Colon Surgery Research Articles

Transversus abdominis plane block in minimally invasive colon surgery: a multicenter three-arm randomized controlled superiority and non-inferiority clinical trial

Background and objectivesThe transversus abdominis plane (TAP) block is the most widely used abdominal field block in colorectal surgery with a postoperative enhanced recovery pathway. We aimed to determine whether the laparoscopic-assisted and ultrasound-guided TAP (US-TAP) blocks provide superior pain relief compared with placebo. We separately investigated whether the laparoscopic-assisted technique was non-inferior to the ultrasound-guided technique in providing pain relief, with a non-inferiority margin of 10 mg morphine dose equivalents.Methods340 patients undergoing elective minimally invasive colon surgery were randomly allocated to one of three groups: (1) US-TAP block, (2) laparoscopic-assisted TAP (L-TAP) block, or (3) placebo. Superiority and non-inferiority were tested for the primary outcome: 24-hour postoperative morphine equivalent consumption. Secondary outcomes, including patient-reported quality of recovery, were included in the superiority analysis.Results127 patients were included in each block group and 86 in the placebo group. The US-TAP block was no different from placebo at −1.4 mg morphine (97.5% CI −6.8 to 4.0 mg; p=0.55). The L-TAP block was superior to placebo at −5.9 mg morphine (97.5% CI −11.3 to −0.5 mg; p=0.01) and non-inferior to the US-TAP block at −4.5 mg morphine (98.75% CI −10.0 to 1.1 mg).ConclusionThe L-TAP block was superior to placebo and non-inferior to the US-TAP block. However, neither met our predetermined estimate of the minimal clinically important difference of 10 mg morphine.Trial registration numberNCT04311099.

Comparative analysis of the oncologic outcomes and risk factors for open conversion in laparoscopic surgery for non-metastatic colorectal cancer: A retrospective multicenter study

PurposeLaparoscopic colon surgery is now commonly used for colorectal cancer (CRC) resection. The objective of this study was to compare the oncologic outcomes between open conversion and laparoscopic surgery, and to identify risk factors for open conversion. MethodsWe retrospectively reviewed the medical records of patients who underwent curative resection for stage 0–III CRC at five Hallym University-affiliated hospitals between January 2011 and June 2021. The patients were divided into the conversion and laparoscopic groups according to whether laparoscopic surgery was completed. ResultsOut of 2231 patients, laparoscopic surgery was completed in 2131 patients and 100 (4.5 %) converted to open surgery. The operation time (P = 0.028) and postoperative hospital stay (P = 0.036) were longer in the conversion group than in the laparoscopic group. Overall (P = 0.022) and severe (Clavien–Dindo classification grade ≥3) (P = 0.048) complications were more frequent in the conversion group than in the laparoscopic group. The 5-year recurrence-free survival (RFS) rate was worse in the conversion group than in the laparoscopic group (P = 0.002). In the multivariable analysis, open conversion was not a prognostic factor for RFS (P = 0.082). Abdominal surgery history (P = 0.021), obstruction (P < 0.001), and T4 stage (P < 0.001) were independently associated with open conversion. ConclusionThe conversion group had worse perioperative and oncologic outcomes. History of abdominal surgery, obstruction, and T4 stage were associated with open conversion. However, conversion itself was not associated with RFS.

