Does Rectocele Repair Combined with Other Perineal Surgeries Affect Outcome Compared to Solo Rectocele Repair?

OBJECTIVES: Rectocele is common in female patients. To date, there is no literature comparing outcomes of rectocele repairs in combination with other perineal surgeries. We aim to analyze perioperative morbidity and mortality as well as long-term outcome of rectocele repair in combination with other perineal surgeries (RR combination) and compare this with solo rectocele repair (solo RR). DESIGN: The type of study was case-control. Data of patients who received solo rectocele repair or rectocele repair in combination with other perineal surgeries between January 2011 and December 2015 were identified and reviewed in a prospectively maintained and IRB-approved database. Ninety-eight patients were included, including 41 patients in the solo RR group and 57 patients in the RR combination group. The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were observed. METHODS: The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were compared, respectively. Covariate adjustment was analyzed by multivariate logistic and Cox regression analysis. RESULTS: Ninety-eight patients with a median age of 57 were included, involving 41 patients in the solo RR group and 57 patients in the RR combination group. Other than the operative approach (p < 0.01), demographics and preoperative characteristics of the 2 groups were comparable. All variables, including length of stay, estimated blood loss, self-limiting rectal bleeding, transfusion, urinary retention, rectal stricture, rectal and perineal infection, rectovaginal abscess, reoperation, effective resolution of obstructive defecation symptoms, residual symptoms rate, and recurrence rate, were comparable among the 2 groups except for operative time (p = 0.03). LIMITATIONS: This study is a single-center study, which may cause bias. In addition, the sample size is limited. Staging of rectocele and routine imaging studies were not performed. CONCLUSIONS: Rectocele repair in combination with other perineal surgeries is feasible, and outcomes are comparable with solo rectocele repair. Transanal versus transvaginal repairs appear to have no influence on outcomes.

Comparisons of the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.

PURPOSE: Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients' outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center. METHODS: All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes. RESULTS: A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (p < 0.001), more contaminated or infected wounds (p = 0.02), different surgical procedures (p = 0.02), and similar surgical outcomes and total medical cost (all p > 0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all p > 0.05). CONCLUSIONS: Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs.

Impact of omentoplasty on anastomotic leak and septic complications after low pelvic anastomosis: a study from the NSQIP database.

PURPOSE: The role of omentoplasty in the prevention of anastomotic leak (AL) in colorectal surgery is controversial. The aim of this study was to evaluate the impact of omentoplasty on AL and septic complications after low pelvic anastomosis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: The ACS-NSQIP database was queried for patients who underwent segmental colectomy with low pelvic anastomosis by using 2012 targeted colectomy participant use data file. Patients were divided into two groups according to omentoplasty versus no-omentoplasty formation. AL and surgical site infections (SSIs) within postoperative 30 days were compared between the groups. RESULTS: A total of 2891 patients (1447 [50.1%] males) with a mean age of 60.2 ± 13.0 years met the inclusion criteria. There were 86 (2.9%) and 2805 (97.1%) patients in the omentoplasty and no-omentoplasty group, respectively. In the multivariate analysis, omentoplasty neither reduced AL (p = 0.83; OR = 0.88, 95% CI, 0.21-2.44) nor organ/space SSIs (p = 0.08; OR = 2.14, 95% CI, 0.91-4.41). Also, this technique did not play any role in reducing AL and organ/space SSI rates regardless of diversion with the exception of its association with higher organ/space SSIs in patients without diverting stoma (9.2% vs 3.8%, p = 0.04). No differences were detected between the groups with respect to the management strategies for AL (p = 0.22). CONCLUSIONS: Omentoplasty did not decrease AL and septic complications after low pelvic anastomosis and had no impact on the postoperative management of AL.

Colonoscopy-induced acute diverticulitis: myth or reality?

