Short-term outcomes of surgical treatment for primary ileocaecal Crohn's disease: Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes.

AIM: Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short-term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. METHOD: A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. RESULTS: A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). CONCLUSION: Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.

Functional outcome and quality of life after transanal minimal invasive pouch surgery.

PURPOSE: To investigate functional outcomes and quality of life (QoL) after restorative proctocolectomy (RPC) using transanal minimal invasive surgery (TAMIS). METHOD: The study consists of two sub-studies. A cohort study comprised 98 consecutive patients, who underwent TAMIS RPC. These patients were the first at our department to undergo TAMIS RPC. We collected information about surgery, complications, postoperative morbidity and mortality ≤ 30 days, and pouch problems. Patients were also invited to participate in a case-control study in which the patients would respond to three different questionnaires, the Inflammatory Bowel Disease Questionnaire (IBDQ), the Short Form-36 General Health Questionnaire (SF-36), and questions from the Pouch Dysfunction Score. We compared the responding TAMIS RPC patients to a Danish national cohort (0-10 years from RPC, n = 514) of patients having RPC between 1980 and 2010. We compared functional outcomes and QoL. RESULTS: Four (4%) of the TAMIS patients had an anastomotic leak; none of these required re-operation with removal of the pouch. Anastomotic leak was treated with antibiotics and drain. Out of the four leaks, only one ended up with a permanent stoma; all others had their stoma reversed successfully. The TAMIS patients had the same number of bowel movements as the patients in the Danish national cohort study. The same was seen with regard to incontinence. We had no conversions in our series of TAMIS procedures. CONCLUSION: The TAMIS technique shows acceptable outcomes, both in regard to postoperative complications and also functional outcome and QoL.

Effect of fixation devices on postoperative pain after laparoscopic ventral hernia repair: a randomized clinical trial of permanent tacks, absorbable tacks, and synthetic glue.

PURPOSE: The method of anchoring the mesh in laparoscopic ventral hernia repair is claimed to cause postoperative pain, affecting the quality of life of the patients. The aim of this randomized study was to compare the effect of three types of fixation devices on postoperative pain, patient quality of life, and hernia recurrence. METHODS: Patients with ventral hernias between 2 and 7 cm were randomized into one of three mesh fixation groups: permanent tacks (Protack™), absorbable tacks (Securestrap™), and absorbable synthetic glue (Glubran™). The primary endpoint was pain on the second postoperative day, measured on a visual analogue scale. Quality of life and recurrence rate were secondary endpoints and investigated through questionnaires and clinical examination at follow-up visits 1, 6, and 12 months after surgery. RESULTS: Seventy-five non-consecutive patients were included in the study, with 25 patients in each group. There was no significant difference between groups for unspecified pain on the second postoperative day (p = 0.250). The DoloTest™ values were 55.3 ± 28.9 mm, 43.5 ± 28.5 mm, and 55.9 ± 26.3 mm for permanent tacks, absorbable tacks, and synthetic glue, respectively. No differences were observed between groups with respect to quality of life of the patients and hernia recurrence rate. CONCLUSIONS: In patients with small- and medium-sized ventral hernias, the type of fixation device did not affect the immediate or long-term postoperative pain, quality of life, or recurrence rate when comparing permanent tacks, absorbable tacks, and synthetic glue for mesh fixation. TRIAL REGISTRATION: NCT01534780.

Incisional hernia and its impact on health-related quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a national prospective cohort study.

BACKGROUND: To evaluate the incidence of incisional hernia (IH) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and its impact on health-related quality of life (HRQoL). METHOD: From June 2006 until June 2016, 152 patients were followed after CRS + HIPEC at Aarhus University Hospital, a single national center. Patients were seen postoperatively in an outpatient clinic at 3, 6, 12, 18, 24, 36 48, and 60 months. Clinical examinations at these follow-up visits were used to evaluate IH events prospectively. The incidence of IH was estimated using competing risk analysis and is presented as the cumulative incidence proportion (CIP). We expected the incidence to be 15% at 12 months. HRQoL was assessed at 12 months by the Short Form (SF-36) questionnaire, which we used to compare patients with an IH to patients without an IH. RESULTS: The median follow-up time was 16.6 months [range 0.9-62.0]. During this period, 14/152 (9.2%) patients developed an IH. The 1-year CIP was 5.9% [95% CI 2.9; 10.4] (n = 8), and the 2-year CIP was 9.2% [95% CI 5.3; 14.5] (n = 14). Patients with an IH were significantly older (67 years [range 48-72]) compared to patients without IH (60 years [range 24-75], p ≤ 0.01). The rate of postoperative complications between patients with and without IH was comparable, except that a greater proportion of patients with IH had a fascial dehiscence (21.4%) compared to patients without an IH (3.6%). Reponses to the SF-36 show that patients with an IH report lower HRQoL with regard to Role-physical (mean difference - 32.9 [95% CI - 60.6; - 5.3]) and Role-emotional (mean difference - 20.2 [95% CI - 43.4; 3.1]), meaning a reduction in work and daily activities due to their physical and psychological health. We found no general decrease in HRQoL. CONCLUSION: CRS + HIPEC do not increase the risk of IH as measured within 12 months postoperatively, contrary to expectations. However, patients with an IH report a limitation in daily activities, which can best be explained by changes in physical and psychological health. A larger cohort from multiple centres is necessary to verify our findings.

