Colon Surgery Research Articles

Hip prosthesis and colon surgery, a decade of surveillance on surgical site infections in Italy, a prospective cohort study: rates, trends, and disease burden in DALYs

BackgroundSurveillance programs are a key element of interventions aiming to reduce rates of surgical site infections (SSIs). The aim of this study was to evaluate rates and trends of SSIs following hip arthroplasty and colon surgery procedures in Piedmont, a region in North-western Italy, from 2010 to 2019. Further, we aimed to assess the burden of SSIs in terms of Disability-Adjusted Life-Years (DALYs).MethodsA prospective cohort study was conducted among 42 hospitals participating in the surveillance system. Procedure-specific SSI rates were calculated and the 2010 - 2019 trend was evaluated using Spearman's Rho test. Patients were stratified according to age, sex and infection risk index according to life expectancy in order to calculate DALYs, using a modified version of the ECDC’s BCoDE toolkit: disease models for both procedure types were adapted to incorporate long-term disability associated with SSIs.ResultsOverall, 20,356 hip arthroplasty and 11,011 colon surgery procedures were monitored over 10 years and were included in our analyses. Hip arthroplasty and colon surgery cumulative SSIs rates were 1.5% and 8% respectively. Using the Spearman’s Rho test, we evaluated a significant downward trend from 2010 to 2019 for colon surgery interventions (Rs − 0.7, p < 0.05), while there was no difference for hip arthroplasty. (Rs − 0.04, p > 0.05).Regarding disease burden, a total of 955.3 (95%CI 837.7–1102.98) and 208.65 (95%CI 180.87–240.90) DALYs were calculated for SSIs following hip arthroplasty, whilst 76.58 (95%CI 67.15–90.71) and 38.62 (95% CI 33.09–45.36) DALYs for SSIs in colon surgery, in 2010 and 2019, respectively.ConclusionsThe significant decrease both in terms of incidence and DALYs found in this study for colon surgery and the stability for hip arthroplasty support the role of surveillance networks in improving quality of care. Despite the smaller SSI rate, the burden associated with SSIs following hip arthroplasty was higher, which is important to consider in light of the aging population in Italy.

Rethinking postoperative care: same-day ileostomy closure discharge improves patient outcomes

BackgroundThe evolution of enhanced recovery protocols (ERPs) in colon and rectal surgery has led to the development of same-day discharge (SDD) procedures for selected patients. Early discharge following diverting loop ileostomy (DLI) closure was first described in 2003. However, its widespread adoption remains limited, with SDD accounting for only 3.2% of all DLI closures in 2005-2006, according to ACS-NSQIP database, and rising to just 4.1% by 2016. Aim of the study was to compare the outcomes of SDD DLI closure with those of DLI closure following the standard ERP. MethodsA retrospective case-matched study compared 125 patients undergoing SDD DLI closure to 250 patients undergoing DLI closure following the standard ERP based on age (± 1 year), sex, ASA score, BMI, surgery date (± 2 months), underlying disease, and hospital site. The primary outcome was comparative 30-day complication rates. ResultsPatients in the traditional ERP group received more intraoperative fluids (1221.1 ± 416.6 vs. 1039.0 ± 368.3ml, P<0.001) but had similar estimated blood loss. Ten patients (8%) in the SDD-ERP group failed same-day discharge. The 30-day postoperative complication rate was significantly lower in the SDD group (14.8%) compared to the standard ERP group (25.7%, P=0.025). This difference was primarily driven by a lower incidence of ileus in the SDD group (9.6% vs. 14.8%, P=0.034). There were no significant differences in readmission rate (9.6% of SDD-ERP vs. 9.2% of standard ERP, P=0.900) and re-operation rates (3.2% of SDD-ERP vs. 2.4% of standard ERP, P=0.650). ConclusionSDD ileostomy closure is a safe, feasible, and effective procedure associated with fewer complications than the present study's standard ERP. This could represent a new standard of care. Further prospective trials are required to confirm the findings of this study. Data availability statementData supporting the research are available upon request to protect the privacy of study participants.