BACKGROUND: Colonoscopy in patients with diverticulosis can be technically challenging and limited data exist relating to the risk of post-colonoscopy diverticulitis. Our aim was to evaluate the incidence, management, and outcomes of acute diverticulitis following colonoscopy. METHODS: Study design is retrospective cohort study. Data were gathered by conducting an automated search of the electronic patient database using current procedural terminology and ICD-9 codes. Patients who underwent a colonoscopy from 2003 to 2012 were reviewed to find patients who developed acute diverticulitis within 30 days after colonoscopy. Patient demographics and colonoscopy-related outcomes were documented, which include interval between colonoscopy and diverticulitis, colonoscopy indication, simultaneous colonoscopic interventions, and follow-up after colonoscopy. RESULTS: From 236,377 colonoscopies performed during the study period, 68 patients (mean age 56 years) developed post-colonoscopy diverticulitis (0.029%; 2.9 per 10,000 colonoscopies). Incomplete colonoscopies were more frequent among patients with a history of previous diverticulitis [n = 10 (29%) vs. n = 3 (9%), p = 0.03]. Mean time to develop diverticulitis after colonoscopy was 12 ± 8 days, and 30 (44%) patients required hospitalization. 34 (50%) patients had a history of diverticulitis prior to colonoscopy. Among those patients, 14 underwent colonoscopy with an indication of surveillance for previous disease. When colonoscopy was performed within 6 weeks of a diverticulitis attack, surgical intervention was required more often when compared with colonoscopies performed after 6 weeks of an acute attack [n = 6 (100%) vs. n = 10 (36%), p = 0.006]. 6 (9%) out of 68 patients received emergency surgical treatment. 15 (24%) out of 62 patients who had non-surgical treatment initially underwent an elective sigmoidectomy at a later date. Recurrent diverticulitis developed in 16 (23%) patients after post-colonoscopy diverticulitis. CONCLUSIONS: Post-colonoscopy diverticulitis is a rare, but potentially serious complication. Although a rare entity, possibility of this complication should be kept in mind in patients presenting with symptoms after colonoscopy.

Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database.

PURPOSE: The aim of this study was to evaluate the impact of various factors on 30-day postoperative morbidity in patients who underwent colorectal surgery (CRS) for colovesical fistula (CVF) in the elective and emergency settings. METHODS: Patients who underwent CRS for CVF between 2005 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database by using current procedural terminology codes. Demographics, perioperative, and operative factors were assessed and compared between two groups classified according to the presence or absence of postoperative complications. RESULTS: Five hundred twelve patients met the inclusion criteria [mean age of 61.4 (±14.7) years, female 214 (42%)]. Etiology of fistula was diverticulitis [N = 438 (85.5%)], colon cancer [N = 39 (7.6%)], and Crohn's disease [N = 35 (6.8%)]. One hundred fifty-two procedures (29.7%) were performed laparoscopically. In 186 patients (36%), no bladder intervention was performed. One hundred forty-nine patients (29.1%) had at least one postoperative complication. Patients who developed complication were older (P = <0.001), more often female (P = <0.001), hypertensive (P = 0.005), anemic (P = <0.001), preoperatively transfused (P = 0.02), and with class 2-3 wound classification (P = 0.01). Independent risk factors affecting morbidity were increased age [odds ratio (OR) 1.23 (1.03-1.47), P = 0.01], decreased hematocrit level [OR 3.04(1.83-5.06), P < 0.0001], and open approach [OR 2.56 (1.35-4.84), P = 0.003]. CONCLUSIONS: Morbidity for CVF remains high. Lower preoperative hematocrit level and increased age were associated with higher risk of complication. Laparoscopic surgery may be preferable when possible as morbidity is less with this approach.

Colorectal squamous cell carcinoma: a rare tumor with poor prognosis.

