Colonoscopy after Diverticulitis

Patients suffering from diverticulitis are at increased risk for colorectal cancer and should undergo colonoscopy to rule out colorectal cancer. The prevalence of colorectal cancer in this population was estimated to range between 1.9 and 2.3%. This prevalence is higher in patients with complicated diverticulitis (abscess, perforation) and ranges between 6.1% and 7.9%. Therefore, interval colonoscopy is strongly recommended after an episode of complicated diverticulitis. The prevalence of colorectal cancer is lower in patients with uncomplicated diverticulitis and approaches the prevalence from screened populations. In patients with uncomplicated diverticulitis, the indication for colonoscopy is still a matter of debate and should be done on a case-by-case basis

Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis.

BACKGROUND: Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery. The objective is to determine if the choice of extraction site modulates the incidence of incisional hernia (IH). METHODS/DESIGN: A systematic review will be performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase and CENTRAL will be searched to look for original studies reporting the incidence of IH after minimally invasive colorectal surgery. Studies will be excluded from the analysis if: 1) they do not report original data, 2) the outcome of interest (incidence of incisional hernia) is not clearly reported and does not allow to extrapolate and/or calculate the required data for network meta-analysis, 3) they include pediatric patients, 4) they include a patients' population with a conversion rate to laparotomy >10%, 5) they do not compare at least two different extraction sites for the operative specimen, 6) they report patients who underwent pure (and not hybrid) natural orifice transluminal endoscopic surgery (NOTES). Network meta-analysis will be performed to determine the incidence of IH per extraction site. DISCUSSION: By determining which specimen extraction site leads to reduced rate of IH, this systematic review and network meta-analysis will help colorectal surgeons to choose their extraction site and reduce the morbidity and costs associated with IH. REGISTRATION: The systematic review and meta-analysis protocol is registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with number CRD42021272226. HIGHLIGHTS: Various sites are used for specimen extraction in oncological minimally invasive colorectal surgery, and the choice of the site may probably modulate the incidence of incisional hernia.The present protocol aims to design a systematic review which will identify original studies comparing two extraction sites during minimally invasive colorectal surgery in terms of incidence of incisional hernia.Network meta-analysis will be performed to determine the incidence of IH per extraction site

Patients’ related sexual outcomes in colorectal surgery

BackgroundPatients undergoing colorectal surgery (CRS) have an increased risk of developing sexual disorders, attributed to different mechanisms. In this context, sexual function (SF) assessment of patients before and after surgery is essential: to identify risk factors for sexual disorders as well as to minimize their impact on overall quality of life (QoL), allowing them a satisfying relationship and sexual life.Material and methodsPatients over 18 years of age who underwent a CRS in the University Hospital of Geneva, Switzerland, between June 2014 and February 2016 were included. Our main objective was to compare and analyze the evolution of SF, QoL, and marital satisfaction (MS) before and after CRS. Specific and standardized tests were used.ResultsA cohort of 72 patients with a median age of 58.73 was analyzed. The majority of CRS was elective (91.5%). A percentage of 52.8% of patients underwent surgery for oncological reasons. There was no statistical difference in SF, sexual QoL, and MS before and after elective or emergency CRS for men. Interestingly, a significant decrease in women’s SF (FSFI) as well as their satisfaction within their couple (Locke–Wallace) until 12 months after surgery was found (p = 0.021). However, they showed a steady SF (GRISS) within their couple until 12 months after surgery.ConclusionRegarding knowledge about difficulties to talk about this intimate topic and gender differences, this general overview raises the question of the necessity to introduce in a long-course follow-up different methods of sexual health assessment with specific stakeholders

Nab-PIPAC: a phase IB study protocol of intraperitoneal cisplatin and nab-paclitaxel administered by pressurised intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of advanced malignancies confined to the peritoneal cavity

Introduction: Intraperitoneal dissemination is a major problem resulting in very poor prognosis and a rapid marked deterioration in the quality of life of patients. Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is an emergent laparoscopic procedure aiming to maximise local efficacy and to reduce systemic side effects. Methods and analysis: Nab-PIPAC, a bicentre open-label phase IB, aims to evaluate safety of nab-paclitaxel and cisplatin association using in patients with peritoneal carcinomatosis (PC) of gastric, pancreatic or ovarian origin as ≥1 prior line of systemic therapy. Using a 3+3 design, sequential intraperitoneal laparoscopic application of nab-paclitaxel (7.5, 15, 25, 37.5, 52.5 and 70 mg/m2) and cisplatin (10.5 mg/m2) through a nebuliser to a high-pressure injector at ambient temperature with a maximal upstream pressure of 300 psi. Treatment maintained for 30 min at a pressure of 12 mm Hg and repeated4-6 weeks intervals for three courses total.A total of 6-36 patients are expected, accrual is ongoing. Results are expected in 2024.The primary objective of Nab-PIPAC trial is to assess tolerability and safety of nab-paclitaxel and cisplatin combination administered intraperitoneally by PIPAC in patients with PC of gastric, pancreatic or ovarian origin. This study will determine maximum tolerated dose and provide pharmacokinetic data. Ethic and dissemination: Ethical approval was obtained from the ethical committees of Geneva and Vaud (CCER-2018-01327). The study findings will be published in an open-access, peer-reviewed journal and presented at relevant conferences and research meetings. Trial registration number: NCT04000906.</p

Glucose-induced β cell production of IL-1β contributes to glucotoxicity in human pancreatic islets

