Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Objectives: Despite being routinely used before elective colorectal surgery in most surgical clinics, mechanical bowel preparation (MBP) remains controversial. This study aimed to investigate postoperative complications and outcomes of right, left, or rectosigmoid resection without MBP. Material and Methods: Patients who underwent elective colorectal surgery without mechanical bowel preparation and oral antibiotics between January 2011 and December 2021 were included in the study. Patients were categorized according to the side of resection, and these subgroups were compared for anastomotic leakage, surgical site infections (SSI), and overall morbidity measured using the Clavien-Dindo complication grade. Results: Data of 422 patients were analyzed. Overall anastomotic leakage was found in 14 patients (3.3%), SSI in 46 (10.9%), collection in 14 (3.3%), mortality in 18 (4.3%), and reoperation in 17 (%4) patients. Anastomotic leakage was observed in six (3.9%) in right colectomy, two (1.9%) in left colectomy, and in six (3.7%) patients in the rectosigmoid resection group when the groups were evaluated separately. There was no statistical difference between the groups (p= 0.630). Furthermore, there was no statistical difference between the groups regarding collection and reoperation (p values were p= 0.31, and p= 0.251, respectively). Conclusion: Study results showed that anastomotic leakage, surgical site infection, intra-abdominal collection, reoperation, and mortality rates were similar to the current literature obtained from the studies with mechanical bowel preparation. In addition, these results were found to be similar according to the resection site.

The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery. DESIGN: A prospective, parallel two-armed, randomized controlled trial. METHODS: Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), before and after the VR application. FINDINGS: The VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO2(P = .019) values) compared to the levels in the control group. CONCLUSIONS: VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.

Do We Underestimate Colorectal Cancer Patients Under 50?

<b> Introduction:</b> Early-onset colorectal cancer (EOCRC) accounts for approximately 10% of all colorectal cancers (CRCs). EOCRC has a certain hereditary predisposition and distinct clinicopathological and molecular features compared to the traditional average-onset of colorectal cancer (AOCRC). As previous publications have shown, EOCRC has a more advanced TNM stage and a more aggressive tumor histopathology. </br></br> <b> Aim:</b> In this study, we aimed to evaluate the differences and similarities of EOCRC compared to AOCRC based on clinicopathological characteristics. </br></br> <b>Material and methods:</b> Between January 2010 and December 2020, 394 patients with inclusion criteria who were operated on at the 3rd level health center for colorectal cancer were included in the study. Patients were divided into two groups as EOCRC (50 years and under) and AOCRC. Pearson's chi-square test was used to compare categorical variables in independent groups. In addition, logistic regression analysis was performed using the Backward method with the variables whose relationship with the age group was evaluated, with P < 0.100. </br></br> <b>Results:</b> Our final analysis included 80 EOCRC cases and 314 controls. When the EOCRC group was compared with the AOCRC group, there was no statistically significant difference between gender, tumor location, T stage of the tumor, and survival (P = 0.190, P = 0.924, P = 0.165, P = 0.574). However, a statistically significant difference in the N stage, degree of differentiation, lymphovascular invasion (LVI) and perineural invasion (PNI) status, and P-values were: P = 0.006, P = 0.029, P = 0.019, and P = 0.003, respectively. </br></br> <b>Conclusion:</b> EOCRC has more aggressive tumor biology than AOCRC. Our study shows that more advanced N stage, poor differentiation, tumor deposits, LVI, and PNI are seen more frequently in EOCRC.

Long-term results from modified sphincteroplasty in patients with traumatic sphincter injury: a retrospective study.

BACKGROUND: The results from sphincteroplasty may worsen over time. Reseparation of the rectum and vagina/scrotum in conjunction with sphincteroplasty achieves good results. Improving the surgical effect of sphincteroplasty through perineal body reconstruction is crucial. OBJECTIVE: To evaluate the long-term results from anterior sphincteroplasty and perineal body reconstruction (modified sphincteroplasty) among patients with traumatic sphincter injury. DESIGN AND SETTING: Retrospective study among patients who underwent modified sphincteroplasty in a university hospital between January 2006 and December 2018. Fifty patients were evaluated in detail. METHODS: The following variables were evaluated: gender, age, additional disease status, time interval between trauma and surgery, surgical technique, duration of hospitalization, follow-up period after surgery, manometric values, electromyography results, magnetic resonance imaging scans, Wexner scores, satisfaction levels with surgery and surgical outcomes. RESULTS: The patients' mean age was 44.6 ± 15.1 years. The median follow-up period was 62 months (range, 12-118). The mean Wexner scores preoperatively, postoperatively in first month (M1S) and at the time of this report (AAS) were 15.5 ± 3.2, 1.9 ± 3.15 and 3.9 ± 5.3, respectively. Although improvements in the patients' mean Wexner scores became impaired over time, the postoperative Wexner scores were still significantly better than the preoperative Wexner scores (P = 0.001). CONCLUSION: Good or excellent results were obtained surgically among patients with traumatic sphincter injury. Performing perineal body reconstruction in addition to sphincteroplasty can provide better long-term continence. Surgical outcomes were found to be better, especially among patients younger than 50 years of age and among patients who underwent surgery within the first five years after trauma.