Outcome one year after robot-assisted rectal cancer surgery: a consecutive cohort study.

PURPOSE: The aim of this study was to investigate outcome after robot-assisted rectal cancer surgery (RARCS). We focused on conversion rate, postoperative complications, pathological evaluation (adequacy of resection margins), and bowel function (low anterior resection syndrome (LARS)) 1 year after surgery. METHODS: An observational study of prospectively registered patients with data obtained from medical records. Data comprise the initial 208 rectal cancer patients operated with robot-assisted surgery at a single Danish university hospital from October 2011 to October 2014. RESULTS: In total, 27 procedures (13%) were converted to open surgery, and 23 of the 27(85%) conversions were in the obese and overweight patients. The anastomotic leak rate was 12 (9%), and further 5 (2%) developed a complication requiring re-operation (ileus, bleeding, wound abscess). In total, 14 (7%) patients had a circumferential resection margin (CRM) ≤ 1 mm (R1-resection). In regard to bowel function, 15/22 (68%) of TME patients had major LARS at 6 months follow-up but at 12 months follow-up this proportion was reduced to 18/34 (53%). CONCLUSIONS: The outcomes after RARCS at a single high-volume university center are overall comparable to outcomes reported from laparoscopic surgery. The results are satisfying because they are achieved during implementation of RARCS. Randomized trials are, however, needed and focus should especially be on long-term follow-up in regard to functional outcome.

Fixation devices in laparoscopic ventral hernia repair: a review.

In laparoscopic ventral hernia repair a mesh is inserted and anchored intraperitoneally to the abdominal wall. Currently, a variety of fixation methods are being used. As a primary goal the ideal fixation method should contribute to preventing recurrences. It should also be associated with less pain, and should prevent adhesion formation, mesh migration, and shrinkage but without contributing to infection, fistula, or seroma. In this review we evaluate the evidence for using each type of available fixation device. A systematic search of the literature, including human as well as animal studies, identified 17 different fixation methods. Their role with regard to effect on major end-points in laparoscopic ventral hernia repair including postoperative pain, infection, seroma formation, adhesions, fixation strength, strength of ingrowth, shrinkage, bowel fistulas, and hernia recurrence, is described in detail. No gold standard exists currently. The vast majority of published results are based on uncontrolled series with short or incomplete follow-up. In this review only three randomized controlled trials were identified.

Short-Term Results of Operative Treatment of Primary Ileocecal Crohn's Disease: Retrospective, Comparative Analysis between Early (Luminal) and Complicated Disease.

Early surgical treatment for patients with ileocecal Crohn's disease (CD) could be an alternative to biological therapy. The aim of this study is to compare operative outcomes following ileocecal resection for patients with luminal and complicated CD. Patients operated for primary ileocecal CD during 8 years in one tertiary-referral hospital were allocated into 2 groups: those operated for early (luminal) disease (ECD), and for complications of CD (CCD). A retrospective comparative analysis was performed. A total of 273 patients were included in the analysis, 85 (31%) of which were in the ECD group. No difference was found regarding time from diagnosis to surgery. Surgical procedures were longer in the CCD group, with lower rates of laparoscopic approach (93 vs. 99%, p = 0.035) and higher conversion rates (20 vs. 2%, p < 0.001). ECD had non-significant differences in terms of major postoperative complications (9.4 vs. 14.9%, p = 0.215), shorter hospital stays, and lower rates of anastomotic leakage (3.5 vs. 6.8%, p = 0.285). Conversely, the CCD group had higher reoperation and re-hospitalization rates. Adequate timing for the indication of surgery in primary ileocecal CD, including an early discussion considering both medical and surgical treatment as options, could positively influence operative outcomes.

[Breast cancer metastasis to the colon]. / Cancer mammae med metastase til colon.

A 69-year-old woman was admitted with diarrhoea, anaemia and elevated C-reactive protein. She was diagnosed with metastases of a carcinoma to the colon; the immunohistochemical profile made lobular breast cancer the most likely primary tumour. But despite thorough examination, such tumour was never found. Twenty-two years earlier, the patient underwent surgery for a benign breast tumour. The benign diagnosis was confirmed in new slides from the then removed tissue. Metastases from breast cancer to the colon are rare, and a primary tumour is usually found. In this case report, however, no primary tumour was found.