PURPOSE: Primary squamous cell carcinomas of the colon and rectum are extremely rare, with an incidence of less than 1% of colorectal malignancies. Our aim in this study was to evaluate patient characteristics, treatment strategy, and postoperative follow-up of patients with colorectal squamous cell carcinoma. METHODS: We reviewed our prospectively maintained colorectal cancer database for all patients who were diagnosed with colorectal squamous cell carcinoma between January 1990 and April 2009. RESULTS: Out of 5149 patients with colorectal malignancy, 11 patients (0.2%) met the study criteria. Median age at the time of diagnosis was 64. Median BMI was 28 kg/m2. The tumors were localized in the rectum (n = 8), right colon (n = 2), and sigmoid colon (n = 1). The pathologic stages of these tumors were I (n = 1), II (n = 4), III (n = 3), and IV (n = 3). Operations performed were abdominoperineal resection (n = 4), right colectomy (n = 2), total colectomy (n = 1), low anterior resection (n = 1), local excision (n = 1), sigmoidectomy (n=1) and end colostomy creation (n = 1). One patient received intraoperative radiotherapy. Postoperative chemotherapy was given to eight patients, and three patients received postoperative radiation therapy. Median follow-up after diagnosis was 42 months (12-96). Three patients developed recurrence after potentially curative surgery. Five patients died from metastatic disease during follow-up. CONCLUSION: Squamous colorectal cancer can be detected in any part of the colon, generally presents at a later stage, and is associated with a poor prognosis. Surgery is the mainstay of treatment. Various adjuvant chemoradiation treatments appear not to influence the outcome. Further cases need to be analyzed in order to find more effective treatment regimens.

Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database.

BACKGROUND: Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database. METHODS: Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between the groups. RESULTS: In total, 93633 patients who underwent colon and/or rectal resection were identified. Among these, 215 patients had incidental splenic procedures (153 open splenectomy, 17 laparoscopic splenectomy, 36 splenorraphy, and 9 partial splenectomy). Open colorectal resections were associated with a significantly increased likelihood of incidental splenic procedures (OR 6.58, p < 0.001) compared to laparoscopic surgery. Incidental splenic procedures were associated with increased length of total hospital stay (OR 1.25, p < 0.001), mechanical ventilation dependency (OR 1.62, p = 0.02), transfusion requirement (OR: 3.84, p < 0.001), re-operation requirement (OR 1.7, p = 0.005), and sepsis (OR: 2.03, p = 0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p = 0.001) and decreased need for re-operation (p < 0.001). CONCLUSIONS: Incidental splenic procedures during colorectal resections are associated with worse short-term outcomes. Use of the laparoscopic technique decreases the need for incidental splenic procedures.

Outcomes of percutaneous drainage without surgery for patients with diverticular abscess.

BACKGROUND: Data on percutaneous drainage followed by observation for diverticular abscess is scant. OBJECTIVE: The aim of this study is to assess outcomes of percutaneous drainage alone in the management of peridiverticular abscess. DESIGN: This is a retrospective study from a prospectively collected database. SETTING: This study was conducted in a high-volume, specialized colorectal surgery unit. PATIENTS: All patients with a diverticular abscess of at least 3 cm in diameter, treated between 2001 and 2012, who had prohibitive comorbidities or refused surgery after percutaneous drainage were included. MAIN OUTCOME MEASURES: The primary outcome measured was the treatment of diverticular abscess with percutaneous drainage alone. RESULTS: A total of 18 patients (11 surgery refusal, 7 comorbidity) were followed up until death, surgery for recurrent diverticulitis, or for a median of 90 (17-139) months. The median abscess size was 5 (3.8-10) cm, and the location was pelvic in 8 cases and intra-abdominal in 10. The mean duration of drainage was 20 ± 1.3 days, with the exception of 2 patients who only had aspiration of the abscess because of technical difficulty in drain placement. Three patients died of preexisting comorbidities between 2 and 8 months after percutaneous drainage. Seven of the surviving patients (7/15) experienced recurrent diverticulitis; 3 of these patients underwent surgery between 7 months and 7 years after the index percutaneous drainage. Of the remaining 4 cases of recurrence, one abscess was treated with repeat percutaneous drainage alone and 3 patients had uncomplicated diverticulitis treated with antibiotics. There were no significant associations between long-term failure of percutaneous drainage and the location of the abscess (p = 0.54) or previous episodes of diverticulitis (p = 0.9). LIMITATIONS: This study was limited because of its retrospective nature, its nonrandomized design, and its small sample size. CONCLUSIONS: Percutaneous drainage alone was successful in avoiding surgery in the majority of this selected patient population with sigmoid diverticular abscess. Future studies should assess the appropriate indications for a more liberal use of percutaneous drainage not followed by elective surgery.

Risk of recurrence and long-term outcomes after colonic diverticular bleeding.

