Analysis of risk factors for concurrent pulmonary infection after operation for colon cancer.

PURPOSE: To investigate the risk factors for concurrent pulmonary infection after radical operation for colon cancer, providing a reference for the prevention and treatment of this condition. METHODS: A total of 486 patients subjected to radical operation for colon cancer in Shanghai Hudong Hospital from December 2014 to December 2017 composed the study group. Their clinicopathologic data and postoperative follow-up were reviewed, including gender, age, body mass index (BMI), preoperative albumin (ALB), preoperative hemoglobin (Hb), hypertension (HBP), diabetes mellitus (DM), smoking history, preoperative pulmonary ventilation dysfunction, tumor size, lymph node metastasis, operative time, intraoperative blood loss, blood transfusion and surgical method. Univariate and multivariate analyses were applied to investigate the risk factors influencing concurrent pulmonary infection after radical operation for colon cancer. The severity of pulmonary infection was assessed using the Clavien-Dindo classification system, and the severity ≥ Grade II suggested that postoperative pulmonary infection (POPI) occurred. RESULTS: Among 486 patients, 20 (4.12%) patients suffered from POPI, including 17 (3.50%) cases of Grade II infection, 2 (0.41%) cases of Grade IIIa infection and 1 (0.21%) case of Grade IVa infection. Univariate analysis showed that POPI was associated with age (≥75 years), gender (male), DM, smoking history, preoperative pulmonary function impairment and blood transfusion. Multivariate analysis indicated that age, preoperative pulmonary ventilation dysfunction, DM and blood transfusion were independent risk factors for POPI. CONCLUSIONS: Age, preoperative respiratory function impairment, DM and blood transfusion are considered as independent risk factors for pulmonary infection after radical operation for colon cancer.

Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial.

BACKGROUND: Long-term outcomes and efficacy of partial stapled hemorrhoidopexy are not known. OBJECTIVE: The purpose of this study was to compare the long-term clinical efficacy and safety of partial stapled hemorrhoidopexy with circumferential stapled hemorrhoidopexy. DESIGN: This was a parallel group, randomized, noninferiority clinical trial. SETTINGS: The study was conducted at a single academic center. PATIENTS: Patients with grade III/IV hemorrhoids between August 2011 and November 2013 were included. INTERVENTIONS: Three hundred patients were randomly assigned to undergo either partial stapled hemorrhoidopexy (group 1, n = 150) or circumferential stapled hemorrhoidopexy (group 2, n = 150). MAIN OUTCOME MEASURES: The primary outcome was the rate of recurrent prolapse at a median follow-up period of 5 years with a predefined noninferiority margin of 3.75%. Secondary outcomes included incidence and severity of postoperative pain, fecal urgency, anal continence, and the frequency of specific complications, including anorectal stenosis and rectovaginal fistula. RESULTS: The visual analog scores in group 1 were less than those in group 2 (p < 0.001). Fewer patients in group 1 experienced postoperative urgency compared with those in group 2 (p = 0.001). Anal continence significantly worsened after both procedures, but the difference between preoperative and postoperative continence scores was higher for group 2 than for group 1. Postoperative rectal stenosis did not develop in patients in group 1, although it occurred in 8 patients (5%) in group 2 (p = 0.004). The 5-year cumulative recurrence rate between group 1 (9% (95% CI, 4%-13%)) and group 2 (12% (95% CI, 7%-17%)) did not differ significantly (p = 0.137), and the difference was within the noninferiority margin (absolute difference, -3.33% (95% CI, -10.00% to 3.55%)). LIMITATIONS: The study was limited because it was a single-center trial. CONCLUSIONS: Partial stapled hemorrhoidopexy is noninferior to circumferential stapled hemorrhoidopexy for patients with grade III to IV hemorrhoids at a median follow-up period of 5 years. However, partial stapled hemorrhoidopexy was associated with reduced postoperative pain and urgency, better postoperative anal continence, and minimal risk of rectal stenosis. See Video Abstract at http://links.lww.com/DCR/A790.Trial registration (chictr.org) identifier is chiCTR-trc-11001506.

Systematic review and meta-analysis of the effect of probiotic supplementation on functional constipation in children.

