Diseases of the Colon & Rectum

Yagyu, Takuki; Hamada, Madoka; Hatta, Masahiko; Kobayashi, Toshinori; Matsumi, Yuki; Inada, Ryo; Matsumoto, Tomoko; Oishi, Masaharu

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003517pmid: 39260442

BACKGROUND: Although loop ileostomy as a diverting stoma has been considered to affect renal dysfunction, few reports have compared loop colostomy with loop ileostomy regarding renal function. This is an important issue in the current setting of increased opportunities to perform surgery on patients with poor renal function. OBJECTIVE: This study aims to reveal the effect of ileostomy on renal dysfunction compared to colostomy following sphincter-preserving rectal surgery. DESIGN: This study was a retrospective analysis. We compared preoperative and postoperative blood urea nitrogen, serum creatinine and estimated glomerular filtration rate values. SETTINGS: The study was conducted at a single academic institution in Osaka, Japan. PATIENTS: From October 2013 to November 2021, 135 consecutive patients underwent rectal surgery with diverting stoma are included. MAIN OUTCOME MEASURES: Differences in pre- and postoperative renal function values by stoma creation site in patients with preoperative chronic kidney disease. Risk factors for patients with newly kidney disease after stoma creation. RESULTS: In the preoperative chronic kidney disease (+) patients, the differences between the pre- and post-values in the blood urea nitrogen (p = 0.047) and the serum creatinine (P = 0.028) values were higher than in the preoperative chronic kidney disease (-) patients. In the preoperative chronic kidney disease (+) patients, ileostomy was significantly associated with an elevation of the serum creatinine value (p = 0.025) and a decrease in estimated glomerular filtration rate value (p = 0.041) from the pre-operative one compared with that of colostomy. In multivariate analysis, ileostomy (odds ratio; 7.443, p = 0.011) and hypertension (4.226, p = 0.008) were independent risk factors of newly kidney disease postoperatively. LIMITATIONS: Limitations to our study includes its retrospective nature and bias due to the stoma site being determined by each surgeon. CONCLUSION: We should take care to choose diverting stoma especially in patients with a risk of kidney disfunction. See Video Abstract.

Lightner, Amy L.

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003535pmid: 39254201

Weaver, Lauren; Goffredo, Paolo

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003524

Sandigo-Saballos, Isabela; Altamirano, Elias; Lee, Hanjoo

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003462pmid: 39239961

Pyo, Dae Hee; Kim, Seijong; Do, Misol; Huh, Jung Wook

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003287pmid: 39264062

BACKGROUND Laparoscopic surgery offers several advantages, but it can be challenging to perform in confined spaces, such as the narrow and deep pelvis, due to poor vision and instrument collisions. Conventional laparoscopic instruments are rigid and straight, which can restrict optimal access to the target organ. Although the use of robotic surgical platforms with flexible wrists has significantly reduced movement restrictions and surgeon fatigue, their high cost remains a barrier to widespread adoption. IMPACT OF INNOVATION Recent technological advancements in laparoscopic instruments have led to the development of an articulating flexible hand-held device that enables greater dexterity and easier access to difficult anatomical locations. This technology has the potential to improve surgical outcomes by using multiple degrees of freedom to perform complex surgical procedures with greater precision. TECHNOLOGY, MATERIALS, AND METHODS The ArtiSential® product line comprises over 30 end-effectors, such as scissors, hooks, and graspers. The benefits of this device are evident throughout the total mesorectal excision, especially when approaching the left lateral side of the mesorectum (the side opposite the surgeon) or the deepest part of the pelvis around the levator ani muscle. The Samsung Medical Center Institutional Review Board approved this study (2022-01-174). PRELIMINARY RESULTS A 79-year-old male with rectal cancer located 9 cm from the anal verge underwent an laparoscopic ultralow anterior resection using ArtiSential®. There were no intraoperative complications. The pathologic results showed that the tumor was at pT3N0 stage. The patient was discharged without any complications. CONCLUSION AND FUTURE DIRECTIONS The articulating device can be effectively used for laparoscopic surgery, but has some challenges related to the bulky handpiece and learning curve. A multicenter prospective cohort study to compare the outcomes of articulating laparoscopic surgery and robotic surgery for patients with rectal cancer is oncoing (clinicaltrials.gov number: NCT05566249).

Raman, Rohith S.; Usry, Benjamin; Hughes, Kevin S; Donahue, Colleen

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003393

Klingler, Michael J.; Erozkan, Kamil; Alipouriani, Ali; Sommovilla, Joshua; Gorgun, Emre

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003526pmid: 39264052

BACKGROUND: Endoscopic submucosal dissection for advanced colon lesions is typically performed with specialized and costly endoscopic knives, potentially limiting accessibility and increasing procedural cost. Alternatively, the tip of an endoscopic snare, which is inexpensive and universally available, has demonstrated safe and efficient use in gastric lesions but lacks sufficient data for use in colon lesions. OBJECTIVE: This study aimed to assess patient outcomes following endoscopic submucosal dissection of advanced colon lesions using the endoscopic snare tip. DESIGN: A retrospective review of a prospectively maintained database at a single tertiary care center was conducted. SETTINGS: This study was conducted at a single tertiary care center. PATIENTS: Adult patients with colon lesions that were not amenable to snare polypectomy were evaluated for endoscopic submucosal dissection. Snare tip resection was performed in select patients with lesions that lifted adequately after submucosal injection. Patients who underwent hybrid resections with endoscopic mucosal dissection were excluded. MAIN OUTCOME MEASURES: En bloc resection rates, operative time, perioperative complications, and short-term outcomes such as length of stay and lesion recurrence on follow-up colonoscopy were evaluated. RESULTS: A total of 121 patients underwent snare tip endoscopic submucosal dissection, with a mean lesion size of 28.8 ± 9.84 mm. Most procedures were performed in the endoscopy suite (81.8%). The en bloc resection rate was 81.8% with an average procedure time of 37.1 ± 29.8 min. There were two perforations (1.70%), one of which was managed operatively. Recurrence occurred in 6 patients (7.89%) at the time of follow-up colonoscopy. LIMITATIONS: This study was retrospective, conducted by two skilled endoscopists with experience in endoscopic resection, and had short-term follow up. CONCLUSIONS: Snare tip endoscopic submucosal dissection for advanced colon lesions demonstrates satisfactory short-term outcomes, suggesting its potential as a safe and accessible alternative to specialized knives, thereby possibly enhancing adoption of endoscopic resection and improving patient accessibility. See Video Abstract.

Tyler, Kelly M.; Colvin, Donald

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003532pmid: 39239954

Turner, Greg A.; Rajkomar, Amrish K.; Heriot, Alexander G; Warrier, Satish K

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003513pmid: 39254203

Eisenstat, Theodore E.

2024 Diseases of the Colon & Rectum

doi: 10.1097/dcr.0000000000003523