Surveillance of surgical site infections using artificial intelligence

Abstract Background Surgical site infection (SSI) is a major health problem associated with high morbidity and mortality, the consequences of which can be very serious for the patient and costly for the organisation. Surveillance systems provide insight into the incidence of SSI, the analysis of which enables improvement plans to be established to reduce it. Traditionally, surveillance systems have been based on manual medical record review for evidence of the presence of surgical infection. Objectives To create and validate a global SSI diagnostic algorithm and to optimise the SSI workload of Preventive Medicine services. Methods The study population included patients undergoing surgical procedures of rectal surgery, colon surgery, knee replacement surgery, hip replacement surgery, coronary bypass and valve surgery, at the Hospital Universitario Vinalopó in Elche (n = 1240). Data mining was used to collect clinical, microbiological and postoperative follow-up values from the electronic medical record. Machine Learning techniques were used to train (n = 1054) and validate the model (n = 186). Time spent on SSI surveillance of the preventive medicine service was measured. Results Model performance after validation was: sensitivity of 0.83 specificity of 0.87, accuracy of 0.87, an F1 score of 0.45, and an area under the curve of 0.87. The time spent by preventive medicine staff in identifying patients with surgical site infection decreased from 168 person-hours per procedure per quarter to 34 person-hours, a 77% reduction in the workload allocated to this task. Conclusions This project not only improves surveillance efficiency, but also optimises the workload in Preventive Medicine services very significantly. Key messages • This project improves the efficiency of surgical site infection surveillance and significantly optimises the workload in preventive medicine departments. • It makes it possible to extend surveillance to new surgical procedures and to work more intensively on preventive measures.

Laparoscopic colon surgery: time to leave the urinary catheter in the operating room?

'Fast track' guidelines have incorporated multimodal measures to optimize perioperative outcomes in surgery, with laparoscopy being a pivotal component for its advantages in early recovery. In this setting,current recommendations regarding the use of aurinary catheter suggest its removal within the first 24-hours postoperatively. However,few studies have assessed the feasibility of leaving the operating room without it. The purpose of this study is to compare the perioperative outcomes of patients undergoing elective laparoscopic colonic resections leaving the operating room with and without a urinary catheter. A retrospective study was conducted utilizing prospectively collected data from patients undergoing elective colon resections over a 17-month period. The patients were classified into two groups based on the presence or absence of a urinary catheter upon leaving the operating room, and subsequently, their perioperative outcomes were compared. A total of 107 patients met the inclusion criteria (n = 28 with a urinary catheter and n = 79 without). Cancer was the most prevalent diagnosis (83.2%), and right hemicolectomy the most frequently performed surgery (32.7%). Two events of urinary catheter reinsertions were reported, both in the no-catheter group (0% vs 2.53%, p = 0.969), andthere were no cases of urinary tract infections. The overall and severe complications ratesexhibited no significant differences (25% vs. 26.6%, p = 1, and 7.14% vs. 5.06%, p = 1)and the length of stay was similar (p = 0.220). Removing the urinary catheter before leaving the operating room appears to be safe and associated with very low rates of urinary retention in selected patients undergoing laparoscopic colonic or upper rectal resections.

Shaping Graduate Medical Education: Status of the Colon and Rectal Surgery Training Program Requirements.

Shaping Graduate Medical Education: Status of the Colon and Rectal Surgery Training Program Requirements.

Laparoscopic sigmoid colectomy with primary anastomosis for experimental modeling in the nonhuman primate.

Laparoscopic colon surgery is performed frequently in the clinical setting for a multitude of reasons including cancer, infection, and autoimmune disease. As a result, extensive research has been conducted in relation to clinical outcomes after surgery, but more recently, in relation to the impact of surgery and other patient factors on physiologic homeostasis including the host microbiome. Despite this, experimental surgical models for laparoscopic colon surgery are scarce in the literature with most studies utilizing rodents. While rodent studies provide valuable insights into basic mechanistic processes, the translation of novel therapeutic approaches to clinical practice often requires the use of large animal models. In exploring the intricate systems biology linking surgery and medicine, sophisticated models such as nonhuman primates (NHPs) play a pivotal role. By closely resembling human anatomical, physiological, and behavioral characteristics, NHPs facilitate the development and refinement of complex surgical techniques and peri-operative practices. Furthermore, they enable longitudinal studies that comprehensively assess both immediate and long-term outcomes. The availability and utilization of multiple robust models enhance the validity of surgical research, leading to more successful translation to human clinical practice. Here we describe our technique for performing a laparoscopic sigmoid colectomy with a primary anastomosis in an NHP. The entire procedure was well tolerated without significant ventilation or hemodynamic issue. To our knowledge, this represents the first laparoscopic sigmoid colectomy with primary anastomosis performed in an NHP. Furthermore, this demonstrates the feasibility of the technique and provides a relevant, preclinical model for the study of surgical colon disease. Although the surgical colectomy model in NHPs closely resembles the clinical scenario, it is crucial to recognize that a 'model' inherently comes with limitations. The intended use of any model should be carefully evaluated concerning the target patient population with the consideration of potential disparities in anatomy, physiology, environmental factors, and disease to properly interpret results. This model provides an opportunity to study mechanisms, from a systems biology perspective, underlying both innovative surgical treatments and their effects on diseases such as colon cancer, as well as benign conditions like inflammatory bowel disease, diverticulitis, and anastomotic leak, offering high predictive value.