PURPOSE: Diverticular disease is one of the most common causes of acute lower gastrointestinal bleeding. We aimed to evaluate the natural history, follow-up, and risk factors associated with re-bleeding (recurrence) in patients with colonic diverticular bleeding. METHODS: We reviewed patients with proven colonic diverticular hemorrhage from September 1993 to June 2012 at our institution. Recurrence was the main outcome measure. RESULTS: We identified 78 out of 95 patients with proven diverticular bleed who were treated non-operatively and were followed up for a median of 57.1 months. Thirty-seven (47 %) of these patients with a median age of 67 years developed recurrent diverticular bleed after a median time of 8.1 months. The bleeding originated from the left colon in 78 (83 %) out of 95 patients in the first bleeding episode and 31(84 %) out of 37 patients during the recurrent bleeding episode. Thirty-six patients (97 %) with recurrent diverticular bleed required surgical intervention. Old age at the time of initial bleeding was associated with recurrence (p = 0.001). Patients with diverticulitis (p < 0.0001), peripheral vascular (p = 0.01), and chronic renal diseases (p = 0.047) were found to have an increased risk for recurrent colonic diverticular bleed. We only had one perioperative mortality due to postoperative sepsis. All other mortalities were not directly associated with surgery. CONCLUSION: Patients with a history of colonic diverticular bleed are prone to recur shortly thereafter. Certain risk factors including increased age, documented diverticulitis, history of peripheral vascular disease, and chronic renal failure may predispose to recurrence.

Early-Onset Colorectal Cancer in Patients under 50 Years of Age: Demographics, Disease Characteristics, and Survival.

INTRODUCTION: Incidence of early-onset colorectal cancer (EO-CRC) is increasing in younger demographics. This study analyzes disease-specific survival in individuals under 50 years of age. METHODS: Patients with colorectal malignancy were identified in the Surveillance Epidemiology and End Results (SEER) database from 2004 to 2015. Cases were categorized into typically screened (age 50-79 years) and non-typically screened (age 20-49 years) cohorts, as well as by decade. Kaplan-Meier curves and Cox proportional hazard models were used to study survival. RESULTS: A total of 240,772 patients with colorectal cancer were analyzed. Average annual percent change in incidence was -0.24% among typically screened patients and +1.12% among patients with EO-CRC. Patients with EO-CRC more frequently presented with distal tumors (70.6% vs. 57.6%, P < .001) and advanced tumor stage (61.3% vs. 48.6%, P < .001). Patients aged 50 and over had comparable 5 year disease-specific survival to younger patients (68.2% vs. 66.4%, P = .31); however, patients in the 3rd, 4th, and 8th decade of life had particularly low survival rates (59.0% vs. 65.8% vs. 65.8%, logrank P < .001). Patients aged 20-29 years had the most increased risk of cause-specific mortality on univariable Cox regression analysis [HR 1.43, 95% CI 1.31-1.56; P < .001], although this was not significant on multivariable analysis [HR 1.06, 95% CI 0.97-1.15; P = .201]. Male sex, older age, advanced stage, rectal and/or cecal primary, and earlier year of diagnosis were independently associated with increased mortality. CONCLUSION: Patients with EO-CRC are diagnosed at a later stage and have lower disease-specific survival than those in typically screened cohorts. Additional studies on tumor biology and surveillance strategies are needed to improve outcomes in this population.

Investigation of the enhanced recovery after surgery protocol outcome on post colectomy patients.

BACKGROUND: An enhanced recovery after surgery (ERAS) protocol was implemented to improve quality and cost effectiveness of surgical care in elective colorectal procedures. METHODS: A retrospective study was conducted from July 2017 to June 2018. The ERAS protocol was initiated on 9 July 2018 and retrospectively reviewed in July 2019 by chart review, the American College of Surgeons National Surgical Quality Improvement Project database and risk stratification using Clavien-Dindo classification for all elective colorectal procedures. RESULTS: A total of 109 patients, 55 (pre-ERAS) and 54 (post-ERAS) are included in the final analysis. There were no differences in complications were recorded (p = 0.37) and 30-day readmissions (p = 0.785). The mean hospital stay was 5.89 ± 2.62 days in pre-ERAS and 4.94 ± 2.27 days in post-ERAS group which was statistically significant (p = 0.047). CONCLUSIONS: An ERAS protocol for colorectal surgery harmonised perioperative care and decreased length of stay.