20. IMPLEMENTATION OF A SEMI-AUTOMATED SEGMENTATION TOOL FOR COLON SURGICAL PLANNING

Abstract Introduction This study outlines the design and implementation of an application focused on optimizing surgical planning for colon surgery through the automated segmentation process of Computed Axial Tomography (CT) images. The tool provides continuous assistance to the user, enhancing the overall process management and efficiency. Methods A module has been developed for the 3DSlicer image computing platform. The algorithm was programmed in Python, primarily utilizing the Slicer, MRML, and VTK libraries. Additionally, DICOM images obtained from a publicly available database were used as samples for the study. Results The implementation of the semi-automatic segmentation method has proved to be successful, achieving the creation of a three-dimensional (3D) model of the colon with satisfactory results. The user has the facility to upload a CT image from a DICOM study, and through few interactions, a 3D model of the colon is generated, optimizing the surgical planning process. Conclusion Although we have successfully developed a semi-automatic segmentation method, the process requires certain specific conditions. For the image to be interpreted correctly, the patient must be treated with iodinated contrast medium prior to the CT study. In addition, an insufflation of the colon should be performed. These prerequisites are essential to ensure the quality and accuracy of the resulting images, which in turn will impact the efficiency of the planning process.

(393) Advancements in Ectopic Reservoir Placement for Inflatable Penile Prostheses

Abstract Introduction Traditional reservoir placement (RP) into the space of Retzius (SOR) during three-piece inflatable penile prosthesis (IPP) implantation has been associated with dire bladder, iliac vessel, and bowel complications, leading many surgeons to pioneer alternative, “ectopic” methods. Despite the extensive literature on ectopic RP, there is little direct comparison of these techniques to one another with respect to efficacy and/or safety. Objective To document an up-to-date, comprehensive analysis of ectopic RP techniques regarding both patient satisfaction and clinical complications. Methods A PubMed literature search of English language articles from 1986-2023 with keywords “inflatable,” “penile prosthesis,” “reservoir,” and “placement” gave 113 publications, 62 of which were included in a comprehensive chronology and investigation after abstract review (last updated 7/3/2023). Analysis of published data yielded 12 retrospective studies detailing 8 ectopic RP techniques that were included for comparison (Table 1). Results Of the ectopic RP methods explored, 8 have sufficient data for comparison: posterior &amp; anterior to transversalis fascia (PTF &amp; ATF); high submuscular (HSM); high submuscular ‘Five-Step’ technique (HSM-FST); lateral retroperitoneal (LR); sub-external oblique (SEO); direct vision, transfascial (DVT); low submuscular with transfascial fixation (LSM w/ TFF); and midline submuscular reservoir (MSMR). Although rare, serious complications have occurred in ectopic RP: PTF reports 2 bladder perforations on implantation, HSM reports a delayed bowel obstruction, and LR reports a colonic injury in a patient with a history of colon surgery. When unsure, a counterincision can be used to lower risk of violating fascial planes and causing visceral injury. Aside from these cases, herniation is the most relevant clinical complication in ectopic RP. There is no reported herniation with LR, SEO, LSM w/ TFF, or MSMR, likely due to fixation steps and/or reinforced spaces. Reports of newer ectopic strategies often have small sample sizes and limited follow-up which potentially under- or overestimate complication rates, indicating a need for more robust longitudinal study. In regards to patient satisfaction, HSM, HSM-FST, and LSM w/ TFF have high and similar rates of patient satisfaction while other techniques do not provide data. In addition to increased rates of reporting, a validated patient survey is needed to standardize comparison of efficacy and patient perspective between different techniques. Importantly, reservoir palpability/visibility relates directly to patient satisfaction. PTF &amp; ATF, HSM, HSM-FST, SEO, and LSM w/ TFF report levels of palpability and/or visibility while LR, DVT, and MSMR have no reported palpability. Conclusions Without standardized patient surveys, consistency in complication reporting, and larger sample sizes, it is impossible to properly compare different ectopic methods. The prosthetic community needs a large, prospective, multisurgeon study comparing ectopic methods to each other, not just to SOR. Until such data is available, implanters should assess different methods in regards to their unique benefit and complication profiles, becoming experts in those that can best serve their patient population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant: AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast // Investor: Sprout.

