Surgical management of stomal prolapse - Is there a superior approach to repair?

Background: Stomal prolapse is an uncommon complication related to ostomy creation without comparative studies to suggest an optimal approach. Our aim was to assess long-term recurrence rates following surgical repair, specifically local repair vs. laparotomy.

Sigmoidectomy for Diverticulitis-A Propensity-Matched Comparison of Minimally Invasive Approaches.

Background: As the availability and use of robotic surgery increases, current data suggest comparable outcomes to laparoscopic surgery but at an increased cost. Elective sigmoid resection for diverticular disease is the most common colorectal application of robotic surgery and there is limited comparative data specifically for this indication.

Methods: We identified all elective cases of laparoscopic- and robot-assisted surgery for diverticular disease among a practice of 7 colorectal surgeons within an established enhanced recovery protocol.

Anal Intraepithelial Neoplasia and Squamous Cell Cancer of the Anus.

Anal intraepithelial neoplasia (AIN) is the premalignant condition of the anal squamous tissue. It is associated with the human papilloma virus and is considered the transition prior to the invasive anal squamous cell carcinoma. It is typically asymptomatic and can be either an incidental finding after anorectal surgery or identified when high-risk patient populations are screened.

Diverticulitis recurrence after percutaneous abscess drainage.

Purpose: Recurrent diverticulitis has been reported in 30-50% of patients who recover from an episode of diverticular-associated abscess. Our aim was to review the outcomes of patients who underwent non-operative management after percutaneous drainage (PD) of colonic diverticular abscess.

Methods: All patients with a diverticular-associated abscess were identified between 2001 and 2012.

High-definition colonoscopy increases adenoma detection rate.

Background: The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates.

Objective: The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy.

Development of The American Society of Colon and Rectal Surgeons' Rectal Cancer Surgery Checklist.

Background: There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality.

Objective: The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer.

Design: A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed.

Does CD10 Expression Predict Lymph Node Metastasis in Colorectal Cancer?

Background: Accurate preoperative prediction of lymph node status would be a revolutionary adjunct in treating colorectal cancer. The immunohistochemical marker CD10 has been suggested recently to have a predictive capacity for lymph node involvement in colorectal cancer.

Objective: The aim of our study was to evaluate the relationship between the presence of the CD10 molecular marker and lymph node metastasis in a US patient population using previously banked colorectal cancer specimens.

Case-matched series of a non-cross-linked biologic versus non-absorbable mesh in laparoscopic ventral rectopexy.

Purpose: Laparoscopic ventral mesh rectopexy (LVR) is an emerging technique for selected patients with rectal prolapse and obstructed defaecation syndrome. Data are insufficient to conclude which type of mesh affords the greatest benefit. Our aim was to compare the outcomes of LVR using a non-cross-linked biologic versus a permanent mesh.

Minimally invasive colorectal resection for benign pathology is associated with persistent proangiogenic plasma compositional changes.

Background: Minimally invasive colorectal resection for cancer is associated with increased plasma levels of numerous proangiogenic proteins for 3 to 4 weeks postoperatively, and plasma from postoperative weeks 2 and 3 stimulates proangiogenic endothelial cell behavior in vitro. It is unknown if similar plasma changes occur after minimally invasive colorectal resection for benign pathology.

Objective: The aim of this study is to assess 1) plasma levels of angiopoetin-2, placental growth factor, and soluble vascular cell adhesion molecule-1 after minimally invasive colorectal resection for benign pathology and 2) postoperative plasma's effects on in vitro endothelial cell proliferation (branch point formation), migration, and invasion.

Anastomotic leaks: technique and timing of detection.

Background: Despite the proven benefits of laparoscopic colorectal surgery, the rate of anastomotic leaks has not changed. This study looks at the time of presentation of anastomotic leaks between laparoscopic and open colectomies.

Methods: Retrospective chart review was performed between July 2008 and 2012.

Continuing medical education, maintenance of certification, and physician reentry.

Continuing medical education serves a central role in the licensure and certification for practicing physicians. This chapter explores the different modalities that constitute CME along with their effectiveness, including simulation and best education practices. The evolution to maintenance of certification and the requirements for both the American Board of Surgery and the American Board of Colon and Rectal Surgery are delineated.

Enterostomal therapy and wound care of the enterocutaneous fistula patient.