Intraoperative Colonoscopy During Colorectal Surgery Does Not Increase Postoperative Complications: An Assessment From the ACS-NSQIP Procedure-targeted Cohort.

Intraoperative colonoscopy (IOC) is an adjunct in colorectal surgery to detect the location of the lesions and assessing anastomotic integrity. The authors aimed to evaluate the safety and feasibility and postoperative morbidity of IOC in left-sided colectomy patients for colorectal cancer. Patients undergoing elective left-sided colectomy without any proximal diversion for colorectal cancer between 2013 and 2016 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted database. Demographics, comorbidities, short-term outcomes, and postoperative morbidity of patients were evaluated. A total of 8811 patients were identified and IOC was performed for 1143 (12.97%) patients. There was no significant difference in postoperative complications between the IOC and non-IOC groups. Patients with IOC had shorter total hospital length of stay. The use of IOC does not adversely affect short-term outcomes after colorectal resections. Surgeons may utilize IOC liberally for left-sided colorectal resections.

Perineal stapled rectal resection without a contour transtar: a modified approach.

Perineal stapled prolapse resection is a novel approach for treating rectal prolapse in elderly and frail patients. This study aimed to report a modified technique using only a straight linear stapler. A 94-year-old female with 15-cm full thickness rectal prolapse was treated using a linear cutter in the left and right lateral quadrants, and then resection was completed by using the same instrument in the anterior and posterior flaps. The procedure was performed under local anesthesia and in a prone jackknife position. There was no morbidity or mortality, and the patient was discharged on postoperative day 2. Follow-up at 9 months revealed no recurrent prolapse, and the patient was asymptomatic. This technique is easy, safe, and fast to perform without using contour transtar (Ethicon Endo-Surgery, Cincinnati, OH).

Factors associated with portomesenteric venous thrombosis after total colectomy with ileorectal anastomosis or end ileostomy.

BACKGROUND: Porto-mesenteric venous thrombosis (PMVT) is an uncommon but serious complication. Data on the risk factors for PMVT following total colectomy with ileorectal anastomosis or end ileostomy (TC/IRA or EI) is limited. This study aimed to evaluate the factors associated with PMVT after TC/IRA or EI. METHODS: Patients who underwent elective TC/IRA or EI between January 2010 and December 2014 were identified from institutional database. Patients who had CT proven PMVT within 30 days of surgery were included in the PMVT positive group. Demographics and perioperative/postoperative 30-day outcomes were compared between groups. RESULTS: Out of 832 patients, 34 patients (4.1%) were diagnosed with PMVT. PMVT positive group were younger (35.8vs.41 years, p = 0.03). Postoperative organ-space surgical site infection (17.6% vs. 4.8%, p = 0.007), deep venous thrombosis (8.8%vs.1.5%, p = 0.02), ileus (38.2%vs.20.8%, p = 0.018), and readmission (50.0%vs.12.7%, p < 0.001) were more common in patients with PMVT, who also had longer hospital stay (8.5vs.6 days, p = 0.002). CONCLUSIONS: PMVT after TC/IRA or EI may occur in non-IBD patients. PMVT should be included in differential diagnosis after TC/IRA or EI in patients with intraabdominal infection or ileus, especially in younger patients.

Does the timing of loop ileostomy closure affect outcome: A case-matched study.

