Annals of Coloproctology

Original Articles

CRC

Impact of iron-deficiency anemia on short-term outcomes after resection of colorectal cancer liver metastasis: a US National (Nationwide) Inpatient Sample (NIS) analysis: Ko-Chao Lee, Yu-Li Su, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung; Ann Coloproctol. 2025;41(2):119-126. Published online April 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00591.0084

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Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) often spreads to the liver, necessitating surgical treatment for CRC liver metastasis (CRLM). Iron-deficiency anemia is common in CRC patients and is associated with fatigue and weakness. This study investigated the effects of iron-deficiency anemia on the outcomes of surgical resection of CRLM.
Methods
This population-based, retrospective study evaluated data from adults ≥20 years old with CRLM who underwent hepatic resection. All patient data were extracted from the 2005–2018 US National (Nationwide) Inpatient Sample (NIS) database. The outcome measures were in-hospital outcomes including 30-day mortality, unfavorable discharge, and prolonged length of hospital stay (LOS), and short-term complications such as bleeding and infection. Associations between iron-deficiency anemia and outcomes were determined using logistic regression analysis.
Results
Data from 7,749 patients (representing 37,923 persons in the United States after weighting) were analyzed. Multivariable analysis revealed that iron-deficiency anemia was significantly associated with an increased risk of prolonged LOS (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.30–3.30), unfavorable discharge (aOR, 2.42; 95% CI, 1.83–3.19), bleeding (aOR, 5.05; 95% CI, 2.92–8.74), sepsis (aOR, 1.60; 95% CI, 1.04–2.46), pneumonia (aOR, 2.54; 95% CI, 1.72–3.74), and acute kidney injury (aOR, 1.71; 95% CI, 1.24–2.35). Subgroup analyses revealed consistent associations between iron-deficiency anemia and prolonged LOS across age, sex, and obesity status categories.
Conclusion
In patients undergoing hepatic resection for CRLM, iron-deficiency anemia is an independent risk factor for prolonged LOS, unfavorable discharge, and several critical postoperative complications. These findings underscore the need for proactive anemia management to optimize surgical outcomes.

Anorectal benign disease

Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study: Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano, Luana Passariello, Pasquale Talento, Giovanna Ioia, Corrado Rispoli, Mariano Fortunato Armellino, Vincenzo Bottino, Adolfo Renzi, Carlo Bartone, Luigi Monaco, Paolino Mauro, Stefano Picardi, Maria Paola Menna, Elisa Palladino, Mario Massimo Mensorio, Vinicio Mosca, Claudio Gambardella, Luigi Brusciano, Ludovico Docimo; Ann Coloproctol. 2024;40(6):602-609. Published online December 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00570.0081

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Abstract PDF: Purpose
Postoperative pain is a major concern for patients undergoing ultrasound scalpel-assisted hemorrhoidectomy, potentially exacerbated by delayed wound healing. This study aimed to evaluate the impact of an intimate cleansing gel containing chlorhexidine, hyaluronic acid, and other anti-inflammatory agents (Antroclean Fisioderm) on postoperative pain, itching, and wound healing in patients who had undergone this procedure.
Methods
This multicenter observational case-control study involved a cohort of consecutive adult patients who underwent hemorrhoidectomy using an ultrasound device. The study compared 2 different postoperative wound management strategies over 1 month after surgery: washing with warm water twice per day (control group) versus a 2-minute topical application of intimate cleansing gel (Antroclean Fisioderm) followed by a warm water wash (intervention group).
Results
The median postoperative pain score was significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). The percentage of patients reporting anal itching was also significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). All patients in the intervention group achieved complete wound healing 4 weeks after surgery, compared to 88 (82%) in the control group (P<0.01). No adverse events were reported.
Conclusion
The topical application of intimate cleansing gel (Antroclean Fisioderm) twice daily for 1 month following ultrasound scalpel-assisted hemorrhoidectomy appears to be associated with faster healing, reduced pain, decreased itching, and improved quality of life, without any adverse effects. Further larger and prospective randomized trials are recommended to confirm these findings.

ERAS

Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer: Victoria Weets, Hélène Meillat, Jacques Emmanuel Saadoun, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong; Ann Coloproctol. 2024;40(5):440-450. Published online September 20, 2024; DOI: https://doi.org/10.3393/ac.2023.00850.0121

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
Methods
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Results
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
Conclusion
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.