An analysis of virtual reality in abdominal surgery-A scoping review.

The integration of virtual reality (VR) in surgery has gained prominence as VR applications have increased in popularity. A scoping review was undertaken, gathering the most relevant sources, utilising a detailed literature search of medical and academic databases including EMBASE, PubMed, Cochrane, IEEE, Google Scholar, and the Google search engine. Of the 18 articles included, 7 focused on VR in colon surgery, 5 addressed VR in pancreas surgery, and the remaining 6 concentrated on VR in liver surgery. All the articles concluded that VR has a promising future in abdominal surgery by facilitating precision, visualisation, and surgeon training. Adopting VR technology in abdominal surgery has the potential to improve preoperative planning, decrease perioperative anxiety among patients, and facilitate the training of surgeons, residents, and medical students. Additional supporting studies are necessary before VR can be widely implemented in surgical care delivery.

Single-shot liposomal bupivacaine in place of rectus sheath catheters to provide non-opiate analgesia after laparotomy: a quality improvement project to reduce the need for ongoing nursing input

Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters (RSCs) are routinely placed during emergency laparotomy for colorectal...

P188 Cumulative inflammatory burden as a risk factor for colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis: a multi-center case-control study

Abstract Background Inflammatory bowel disease (IBD) patients with concomitant primary sclerosing cholangitis (PSC-IBD) have a 25-year cumulative risk of up to 50% to develop colorectal neoplasia (CRN). Mucosal inflammation is an important driver of CRN, but it is unknown whether this also applies to PSC-IBD patients. We aimed to assess the impact of chronic mucosal inflammation per colonic segment on CRN risk in PSC-IBD patients. Methods This is a multi-center case-control study including cases with PSC-IBD and CRN and controls with PSC-IBD without CRN. Subjects were included from 8 medical centers in Canada and the Netherlands. Exclusion criteria were a CRN diagnosis prior to IBD or PSC diagnosis, familial CRC syndromes, and &amp;lt;2 available colonoscopy reports. Data was collected on demographics, IBD and PSC disease characteristics, CRN lesions, and endoscopy reports between 1977 and 2023. Pan-colonic and segmental (right colon, transverse colon, left colon, rectum) endoscopic cumulative inflammatory burden scores were calculated as the sum of (mean) endoscopic inflammation severity between colonoscopies x length of the surveillance interval until index procedure. The index procedure was the colonoscopy during which CRN was detected (cases) or randomly selected and matched for disease duration (controls). The primary outcome was a CRN diagnosis, secondary outcomes were CRN grade and location, time to CRN (Kaplan-Meier curve), pan-colonic cumulative inflammatory burden, cumulative inflammatory burden per colonic segment harboring CRN, and colonic surgery. Results We included 335 PSC-IBD patients (224 UC, 101 CD) with a median follow-up of 8 years (IQR: 5.0-14.0) and 6 endoscopies (IQR: 4.0-8.0). Median disease duration was 19.5 years for IBD (IQR: 11.0-26.0) and 13 years for PSC (IQR: 7.0-19.0). Advanced neoplasia (HGD or CRC) was found in 35 out of 102 cases (34%). Fifty-six (55%) cases were diagnosed with &amp;gt; 1 lesion, and 43 (42%) had ≥ 1 right-sided lesion. Median time to index CRN was 17 years (IQR: 8.0-24.0). Sixty-six patients underwent (sub)total colectomy or proctocolectomy, including 49 (74%) due to CRN diagnosis. There was no difference in pan-colonic cumulative inflammatory burden scores (mean scores: 4.7 (cases) and 3.7 (controls); P=0.21, 95%-CI: -2.52-.56) and segmental scores (mean scores: 4.9 (cases) and 4.1 (controls); P=0.27, 95%-CI: -2.29-.65) between cases and controls. Mortality was 13% (n=45.) Conclusion In this large multi-center cohort study, the risk for CRN-associated colectomy in PSC-IBD was high, while pan-colonic and segmental cumulative inflammatory burden scores were not associated with CRN risk.