Long-term results from modified sphincteroplasty in patients with traumatic sphincter injury: a retrospective study

ABSTRACT BACKGROUND: The results from sphincteroplasty may worsen over time. Reseparation of the rectum and vagina/scrotum in conjunction with sphincteroplasty achieves good results. Improving the surgical effect of sphincteroplasty through perineal body reconstruction is crucial. OBJECTIVE: To evaluate the long-term results from anterior sphincteroplasty and perineal body reconstruction (modified sphincteroplasty) among patients with traumatic sphincter injury. DESIGN AND SETTING: Retrospective study among patients who underwent modified sphincteroplasty in a university hospital between January 2006 and December 2018. Fifty patients were evaluated in detail. METHODS: The following variables were evaluated: gender, age, additional disease status, time interval between trauma and surgery, surgical technique, duration of hospitalization, follow-up period after surgery, manometric values, electromyography results, magnetic resonance imaging scans, Wexner scores, satisfaction levels with surgery and surgical outcomes. RESULTS: The patients' mean age was 44.6 ± 15.1 years. The median follow-up period was 62 months (range, 12-118). The mean Wexner scores preoperatively, postoperatively in first month (M1S) and at the time of this report (AAS) were 15.5 ± 3.2, 1.9 ± 3.15 and 3.9 ± 5.3, respectively. Although improvements in the patients' mean Wexner scores became impaired over time, the postoperative Wexner scores were still significantly better than the preoperative Wexner scores (P = 0.001). CONCLUSION: Good or excellent results were obtained surgically among patients with traumatic sphincter injury. Performing perineal body reconstruction in addition to sphincteroplasty can provide better long-term continence. Surgical outcomes were found to be better, especially among patients younger than 50 years of age and among patients who underwent surgery within the first five years after trauma.

Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections

Background/aim: Sphincter-preserving surgery is one of the main goals in the treatment of rectal cancer because it improves the quality of life (QoL). However, some patients may experience disrupted symptoms called anterior or low anterior resection syndrome (LARS). This study was designed to evaluate the frequency and influencing factors of LARS in patients who underwent sigmoid or rectal resection. Materials and methods: In this retrospective, clinical study, patients who underwent rectal or sigmoid resection and anastomosis due to any benign and malignant reasons were evaluated in terms of LARS between January 2010 and November 2019 at Medical Faculty Hospital of Mersin University. The frequency and severity of LARS were determined by using a standard scale. Furthermore, influencing factors including lesion localization, operation, the proximity of anastomosis to the anal verge, creation of stoma, chemotherapy, and radiotherapy application were investigated. Results: Out of a total of 550 patients, 276 were included in this study. The major LARS incidence was found as 27.2%. Very low anterior resection (VLAR) (OR = 42.40 (95% CI [11.14­161.36], P < 0.0001), protective ileostomy (OR = 12.83 (95% CI [6.58­25.0], P < 0.0001), end colostomy (OR = 8.55 (95% CI [1.36­53.61], P = 0.022), receiving chemotherapy (OR = 3.08 (95% CI [1.71­5.53], P < 0.0001), and radiotherapy (OR = 2.51 (95% CI [1.38­4.57], P = 0.003) and the ROC analysis showed that creating an anastomosis placed at most 8.5 cm from the anal verge was found to be a major influencing factor on LARS (P < 0.05). Conclusions: LARS may frequently occur in patients who have undergone rectal resection. In this study, the most important factors influencing LARS were found to be the proximity of anastomosis to the anal canal and creating a protective stoma. Receiving chemoradiotherapy also plays an important role in LARS.

Mean platelet volume and the ratio of mean platelet volume to platelet count in the diagnosis of acute appendicitis.

BACKGROUND: Mean platelet volume (MPV) is an inflammatory marker. Recent studies have shown that there is a negative correlation between platelet count (PC) and MPV and that the ratio of these two values may be more meaningful. The aim of our study was to investigate the diagnostic value of MPV and the MPV/PC ratio in acute appendicitis. METHODS: Patients who were admitted to the emergency department and underwent appendectomy for acute appendicitis between January 2013 and May 2016 were evaluated retrospectively. The patients were divided into three groups based on their histopathological findings: the control group (negative appendicectomy) and the uncomplicated and complicated appendicitis groups. Leukocyte count, CRP (C-reactive protein) levels, PC, MPV and the MPV/PC ratio were compared among the groups. RESULTS: A total of 424 patients, including 231 men, were included in the study. The average age of all patients was 34.9 ±â€¯13.2 years. There was no statistically significant difference between the uncomplicated appendicitis, complicated appendicitis and control groups in terms of MPV, PC and the MPV/PC ratio. Leukocyte count had a strong discriminatory property based on the area under curve (AUC) 0.73, (p < 0.001). CRP levels, MPV, PC and the MPV/PC ratio had weak discriminatory power with AUC values <0.65. Using receiver operating characteristic (ROC) analysis, the sensitivity and specificity of MPV were 83.79% and 23.21%, respectively, and 66.48% and 48.21%, respectively, for the MPV/PC ratio. CONCLUSIONS: In our study, MPV and the MPV/PC ratio were not useful in the diagnosis of acute appendicitis.