Surendra Kumar Mantoo

Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation?

Function, morbidity and recurrence of symptoms after robotic‐assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for pelvic floor disorders (PFDs) were compared.

The magnetic anal sphincter in faecal incontinence: is initial success sustained over time?

In the short term, implantation of a magnetic anal sphincter (MAS) is a safe and effective treatment for faecal incontinence (FI). In this paper we show that the initial results stand the test of time and patient satisfaction remains high in the medium term.

The magnetic anal sphincter: a new device in the management of severe fecal incontinence

The authors aim to report the concept and technique of implantation and the first results of the clinical use of the magnetic anal sphincter (MAS) in the management of fecal incontinence (FI). The MAS device is designed to augment the native anal sphincter. The implant is a series of titanium beads with magnetic cores linked together with independent titanium wires. To defecate, the force generated by straining separates the beads to open up the anal canal. The technique of implantation is simple with no requirement of adjustments. The MAS has a role in the management of severe FI. The device has acceptable and comparable adverse effects to other therapies. FI and Fecal Incontinence Quality of Life scores are significantly improved in the short term. The MAS offers a simple and less invasive option of anal reinforcement. It is one step further in the quest for an ideal artificial anal sphincter device.

The impact of anorectal malformations on anorectal function and social integration in adulthood: report from a national database.

The impact of anorectal malformation (ARM) on bowel function and social, educational and occupational end‐points was investigated in adult patients entered on a national database.

‘Start to finish trans‐institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients

The frail elderly surgical patient is at increased risk of morbidity after major surgery. A transdisciplinary Geriatric Surgery Service (GSS) has been shown to produce consistently positive results in our institution. A trans‐institutional transdisciplinary Start to Finish (STF) programme was initiated incorporating seamless prehabilitation and rehabilitation to enhance the outcome further.

Endoscopic pilonidal sinus treatment in the Asian population.

Introduction: This study aims to evaluate the early results of endoscopic pilonidal sinus treatment (EPSiT) in the Asian population and illustrate the surgical technique and its modifications by a video presentation (Supplemental Digital Content 1, http://links.lww.com/SLE/A115). Materials and Methods: Retrospective review of 9 patients with pilonidal sinus disease treated with EPSiT is performed in a single institution. Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic and patient satisfaction levels were assessed through a standardized phone interview. Results: The median age was 24 years (range, 16 to 41 y). The median duration of follow-up was 2.5 months (range, 1 to 5 mo). Median duration of sinus healing is 6 weeks (range, 2 to 7 wk). One patient had pain despite sinus healing. Satisfaction rate was 78% (7/9). Conclusions: EPSiT is a minimally invasive and cosmetically favorable procedure. A larger sample size and a longer follow-up is required to determine if it improves healing time and long-term recurrence rate.

Laparoscopic Hartmann reversal: Video presentation of a case.

Laparoscopic Hartmann reversal (LHR) has decreased postoperative recovery time and a lower wound infection rate compared to open HR. However its technical difficulty and high conversion rates make it a challenging procedure. We aim to demonstrate the technique of LHR via a video presentation. Our patient, a 64 year old Chinese man with no history of previous surgery underwent a Hartmann procedure for an obstructing sigmoid stricture secondary to diverticular disease. Three months later, he underwent an elective LHR.

Transdisciplinary Fecal Incontinence Management

Transdisciplinary approach is attractive and necessary for optimal and successful management of fecal incontinence (FI). Incontinence usually results from diverse pathophysiological processes and is multifactorial in etiology. Structural abnormalities like anal sphincter muscle injury and prolapse disorders of the anorectum, functional abnormalities like impaired rectal sensation, change in stool characteristics, dietary influences, and medications, or even aging with impairment of cognitive function can all result in deranged bowel function. This multifactorial etiology results in different types of FI and thereby the need for multiple management options.

Supraclavicular lymph node metastasis as a first sign of rectal cancer without visceral metastasis.

However, the meta-analysis does show non-statistically significant trends to benefit from IONM in some subgroups, for example permanent RLNP in Graves’ disease, transient RLNP in retrosternal goitres, and all RLN palsies for patients in the seven comparative trial subgroup (almost half of the meta-analysis patients). We interpreted from this there is only a small amount of evidence in the RCT and meta-analysis to demonstrate the benefit of IONM. This statement was not intended to be misleading, but agree overall evidence for clear benefit is lacking. However, data show some significant results and trends and therefore the jury must be considered still out on the overall value of IONM. Dralle noted that to show a statistically significant difference for RLNP in multi-nodular goitre, with and without IONM, would require nine million cases in each arm of an RCT. Perhaps the greatest value of IONM is in preventing bilateral RLNP. If RLNP occurs, a decision whether to resect the contralateral side can be made. It is also of great value as a prognostic tool to reassure the patient who has sustained a temporary RLNP – a visually intact RLN with an initial normal signal, which is then lost, predicts almost 100% recovery from the neurapraxia. IONM is also a valuable research tool, it has facilitated significant advances in knowledge of neuroanatomy, neurophysiology and neuropathology of the RLN, and its ongoing use will enable its place in thyroid surgery to be further evaluated. All thyroidectomies are potentially difficult and it is not possible to predict when a patient will be technically challenging or when unexpected anatomy will be found. Therefore, it is not possible to predict when IONM is likely to be of greatest value. There is a steep learning curve in the use of IONM. Therefore, it is suggested that expertise in its use is developed in cases such as multi-nodular goitres, rather than using it selectively for difficult cancers and re-operative cases. It is stated in the discussion of the RCT that ‘only good understanding of the electrophysiological background of the nerve monitoring method and daily practice in uncomplicated operations allows mastery of this novel technique’. For these reasons, we suggested in the Editorial and consensus statement that routine use of IONM could be considered for all thyroid surgery. We wish to be clear that the use of IONM for all thyroid surgery is not the current standard of care. However, for the next generation of thyroid surgeons, it appears that it may well become so.