Global International Society of University Colon and Rectal Surgeons in collaboration with European Society of Coloproctology audit on office-based and surgical treatment of haemorrhoidal disease: Study protocol.

AIM: Haemorrhoidal disease (HD) is one of the most common anal disorders in the adult population. Despite that, treatment options differ among different countries and specialists, even for the same grade of HD. The aim of this study is to evaluate the differences in patient demographics, surgeon preference for the treatment option, outcomes as well as patient satisfaction rate for the procedure using an office-based or surgical approach for the treatment of HD among International Society of University Colon and Rectal Surgeons (ISUCRS) and European Society of Coloproctology (ECSP) fellows. METHOD: A panel of the ISUCRS and ECSP members will answer questions that are included in a questionnaire about the treatment of HD. The questionnaire will be distributed electronically to ISUCRS and ECSP fellows included in our database and will remain open from 1 April 2024 to 31 May 2024. CONCLUSION: This multicentre, global prospective audit will be delivered by consultant colorectal and general surgeons as well as trainees. The data obtained will lead to a better understanding of the incidence of HD, treatment and diagnostic possibilities. This snapshot audit will be hypothesis generating and inform areas the need future prospective study.

International Society of University Colon and Rectal Surgeons survey of surgeons' preference on rectal cancer treatment.

PURPOSE: Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient. METHODS: A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020. RESULTS: One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons' age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons' inclination toward open approach. CONCLUSION: Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.

COVID-19 and the Global Impact on Colorectal Practice and Surgery.

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. MATERIALS AND METHODS: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. RESULTS: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. CONCLUSION: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period.

"Peek port": a novel approach for avoiding conversion in laparoscopic colectomy.

BACKGROUND: This study aimed to assess the efficacy of a method for avoiding conversion to laparotomy in patients considered for laparoscopic colectomy. Patients deemed to be at high risk for conversion to laparotomy were initially approached via an 8-cm midline incision ("peek port") with the laparoscopic equipment unopened. If intraperitoneal conditions were favorable, the procedure was performed using hand-assisted laparoscopy. If intraperitoneal conditions were unfavorable, the incision was extended to a formal laparotomy. Patients deemed to be at low risk for conversion to laparotomy were approached laparoscopically from the outset. METHODS: Data from 241 consecutive patients brought to the operating room for intended laparoscopic colectomy were retrieved from a prospective database. RESULTS: The study population consisted of 132 men and 109 women with a mean age of 62 years and a mean body mass index (BMI) of 28. Prior abdominal surgery had been performed in 49% of these patients. Inflammatory conditions accounted for 38% of the diagnoses, and enteric fistulas were present in 7% of the cases. Of the 25 patients who underwent the initial "peek port," 8 (32%) underwent immediate incision extension to formal laparotomy. Hand-assisted laparoscopic colectomy was performed in 17 (68%) of these 25 patients, with one subsequent conversion to formal laparotomy. Of the 216 patients initially approached laparoscopically, 5 (2%) required conversion to laparotomy. The laparotomy rate for the "peek port" group (9/25, 36%) was higher than for the initial laparoscopy group (5/216, 2%) (p < 0.0001). Of the 233 patients from both groups who underwent laparoscopy, the overall rate for conversion to laparotomy was 3% (6/233). CONCLUSIONS: The "peek port" approach to the patient with a potentially hostile abdomen allows for rapid assessment of intraperitoneal conditions and is associated with an overall low rate of conversion from laparoscopy to laparotomy. This technique should reduce overall cost by avoiding the use of laparoscopic equipment as well as potential complications related to trocar placement and laparoscopic dissection in patients who will ultimately require formal laparotomy.