Endoscopic resection of colorectal adenomas helps reduce colorectal cancer mortality. However, post-polypectomy metachronous adenomas may reduce the sufficiency of colonoscopy scanning. To explore the risk factors for post-polypectomy metachronous colorectal adenoma and establish a risk prediction model. This retrospective cohort study included patients who underwent colonoscopy at Beijing Friendship Hospital from January 2013 to January 2023. Data on patients' demographics, laboratory results, colonoscopy findings, and pathology reports were collected. The enrolled patients were randomly divided into a training set and a validation set in a 7:3 ratio. LASSO analysis was employed to identify risk factors for metachronous adenomas. Based on these risk factors, a Cox regression model was used to create a risk prediction model. The C-index was calculated to assess the model's prediction accuracy, while time-dependent ROC (td-ROC) curves and calibration curves evaluated model predictive performance. A Decision Curve Analysis (DCA) was conducted to assess clinical utility. A total of 523 patients meeting the inclusion and exclusion criteria were enrolled and randomly divided into a training set (n = 366) and a validation set (n = 157). Twenty-one clinical and pathological features were included in the LASSO regression analysis. Among these, age, gender, baseline adenoma size, baseline adenoma location, baseline pathological grade, history of hypertension, and serum LDL level were included in the multivariable Cox regression analysis, leading to the establishment of a visualized nomogram model. The C-index of the predictive model was 0.729 (95% CI: 0.686, 0.772) in the training set and 0.724 (95% CI: 0.667, 0.781) in the validation set. The time-dependent ROC curve and calibration curve indicated good reliability of the model, and the DCA curve suggested satisfactory clinical utility. An online webserver was also constructed to visualize the model and facilitate the calculation of metachronous adenoma risk for clinicians (URL: https://colorectal-metachronous-adenoma-prediction.shinyapps.io/DynNomapp/). A total of 7 risk factors for post-polypectomy metachronous adenoma were identified. A risk prediction model that possesses good prediction accuracy and good clinical utility was established, providing a reliable tool for patient risk stratification.

In colorectal cancer (CRC), diverting ileostomy prevents the occurrence and severity of anastomotic leakage (AL) during surgery. However, an ileostomy cannot prevent reoperation due to severe AL in some cases, and an approach other than ileostomy may be required. This study identified the risk factors of AL and reoperation due to AL in patients with diverting ileostomies. Patients diagnosed with CRC who underwent resection surgery accompanied by diverting ileostomy between January 2015 and December 2023 were included. We analyzed the risk factors for AL and reoperation due to AL. Stoma-related complications and perioperative results of stoma reversal surgery were also analyzed. In total, 120 patients were enrolled. AL occurred in 21 (17.5%) patients. Multivariate analysis revealed that tumor location in the lower rectum was the only risk factor for AL (P = 0.0095). Of these 21 patients, four (19.0%) required reoperation, while 17 (81.0%) recovered without reoperation. The rates of T4 tumors (P = 0.022) and stenosis (P < 0.001) were significantly higher in the reoperation group. Among the 120 patients, a high-output stoma was observed in 36 patients (30.0%), and outlet obstruction occurred in 19 patients (15.8%). In stoma reversal surgery, two patients (1.7%) experienced severe complications (Clavien-Dindo grade ≥ III). Lower rectal tumors are associated with a high risk of AL, and diverting ileostomy should be considered in such cases. Due to small number of AL patients requiring reoperation, the finding is exploratory. However, in patients with stenosis and T4 invasion, the merits of ileostomy might be restricted.

To clarify the histological architecture of the intersphincteric region of the anal canal by delineating the layer-specific organization and spatial relationships among the anal sphincter complex and associated muscular and connective tissue components. Tissue blocks containing the lateral wall of the anal canal were obtained from 11 adult human cadavers donated for anatomical research. Specimens were examined using descriptive histological and immunohistochemical analyses in transverse and coronal planes. The internal and external anal sphincters, longitudinal muscle, levator ani, interbundle gaps, and connective tissue compartments were identified and analyzed with respect to their three-dimensional organization. The intersphincteric region exhibited a heterogeneous and layered architecture rather than a uniform plane. The longitudinal muscle demonstrated a mosaic organization consisting of dense and loose components. The dense component terminated near the mid-height of the internal anal sphincter (mean, 54% of its length), whereas the loose component expanded inferiorly and formed a spacious compartment characterized by sparse smooth muscle fibers and loose connective tissue. Inferiorly, loose longitudinal muscle fibers branched and traversed natural interbundle gaps within the external anal sphincter. In addition, two partially overlapping layers of the levator ani were consistently observed, with interposed gaps contributing to the structural complexity of the intersphincteric region. The intersphincteric region of the anal canal is a structurally complex and compartmentalized anatomical entity. Its heterogeneous histological architecture provides an anatomical substrate that may explain the initiation and directional spread of anal fistulas, including pathways described in classical fistula classifications.

