Sacral nerve stimulation in slow-transit constipation: effectiveness at 5-year follow-up.

AIM: The aim of this study is to evaluate the short- and long-term efficacy of sacral nerve stimulation (SNS) for treating slow-transit constipation (STC). METHOD: This is a retrospective cohort analysis of the efficacy of SNS in treating patients affected by STC, who previously failed to respond to conservative therapies. Only patients free of concomitant diseases were enrolled in our study. A temporary stimulation lead was initially implanted; patients with a > 50% symptom reduction were eventually deemed eligible for a permanent implant. RESULTS: This study enrolled 25 patients who underwent a SNS test stimulation; 21 patients (13 women; median age 32 years) eventually got a permanent implant. The median preoperative Cleveland Clinic Constipation Score (CCCS) was 21 (16-25). Preoperative colorectal transit time recorded a median of 10 markers (7-19) retained in the colorectal tract. At 6-month postoperative follow-up, the total number of markers retained in the colorectal tract decreased to 3 (0-4). The CCCS score improved during the first postoperative year (P < 0.001), but progressively worsened over the longer term. The SF-36 questionnaire showed an improvement in all 8 scales measuring physical and psycho-emotional states; all parameters recorded into the bowel diary also improved. Overall, at 60-month follow up, the overall neuromodulator removal rate was 48%. CONCLUSIONS: The SNS is a minimally invasive surgical procedure that we tested for treating STC. The short-term outcome was promisingly after 6 months; however, there was a declining trend beyond this interval. Thus, the long-term efficacy of SNS needs to be further assessed.

Stapled Hemorrhoidopexy: Results at 10-Year Follow-up.

BACKGROUND: Despite the advantages of stapled hemorrhoidopexy reported in the literature in terms of postoperative pain, hospital stay, and duration of convalescence, it was described to have a higher recurrence rate compared with conventional hemorrhoidectomy. OBJECTIVE: The aim of this study was to evaluate clinical outcomes and patient satisfaction after stapled hemorrhoidopexy at 10-year follow-up. DESIGN: This was a retrospective cohort analysis conducted on prospectively collected data. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse between January and December 2006 were included. MAIN OUTCOME MEASURES: Patients satisfaction and recurrence rates were measured. RESULTS: Eighty-six patients (45 men and 41 women; median age, 49 y (range, 31-74 y)) underwent stapled hemorrhoidopexy. Eight patients had urinary retention during the immediate postoperative period, and 2 patients required a reoperation for suture line bleeding. The median hospital stay was 12 hours (range, 12-96 h). No suture line dehiscence, rectovaginal fistula, pelvic sepsis, anal abscess, or anal stenosis was recorded during the follow-up. Seventy-seven patients (90%) completed the expected follow-up, with a median duration of 119.0 months (range 115.4-121.8 mo). Among them, 30 patients (39%) experienced a recurrent hemorrhoidal prolapse, 8 of whom needed a reoperation. Thirty-four patients (44%) reported urge to defecate with a median visual analog scale of 1 (range, 1-7). Six patients (8%) reported gas leakage at the last follow-up visit, whereas no liquid or solid stool leakage was recorded. Satisfaction rate at 10-year follow-up was 68%. LIMITATIONS: The study was limited by its small sample size and lack of a control group. CONCLUSIONS: The high recurrence rate and low patient satisfaction rate showed that stapled hemorrhoidopexy reduces its efficacy in the long-term. See Video Abstract at http://links.lww.com/DCR/A510.

Outcomes of laparoscopic surgery for pT3/pT4 colorectal cancer in young vs. old patients.

BACKGROUND: Laparoscopy for locally advanced colorectal cancer is not standardized yet and its potential risks and benefits in elderly patients are still under debate. The aim of this study was to evaluate clinical and oncologic results of laparoscopic surgery for pT3/pT4 lesions in both old and young people. METHODS: Between 2006 and 2015, 115 patients aged <70 years and 112 patients aged ≥70 years underwent elective laparoscopic surgery for pT3/pT4 colorectal cancer presenting without distant metastasis at the Department of General Surgery, Trieste. Characteristics of the study populations, including demographic, operative and tumor features, were prospectively collected and short-term and long-term clinical, pathologic and oncologic outcomes were retrospectively analyzed. RESULTS: No difference was found in terms of tumor features, type and duration of surgery, and quality of resection. Old patients were found to have significantly higher rates of conversion (P=0.02) and postoperative mortality(P=0.03), whereas postoperative complications and reintervention rates - although higher in the elderly - did not differ on statistical analysis (P=0.13 and P=0.19, respectively). Local and distant recurrence rates were not statistically different between the two groups (P=0.64 and P=0.34, respectively). Adjuvant chemotherapy was more frequently offered to young people (P<0.001), who were considered significantly healthier than old ones (P<0.001). Overall survival was significantly lower among the elderly (P=0.001), but 5-year disease-free survival did not differ between the two groups (P=0.09). CONCLUSIONS: Laparoscopic surgery for locally advanced lesions is feasible, but old patients present an increased risk of conversion and postoperative morbidity and mortality, which may alter long-term outcomes determining an apparent decrease in survival.

Laparoscopic vs. open approach for pT3/pT4 colorectal cancer in the elderly: ten-year experience in a single center.

BACKGROUND: The role of laparoscopic surgery for pT3/pT4 colorectal cancer (CRC) is still under debate. The aim of this study was to compare the outcomes of laparoscopic and open procedures for pT3/pT4 CRC in elderly patients. METHODS: From January 2004 to December 2015, 225 patients aged ≥70 years underwent elective colorectal surgery for pT3/pT4 CRC at the Department of General Surgery, University Hospital of Trieste. Patients' demographics, tumor's characteristics, intraoperative factors, short-term and long-term outcomes were retrospectively analyzed. RESULTS: The study included 113 patients undergone open surgery and 112 who underwent laparoscopic surgery. Age was found to be statistically different between the two group, with open surgery patients being older than laparoscopic ones (P=0.009). The tumor location differed between the two groups (P=0.004), determining a variation in the incidence of surgical procedures performed (P<0.001). No other statistically significant differences were found in terms of intraoperative, histopathologic and oncologic factors. CONCLUSIONS: Laparoscopy is as safe as open surgery for pT3/pT4 CRC and it is often feasible, though in old patients higher conversion rates should be anticipated than in younger ones.