Citations

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Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Anorectal benign disease

Immediate sphincter repair following fistulotomy for anal fistula: does it impact the healing rate and septic complications?: Maher A. Abbas, Anna T. Tsay, Mohammad Abbass; Ann Coloproctol. 2024;40(3):217-224. Published online June 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01144.0163

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Abstract PDF

Purpose
Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair.
Methods
This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications.
Results
In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42).
Conclusion
Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

Citations

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Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Annals of Coloproctology.2024; 40(5): 521. CrossRef

Technical Note

Technical tips

Introduction of extraperitoneal tunneling method: a way to secure the drain tube in the pelvic cavity after proctectomy: Sung Il Kang, Sohyun Kim, Jae Hwang Kim; Ann Coloproctol. 2024;40(2):182-185. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00073.0010

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Abstract PDF: The effectiveness of closed drainage tube insertion after low anterior resection has been controversial. We believe that drain tube displacement, which occurs up to 35% in real clinical practice, reduces the effectiveness of the drain tube. We report in this video a simple way to secure the drain tube in the pelvic cavity after low anterior resection and introduce a case that used the drain fixation method and treated anastomotic leakage without interventional procedure.

Original Article

Colorectal cancer

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study: Ahmad Sakr, Seung Yoon Yang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim; Ann Coloproctol. 2024;40(1):27-35. Published online February 28, 2024; DOI: https://doi.org/10.3393/ac.2022.01067.0152

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Abstract PDF

Purpose
Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.
Methods
In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.
Results
Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.
Conclusion
Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Citations

Citations to this article as recorded by

Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Technical Note

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience: Michael Jones, Brendan Moran, Richard John Heald, John Bunni; Ann Coloproctol. 2024;40(1):82-85. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00038.0005

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Abstract PDF: Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Original Articles

Colorectal cancer

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea: Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee; Ann Coloproctol. 2023;39(6):493-501. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2023.00437.0062

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

Stoma

Protective loop ileostomy or colostomy? A risk evaluation of all common complications: Yi-Wen Yang, Sheng-Chieh Huang, Hou-Hsuan Cheng, Shih-Ching Chang, Jeng-Kai Jiang, Huann-Sheng Wang, Chun-Chi Lin, Hung-Hsin Lin, Yuan-Tzu Lan; Ann Coloproctol. 2024;40(6):580-587. Published online January 27, 2023; DOI: https://doi.org/10.3393/ac.2022.00710.0101

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Abstract PDF

Purpose
Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice.
Methods
Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared.
Results
There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. For stoma retraction, the multivariate analysis revealed that female (odds ratio [OR], 4.00; 95% confidence interval [CI], 2.13–7.69; P<0.001) and long diversion duration (≥4 months; OR, 2.33; 95% CI, 1.22–4.43; P=0.010) were independent risk factors, but ileostomy was an independent favorable factor (OR, 0.40; 95% CI, 0.22–0.72; P=0.003). The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542).
Conclusion
We suggest avoiding colostomy in patients who are female and potential prolonged diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

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Gut microbiome and plasma metabolome alterations in ileostomy and after closure of ileostomy
Liang Xu, Xiaolong Li, Lang Chen, Haitao Ma, Ying Wang, Wenwen Liu, Anyan Liao, Liang Tan, Xiao Gao, Weidong Xiao, Hua Yang, Guangyan Ji, Yuan Qiu, Wei-Hua Chen, Qin Liu, Song Liu, Yang Yang
Microbiology Spectrum.2025;[Epub] CrossRef
Effect of one-stitch method of temporary ileostomy on the surgical outcomes and complications after laparoscopic low anterior resection in rectal cancer patients: a propensity score matching analysis
Xin-Peng Shu, Jia-Liang Wang, Zi-Wei Li, Fei Liu, Xu-Rui Liu, Lian-Shuo Li, Yue Tong, Xiao-Yu Liu, Chun-Yi Wang, Yong Cheng, Dong Peng
European Journal of Medical Research.2025;[Epub] CrossRef
The Differences in Postoperative Nursing Between Temporary Ileostomy and Temporary Colostomy: A Retrospective Cohort Study
Mei Wang, Lihong Dai, Xia Fang, Yan Zheng, Yuanhao Shen, Yang Yu
Nursing Open.2025;[Epub] CrossRef
Uso de ileostomía derivativa en cáncer de ovario. Revisión de la literatura
Franco Rafael Ruiz-Echeverría, Pedro Hernando Calderón-Quiroz, Juliana Rendón-Hernández
Revista Colombiana de Cirugía.2024;[Epub] CrossRef
Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer
Shilai Yang, Gang Tang, Yudi Zhang, Zhengqiang Wei, Donglin Du
International Journal of Colorectal Disease.2024;[Epub] CrossRef
The Role of Colon in Isolated Intestinal Transplantation: Description of 4 Cases
Pierpaolo Di Cocco, Giulia Bencini, Alessandro Martinino, Egor Petrochenkov, Stepan Akshelyan, Kentaro Yoshikawa, Mario Spaggiari, Jorge Almario-Alvarez, Ivo Tzvetanov, Enrico Benedetti, Gaetano Gallo
International Journal of Surgical Oncology.2024;[Epub] CrossRef