Colon and Rectal Surgery

Colon and Rectal Surgery

The impact of standardized robotics course training during colorectal surgery fellowship on post-training practice: a survey of graduates

The Association of Program Directors for Colon and Rectal Surgery (APDCRS) has sponsored a standardized robotics course for colorectal and minimally invasive surgery fellows since 2011. The study objective was to assess the impact of the APDCRS-sponsored course on surgical approaches adopted by young colorectal surgeons before, during, and after fellowship. An internet-based survey was administered to 2014–2022 ACGME-accredited colorectal surgery program graduates. Study variables were summarized using frequencies and proportions. Survey response rate was 43.2%. Laparoscopic and robotic volumes were consistently higher than open and hand-assist laparoscopic volumes over the study period. About 70.0% of fellows performed ≥ 20 laparoscopic cases before 2017, and over 80% had experience with ≥ 20 laparoscopic cases during/after 2017. An increasing trend of performing ≥ 20 robotic colorectal cases during fellowship was observed (before 2017: 75.0%, 2018–2019: 76.9%, and 2021–2022: 84.8%). Multivariate logistic regression analysis showed that higher robotic volume (≥ 25 colorectal cases) during general surgery residency increased odds of performing ≥ 50 robotic cases during fellowship (OR: 4.38, 95% CI 0.88, 26.1). Higher robotic volumes during fellowship correlated with higher robotic volumes in the first year of post-fellowship practice. 88.6% of respondents agree (21.0%) or strongly agree (67.6%) that the APDCRS robotics training course met expectations, and 83.8% agree or strongly agree that the course prepared them for post-graduate robotics practice. The APDCRS-sponsored robotics training course met expectations and prepared colorectal surgery fellows for adopting the robotic approach after graduation, with the majority of respondents reporting that they utilize robotics in their post-graduation colorectal practice.

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study.

We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level. The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL. From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%). We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Postoperative outcomes after receipt of ertapenem antimicrobial prophylaxis for colon surgery: a multicenter retrospective cohort study.

To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens. Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015. Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups. A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08-2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68-1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%-.5%) and did not differ statistically. Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.

The impact of colectomy and restorative procedure on pouch function after ileo-pouch-anal anastomosis in ulcerative colitis. The icon fun study on behalf of the Italian Society of Colon and Rectal Surgery (SICCR) Inflammatory Bowel Diseases committee

BackgroundAvailable guidelines lack in indications on surgical standard in Ulcerative Colitis (UC) AimsTo determine the role of surgical strategies of colectomy and proctectomy with pouch-anal-anastomosis (IPAA) on functional outcomes in a nationwide population multicenter study. The secondary aims consisted of perioperative outcomes and complications. MethodsData on 379 patients who underwent total abdominal colectomy and proctectomy with ileo-pouch-anal-anastomosis (IPAA) with or without diverting ileostomy were retrospectively collected in a red cap multicenter-database searching for variables that could impact on pouch outcomes as cuffitis, pouchitis, anastomotic stenosis, pouch stenosis, failure or pathological Low-Anterior-Resection-Syndrome (LARS) score. ResultsMesocolic dissection sealing vessels at major trunks and from medial to lateral are associated with better outcomes. Laparoscopy is associated with lower rate of cuffitis over time (p = 0.028). Mesentery lengthening is associated with higher pouchitis rate (p = 0.015) and earlier failure (p < 0.0001). Hand-sewn IPAA results in early anastomotic stenosis (p = 0.00011). The Transanal-Transection and Single-Stapling Anastomosis (TTSS) showed to be protective against pouchitis. Extended dissection of adhesions correlates with lower rate of pouchitis-episodes (p = 0.0057). ConclusionsThe study highlights advantages of laparoscopy. New techniques such as TTSS promise further improvements. Mesentery lengthening correlates with high risk of pouch-failure and pouchitis, hand-sewn anastomosis increased risk of stenosis.

