal Surgeons (ASCRS) is>85%. This high rate is assumed to be the result of heightened awareness of CRC. The purpose of the present paper was to determine if observed participation rates in the USA are the result of increased awareness of CRC alone.