Anorectal benign disease

The importance of compression time in stapled hemorrhoidopexy: is patience a virtue?: Byung Eun Yoo, Wook Ho Kang, Yong Teak Ko, Young Chan Lee, Cheong Ho Lim; Ann Coloproctol. 2024;40(2):176-181. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00556.0079

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Abstract PDF

Purpose
The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.
Methods
This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grades III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.
Results
A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).
Conclusion
Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by

Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef

Stoma

Benefits and risks of diverting stoma creation during rectal cancer surgery: Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki; Ann Coloproctol. 2024;40(5):467-473. Published online December 5, 2022; DOI: https://doi.org/10.3393/ac.2022.00353.0050

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Abstract PDF

Purpose
A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared.
Results
The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group.
Conclusion
Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Citations

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Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer
Hirotaka Momose, Makoto Takahashi, Masaya Kawai, Kiichi Sugimoto, Hiromitsu Takahashi, Shunsuke Motegi, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shun Ishiyama, Yuichi Tomiki, Kazuhiro Sakamoto
Journal of the Anus, Rectum and Colon.2025; 9(1): 88. CrossRef
Prevalence and pooled risk factors of stoma outlet obstruction after colorectal surgery with diverting ileostomy: a systematic review and meta-analysis
Jian-xin Gan, Hai-peng Liu, Kang Chen
International Journal of Colorectal Disease.2025;[Epub] CrossRef
The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
Journal of Personalized Medicine.2024; 14(1): 121. CrossRef
Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multicentre retrospective study
Scott MacDonald, Li‐Siang Wong, Hwei Jene Ng, Claire Hastings, Immogen Ross, Tara Quasim, Susan Moug
Colorectal Disease.2024; 26(5): 994. CrossRef
Nomogram for predicting the probability of rectal anastomotic re-leakage after stoma closure: a retrospective study
Yuegang Li, Gang Hu, Jinzhu Zhang, Wenlong Qiu, Shiwen Mei, Xishan Wang, Jianqiang Tang
BMC Cancer.2024;[Epub] CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
Effect of intraoperative anastomotic reinforcement suture on the prevention of anastomotic leakage of double-stapling anastomosis for laparoscopic rectal cancer: a systematic review and meta-analysis
Chaoyang Wang, Xiaolong Li, Hao Lin, Jiahua Ju, Haibao Zhang, Yongjiang Yu
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef

Review

Benign diesease & IBD,Rare disease & stoma

Prolapse of intestinal stoma: Kotaro Maeda; Ann Coloproctol. 2022;38(5):335-342. Published online October 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00465.0066

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Abstract PDF

Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

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Gastrointestinal Nursing.2025; 23(2): 89. CrossRef
Incarcerated trans-stomal herniation resembling a stomal prolapse – a case report
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Ileostomy: Early and Late Complications
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Linear stapler refashioning technique for irreducible stomal prolapse—A video vignette
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Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study
Takuya Yano, Masanori Yoshimitsu, Chiyomi Ishibashi, Atsuko Nishibara, Kanyu Nakano, Hitoshi Idani, Masazumi Okajima
Journal of the Anus, Rectum and Colon.2023; 7(4): 258. CrossRef
Intestinal Stomas—Current Practice and Challenges: An Institutional Review
Isam Mazin Juma, Tabarak Qassim, Mirza Faraz Saeed, Aya Qassim, Sana Al-Rawi, Sabrina Al-Salmi, Mustafa Thaer Salman, Ibrahim Al-Saadi, Abdulaziz Almutawea, Eman Aljahmi, Mohamed Khalid Fadhul
Euroasian journal of hepato-gastroenterology.2023; 13(2): 115. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
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The Ewha Medical Journal.2023;[Epub] CrossRef

Original Articles

Surgical management of retrorectal tumors: a single-center 12 years’ experience: Amirhosein Naseri, Behnam Behboudi, Ali Faryabi, Seyed Mohsen Ahmadi Tafti, Amirsina Sharifi, Mohammad Reza Keramati, Mohammad Sadegh Fazeli, Amir Keshvari, Mehdi Zeinalizadeh, Reza Akbari Asbagh, Niloufar Hoorshad, Alireza Kazemeini; Received April 26, 2022 Accepted June 23, 2022 Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00297.0042 [Epub ahead of print]