Erratum / Corrigendu

Clinical Outcome in Acute Small Bowel Obstruction after Surgical or Conservative Management

Background: Small bowel obstruction (SBO) is characterized by a high rate of recurrence. In the present study, we aimed to compare the outcomes of patients managed either by conservative treatment or surgical operation for an episode of SBO. Methods: The outcomes of all patients hospitalized at a single center for acute SBO between 2004 and 2007 were assessed. The occurrence of recurrent hospitalization, surgery, SBO symptoms at home, and mortality was determined. Results: Among 221 patients admitted with SBO, 136 underwent a surgical procedure (surgical group) and 85 were managed conservatively (conservative group). Baseline characteristics were similar between treatment groups. The median follow-up time (interquartile range) was 4.7 (3.7-5.8) years. Nineteen patients (14.0%) of the surgical group were hospitalized for recurrent SBO versus 25 (29.4%) of the conservative group [hazard ratio (HR), 0.5; 95% CI, 0.3-0.9]. The need for a surgical management of a new SBO episode was similar between the two groups, ten patients (7.4%) in the surgical group and six patients (7.1%) in the conservative group (HR, 1.1; 95% CI, 0.4-3.1). Five-year mortality from the date of hospital discharge was not significantly different between the two groups (age- and sex-adjusted HR, 1.1; 95% CI, 0.6-2.1). A follow-up evaluation was obtained for 130 patients. Among them, 24 patients (34.8%) of the surgical group and 35 patients (57.4%) of the conservative group had recurrent SBO symptoms (odds ratio, 0.4; 95% CI, 0.2-0.8). Conclusions: The recurrence of SBO symptoms and new hospitalizations were significantly lower after surgical management of SBO compared with conservative treatment

Comprehensive Treatment Algorithms of the Swiss Peritoneal Cancer Group for Peritoneal Cancer of Gastrointestinal Origin

Peritoneal cancer (PC) is a dire finding, yet in selected patients, long-term survival is possible. Complete cytoreductive surgery (CRS) together with combination immunochemotherapy is essential to achieve cure. Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are increasingly added to the multimodal treatment. The Swiss Peritoneal Cancer Group (SPCG) is an interdisciplinary group of expert clinicians. It has developed comprehensive treatment algorithms for patients with PC from pseudomyxoma peritonei, peritoneal mesothelioma, gastric, and colorectal origin. They include multimodal neoadjuvant treatment, surgical resection, and palliative care. The indication for and results of CRS HIPEC and PIPAC are discussed in light of the current literature. Institutional volume and clinical expertise required to achieve best outcomes are underlined, while inclusion of patients considered for CRS HIPEC and PIPAC in a clinical registry is strongly advised. The present recommendations are in line with current international guidelines and provide the first comprehensive treatment proposal for patients with PC including intraperitoneal chemotherapy. The SPCG comprehensive treatment algorithms provide evidence-based guidance for the multimodal care of patients with PC of gastrointestinal origin that were endorsed by all Swiss clinicians routinely involved in the multimodal care of these challenging patients

Near infrared imaging in colorectal surgery

Introduction: Near infrared imaging technologies are developing quickly. The injection of a dye with the use of a near infrared scope allow to identify structures that are not visible on the regular spectrum. We describe in this work the main applications for colorectal surgery, one for the study of the microvacularisation of the anastomosis and the second on lymphnode mapping for colorectal cancer. Method Indocyanine green(ICG) is the dye used for this application, it is very safe. A stimulation of the dye after its injection by a near infrared light allows to see it with the use of the appropriate scope. Three scope are currently used for this application in minimally invasive surgery, the Pinpoint (Novadaq), the Olympus prototype and the D-Light (Storz) . Results: The use of this technology allowed to see the microvascularisation of an anastomosis in real time, this could potentially lead to a decrease in leak rate or anastomotic trouble. The use of the NIR technology is at the early beginning for lymphnode mapping, but seems very promising if we can prove the concept of sentinel lymphnode in laparoscopic colorectal surgery. Early results show the possibility to identify primary lymphnodes in the lymphatic route in real time, shortly after injection. Conclusion: The use of ICG and the near infrared technology allows to increase reality in a way that was never possible before. Both indications (microcirculation assessment and lymphnode mapping) are relevant from a clinical point of view and should therefore be further investigated

Monitoring des greffes d'îlots pancréatiques par résonance magnétique nucléaire

Introduction: Le marquage des îlots pancréatiques par nanoparticules de fer permet de suivre les îlots après la greffe. Nous avons étudié deux nanoparticles utilisées en clinique(ferucarbotran/ferumoxide) en termes de toxicité, de captation du fer et d'imagerie par résonance magnétique à 1.5T. Méthode: Incubation durant 24h à différentes concentrations de fer(14-280µg/ml). La réponse insulinique a été comparée, des études immunohistochimiques (insuline et fer), ainsi que de la microscopie électronique ont été réalisée. Imagerie à 1.5T. Résultats: La viabilité et la fonction des îlots est comparable. La captation du fer est meilleure pour le ferucarbotran que pour le ferumoxide en immunohistochimie et microscopie électronique. L'imagerie ex-vivo et in-vivo (rat) montre un meilleur signal avec le ferucarbotran. Le signal persiste 8 semaines en l'absence de rejet. Nous avons aussi montré une excellente corrélation radio-histologique. Conclusion: Le ferucarbotran est le produit de contraste disponible le plus approprié pour l'imagerie des îlots par résonance magnétique