Closed-incision negative-pressure wound therapy reduces superficial surgical site infections after open colon surgery: an NSQIP Colectomy Study

The use of closed incision negative pressure wound therapy (iNPWT) has increased in the last decade across surgical fields, including colectomy. Compare postoperative outcomes associated with use of (iNPWT) following open colectomy from a large national database. A retrospective review of patients who underwent operations from 2015-2020 was performed using National Surgical Quality Improvement Program (NSQIP) Targeted Colectomy Database. Intraoperative placement of iNPWT was identified using Current Procedural Terminology (CPT) codes in patients undergoing open abdominal operations with closure of all wound layers including skin. Propensity score matching was performed to define a control group who underwent closure of all wound layers without iNPWT. Patients were matched in a 1:4 (iNPWT vs. control) ratio and postoperative rates of superficial, deep and organ-space SSI, wound disruption, and readmission. Between 2015-2020, iNPWT was used in 483 (0.6%) undergoing open colectomies. A matched cohort of 1884 was selected. Patients with iNPWT had longer median operative time (170 [IQR 129-232] vs. 161[IQR:114-226] minutes, p<0.05) (Table 2). Compared to patients without iNPWT, Patients with iNPWT experienced a lower rate of 30-day superficial incisional SSI (3% vs. 7%, p<0.05) and readmissions (10% vs 14%; p < 0.05). iNPWT did not decrease risk of deep SSI, organ-space SSI, or wound disruption. Although there is a slightly increased operative time, utilization of iNPWT in open colectomy is associated with lower odds of superficial SSI and 30-day readmission. This suggests that iNPWT should be routinely utilized in open colon surgery to improve patient outcomes.

Indocyanine green fluorescence angiography could reduce the risk of anastomotic leakage in rectal cancer surgery: a systematic review and meta-analysis of randomized controlled trials.

Several papers have shown that use of indocyanine green (ICG) decreases incidence of anastomotic leakage (AL) during colonic surgery, but no clear evidence has been found for rectal cancer surgery. Therefore, with this systematic review and meta-analysis of randomized controlled trials (RCTs) we aimed to assess if ICG could also reduce risk of AL in rectal cancer surgery. PubMed, Scopus, CINAHL and Cochrane databases were searched for RCTs assessing the effect of intraoperative ICG on the incidence of AL of the colorectal anastomosis. Pooled relative risk (RR) and pooled risk difference (RD) were obtained using models with random effects. Risk of bias was evaluated with the Rob2 tool and the quality of evidence was assessed using the GRADE Pro tool. Four RCTs were included for analysis, with a total of 1510 patients (743 controls and 767 ICG patients). The rate of AL was 9% in the ICG group (69/767) and 13.9% (103/743) in the control group (p = 0.003, RR -0.5, 95% CI -0.827 to -0.172, heterogeneity test 0%, p = 0.460). The RD in terms of incidence of AL was significantly decreased by 4.51% (p = 0.031, 95% CI -0.086 to -0.004, heterogeneity test 28%, p = 0.182) when using ICG. Our meta-analysis suggested that use of ICG during rectal cancer surgery could reduce the rate of AL.

Accelerated enhanced recovery after colon cancer surgery with discharge within one day after surgery: a systematic review

BackgroundRecent studies have demonstrated that accelerated enhanced recovery after colorectal surgery is feasible for specific patient populations. The accelerated enhanced recovery protocols (ERP) tend to vary, and the majority of studies included a small study population. This hampers defining the optimal protocol and establishing the potential benefits. This systematic review aimed to determine the effect of accelerated ERPs with intended discharge within one day after surgery.MethodsPubMed (MEDLINE), Embase, Cochrane and Web of Science databases were searched using the following search terms: colon cancer, colon surgery, accelerated recovery, fast track recovery, enhanced recovery after surgery. Clinical trials published between January 2005 – February 2023, written in English or Dutch comparing accelerated ERPs to Enhanced Recovery After Surgery (ERAS) care for adult patients undergoing elective laparoscopic or robotic surgery for colon cancer were eligible for inclusion.ResultsThirteen studies, including one RCT were included. Accelerated ERPs after colorectal surgery was possible as LOS was shorter; 14 h to 3.4 days, and complication rate varied from 0–35.7% and readmission rate was 0–17% in the accelerated ERP groups. Risk of bias was serious or critical in most of the included studies.ConclusionsAccelerated ERPs may not yet be considered the new standard of care as the current data is heterogenous, and data on important outcome measures is scarce. Nonetheless, the decreased LOS suggests that accelerated recovery is possible for selected patients. In addition, the complication and readmission rates were comparable to ERAS care, suggesting that accelerated recovery could be safe.

