1,721,173 research outputs found
Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx collaborative
No full textBACKGROUND:
A total of 15-20% of patients with rectal cancer patients have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, and often dependent on local resources and available expertise.
METHODS:
members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when >85% agreement on a statement was achieved.
RESULTS:
a total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the fifteen statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of MRI Liver was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial Computed Tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panelists would consider simultaneous pelvic exenteration and liver resection.
CONCLUSION:
this Delphi highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach
TAMIS-Flap Technique: Full-thickness Advancement Rectal Flap for High Perianal Fistulae Performed through Transanal Minimally Invasive Surgery
No full textThe formation of an advancement rectal flap could be technically demanding in the presence of high perianal of rectovaginal fistula, and the outcomes could be frustrated by the inadequate view, bleeding and a poor exposure through the standard transanal approach. The application of the transanal minimally invasive surgery (TAMIS) to the advancement rectal flap procedure could overcome these difficulties. In the lithotomy position, a partial fistulectomy was performed and the internal opening was closed. A full-thickness flap was mobilized initially through the classic transanal approach. Subsequently, the TAMIS port was inserted and the mobilization of the flap was carried on proximally for as long as required. The laparoscopic visualization allowed a perfect view, a proper orientation of the flap and accurate hemostasis. The TAMIS-flap procedure seems a promising technique to perform a long advancement rectal flap to treat high perianal or rectovaginal fistulae (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A208)
Fecal-oral transmission of SARS-CoV-2: review of laboratory-confirmed virus in gastrointestinal system
No full textPurpose: The objective was to collect the data available regarding the presence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal system and to evaluate whether the digestive system could contribute to viral transmission. Methods: Bibliographic databases were searched to identify all studies documenting, in adult patients with a confirmed diagnosis of coronavirus disease 2019 (COVID-19): (1) the presence of SARS-CoV-2 ribonucleic acid in the feces; (2) the presence of SARS-CoV-2 ribonucleic acid in the intestinal cells; (3) live SARS-CoV-2 in the feces. Results: Twenty seven met the inclusion criteria. In 26 studies, the presence or absence of SARS-CoV-2 ribonucleic acid in the feces of COVID-19 patients had been reported. Out of the 671 patients, 312 (46.5%) had a positive stool sample for viral nucleic acid. Of these patients, 63.9% remained positive for viral nucleic acid in the feces after pharyngeal swabs became negative; Three studies also evaluated the viral ribonucleic acid in the gastrointestinal tissues and the presence of SARS-CoV-2 nucleic acid was found in samples of 3 patients out of 8 examined (37.5%). The presence of the live virus in stool samples was confirmed in two studies but no in in a recent study from Germany. These results suggested that SARS-CoV-2 could infect gastrointestinal epithelial cells and it may be transmitted through the digestive tract. Conclusion: In order to control the pandemic, every effort should be made to understand all the possible routes of transmission of the infections, even the less important ones
Redo Gracilis Muscle Transposition for Recurrent Complex Pouch-Vaginal Fistula: A Feasible and Effective Pouch Salvage Surgical Procedure.
No full textBACKGROUND. Pouch-vaginal fistulae (PVF) affect 4 to 16% of women after ileal-pouch-anal anastomosis (IPAA) and significantly impact the patients’quality of life. They indeed represent a challenge for the surgeon. A variety of surgical options have been described but the reported pouch failure rate varies between 20 and 30% after the development of a PVF. Gracilis muscle transposition (GMT) is often considered a last resort treatment after the failure of multiple previous attempts.
CASE REPORT. A 45 years old women came to our tertiary IBD surgical department due to a recurrent PVF. She had already been treated elsewhere with multiple surgical repairs (mucosal advancement flaps, local injection of Adalimumab and redo-pouch). She had a severe pelvic sepsis and an IPAA stricture. Therefore, a pelvic surgical toilette, a diverting loop ileostomy and the dilatation of the anastomotic stricture were performed. After twelve months, a left GMT was fashioned. Unfortunately, three months after the procedure, a pouchoscopy and a contrast enema revealed an early recurrence of the fistula. After further six months, the patient was scheduled for a redo GMT as a rescue procedure of a pouch salvage strategy. After the transversal incision through the perineal body the pouch-vaginal fistulous track was identified and repaired. The left gracilis muscle was still in place, viable and well-vascularized. The right gracilis mucle was transposed to the perineum and secured to the apex of the dissection in the cavity between vagina and pouch, lying along the left muscle previously placed. After three months healing, of the PVF was assessed and confirmed with pouchoscopy. So, the patient was scheduled for closure of the ileostomy. Twelve months after reversal of fecal diversion, the successful healing is maintained.
DISCUSSION. GMT is usually advocated as a last resort strategy for PVF before declaring a pouch failure. However, redo gracilis GMT is a faesible and effective pouch salvage procedure in a tertiary IBD surgical center
Surgical treatment of colonic Crohn's disease: a national snapshot study
Full text linkAIM: The different surgical options for patients with colonic Crohn's disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD.METHODS: All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30days of surgery.RESULTS: One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p=0.017) and shorter length of hospital stay (p<0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥3 complications (p=0.023) and longer in-hospital stay (p=0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p=0.626).CONCLUSIONS: Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%
Surgical treatment of rectal tumors
No full textL'escissione chirurgica del carcinoma del retto rappresenta attualmente l'unica terapia in grado di offrire possibilità di cura per tale malattia. TME, i margini circonferenziali e la radioterapia neoadiuvante preoperatoria rappresentano l'innovazione piu' significativa in termini di stadiazione ed efficacia della terapi
P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients
No full textAdenocarcinoma below ileoanal anastomosis for ulcerative colitis: Report of a case and review of the literature
No full textBACKGROUND: Restorative proctocolectomy with handsewn ileoanal anastomosis and mucosectomy is warranted in patients with dysplasia and/or cancer on ulcerative colitis to prevent subsequent neoplastic changes in the retained mucosa. However, complete excision of the colonic mucosa cannot be obtained reliably. We report a case of anal canal adenocarcinoma after handsewn anastomosis with mucosectomy. METHODS: A 47-year-old patient, previously submitted to ileorectal anastomosis for colonic cancer on ulcerative colitis, underwent completion proctectomy and handsewn ileoanal anastomosis with mucosectomy for recurrent anastomotic cancer. Two years later, we submitted the patient to pouch removal with permanent ileostomy for a mucinous adenocarcinoma of the anal canal (T2N2Mx) found at follow-up pouch endoscopy. CONCLUSIONS: Only four cases of adenocarcinoma after handsewn anastomosis have been reported in the literature. This new case we report confirms that the risk of malignancy after ileoanal anastomosis with mucosectomy, although small, is real, despite the surgeon taking care with this particular step of the procedure. Careful surveillance is needed in patients with surgical treatment for long-term ulcerative colitis or dysplasia
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