The Emerging Role of the Microbiota and Antibiotics in Diverticulitis Treatment

AbstractDiverticular disease is the leading cause of elective colon surgery. With a rising incidence in younger populations, it continues to pose a significant burden on the health care system. Traditional etiopathogenesis implicated an infectious mechanism, while recent challenges to this theory have demonstrated the microbiome playing a significant role, along with genetic predispositions and associations with obesity and diet. Therefore, the role of antibiotics in uncomplicated disease merits reconsideration. In this review, we aim to outline the current knowledge regarding antibiotics for diverticulitis treatment, broadly define the microbiome components, functions, and modifiability, and discuss newly proposed pathogenetic mechanisms for diverticular disease that incorporate information regarding the microbiome. Analytic techniques for microbiota characterization and function continue to advance at a rapid pace. As emerging technology advances, we will continue to elucidate the role of the microbiome in diverticular disease development.

Anastomotic leak occurs independently from microbiota shifts associated with surgical bowel preparation

Following bowel surgery, infectious complications, including anastomotic leak (AL), remain major sources of morbidity and mortality. Bowel preparation is often administered with the assumption that gut decontamination reduces post-surgical complications. In this study, we tested this hypothesis using a murine model of colon surgery. The mice were fed either regular chow or a high-fat, high-sugar Western diet. The day before surgery, the mice received one of four interventions: water (control), mechanical bowel preparation (MBP), oral antibiotics (OA), or both MBP and OA. We found no differences in the rates of AL among the experimental groups, and diet did not appear to affect the outcomes. Exploratory analyses showed changes in the gut microbiome consistent with the different treatments, but investigations of fecal short-chain fatty acids and RNA sequencing of colonic tissue did not reveal specific effects of the treatments or the presence of AL. However, we did identify bacterial genera that may be causally associated with AL and developed a predictive index from stool samples as a marker for the presence of AL. Future research is needed to identify and validate a microbial predictive tool and to uncover the microbial-driven mechanisms that lead to AL.

Indocyanine Green (ICG) Fluorescence in the Assessment of Vascularity of Anastomotic Margins in Colorectal Surgery in a Lower Middle-Income Country (LMIC) Hospital.

One of the uses of indocyanine green (ICG) in the surgical field is the evaluation of the anastomotic margins in colorectal surgery. This is of particular importance because fluorescence imaging may aid in detecting vascular compromise, allowing the surgeon to change the resection margin thereby decreasing the chance of an anastomotic leak. To date, there has been no study with its use locally. This study aimed to determine whether the use of ICG can safely identify if the margins of resection are well-vascularized in patients undergoing left-sided colon or rectal surgery, which in turn may reduce anastomotic leak rates. Through a retrospective study design, the investigators gathered data of patients who underwent left-sided colon or rectal surgery. The groups were divided into those with and without the use of ICG and a comparative data on the anastomotic leak rates were analyzed. Eighty-six (86) patients with similar patient characteristics, tumor staging, and surgical approach were compared. Both the leak rates identified during the initial hospital stay and at 30 days post-operatively were lower in those where ICG was used (p=0.035, p=0.047, respectively) than those where ICG was not used. ICG fluorescence imaging may reduce the anastomotic leak rates in patients undergoing colorectal surgery.