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting.

Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.

Development of an Anisotropic Hyperelastic Material Model for Porcine Colorectal Tissues.

Many colonic surgeries include colorectal anastomoses whose leaks may be life-threatening, affecting thousands of patients annually. Various studies propose that mechanical interaction between the staples and neighboring tissues may play an important role in anastomotic leakage. Therefore, understanding the mechanical behavior of colorectal tissue is essential to characterizing the reasons for this type of failure. So far, experimental data characterizing the mechanical properties of colorectal tissue have been few and inconsistent, which has significantly limited understanding their behavior. This research proposes an approach to developing an anisotropic hyperelastic material model for colorectal tissues based on uniaxial testing of freshly harvested porcine specimens, which were collected from several age- and weight-matched pigs. The specimens were extracted from the same colon tract of each pig along their circumferential and longitudinal orientations. We propose a constitutive model combining Yeoh isotropic hyperelastic material with fibers oriented in two directions to account for the hyperelastic and anisotropic nature of colorectal tissues. Experimental data were used to accurately determine the model's coefficients (circumferential, R2 = 0.9968; longitudinal, R2 = 0.9675). The results show that the proposed model can be incorporated into a finite element model that can simulate procedures such as colorectal anastomoses reliably.

Pelvis metastasis with rectal infiltration in hepatocellular carcinoma - a rare case report

Background: Hepatocellular carcinoma (HCC) is the most prevalent primary hepatic neoplasm, with approximately 50% of cases eventually developing metastasis. HCC metastasis to the pelvis is exceedingly rare due to the significant anatomical distance and intricate metastatic pathways involved. Case Presentation: In this case report, we present a 60-year-old male with HCC metastasis to the pelvis that had infiltrated the rectum. Initially, we suspected the pelvic mass to be a gastrointestinal stromal tumor, but histopathological and immunohistochemical examinations revealed it to be HCC metastasis. The dissemination of the tumor was suspected to have occurred through peritoneal implantation following a radiofrequency ablation (RFA) procedure that the patient had undergone 10 months prior. A resection surgery of the sigmoid colon up to the tumor-free mid-rectum was performed. The patient is currently stable and undergoing routine outpatient care, now in the third-month post-surgery. Conclusion: This case report unveils a rare HCC metastasis to the pelvis with rectal infiltration. We conclude that in HCC patients presenting with obstructive symptoms, suspicion of metastasis to the pelvis should be considered, especially in patients who have undergone an RFA procedure. Limited diagnostic support from computed tomography scans and colonoscopies made establishing a definitive diagnosis before surgery challenging. However, patients can attain a favorable prognosis with effective surgical intervention, underscoring the importance of prompt and effective treatment in such cases.

Non-malignant left colon emergency surgery: evaluation of factors affecting clinical outcomes and complications.

Emergency colorectal resections hold a significant position in general surgical practice, and pathologies of the left colon are relatively common. This study was conducted to assess the outcomes of isolated left colon surgeries with benign etiologies, drawing on clinicopathological and biochemical data. We carried out a retrospective review and statistical analysis of demographic, clinical, and laboratory data of patients who underwent left colon surgery at the general surgery clinic of a tertiary care hospital, excluding those with malignancy-related emergencies, from January 2017 to January 2022. The average age of the 48 patients in the study was 56.9±16.4 years. Complicated acute diverticulitis was the most frequent indication for emergency surgery (n=19, 39.6%). The Hartmann procedure was the surgical technique most often employed (n=30, 62.5%). The rates of postoperative morbidity and mortality within 30 days were 27.1% and 8.3%, respectively. Increased postoperative morbidity was linked to advanced age (mean 65.4±15.8 vs. 53.8±15.7, p=0.028), the preoperative administration of vasopressors, lower platelet counts, hypoalbuminemia (<3 mg/dl), and azotemia (blood urea nitrogen >20 mg/dl). There was no statistically significant correlation between comorbidities, American Society of Anesthesiologists (ASA) scores, surgical methods, or other clinical data and postoperative outcomes. For emergency colorectal surgery pertaining to left colon pathologies, it is critical to conduct a comprehensive evaluation in the perioperative period, especially for elderly and hypotensive patients with renal function abnormalities and for those requiring vasopressors.