Robotic surgery is a well-validated treatment option for colorectal cancer (CRC). We aimed to evaluate the efficacy and safety of the Weigao (WG) robotic system compared with those of the da Vinci(DV) platform for the surgical resection of CRC. We retrospectively analyzed patients with stage I-III CRC who underwent robotic CRC resection using the Weigao or da Vinci Surgical System. Statistical analysis of perioperative clinical data, including preoperative, intraoperative, and postoperative parameters was conducted. A total of 103 patients were included and divided into the WG (n = 65) and DV (n = 38) groups. All patients achieved surgical success, and there were no significant differences in preoperative baseline characteristics. However, the WG group demonstrated a significantly longer operative time. Patients in the WG group experienced a shorter time to first flatus and alow incidence of postoperative deep vein thrombosis. Notably, the total hospitalization cost was significantly lower when the Weigao Surgical System was used. This study demonstrated that the Weigao robotic system was comparable to the da Vinci system in terms of safety and efficacy for CRC surgery. Moreover, the total hospitalization cost was significantly reduced with the Weigao Surgical System, highlighting its potential as a cost-effective surgical option.

A new robotic platform, the Hugo™ robotic-assisted surgery (RAS) system, has been introduced to the market, featuring innovations such as modular arms and an open console, distinguishing it from the Da Vinci system. These differences highlight the need to establish specific, standardized training, credentialing criteria, and clinical guidelines for the use of this platform. To date, this represents the first international expert consensus on the Hugo™ RAS system. Eleven European colorectal experts with experience using the Hugo™ RAS platform were invited to participate in this Delphi study. Seventy-seven questions related to this robotic platform were grouped into six domains: (1) required knowledge, (2) technical skills, (3) nontechnical skills, (4) assessment of competency/proficiency during training, (5) credentialing and clinical outcome data, and (6) setups and surgical technique. A three-round Delphi process was conducted. Participants were asked to indicate their agreement or disagreement using a Likert scale (0-5) regarding the proposed themes. Consensus was reached, with a minimum agreement level of 0.80 (80%). All the experts completed the three Delphi rounds, ensuring a 100% response rate throughout the process. Of the 78 statements evaluated, 33 (42%) achieved consensus agreement (> 80%) and were considered consensus recommendations, while 15 statements showed consensus disagreement (< 20%). The remaining items reflected areas of uncertainty. The first consensus statement on robotic colorectal surgery with the Hugo™ RAS platform, developed by a European panel of experts, represents an important milestone and provides recommendations for colorectal surgeons considering the adoption of this new robotic platform.

Postoperative acute pain is a major obstacle to archiving key goals in modern perioperative treatment concepts such as ERAS® (enhanced recovery after surgery). Despite a multimodal pain management concept, some patients continue to suffer from severe pain. The aim of this analysis is to identify predictors of severe postoperative pain following elective minimally invasive intestinal surgery. Data from 49 patients, who underwent intestinal resection between April 2021 and March 2022 were used for this purpose. Various pre- and intraoperative characteristics were examined for their influence on pain in the morning in a univariate and multivariate analysis. Increased postoperative pain is defined by a NRS (numerical rating scale) of at least 4 at rest. It was found that patients with severe postoperative pain (n = 16) on the first postoperative day (POD) had a significantly higher BDI (Beck Depression Index) score of 16.1 (± 10.46) compared to patients without severe postoperative pain (n = 33) with 8.89 (± 7.03) (p = 0.007). In the multivariate analysis, the BDI score was also significant with an Odds Ratio of 1.14 (CI 95% 1.02-1.29, p = 0.002). On POD 2, patients with increased pain (n = 10) were significantly younger (53.1 years (± 16.40)) than patients without increased pain (n = 39) (65.8 years (± 12.64)) (p = 0.01). This was also confirmed in the multivariate analysis with an Odds Ratio of 1.12 (CI 95% 1.02-1.24, p = 0.019). It was demonstrated that a younger age, higher BDI score and the presence of IBD are significant predictors of severe postoperative pain despite multimodal pain management.

