Novel Approach to Removal of Rectal Foreign Bodies.

BACKGROUND: Retained rectal foreign bodies are a common concern in patients presenting to the emergency department. Thankfully, the rates of injury from these retained objects are low. Numerous techniques have been described for the extraction of these foreign bodies, including using endoscopic snares, Foley catheters to break suction mechanisms, and various kinds of clamps to grasp the objects. Some foreign bodies may not be amenable to snaring or grasping with forceps. We describe the use of laparoscopic specimen extraction bags to remove such objects. TECHNIQUE: The patient is placed in the lithotomy position under the appropriate level of anesthesia. The extraction bag is opened out of the pouch, and the metallic ring is lubricated. The ring is then compressed with 1 hand and gently guided into the rectum between the rectal wall and the foreign body with the other hand. The ring is then allowed to expand, and the foreign body is encircled. The bag is then closed around it, and the object is removed. RESULTS: The specimen-extraction bag works especially well for spherical objects and objects that are hard to grasp with clamps. We were able to extract a billiard ball and a glitter ball with this technique. It has minimal risk of injury to the rectum. CONCLUSIONS: Colorectal surgeons have a wide array of tools to use, and it is prudent to cater the tool to the task at hand. We can refashion the laparoscopic specimen extraction bag for removal of certain foreign bodies. It behooves the surgeon to consider all the tools at his or her disposal and to consider the best one for the job.

Colon and rectal surgery surgical site infection reduction bundle: To improve is to change.

BACKGROUND: Despite the introduction of the Surgical Care Improvement Project, surgical site infections remain a source of morbidity. The aim of this study was to determine the value of implementing a colorectal bundle on SSI rates. METHODS: Between 2011 and 2016 a total of 1351 patients underwent colorectal operations. Patients were grouped into pre-implementation (Group A, January 1, 2011-December 31, 2012), implementation (Group B, January 1, 2013-December 31, 2014) and post-implementation (Group C, January 1, 2015-December 31, 2016). Primary endpoints were superficial SSI, deep SSI, wound separation and total SSI. RESULTS: After the bundle was implemented, there was a significant reduction in superficial (6.6%-4%, p < 0.05), deep (3.7%-1.1%, p < 0.05), and total SSI rates (10.9%-4.7%, p < 0.05). Comparing Group A to Group C there was a decrease in total SSI (9.4%-4.7%, p < 0.05). CONCLUSION: Implementation of the bundle resulted in a reduction in overall SSI rates particularly as compliance increased. This study offers evidence that small changes can lead to significant decreases in surgical site infections.

A better cell cycle target for gene therapy of colorectal cancer: cyclin G.

The purpose of this study was to evaluate the overexpression of cyclin G in colorectal neoplasia, which may be a more frequent event than cyclin D1 during the cell cycle and thus may have a more enhanced therapeutic potential in treating colorectal cancer. Ninety formalin-fixed, paraffin-embedded human colon and rectal specimens were obtained from the Pathology Department of Norris Cancer Center/University of Southern California. The tissues had been obtained after surgical resection between 1995 and 2001, and had been processed by routine clinical histopathologic methods. Ninety-one percent of colorectal tumors had cyclin G overexpression. These cyclin-positive patients were evenly distributed between men and women, and between tumor locations, that is, 36% rectal tumors and 34% right-sided tumors. Thirty-two percent were well differentiated, and 66% were moderately differentiated. Thirty patients (38%) had stage I disease, 16 (20%) had stage II disease, 25 (32%) had stage III, and seven (9%) had stage IV disease. Eight patients (10%) in this group had recurrent disease during follow-up. There was no correlation between cyclin G overexpression and clinical and pathologic characteristics. Cyclin D1 overexpression was found to be present in only 42% of colorectal adenocarcinomas. There was no correlation between cyclin D1 overexpression and clinical and pathologic characteristics. The present study demonstrates that cyclin G overexpression is a frequent event in colorectal cancer. This frequent event in colorectal carcinogenesis may facilitate new therapeutic approaches acting as a target for gene therapy, possibly directed at downregulating cyclin G in colorectal cancer.