Endoscopic submucosal dissection of distal intestinal tumors using grasping forceps for traction Abstract Background The aim of this study was to assess the efficacy of traction device-assisted endoscopic submucosal dissection (ESD) of the rectum and the distal segment of sigmoid colon using grasping forceps. Methods A total of 43 patients scheduled for colonic ESD at our institution were enrolled between January 2013 and June 2017. The patients were randomly allocated to receive conventional ESD (group A) or traction device-assisted ESD (group B). The procedure time, complication rate, and en-block resection rate in the two groups were compared. Results A total of 41 patients completed the study. The procedure time, complication rate and en-block resection rate were, respectively, 104.1 ± 34.7 min, 15%, 90% in the routine group (group A) and 84.7 ± 23.5 min, 9.5%, 90.5% in traction device-assisted ESD (group B). The procedure time in group B was significantly less than that in group A (F = 4.442, p < 0.05). Conclusions Traction device-assisted ESD using grasping forceps is safe and effective in distal colon ESD.

Longer small bowel segments are resected in emergency surgery for ileocaecal Crohn’s disease with a higher ileostomy and complication rate Abstract Background Repeated intestinal resections may have disabling consequences in patients with Crohn’s disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn’s disease. Methods A prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn’s disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn’s disease undergoing elective surgery; (2) patients with ileocaecal Crohn’s disease undergoing emergency surgery; (3) patients with recurrent Crohn’s disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes. Results One hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn’s disease. Conclusions Patients undergoing emergency surgery for Crohn’s disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel.

Simultaneous transabdominal and transanal indocyanine green fluorescence imaging for low colorectal anastomosis

Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis Abstract Background Minimally invasive colectomy has become the standard for treatment of colonic disease in many centers. Restoration of bowel continuity following resection can be achieved by intracorporeal (IC) or extracorporeal (EC) anastomosis. The aim of this systematic review was to assess the outcomes of IC compared to EC anastomosis in minimally invasive right colectomy. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic literature search for studies assessing the outcome of IC and EC anastomosis in laparoscopic and robot-assisted right colectomy was conducted. The primary outcome of this review was postoperative complications. Secondary outcomes included operative time, blood loss, length of stay, conversion to open surgery, and bowel recovery. Results Twenty-five studies including 4450 patients were evaluated. 47.7% of patients had IC anastomosis and 52.3% had EC anastomosis. The weighted mean length of extraction site incision in the IC group was shorter than the EC group. The EC group had significantly higher odds of conversion to open surgery (OR 1.87, 95% CI 1–3.45, p = 0.046), total complications (OR 1.54, 95% CI 1.05–2.11, p = 0.007), anastomotic leakage (AL) (OR 1.95, 95% CI 1.4–2.7, p = 0.003), surgical site infection (SSI) (OR 1.69, 95% CI 1.4–2.6, p = 0.002), and incisional hernia (OR 3.14, 95% CI 1.85–5.33, p < 0.001) compared to the IC group. Both groups had similar rates of ileus, small bowel obstruction, bleeding, and intra-abdominal infection. Conclusion IC anastomosis was associated with significantly shorter extraction site incisions, earlier bowel recovery, fewer complications, and lower rates of conversion, AL, SSI, and incisional hernia than has the EC anastomosis.

Italian guidelines for the surgical management of enteral stomas in adults Abstract Background Worldwide, stomas represent a medical and social problem. Data from the literature on stoma management are extensive but not homogeneous. In Italy, no guidelines exist for this topic. Thus, clear and comprehensive clinical guidelines based on evidence-based data and best practice are need. In 2018, the Multidisciplinary Italian Study group for STOmas, called MISSTO, was founded. The aim was to elaborate guidelines for practice management of enteral and urinary stomas in adults. Methods A systematic review of the literature was performed using PubMed, National Guideline Clearinghouse, and other databases. The research included guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: “stoma preparation”, “stoma creation”, “stoma complications”, “stoma care”, and “stoma reversal”. The systematic review was performed for each topic, and studies were evaluated according to the GRADE system, AGREE II tool. Results Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care was held. After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines was elaborated and prepared for publication. This manuscript is focused on statements on the surgical management of enteral stomas. Conclusions These guidelines are the first Italian guidelines on multidisciplinary management of enteral stomas with the aim of assisting surgeons during stoma management and care.

The third arm: the surgeon’s friend in the management of intraoperative complications in robotic-assisted rectal surgery

Correction to: Pelvic fat volume reduction with preoperative very low energy diet (VLED): implications for rectal cancer surgery in the obese Due to substantial contributions by Dr. Phillip Malouf and Dr. Stephen Bell

Purulent meningitis as a rare complication following laparoscopic ventral rectopexy: suspected etiopathogenesis and treatment

Resection of colonic lesions: full thickness, full monty?

Recalled stapler device, high complication rate, non validated scoring system and misquote from the STARR surgeons