Magnetoelectric biofeedback therapy (MEBFT) is an emerging intervention for moderate rectocele-associated obstructed defecation syndrome (ODS); however, its efficacy and mechanisms remain unclear. This study compared MEBFT with conventional biofeedback therapy (BFT) and developed a 3D high-resolution anorectal manometry (HR-ARM)-based predictive model for clinical decision-making. In this prospective, single-blind, randomized controlled trial, 68 female patients with defecography-confirmed moderate rectocele-associated ODS were treated in the outpatient department of Tianjin Union Medical Center from January 2019 to June 2024). Patients were randomly assigned in a 1:1 ratio to either the MEBFT or BFT group. Primary outcomes included 3D HR-ARM parameters, Glazer surface electromyography, and patient-reported outcomes (Cleveland Clinic Constipation and Patient Assessment of Constipation Quality of Life scores) at baseline and 3months. The secondary outcomes included predictive indicators derived from the Hosmer-Rothman model and treatment response stratification. MEBFT significantly improved fast-twitch fiber recruitment, anorectal function, and quality of life compared to BFT (all P < 0.01). The Hosmer-Rothman model identified a negative MRP-MTV interaction (synergy index = 0.20), with the R11 phenotype (MRP < 80mmHg-MTV < 135cc) predicting an 82.35% response to MEBFT after 3months of treatment (area under the curve [AUC] = 0.72). Phenotypic stratification-guided management: R11 for MEBFT, R00 (elevated MRP-MTV) for surgical evaluation, and R10/R01 for extended MEBFT with surgical backup. MEBFT demonstrated superior clinical effectiveness, anorectal functional recovery, and quality of life compared with BFT after 3months of treatment. The exploratory Hosmer-Rothman model may provided a moderate-accuracy phenotype-based approach using 3D HR-ARM parameters to stratify treatment response and optimize the individualized management of moderate rectocele-associated ODS. 1. Dateofregistration(needstobebeforetheDateoftheFirstPatient): December 26, 2023. 2. Dateofinitialparticipantenrollment: January 9, 2019. 3. Clinicaltrialidentificationnumber: ChiCTR2300079173. 4. URLoftheregistrationsite: http://www.chictr.org.cn/.

This study aimed to examine the pudendal nerve in the context of tumors involving the pudendal canal and to clarify its anatomical course and the structural composition of Alcock's canal, while elucidating the relationships among the obturator internus nerve, sacrotuberous ligament, and fascia of the obturator internus muscle. Six cadavers (12 pelvic halves) were dissected. The dissections focused on the pudendal canal, particularly the positions and interrelationships of the fasciae, muscles, ligaments, and surrounding fascial structures from medial and posterior perspectives. The sacrotuberous ligament comprised two distinct layers, with the pudendal canal located within its structure. The proper fascia was distinguishable and situated on the muscle side of the obturator internus muscle. The pudendal nerve was traced within the fascia of the sacrotuberous ligament, whereas the obturator internus nerve coursed between the obturator internus muscle and its proper fascia. Coronal section examination of the right pelvis confirmed that the pudendal nerve was enveloped by fascia. The obturator internus nerve ran along the muscle side of the obturator internus fascia, occupying a layer distinct from that of the pudendal nerve. The pudendal nerve travels within the fascia derived from the sacrotuberous ligament and does not pass through the fascia of the obturator internus. The proper fascia of the obturator internus muscle is located relatively close to the muscle, and the obturator internus nerve courses between the obturator internus muscle and its own fascia. These findings describe the anatomy of the pudendal canal and may provide a foundation for future surgical investigation.

The LARS score is a practical tool to screen for bowel dysfunction after rectal cancer surgery. However, clinical experience suggests that it may overlook relevant symptoms and/or overestimate impact in some patients. This study aimed to explore whether the International Consensus Definition of LARS complements the LARS score in identifying patients with bowel dysfunction. We conducted a cross-sectional study including patients treated for rectal cancer across two hospitals between January 2021 and December 2024. Demographic and clinical data were collected retrospectively. Functional outcomes were assessed during outpatient follow-up using both the LARS score and the International Consensus Definition criteria. Sixty-two patients were included. According to the LARS score, 39 (62.9%) had "no LARS", 10 (16.1%) "minor LARS" and 13 (21%) "major LARS". Using the International Consensus Definition, 24 (38.7%) met the criteria for LARS. Nine patients (14.5%) were classified differently by the two tools. Five patients classified as "no LARS" by the LARS score met the International Consensus Definition due to unpredictable bowel function and emptying difficulties with a reported impact on daily life. In contrast, four patients with "minor or major LARS" did not meet the International Consensus Definition criteria because no consequences were reported. In this exploratory cross-sectional cohort, the International Consensus Definition did not identify substantially more patients than the LARS score but provided complementary information by linking symptoms to their perceived consequences. Combining both tools may offer a more comprehensive appraisal of LARS until newer multidimensional instruments become available.