E. Tiret

Surgical resection of retrorectal tumours in adults: long‐term results in 47 patients

Retrorectal tumours (RT) are uncommon, and diagnosis and management remain difficult. The aim of this study was to evaluate the results of the surgical management of RT in our institution.

Antegrade colonic enema for faecal incontinence in adults: long-term results of 75 patients

Aimu2002 Faecal incontinence is a significant source of distress, and a permanent stoma is frequently offered to these patients. The antegrade colonic enema (ACE) procedure is an alternative approach to treat faecal incontinence. The long‐term outcome remains unknown in adults with faecal incontinence. The aim of this study was to evaluate the long‐term results of the ACE procedure for incontinence in adults and its impact upon quality of life.

Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?

The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmanns procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection.

Female sexual function after abdominoperineal resection for squamous cell carcinoma of the anus and the specific influence of colpectomy and vertical rectus abdominis myocutaneous flap.

Aimu2002 Abdominoperineal resection (APR) is the only curative treatment for recurrent or persisting squamous cell carcinoma of the anus after radiochemotherapy. A vertical rectus abdominis myocutaneous (VRAM) flap reduces perineal morbidity. The sexual life (SL) of women after APR is unknown. Aims of this study were to evaluate SF of women after APR.

Sacral nerve stimulation for the treatment of faecal incontinence after ileal pouch anal anastomosis

The functional results after panproctocolectomy and ileal pouch anal anastomosis (IPAA) are favourable [1], but a proportion of patients will experience faecal incontinence and high stool frequency. The management of these patients is difficult, requiring a combination of dietary modifications, medication and pelvic floor rehabilitation. Sacral nerve stimulation (SNS) has revolutionalized the treatment of faecal incontinence with good results [2]. We report on a successful case of SNS for the treatment of faecal incontinence after IPAA.

Immediate outcome, long‐term function and quality of life after extended colectomy with ileorectal or ileosigmoid anastomosis

Total/subtotal colectomy with ileorectal (IRA) or ileosigmoid (ISA) anastomosis is associated with various reported rates of morbidity, function and quality of life. Our object was to determine these end‐points in a series of patients undergoing these operations in our institution.

Revision of an ileoanal pouch for recurrent pouch adenomas in a patient with familial adenomatous polyposis: a case report

An 18-year-old woman with FAP had a colectomy and ileorectal anastomosis. At the age of 28, she had developed numerous rectal adenomas. Histological examination showed villous tubular adenoma with low-grade dysplasia. A restorative proctectomy with IPAA was performed with a good functional result. Surveillance of the duodenum, pouch and proximal ileum was conducted regularly. At the age of 54, adenomas with low-grade dysplasia in the pouch were resected (Fig. 1). Eight months later, numerous adenomas were present, including one with high-grade dysplasia. It was decided to resect the pouch but as there were no adenomas in the proximal ileum, a new pouch with a manual ileoanal anastomosis was created. To allow a tension-free anastomosis, a Kocher manoeuvre and mobilization of the mesentery were effected and a new ileal pouch, 18 cm in length, was constructed. The postoperative course was uneventful. Histopathological examination did not show any sign of malignancy or high-grade dysplasia. After a follow up of 12 months, the functional results were similar to the preoperative state.

Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients

BackgroundPostoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality.MethodsAll patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality.ResultsA total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48xa0h. Major complications (Dindo–Clavien >u20092) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASAu2009>u20092 (ORu2009=u20092.75, 95% CIu2009=u20091.07–7.62, pu2009=u20090.037), multiorgan failure (MOF) (ORu2009=u20095.22, 95% CIu2009=u20092.11–13.5, pu2009=u20090.0037), perioperative transfusion (ORu2009=u20092.7, 95% CIu2009=u20091.05–7.47, pu2009=u20090.04) and upper GI origin (ORu2009=u20093.55, 95% CIu2009=u20091.32–9.56, pu2009=u20090.013). Independent risk factors for morbidity were: MOF (ORu2009=u20092.74, 95% CIu2009=u20091.26–6.19, pu2009=u20090.013), upper GI origin (ORu2009=u20093.74, 95% CIu2009=u20091.59–9.44, pu2009=u20090.0034) and delayed extubation (ORu2009=u20090.27, 95% CIu2009=u20090.14–0.55, pu2009=u20090.0027).ConclusionMortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.

Hartmann’s reversal after colonic perforation or anastomosis leakage, is it the same procedure? A retrospective study of 150 patients

PurposeThe high morbidity rates reported might influence surgeons’ decisions of whether to perform Hartmann’s reversal (HR). Our aim was to report the results of HR after “primary” Hartmann’s procedure (HP) or in redo surgery for failed anastomosis.MethodsAll patients operated between 2007 and 2015 were included. Data and postoperative course were obtained from a review of medical records and databases.ResultsOne hundred fifty patients (age 60, range (20–91) years, 62% male) were included. Eighty-six patients (57%) were ASA ≥u20092. HP was mostly performed for diverticulitis (29.3%) and anastomotic leakage (24%). HR was possible in 145(97%) patients including six with previous failed attempt. Overall morbidity was 22.7% including 11.7% severe complications (Dindo 3–4). Operative blood loss and Charlson comorbidity index were the only significant risk factor for postoperative pelvic complications (pu2009=u20090.03; pu2009=u20090.0002, respectively).ConclusionsIn a colorectal tertiary center, HR was feasible in 97% with a low morbidity and a 3.4% anastomotic leakage rate.

Metachronous colorectal cancer risk in Lynch syndrome patients—should the endoscopic surveillance be more intensive?

PurposeRegular follow-up for patients with Lynch syndrome (LS) is vital due to the increased risk of colorectal (50–80%), endometrial (40–60%), and other cancers. However, there is an ongoing debate concerning the best interval between colonoscopies. Currently, no specific endoscopic follow-up has been decided for LS patients who already have an index colorectal cancer (CRC). The aim of this study was to evaluate the risk of metachronous cancers (MC) after primary CRC in a LS population and to determinate if endoscopic surveillance should be more intensive.MethodsA prospective cohort of patients with a confirmed diagnosis of hereditary CRC since 2009 was included. Patients with LS and a primary CRC were the cohort of choice.ResultsOne hundred twenty-one patients were included with a median age of 44xa0years(16–70). At least one MC occurred in 39 patients (32.2%), with a median interval of 67xa0months (6–300) from index cancer. Fifteen (38.5%) developed two or more MCs during follow-up, with a median number of two (2–6) tumors occurring. Metachronous CRC were diagnosed after a median interval of 24 (6–57) months since last colonoscopy and were more commonly seen in MSH2 mutation carriers (58 vs. 35%, pu2009=u20090.001). After a median follow-up of 52.9 (3–72) months, no cancer-related deaths were recorded.ConclusionPatients with LS have an increased risk of MC, especially CRCs. With a median time period of 24xa0months between colonoscopy and metachronous CRC, the interval between surveillance colonoscopies following primary CRC should not exceed 18xa0months, especially in patients with MSH2 mutation.