Retroperitoneal Approach to D3-Lymph Node Dissection With Left Colic Artery Preservation in the Treatment of Sigmoid Cancer.

Laparoscopic approaches and robot-assisted operations are used for colorectal cancer surgery because of their minimal invasiveness.1 However, changes in intra-abdominal pressure during laparoscopy can lead to cardiovascular complications in compromised patients;2 obesity and intraabdominal adhesions may further interfere with laparoscopic procedures. The retroperitoneal approach may facilitate minimally invasive surgery, even in patients with comorbidities. The technique for high ligation of the inferior mesenteric artery has been described in left colonic surgeries.3 However, complete termination of the blood supply through this artery may lead to a higher frequency of anastomotic leakage.4. We present a novel retroperitoneal approach for D3-lymph node dissection with low ligation of the inferior mesenteric artery and preservation of the left colic artery. This method can reduce the duration of laparoscopic procedures for compromised patients and meet the standards for extended lymph node dissection with tumor-specific mesocolic excision.5,6. The procedure started with the installation of a paraumbilical optical trocar to introduce a 30-degree optical system. The SILS™ Port (Covidien, Medtronic) was inserted into the retroperitoneal space via a 4-cm incision, made 2 cm below and parallel to the anterior superior iliac spine in the left flank under the control of the optical system. The horizontal aspect of the duodenum served as the cranial landmark during interfascial dissection, with the dissection proceeding in a cranial and medial direction. During the dissection, the left ureter was the primary landmark, passing medial to the gonadal vessels and Gerota's fascia.The aorta was exposed medially and the inferior mesenteric artery was identified. The inferior mesenteric artery was skeletonized from its origin until the branching of the left colic artery and the sigmoid artery. The left colic artery was skeletonized until the passage of the inferior mesenteric vein, and the apical lymphatic nodes with mesocolic tissue were mobilized and excised. The inferior mesenteric artery was cut below the left colic artery.The final step was performed laparoscopically. The parietal fascia along Toldt's line was cut laterally to complete the mesocolon excision. The parietal fascia was cut along the right side of the aorta to free the mesocolonic medial border. The sigmoid mesocolon was dissected at the proximal and distal resection margins.Following mobilization, the colon was cut 10 cm distal to the tumor margin using a linear stapler. The specimen was then extracted using an SILS incision. The sigmorectal anastomosis was made. Atypical hepatic resection was performed using two additional trocars. The incidence of pain syndrome in the early postoperative period was low. Blood loss reached 100 mL. The duration of the surgery was 300 min. The retroperitoneal step took 63 min. Metastases were observed in 7 of the 41 harvested lymph nodes. The patient was discharged on the 8th postoperative day. The retroperitoneal technique can be safely performed. Anatomical structures are readily accessible and easily visualized with this approach after special training, enabling extended lymph node dissection.

Developing and reporting a healthcare-associated infection composite score for health system board review

Background One strategy for supporting a hospital or health system's board of directors (Board), with their quality oversight responsibility is to review the organization's performance on quality measures. But for large systems, the number of measures needing review is quite burdensome and makes priority setting difficult. Our goal was to develop a scoring method that summarizes multiple quality measures together, while still maintaining the Board's opportunity to examine individual measures where there are specific concerns. Methods We calculated an overall health system-level composite performance score using six publicly reported healthcare-associated infections reported by the Centers for Medicare and Medicaid Services on their Care Compare website [central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSIs) for colon surgery and abdominal hysterectomy, hospital-onset Methicillin-resistant Staphylococcus aureus bacteremia (MRSA), and hospital-onset Clostridioides difficile ( C. diff)], where relative weights assigned to each infection type reflect the severity of patient harm. We also calculated a health-system composite performance target. For individual infection types, we calculated system-wide scores and targets and categorized individual hospital performance into three performance categories. Results The health system's composite score between 2015 and 2019 ranged from a high of 1.10 to a low of 0.71. The health system's composite score in 2017–2019 was better than the composite target. Of the 34 measures used to calculate the 2019 composite score, 20 were better than internal standardized infection ratio (SIR) targets, seven were between internal targets and SIR of 1.0, and seven were worse than SIR of 1.0. Discussion The Board communicated they find this composite score reporting approach helpful for streamlining their understanding of HAI performance, as compared to traditional approaches of reporting out individual performance measures. Approaches that streamline Board review of quality and safety performance are important as we hold Board members accountable for overseeing quality, seek greater engagement from the Board, and work to minimize measure review overload.

