Diagnostics in Colorectal Surgery

The rapid development in radiological examinations has opened a new chapter in colorectal surgery. Unlike classical books, in this section we preferred to use more modern and everyday practical methods such as endoscopy or magnetic resonance imaging or endorectal ultrasonography, rather than sparing less used examinations such as X-rays and barium graphs

Endoskopide yenlikçi girişimler

Hipokrat döneminde hastayı ameliyat etmeden gastrointestinal kanalı görüntüleme şeklinde başlayan endoskopi süreci zaman içinde gelişmiştir. Günümüzde tanı koymanın yanı sıra tedavi edici yöntemlerin de uygulandığı endoskopik sistemler mevcuttur. Teknolojide atılan adımlar ile tanısal özellikleri, kısıtlı da olsa, biyopsiye gerek kalmadan sergileyebilecek düzeye gelen FICE, NBI gibi sistemler mevcuttur. Teknolojideki ilerlemeler ile gelecekte birçok açık cerrahi yöntemin yerini alabilecek duruma gelen endoskoplar umut vericidir

A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus.

Objectives: Although many surgical methods have been described for sacrococcygeal pilonidal sinus treatment, the best option is still controversial. We aimed to compare postoperative outcomes of these different methods in terms of advantages and disadvantages. Methods: The records of 320 patients undergone surgery for primary or recurrent pilonidal sinus between May 2013 and May 2017 were retrospectively analyzed. Demographical data, pre operative stories, wound site infection, seroma development, wound dehiscence, time of healing, duration of return to work, and if there is any recurrence of 303 patients included in the study were recorded. Upon wide local excision, the first surgeon performed marsupialisation and the lay open technique, second surgeon performed vertical excision and primary closure, third surgeon performed Limberg flap transposition and fourth surgeon performed Karydakis' flap transposition. Results: There was no significant difference between the patients in terms of demographical characteristics. The duration of surgery was statistically significantly higher in primary closure method (p = 0.001). The mean duration of return-to-work was statistically significantly lower in primary closure method (p = 0.002). In primary closure method, the recurrence rate was found to be statistically significantly higher than the other methods (p = 0.009). Conclusion: We do not suggest the use of primary closure method in treatment of pilonidal sinus. Because of lower rates of recurrence and shorter durations of return to work, the Karydakis and Limberg methods are seen as safer methods when compared to lay-open and marsupialization method

Appendicitis epiploicae: a rare cause of acute abdomen

Acute appendicitis is one of the most common causes of right lower quadrant acute abdominal pain in adults. Some other conditions, including appendicitis epiploicae, can simulate an acute abdomen. Appendicitis epiploicae or epiploic appendicitis usually originates in the sigmoid colon and rarely from other parts of colon. We report a case of a 20-year-old man with appendicitis epiploicae of the caecum, who underwent surgery for acute appendicitis. Analysis of this uncommon condition, together with a review of the pertinent literature, are presented

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care