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Abstract PDF

Purpose
Retrorectal tumors (RTs) are rare tumors that arise in the space between the mesorectum and the pelvic wall and often originate in embryonic tissues. The primary treatment for these tumors is complete excision surgery, and choosing the best surgical approach is very important.
Methods
In this study, we retrospectively collected the data of 15 patients with RTs who underwent surgery in Imam Khomeini Hospital (Tehran, Iran) for 12 years to share our experiences of patients’ treatment and compare different surgical approaches.
Results
A total of 5 tumors were malignant, 10 were benign, and most of the tumors were congenital. Malignant tumors were seen in older patients. Three surgical procedures were performed on patients. Three patients underwent abdominal approach surgery, and 8 patients underwent posterior surgery. A combined surgical approach was performed on 4 patients. Two patients underwent laparoscopic surgery. The abdominal approach had the least long-term complication, and the combined approach had the most complications; laparoscopic surgery reduced the length of hospital stay and complications after surgery.
Conclusion
A multidisciplinary team collaboration using magnetic resonance imaging details is necessary to determine a surgical treatment approach. It could reduce the need for a preoperative biopsy. However, every approach has its advantages and disadvantages, and individualized treatment is the key.

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Tailgut Cyst—Gynecologist’s Pitfall: Literature Review and Case Report
Andrei Mihai Malutan, Viorela-Elena Suciu, Florin Laurentiu Ignat, Doru Diculescu, Razvan Ciortea, Emil-Claudiu Boțan, Carmen Elena Bucuri, Maria Patricia Roman, Ionel Nati, Cristina Ormindean, Dan Mihu
Diagnostics.2025; 15(1): 108. CrossRef

Malignant disease,Colorectal cancer,Complication,Biomarker & risk factor

Presepsin (soluble CD14 subtype) as a risk factor for the development of infectious and inflammatory complications in operated colorectal cancer patients: Kayrat Shakeyev, Yermek Turgunov, Alina Ogizbayeva, Olga Avdiyenko, Miras Mugazov, Sofiko Grigolashvili, Ilya Azizov; Ann Coloproctol. 2022;38(6):442-448. Published online April 4, 2022; DOI: https://doi.org/10.3393/ac.2022.00115.0016

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Abstract PDF

Purpose
In this pilot study the dynamic of presepsin (soluble CD14 subtype, sCD14-ST) in blood serum was assessed as a possible risk factor for the development of systemic inflammatory response syndrome (SIRS) and infectious and inflammatory complications in operated colorectal cancer patients.
Methods
To determine sCD14-ST by enzyme-linked immunosorbent assay method venous blood was taken 1 hour before surgery and 72 hours after it (3rd day). The presence of SIRS and organ dysfunctions (ODs) according to the Sequential Organ Failure Assessment scale were assessed.
Results
Thiry-six patients with colorectal cancer were enrolled in the study. sCD14-ST level before surgery was 269.8±103.1 pg/mL (interquartile range [IQR], 196.7–327.1 pg/mL). Despite the presepsin level on the 3rd day being higher (291.1±136.5 pg/mL; IQR, 181.2–395.5 pg/mL), there was no statistical significance in its dynamics (P=0.437). sCD14-ST value both before surgery and on the 3rd day after it was significantly higher in patients with bowel obstruction (P=0.038 and P=0.007). sCD14-ST level before surgery above 330 pg/mL showed an increase in the probability of complications, SIRS, and OD (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.1–28.2; OR, 7.0; 95% CI, 1.3–36.7; and OR, 13.0; 95% CI, 1.1–147.8; respectively). Patients with OD had higher levels on the 3rd day after surgery (P=0.049).
Conclusion
sCD14-ST level in operated colorectal cancer patients was much higher if they were admitted with complication like bowel obstruction. Higher preoperative levels of sCD14-ST increase the probability of postoperative complications, SIRS, and OD. Therefore, further studies with large sample size are needed.

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Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis: Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho; Ann Coloproctol. 2023;39(1):50-58. Published online November 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00773.0110

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3 Citations

Abstract PDF Supplementary Material

Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

Citations to this article as recorded by

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Rashid, Muhammad Umar
DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 35. CrossRef
Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
Ming Liu, Ping Yang, Yunpeng Gou
Frontiers in Pediatrics.2024;[Epub] CrossRef
Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
Frontiers in Pediatrics.2024;[Epub] CrossRef

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