Assessment of Education and Management of Endometriosis Among Colorectal Surgeons and Residents

Study ObjectiveA To identify the type of endometriosis education and surgical training colorectal surgery residents are exposed to during training. b To determine the current surgical management of endometriosis among recently graduated colorectal surgeons and their level of comfort. DesignA qualitative cross-sectional study was performed. An anonymous questionnaire was emailed to colorectal surgery residents of 2023 and recent graduates for completion. Data was then extracted and analyzed from REDCap. A chi-square test was performed on the primary outcome variables. SettingA REDCap electronic survey was administered through email to each participant. PatientsAll colorectal surgery residents in 2023 and recent graduates from Colon and Rectal Surgery subspecialty from 2012 to 2022. InterventionsA 17-item anonymous questionnaire was sent via email through REDCap. Measurements and Main ResultsThe survey was completed by 70 participants. Most respondents (58.5%) did not receive formal education on bowel endometriosis. Forty percent of participants (28/70) did not feel they received adequate training for surgical management of bowel endometriosis. In terms of surgical exposure, 3.8% (2) responded they had been involved in >15 bowel endometriosis cases and 18 (25.7%) had been exposed to 1–5 cases during colorectal training. Factors that predicted feeling adequately trained in managing endometriosis included formal endometriosis education (OR 4.70, 95% CI 1.37−16.12, p-value .027) and surgical exposure during training (OR 4.38, 95% CI 1.18–16.26, p-value .014). Additionally, the number of cases exposed during training is highly correlated with feeling adequately trained. ConclusionMore than half of colorectal surgeons did not receive formal education on bowel endometriosis and the majority had only been exposed to 1–5 cases during their colorectal training. An overwhelming majority were interested in further education. This study highlights opportunities for improvement in the exposure to education and surgical management of endometriosis among colorectal surgery trainees.

Colon and Rectal Surgery Regional Society Meetings

Colon and Rectal Surgery Regional Society Meetings

Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors.

Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.

Outcomes after right-sided colon surgery in Crohn's disease versus cancer.

Surgery for Crohn's disease (CD) is considered to have more complications due to the underlying inflammation, immunosuppression, and malnutrition.We sought to study the outcomes of right-sided colonic resection in patients with CD and patients with cancer at a high-volume tertiary center utilizing a standardized perioperative protocol. This is a retrospective study of outcomes for all patients with CD or patients undergoing ileocolic resection or right hemicolectomy with ileocolic anastomosis at a single institution from 2013 to 2022. Patients were excluded if they simultaneously underwent another procedure or ostomy creation. Data were analyzed using Wilcoxon rank-sum and chi-squared tests for univariate analyses, and logistic and linear regressions for multivariate analyses. In total 141 patients with CD and 589 patients with cancer were included. Patients with CD were significantly younger with lower body mass index and less likely to have comorbidities, including diabetes and hypertension. Patients with CD were less likely to have a smoking history or prior abdominal surgery, but more likely to be on steroids. Both groups had similar rates of laparoscopy, intraoperative complications, and blood loss. Despite the preoperative and intraoperative differences, both patients with CD and patients with cancer had similar lengths of stay (LOS), readmission, reoperation, and mortality rates.None of the surgical outcomes differed significantly between the two groups.On multivariate analysis, CD diagnosis was not associated with reoperation, readmission, mortality, or LOS while controlling for other characteristics. With the use of standardized perioperative protocols, surgery for CD at a high-volume center with expertise in CD can be performed with comparable results to other indications like cancer.