Jorge Canedo

Surgical resection in Crohn’s disease: is immunosuppressive medication associated with higher postoperative infection rates?

Aim  The aim of this study was to analyse postoperative infection in patients undergoing surgery for Crohn’s disease (CD) according to the use of preoperative immunosuppressants, including infliximab.

Ileal pouch-anal anastomosis in elderly patients: is there a difference in morbidity compared with younger patients?

Aim  The aim of this study was to review the recent results of ileal pouch–anal anastomosis (IPAA) in elderly patients compared with younger patients.

Granulomas in Crohn's disease: does progression through the bowel layers affect presentation or predict recurrence?

Aim  The aim of the study was to correlate the presence and pattern of distribution of granulomas in resected specimens to clinical characteristics and outcome in patients undergoing surgery for Crohn’s disease.

Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time?

BACKGROUND: The surgical approach to recurrent full-thickness rectal prolapse after perineal rectosigmoidectomy is complicated by recurrent prolapse. The majority of patients who undergo perineal rectosigmoidectomy are elderly with comorbidities. Therefore, redo perineal rectosigmoidectomy is usually selected to avoid postoperative complications. OBJECTIVE: This study aimed to evaluate the safety and efficacy of redo perineal rectosigmoidectomy for recurrent full-thickness rectal prolapse. DESIGN: This is a retrospective cohort study. SETTING: This study was conducted at Cleveland Clinic Florida, from January 2000 to March 2009. PATIENTS: One hundred thirty-six patients (129 women), mean age 78 (range, 31–98) years, were included in the study; 113 patients with full-thickness rectal prolapse underwent primary perineal rectosigmoidectomy, and 23 patients with recurrent full-thickness rectal prolapse underwent redo perineal rectosigmoidectomy. INTERVENTIONS: All patients underwent perineal rectosigmoidectomy. MAIN OUTCOME MEASURES: Perioperative outcomes, recurrence curves, and risk of recurrence were compared between the 2 groups. Age, anterior compartment prolapse, concurrent levatorplasty, and length of bowel resection were analyzed to identify factors potentially influencing recurrence. RESULTS: Both groups had comparable demographics, BMI, and ASA scores. Operative time, blood loss, length of bowel resection, hospital stay, and follow-up (mean, 42.5 months) were similar in both groups. There was no significant difference in overall complication rates (redo perineal rectosigmoidectomy 17.4% vs primary perineal rectosigmoidectomy 16.8%; p = 1.00). The recurrence rate for full-thickness rectal prolapse was significantly higher for redo perineal rectosigmoidectomy than primary perineal rectosigmoidectomy (39% vs 18%; p = 0.007). None of the factors analyzed was associated with recurrence in either group. LIMITATIONS: This study was limited by its retrospective methodology. In addition, functional outcomes were not evaluated, because many of the patients died during the follow-up period or were unavailable because of advanced age. CONCLUSIONS: Redo perineal rectosigmoidectomy is as safe and feasible as primary perineal rectosigmoidectomy in elderly and fragile patients with recurrent full-thickness rectal prolapse. However, the re-recurrence rate for full-thickness rectal prolapse is substantially higher for redo perineal rectosigmoidectomy than primary perineal rectosigmoidectomy.

Short‐term outcome of infliximab and other medications on patients with inflammatory bowel disease undergoing ileostomy reversal

Aim  We evaluated the impact of immunosuppressive drugs on the short‐term outcome following loop ileostomy closure in patients with inflammatory bowel disease.

Are postoperative complications more common following colon and rectal surgery in patients with chronic kidney disease

Aim  According to National Kidney Foundation guidelines, early stages of chronic kidney disease (CKD) can be detected through the estimated glomerular filtration rate (eGFR). We assessed complications following colorectal surgery (CRS) in patients with CKD Stages 3 and 4, as defined by the eGFR.