Robotic Combined Anterior & Posterior Repair of a Rectal Prolapse, Rectocele, and Sigmoidocele with a Mesh

RP is often seen in patients over the age of fifty, particularly women. These patients frequently suffer from other concomitant pathologies like rectocele, sigmoidocele, cystocele, or even enterocele. Rectopexy with a mesh has been an established treatment for rectal prolapse. The utilization of the robotic system allows for a successful repair within a confined pelvic space, especially for precise suture placement when working with the mesh. A 77-year-old female presented with ODS symptoms found to be caused by a progressive rectal prolapse. Her pre-operative ODS score was 9/20. Pelvic floor evaluation revealed concomitant rectocele and sigmoidocele. The patient was offered a robotic-assisted rectopexy with mesh placement to address the three concomitant pathologies. During the procedure, a posterior mesorectal mobilization with autonomic nerve preservation was performed to address the posterior leading edge of the prolapse. Subsequently, the vagina was separated from the anterior portion of the rectum and dissected down to the levator ani muscle and the perineal body. This allowed for the affixation of a polypropylene mesh to the anterior portion of the rectum. Anterior suspension of the mobilized rectum with the mesh addressed all three pathologies. No recurrence or complications occurred at two-year follow-up. The patient’s ODS score decreased to 1/20

Robotowa operacja naprawcza wypadania odbytnicy ze współistniejącymi rectocele i sigmoidocele z użyciem siatki

Wypadanie odbytnicy (WO) jest schorzeniem występującym najczęściej u pacjentów w wieku powyżej 50 lat, szczególnie u kobiet. Z WO zazwyczaj współistnieją inne patologie, takie jak: uwypuklenie odbytnicy (rectocele), wpuklenie esicy (sigmoidocele), uwpuklenie pęcherza moczowego (cystocele), a nawet przepuklina zawierająca pętle jelita cienkiego (enterocele). Rektopeksja z użyciem siatki jest metodą o powszechnie uznawanej skuteczności w leczeniu wypadania odbytnicy. Zastosowanie robota chirurgicznego ułatwia preparowanie tkanek w obrębie miednicy mniejszej i jest szczególnie pomocne podczas zakładania szwów mocujących siatkę. W niniejszym artykule przedstawiono przypadek 77-letniej kobiety, u której stwierdzono objawy zespołu zaburzeń defekacji (ang. obstructed defecation syndrome; ODS), którego przyczyną było wypadanie odbytnicy. W trakcie postępowania przedoperacyjnego objawy pacjentki w skali ODS Score oceniono na 9/20. Podczas dalszej diagnostyki, poza wypadaniem odbytnicy, stwierdzono współistniejące rectocele i sigmoidocele. Pacjentka została zakwalifikowana do robotowej rektopeksji z użyciem siatki. W pierwszym etapie operacji wykonano uwolnienie tylnej części mezorektum z zaoszczędzeniem nerwów układu autonomicznego. Następnie wypreparowano przegrodę odbytniczo-pochwową, oddzielając pochwę od przedniej części odbytnicy do poziomu mięśni dźwigaczy odbytu (mięśni dna miednicy) i rozworu moczowo-płciowego, co umożliwiło przymocowanie siatki polipropylenowej do przedniej ściany odbytnicy. Podwieszenie przedniej ściany odbytnicy przy użyciu siatki rozwiązało problem trzech współistniejących patologii. U pacjentki w trakcie dwuletniej obserwacji nie odnotowano nawrotu ani istotnych powikłań pooperacyjnych, a wynik ODS Score uległ obniżeniu do 1/20

Serum depletion of complement component 5a is associated with increased inflammation and poor clinical outcomes in patients with perianal fistulas

Background: Persistent disease is a significant issue in the management of perianal fistulas, with up to 50% of patients representing following surgery and requiring additional treatment. Objective: The purpose of this study was to identify a novel prognostic modality in hopes of risk stratifying patients for persistent disease following corrective surgery. Design: This was a retrospective study based on prospectively collected data using a combination of histopathology, high throughput proteomic arrays, and ELISA based methods. Settings: This study used data on patients who underwent corrective surgery for perianal fistulas at the University of Illinois Hospital between June 2019 and July 2020. Patients: A cohort of 22 consecutive patients who corrective surgery for perianal fistulas was included in this study. The patients were divided into 2 groups: those with resolving fistulas (N = 13) and those with persisting fistulas (N = 9). Main outcome measures: Non-resolving fistulas were determined by disease re-presentation within 2 months of corrective surgery. Results: Serum samples from patients with persistent perianal fistulas displayed a consistent decrease in the expression of complement pathway component C5a compared to either healthy controls or patients with resolving forms of disease. This was paralleled by an increase in fistula expression of C5a and an associated increase in tissue infiltrating leukocytes and IL-1β expression. Limitations: The study was limited by its retrospective design, relatively small sample size, and single center data analysis. Conclusions: These results suggest that C5a is modestly depleted in patients with non-resolving forms of disease, and traffics to the site of tissue damage and inflammation. Accordingly, serum C5a warrants continued investigation as a prognostic biomarker and predictor of recurrence in patients presenting with perianal fistulas. See Video Abstract at http://links.lww.com/DCR/B982

Management of colorectal cancer during the COVID‐19 pandemic: Recommendations from a statewide multidisciplinary cancer collaborative

COVID-19 has resulted in significant disruptions in cancer care. The Illinois Cancer Collaborative (ILCC), a statewide multidisciplinary cancer collaborative, has developed expert recommendations for triage and management of colorectal cancer when disruptions occur in usual care. Such recommendations would be applicable to future outbreaks of COVID-19 or other large-scale disruptions in cancer care

Outcomes of perineal wound closure techniques after abdominoperineal resections in rectal cancer: an NSQIP propensity score matched study

Perineal defects following abdominoperineal resections (APRs) for rectal cancer may require myocutaneous or omental flaps depending upon anatomic, clinical and oncologic variables. However, studies comparing their efficacy have shown contradictory results. We aim to compare postoperative complication rates of APR closure techniques in rectal cancer using propensity score-matching. The American College of Surgeons Proctectomy Targeted Data File was queried from 2016 to 2019. The study population was defined using CPT and ICD-10 codes for patients with rectal cancer undergoing APR, stratified by repair technique. Perioperative demographic and oncologic variables were controlled for by propensity-score matching. Multivariate logistic regression analysis was performed for wound and major complications (MCs). Of the 3291 patients included in the study, 85% underwent primary closure (PC), 8.3% rectus abdominis myocutaneous (RAM) flap, 4.9% pedicled omental flap with PC, and 1.9% lower extremity (LE) flap repair. Primary closure rates were significantly higher for patients with stage T1 and T2 tumors (p p p < 0.001). After propensity score matching for comorbidities and oncologic variables, there was no significant difference in 30-day postoperative wound or MC rates between perineal closure techniques. The complication rates of the different closure techniques are comparable when tumor stage is considered. Therefore, tumor staging and concurrent procedures should guide clinical decision making regarding the appropriate use of each technique.</p