Techniques in Coloproctology最新文献

Background: Complete rectal prolapse, associated incontinence and obstructive symptoms, significantly impairs quality of life. Minimally invasive ventral mesh rectopexy, the current standard, being transperitoneal, entails risks of vascular, bowel injury, and adhesions, besides mesh and tack fixation issues. This study evaluates the feasibility, safety, and short-term outcomes of a novel total extraperitoneal anterior rectopexy that avoids peritoneal transgression and sacral fixation.

Methods: In this prospective single-center study conducted from July 2024 through the time of publishing, 20 patients (11 male, 9 female; mean age 34.6 ± 14.2 years) with complete rectal prolapse who had a body mass index < 28 kg/m² and who had not had prior abdominal surgery underwent this procedure, which involved transfascial rectal fixation to the abdominal wall with preperitoneal mesh placement. Operative variables, complications, recurrence, functional outcomes [St. Mark's Incontinence Score (SMIS), obstructed defecation syndrome (ODS) score, quality-of-life questionnaires], sigmoidoscopy, manometry, and defecography were assessed.

Results: Mean operative time was 181.2 ± 41.6 min, blood loss 70.6 ± 30.6 mL, and hospital stay 4.1 ± 2.7 days. During median 8-month follow-up, two patients (10%) experienced mucosal prolapse. There was no mortality nor were there major complications. Four patients developed transient hematuria, resolving conservatively. Significant improvements were observed in SMIS (18.6 ± 2.4 to 14.4 ± 2.8; p = 0.0357) and ODS scores (16.3 ± 3.2 to 8.1 ± 3.9; p < 0.0001). Quality-of-life improved, while manometric and defecographic parameters were not significantly altered.

Conclusions: Total extraperitoneal anterior rectopexy is feasible and safe, avoiding peritoneal entry and sacral fixation while achieving favorable early outcomes. Larger, long-term validation is needed.

Background: Low anterior resection syndrome (LARS) is a common postoperative sequala affecting up to 70% of patients following rectal cancer surgery. Characterized by urgency, frequency, incontinence, and incomplete evacuation, LARS can significantly impair quality of life. Sacral neuromodulation (SNM) has emerged as a potential therapy for patients with refractory symptoms.

Methods: This retrospective single-center study included 43 patients with LARS unresponsive to conservative therapy who underwent SNM between 2017 and 2025. All patients received the InterStim™ device following a positive test phase. Demographic, clinical, and surgical data were collected and analyzed. The primary outcomes were changes in LARS and Wexner incontinence scores. Secondary outcomes included changes in quality of life measured by the Fecal Incontinence Quality of Life (FIQL) questionnaire and Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) survey.

Results: LARS scores improved from a mean of 37.9-29.9 (p < 0.001) and Wexner scores from 14.2 to 10.4 (p < 0.001). FIQL scores improved significantly across all subdomains: lifestyle (1.49-2.28, p < 0.001), coping (1.39-2.26, p < 0.001), depression (1.66-2.38 p < 0.001), and embarrassment (1.58-2.40, p < 0.001). PROMIS-10 scores also improved, with physical health increasing from 35.7 to 41.4 (p = 0.01) and mental health from 40.3 to 45.1 (p = 0.02). Six patients required device revision, and three experienced minor complications.

Conclusions: SNM significantly improves bowel function and quality of life in patients with LARS refractory to conservative management and represents a promising therapeutic option.

Background: Colon cancer located at the splenic flexure exhibits dual lymphatic drainage via the left middle colic artery (lt-MCA) to the superior mesenteric artery (SMA) system and the left colic artery (LCA) to the inferior mesenteric artery (IMA) system. However, an additional pathway-the Arc of Riolan (AoR) artery, central anastomotic vessels connecting the SMA and IMA-may also serve as a route for metastasis. This case highlights the importance of central vascular ligation of the AoR in splenic flexure cancer.

Case: We present a rare case of isolated AoR lymph node metastasis in a 72-year-old male with advanced splenic flexure cancer. The patient presented with multiple synchronous tumors (splenic flexure, sigmoid, and rectum) and underwent extended left hemicolectomy with central vascular ligation (CVL) of the AoR, revealing metastatic involvement exclusively in AoR nodes. This represents the first documented case of isolated AoR nodal metastasis, emphasizing the need for AoR lymphadenectomy when present.

Discussion: Recent studies suggest that accessory middle colic arteries (aMCA) and AoR may represent the same anatomical structure, with metastasis rates of 3.7-6.3% in corresponding nodes. Our findings support that AoR should be considered a critical target for CVL in splenic flexure cancer, particularly when identified pre- or intraoperatively.

Conclusions: Surgeons should recognize AoR as a possible isolated metastatic pathway and perform thorough nodal dissection along this vessel when present to ensure optimal oncologic outcomes.

Background: Acute anal fissure is a common cause of severe pain in the anorectal region. The standard treatment is the topical application of a calcium channel blocker or glyceryl trinitrate. Despite acute anal fissure being a common proctologic condition, data on the healing rates and long-term outcomes remain scarce. This study aimed to evaluate data from our centre, with a special focus on long-term follow-up and recurrent disease.

Methods: All consecutive patients who presented with acute anal fissure between January 2016 and December 2016 were retrospectively identified. Patients were included if their clinical symptoms lasted for less than 6 weeks, secondary changes to fissure morphology were absent, and data from follow-up examinations were available. Clinical features, symptoms, therapy and long-term outcomes were evaluated.

Results: A total of 623 patients with a median age of 45 years were included; 342/623 patients were female (54.9%). The median follow-up period was 41 months (range 6 weeks-89 months), and 39.5% of the patients had a follow-up duration exceeding 5 years. Most fissures occurred in the 6 o'clock lithotomy position (63.7%), in the 12 o'clock position (21.0%), or in both (4.5%). In 67/623 patients, the fissure was in an atypical region (10.8%). In 439/623 patients, the fissure healed completely (70.5%). A total of 8.7% of the patients underwent fissurectomy, and 180/623 patients experienced recurrence (28.9%).

Conclusions: The management of acute anal fissure can be challenging because recurrence is common. Conservative management is successful in the majority of cases. Surgery is necessary only for a minority of patients.