Enterocutaneous fistulas represent a challenging situation with respect to wound care and stoma therapy. An understanding of the principles of wound care and the various techniques and materials that are available is of vital importance to enhance patient comfort and recovery as well as facilitate fistula healing. Skin barriers, adhesives, dressings, pouches, and negative pressure dressings are all materials that are available in the armamentarium of the enterostomal therapist.

Microsatellite instability and MLH1 hypermethylation - incidence and significance in colorectal polyps in young patients.

Objective: Microsatellite instability (MSI) is observed in most hereditary nonpolyposis colorectal cancer-related colorectal cancers (CRC). The original Bethesda criteria recommends MSI testing in patients View Article and Find Full Text PDF

Colonoscopy in the office setting is safe, and financially sound ... for now.

Purpose: In 2000, the Centers for Medicare & Medicaid Services announced a plan to allow for enhanced reimbursement for office endoscopy. This change in reimbursement was phased in during three years. The purpose of this study was to evaluate the fiscal outcomes and quality measures in the first two and a one-half years of performing endoscopy in an office setting under the new Centers for Medicare & Medicaid Services guidelines.

The management of lower gastrointestinal hemorrhage.

Purpose: Gastrointestinal hemorrhage is a common clinical problem, which accounts for approximately 1 to 2 percent of acute hospital admissions. The colon is responsible for approximately 87 to 95 percent of all cases of lower gastrointestinal bleeding, with the remaining cases arising in the small bowel. The etiology, diagnostic evaluation, management, and treatment options available for lower gastrointestinal hemorrhage were reviewed.

Evaluation of transarterial embolization for lower gastrointestinal bleeding.

Introduction: Transcatheter arterial embolization has been used as a therapeutic maneuver for lower gastrointestinal bleeding. The availability of highly selective arteriography has made this procedure safer and warrants re-evaluation.

Methods: A retrospective chart review was done of all patients undergoing arteriography for presumed lower gastrointestinal bleeding at two acute-care community hospitals.

Limited hemorrhoidectomy: results and long-term follow-up.

Purpose: Three-column excision has traditionally been the preferred treatment for symptomatic hemorrhoidal disease in patients failing nonoperative treatments. There are few data evaluating focused surgical management of only the symptomatic hemorrhoidal complexes by limited hemorrhoidectomy. The purpose of this study was to evaluate patient outcome after one-quadrant or two-quadrant hemorrhoidectomy for symptomatic hemorrhoids.

Outcome after incision and drainage with fistulotomy for ischiorectal abscess.

Concomitant anal fistulotomy (F) and incision and drainage (I&D) of ischiorectal abscesses (IA) are often avoided, for fear of irreversibly impairing anal continence. However, failure to identify and treat the frequently associated trans-sphincteric anal fistula dooms the patient to recurrent anal suppurative disease. We have employed an aggressive approach of performing I&D and F for IA at the time of initial presentation.

Prospective comparison of gastric emptying after laparoscopic-aided colectomy versus open colectomy.

Laparoscopic colectomy has been associated with a shorter postoperative ileus when compared to open colectomy, although the mechanism is unclear. This study is designed to evaluate gastric emptying following open colectomies (OC) versus laparoscopic-aided colectomies (LAC) using serial serum acetaminophen levels (ACE), which correlate with gastric emptying. The study groups were limited to patients undergoing either right or left colectomy who received general anesthetic.

The single-stapled ileo pouch anal anastomosis: a reasonable compromise.

Minimal anal sphincter disruption and preservation of the transitional epithelium during ileal pouch anal anastomosis (IPAA) are believed to play important roles in improving functional outcome. As a result, many surgeons have abandoned the traditional mucosectomy in favor of a double-stapled technique. The natural history of the retained colonic epithelium that occurs with this approach is uncertain.

Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow.

Preoperative external beam radiation therapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on healing of colorectal anastomoses. We serially evaluated colorectal anastomotic healing following moderate dose RT. Twenty-four adult female pigs were administered 4250 centiGrays (cGy) of external beam pelvic RT over 4 weeks followed by rectosigmoid resection with handsewn or circular stapled anastomosis.

Short-chain fatty acid enemas: a cost-effective alternative in the treatment of nonspecific proctosigmoiditis.

The purpose of this study was to perform a randomized, prospective comparison of corticosteroid enemas (CS--100 mg of hydrocortisone/60 cc P.R. q.