I. Lindsey

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

BackgroundAnastomotic leakage is a devastating complication of colorectal surgery. However, there is no technology indicative of in situ perfusion of a laparoscopic colorectal anastomosis.MethodsWe detail the use of near-infrared (NIR) laparoscopy (PinPoint System, NOVADAQ, Canada) in association with fluorophore [indocyanine green (ICG), 2.5xa0mg/ml] injection in 30 consecutive patients who underwent elective minimally invasive colorectal resection using the simultaneous appearance of the cecum or distal ileum as positive control.ResultsThe median (range) age of the patients was 64 (40–81) years with a median (range) BMI of 26.7 (20–35.5)xa0kg/m2. Twenty-four patients had left-sided resections (including six low anterior resections) and six had right-sided resections. Of the total, 25 operations were cancer resections and five were for benign disease [either diverticular strictures (nxa0=xa03) or Crohn’s disease (nxa0=xa02)]. A high-quality intraoperative ICG angiogram was achieved in 29/30 patients. After ICG injection, median (range) time to perfusion fluorescence was 35 (15–45)xa0s. Median (range) added time for the technique was 5 (3–9)xa0min. Anastomotic perfusion was documented as satisfactory in every successful case and encouraged avoidance of defunctioning stomas in three patients with low anastomoses. There were no postoperative anastomotic leaks.ConclusionPerfusion angiography of colorectal anastomosis at the time of their laparoscopic construction is feasible and readily achievable with minimal added intraoperative time. Further work is required to determine optimum sensitivity and threshold levels for assessment of perfusion sufficiency, in particular with regard to anastomotic viability.

Consensus on ventral rectopexy: report of a panel of experts

Ventral rectopexy (VR) has gained in popularity amongst colorectal surgeons as an operation that addresses functional bowel symptoms by correcting anatomical abnormalities in patients with internal (rectal intussusception) and external rectal prolapse. The operation includes fixation of a synthetic or biological implant to the ventral rectum and vaginal vault. There is current concern over the fixation of any material placed transvaginally or paravaginally in pelvic organ prolapse surgery because of the risks of erosion and sepsis [1]. Concerns have also been expressed regarding patient selection for VR, choice of material, operative technique and a lack of high-level evidence. In order to address these concerns, two Consensus Conferences were held, the first on 25 September 2012 at the Austria Trend Hotel, Vienna, Austria and the second on 17 May 2013 at St John’s College, Oxford, UK to develop a consensus opinion from expert colorectal surgeons with a subspeciality of pelvic floor practice and experience of performing VR. Most had performed 100 or more ventral rectopexies.

Local recurrence after stenting for obstructing left‐sided colonic cancer

Self‐expanding metallic stents (SEMS) may be used in acute obstructing left‐sided colonic cancers to avoid high‐risk emergency surgery. However, oncological safety remains uncertain. This study evaluated the long‐term oncological outcome of SEMS as a bridge to elective curative surgery versus emergency resection.

A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer.

Aimu2002 Transanal endoscopic microsurgery (TEM) for early rectal cancer (ERC) gives results similar to major surgery in selected cases. Endorectal ultrasound (ERUS) is an important part of the preoperative selection process. This study reports its accuracy and impact for patients entered on the UK TEM database.

Completion surgery following transanal endoscopic microsurgery: assessment of quality and short- and long-term outcome.

Patients with unfavourable pathology after transanal endoscopic microsurgery (TEM) should be offered completion surgery (CS) if appropriate. The aim of this retrospective cohort study was to assess the short‐term outcome and long‐term oncological results of CS and identify factors compromising the quality of resection specimens.

Laparoscopic Ventral Rectopexy for Faecal Incontinence: Equivalent Benefit is seen in Internal and External Rectal Prolapse

AimAn external rectal prolapse (ERP) is often associated with faecal incontinence, and surgery is the recommended therapy. It has been suggested that correction of a high grade internal rectal prolapse (HIRP) is also worthwhile for patients with faecal incontinence. The aim of the present study is to compare the results of laparoscopic ventral rectopexy (LVR) in patients with faecal incontinence associated with either an ERP or a HIRP.MethodConsecutive patients suffering from faecal incontinence, who underwent a LVR between June 2010 and October 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 1xa0year after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI; range 0–61) and the Gastrointestinal Quality of Life Index (GIQLI).ResultsLVR was performed in 50 incontinent patients with a HIRP, and in 41 patients with an ERP. Preoperatively, the FISI was higher in patients with HIRP (HIRP 42 versus ERP 30, Pu2009<u20090.01). The recurrence rate at 1xa0year was similar in both groups (HIRP 6xa0% versus ERP 2xa0%, Pu2009=u20090.156). The FISI scores were significantly reduced in both groups (HIRP 48xa0% versus ERP 50xa0%, both Pu2009<u20090.01). GIQLI was equally improved in both groups (HIRP 17xa0% versus ERP 18xa0%, both Pu2009<u20090.01).ConclusionLaparoscopic ventral rectopexy for the treatment of faecal incontinence achieves equivalent outcomes in both patients with an external rectal prolapse or high grade internal rectal prolapse.

Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse.

Limited literature exists on whether slow colonic transit adversely influences the results of outlet obstruction surgery. We compared the functional results of laparoscopic ventral rectopexy (LVR) for obstructed defaecation secondary to high grade internal rectal prolapse in patients with normal and slow colonic transit.

Erratum to: Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse?

Background nHigh-grade internal rectal prolapse appears to be one of the contributing factors in the multifactorial origin of faecal incontinence. Whether it affects the outcome of sacral neuromodulation is unknown. We compared the functional results of sacral neuromodulation for faecal incontinence in patients with and without a high-grade internal rectal prolapse.

Laparoscopic ventral rectopexy is effective for solitary rectal ulcer syndrome when associated with rectal prolapse

Solitary rectal ulcer syndrome (SRUS) is uncommon and its management is controversial. The aim of this study was to evaluate the outcome of patients with SRUS who underwent laparoscopic ventral rectopexy (LVR).

Adhesions are Common and Costly after Open Pouch Surgery

PurposeOpen ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.Materials and MethodsWe reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.ResultsTwo hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2–20.1xa0years). There were 76 (28%) readmissions (median length of stay, 7.4xa0days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1xa0year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%, pu2009<u20090.0001) and had less SBO episodes within 12xa0months of surgery (0% vs 14%, pu2009<u20090.0001) than open patients. Modeling a laparoscopic approach cost