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea.

Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes. Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre- and post-COVID-19 groups were analyzed. In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015-2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749-2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928-1.682; P=0.142). During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

Colon and Rectal Surgery Regional Society Meetings.

Colon and Rectal Surgery Regional Society Meetings.

Colon and Rectal Surgery Fellowship Applicant and Matching Trends in the United States: An Analysis of National Resident Matching Program Data.

Colon and Rectal Surgery fellowships are training programs that aim to train surgeons in the management of small bowel, colon, rectal, and anal pathologies. We investigated trends in Colon and Rectal Surgery fellowship match to help applicants anticipate future fellowship application cycles. This was a retrospective cohort study of applicants in the Colon and Rectal Surgery match from 2009 to 2023. Proportion of positions filled, match rates, and rank-order lists were collected. The impact of US-MD, non-US-MD, and DO status on match rate was assessed. We used the Mann Kendall trend test to obtain tau statistic and P-value for temporal trends over time, while associations between categorical variables were investigated by a chi-square test. Fellowship programs increased from 43 to 67, positions increased from 78 to 110, and number of applicants rose from 113 to 135. Nearly all positions were filled from 2009 to 2023 (range: 96.3%-100%). The overall match rate fluctuated between 67.3% and 80.7%. The match rate over the past 5years was 72.0%. The match rate for US-MDs was 80.0%, while non-US-MDs had a 56.2% match rate. The percentage matching at each rank were first choice 28.0%, second choice 10.4%, third choice 6.9%, and fourth choice or lower 23.5%. Despite an increase in Colon and Rectal Surgery fellowship positions, the overall match rate has not changed significantly over the years, mainly as a result of increased applicants.

Performance of intraoperative surgical smoke management technologies for laparoscopic surgery: A comparative in-vivo pig study

BackgroundVarious technologies exist to remove surgical smoke. Despite high significance in surgical practice, comparative in-vivo performance data are missing. Study designThe performance of five smoke management technologies (venting, passive filtering, active filtering, circular filtration, electrostatic precipitation) was analysed in-vivo by three different laparoscopic interventions (cholecystectomy, atypic liver resection, colon surgery) with high-energy surgical instruments. Surgical smoke formation/evacuation was characterised by various aerosol-analytical instruments. In addition, operational parameters like CO2 consumption and capnoperitoneal pressure were determined. ResultsThe half-life of particle concentration was found to be a suitable parameter to describe smoke elimination efficacy and varied between (10 - 45) s. It is shown that the efficacy of smoke elimination technologies based on particle removal by evacuation can also be predicted by simple equations. Furthermore, it was found that the combination of surgical cutter and tissue defines charge and polarity of surgical smoke that influences especially the efficacy of electrostatic precipitation. Depending on the smoke elimination technology, the CO2 consumption varied between (0.5 - 16) L/min, the capnoperitoneal stability between (2 - 17) %. ConclusionsEach smoke elimination technology showed advantages and disadvantages. Simple charcoal filters rapidly degrade and should be exchanged regularly during surgery. Active filtering is efficient for smoke management, but the unstable capnoperitoneum interferes with surgery. Circular filtration forms a stable capnoperitoneum, but the valveless trocar promotes relevant levels of smoke release into the environment. Electrostatic precipitation was found to be most efficient for smoke management with minimal CO2 consumption and highly-stable capnoperitoneum.