INTRODUCTION: The optimal timing for the closure of loop ileostomies remains controversial. The aim of this study is to determine whether ileostomy closure (<3 months post formation) affects stoma-related morbidity compared to late closure (≥3 months post formation). METHODS: All patients who had loop ileostomy and ileostomy closure between 2012 and 2015 were identified from an IRB-approved, prospectively maintained institutional database.The patients who underwent ileostomy closure (<3 months) were compared against matched patients undergoing ileostomy closure (≥3 months). The outcomes for the two groups were compared. RESULTS: A total of 358 patients were analyzed. Mean age was 46 ± 17 years. There were 179 patients in each group [ileostomy closure (<3 months) and ileostomy closure (≥3 months)]. Both groups were matched. Groups were comparable in preoperative characteristics and demographics. All of the peri-operative variables were comparable. No difference was observed in estimated blood loss (EBL), operative time (OT) and length of stay (LOS) (all p > 0.05). Postoperative outcomes including wound infection, post-operative bleeding, intra-abdominal abscess, ileus, small bowel obstruction (SBO), anastomotic leak, reoperation, surgery related readmission, postoperative transfusion were also similar among the groups (p > 0.05). CONCLUSIONS: Ileostomy closure (<3 months) is practical and safe. It does not increase morbidity and significantly reduces the time patient has a stoma. This may be advantageous in regards to having a reduced possibility of stoma related complications.

Natural history of bleeding risk in colonic diverticulosis.

Colonic diverticulosis prevalence is gradually increasing worldwide. From 3% to 15% of the patients with diverticulosis will bleed at some point. The risk for rebleeding after the first episode is substantial but varies in the literature between 13-48%. We analyzed risk factors for diverticular bleed and management options for initial and recurrent diverticular bleeding. A review of the literature on this subject is presented.

Colonic Diverticulosis and Diverticulitis in Renal Transplant Recipients: Management and Long-Term Outcomes.

Data regarding management of colonic diverticulitis in renal transplant recipients (RTRs) are limited. This study aims to identify prevalence, risk factors, and outcomes in RTRs with colonic diverticulosis and diverticulitis. Between January 2004 and December 2013, all patients who underwent kidney transplantation were analyzed. Among all RTSs, patients who had a pretransplant colonoscopic diagnosis of diverticulosis and patients with a proven attack of diverticulitis were included in our analysis. There were 1578 RTRs with a mean age of 50 ± 14 years at the time of transplantation. Of these, 409 patients had colonoscopic evaluation and 174 (43%) were diagnosed with diverticular disease. Fifteen (0.9%) out of 1578 developed a primary attack of diverticulitis. Two patients underwent a Hartmann's procedure due to perforation. Among 13 patients who were initially treated nonoperatively, 4 required surgery due to refractory diverticulitis (n = 2) and recurrence (n = 2). Tobacco use (59% vs 48%, P = 0.02), increased age (58 vs 51 years, P < 0.0001), diabetes (33% vs 35%, P = 0.03), coronary artery disease (38% vs 22%, P = 0.001), and autosomal dominant polycystic kidney disease etiology (P = 0.04) were more common in RTRs with diverticulosis. Majority of RTRs with diverticulitis can be managed nonoperatively. Surgical treatment is warranted in patients with perforated, persistent, and recurrent diverticulitis. A special care and follow-up may be needed in RTRs with autosomal dominant polycystic kidney disease etiology, smoking history, and coronary artery disease due to higher risk of diverticulosis and subsequent potential diverticulitis.

Does omental pedicle flap reduce anastomotic leak and septic complications after rectal cancer surgery?

INTRODUCTION: Whether creation of omental pedicle flap (OPF) to reinforce bowel anastomosis can reduce septic outcomes remains controversial. The aim of this study was to investigate the role of this technique on anastomotic leak and septic complications after rectal cancer surgery. METHODS: Patients who underwent rectal cancer surgery from 01/2008 to 12/2013 were identified and categorized into two groups based on OPF creation versus no-OPF creation. Clinical, operative characteristics and postoperative anastomotic leak and surgical site infections within 30 days after surgery were compared between the groups. RESULTS: There were 65 (14%) and 403 (86%) patients in OPF and no-OPF group, respectively. In multivariate analysis, OPF was not found to be associated with anastomotic leak (p = 0.35), organ/space infections (p = 0.99) and overall surgical site infections (p = 0.65). Three hundred and sixty eight (78.6%) patients underwent diversion. OPF did not reduce septic complications irrespective of the stoma status (p > 0.05). There were no differences between the two groups in terms of operative (p = 0.46) and non-operative management (p = 0.14). CONCLUSION: OPF neither reduced the incidence of anastomotic leak and surgical site infections nor had any impact on the management of anastomotic leak.