Resection margins, lymph node harvest and 3 year survival in open and laparoscopic colorectal cancer surgery; a prospective cohort study

IntroductionLaparoscopic colorectal cancer surgery has been gaining popularity in the last decade. However, there are concerns about adequate lymph node dissection and safe resection margins in laparoscopic colorectal cancer surgery. This study was aimed at comparing the lymph node (LN) clearance and surgical resection margins and 3-year survival for open and laparoscopic colorectal cancer surgery.MethodA pre-tested interviewer administered questionnaire was used to assess the adoption of the laparoscopic approach by Sri Lankan surgeons. Data was collected prospectively from patients who underwent open or laparoscopic colorectal cancer surgery at the University Surgical Unit of the National Hospital of Sri Lanka from April 2016 to May 2019. The histopathology records were analysed to determine the longitudinal and circumferential resection margins(CRM) and the number of lymph nodes harvested. The resection margins were classified as positive or negative. The total number of LN examined was evaluated. Presence of local recurrence and liver metastasis was determined by contrast enhanced CT scan during 3-years of follow up. Chi square, T test and z test for proportions were used to compare CRM, LN harvest and survival rates between the groups.ResultsOf the surgeons interviewed only 11 (18.4%) performed laparoscopic colorectal cancer surgery. A total of 137 patients (83 males and 54 females) were studied. Eighty-one procedures were laparoscopic and 56 procedures were open. All patients had clear longitudinal resection margins. Seventy-eight patients in the laparoscopic group (96%) and 51 patients (91%) in the open group had clear CRM (p > 0.05). A total of 2188 LNs (mean 15.9) were resected in all procedures. Six-hundred-eighty-nine lymph nodes were removed during open procedures (mean 12.3, SD 0.4) and 1499 (mean 18.5, SD 0.6) were removed during laparoscopy (p < 0.05). At 3 years follow-up the disease-free survival in the laparoscopic and open colon cancer patients was 27/41 (65.8%) and 16/29 (55.1%) respectively (p = 0.35). Disease free survival in the laparoscopic and open rectal cancer patients was 23/38 (60.5%) and 13/25 (52.0%) respectively (p = 0.40). Four patients were lost during follow-up.Discussion and conclusionCRM was comparable in the two groups. Laparoscopic group had a significantly higher LN harvest. Three-year survival rates were similar in the two groups. Acceptable results can be obtained with laparoscopic colorectal cancer surgery.

Fate of de-functioning ileostomy after left colon and rectal cancer resection: observation from a single unit of a cancer hospital.

Background: De-functioning ileostomy (DS) has been shown to reduce rate of anastomotic leak after left colon and rectal cancer resection and can avoid consequences of leak with its morbidity and possible mortality. Externalisation of bowel is not easily appreciated; patients always inquire about the timing of closure and not all stomas are closed. The aim of the study is to assess the timing of stoma closure and the reasons for stoma becoming permanent. Methods: Patients who underwent surgery for left colon and rectal cancer with de-functioning stoma from April 2019 to May 2022 in single unit of Bhaktapur Cancer Hospital, were assessed regarding timing of stoma closure. We have made a policy of stoma closure after completion of adjuvant therapy. De-functioning stoma that was not reversed at follow up were assessed regarding reason for it becoming permanent. Results: Forty-two patients underwent de-functioning stoma during the study period; 30 after rectal resection, 2 after pouch creation, 6 after anterior resection and 4 after left hemicolectomy. Twenty-eight (77%) stomas were closed, 5 are receiving adjuvant treatment. Closure was not done in 8 patients; 5 due to recurrence of disease; 1 due to patient wish, 2 deaths occurred prior to closure, one due to COVID-19 and another due to acute myocardial infraction. One patient with multiorgan resection died within 30 days of surgery due to other medical cause. The median time of stoma closure after completion of adjuvant treatment is 8 weeks, IQR (7-10). Patients had to stay with stoma for a median period of 6months, IQR (5-8). The median time for discharge after stoma reversal is 9 days, IQR (7-10). There were 4 Grade II Clavien-Dindo complications after stoma closure. Conclusion: Seventy- seven percent of patients with DS underwent closure in our series. Recurrence was the most common cause for it becoming permanent.