BACKGROUND: To evaluate the effect of probiotic supplementation on functional constipation in children. METHODS: We performed electronic searches in PubMed, Embase, and Cochrane Library without language restriction to identify relevant studies from the time of inception of these databases to March 2018. The relative risk or weighted mean difference was calculated to evaluate the treatment effect of probiotics using random-effects model. RESULTS: We included 4 trials reporting data on 382 children with functional constipation. Overall, there were no significant differences in treatment success (P = .697), spontaneous bowel movements per week (P = .571), fecal soiling episodes per week (P = .642), straining at defecation (P = .408), use of lactulose (P = .238), use of laxatives (P = .190), fecal incontinence (P = .139), pain during defecation (P = .410), flatulence (P = .109), and adverse events (P = .979) between probiotics and placebo. Further, the use of probiotics was associated with lower frequency of glycerin enema use (weighted mean difference -2.40, P = .004) and abdominal pain (weighted mean difference -4.80, P < .001). CONCLUSION: The findings of this study suggested that the use of probiotics was associated with significant improvement in glycerin enema use and abdominal pain but did not affect the treatment success and other function indices.

[Diagnosis and surgical treatment for rectovaginal fistula].

Rectovaginal fistulas are distressing conditions to patients and present a therapeutic challenge to surgeons. Whether the etiology of the fistula is obstetric, Crohn's disease-related, or cryptoglandular, a thorough anatomy evaluation is required in order to select the correct repair. No single surgical technique is suitable for all rectovaginal fistulas as of now. Less invasive surgery should be selected in primary repair, and endorectal advancement flap repair was recommended as the first line therapy in most guidelines for the treatment of rectovaginal fistulas. Preoperative fecal diversion has not been shown consistently to lead to better outcomes, thus most surgeons suggested that diverting stoma is not imperative in majority of patients, unless the tissue interposition was undertaken. The tissue interposition or transabdominal repair should be considered for multiple failure or recurrent complex rectovaginal fistulas. Familiarity with the various surgical techniques described and the ability to apply the appropriate surgery to correct patients will increase the chance of a successful intervention.

[The past, presence and future of ligation of intersphincteric fistulous tract for the treatment of fistula in ano].

This paper is to summarize the successful rate, complication morbidity, and the impact of ligation of the intersphinteric fistula tract (LIFT) on anal continence, and to illustrate the efficacy of LIFT procedure for the treatment of high transphinteric fistula in ano and the challenging problems existed in practice through literature review retrospectively. LIFT procedure appears to be an effective sphincter conserving approach with less complications and minimal impact on anorectal function for the treatment of high transsphincteric fistula in ano.

Long-term outcome of infliximab combined with surgery for perianal fistulizing Crohn's disease.

AIM: To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn's disease (CD). METHODS: The work was performed as a prospective study. All patients received infliximab combined with surgery to treat perianal fistulizing CD, which was followed by an immunosuppressive agent as maintenance therapy. RESULTS: A total of 28 patients with perianal fistulizing CD were included. At week 30, 89.3% (25/28) of the patients were clinically cured with an average healing time of 31.4 d. The CD activity index decreased to 70.07±77.54 from 205.47±111.13 (P<0.01) after infliximab treatment. The perianal CD activity index was decreased to 0.93±2.08 from 8.54±4.89 (P<0.01). C-reactive protein, erythrocyte sedimentation rate, platelets, and neutrophils all decreased significantly compared with the pretreatment levels (P<0.01). Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up. After a median follow-up of 26.4 mo (range: 14-41 mo), 96.4% (27/28) of the patients had a clinical cure. CONCLUSION: Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD, and this treatment was associated with better long-term outcomes.

[Clinical management of pilonidal diseas-interpretation of practice parameters for the management of pilonidal disease from American Society of Colon and Rectal Surgeons].

Pilonidal disease is a common clinical condition which is not sufficiently recognized with regard to the clinical manifestation and treatment by colorectal surgeons in China, resulting in high misdiagnosis rate and recurrent rate. With reference to the Practice Parameters for the Management of Pilonidal Disease published in 2013 by The American Society of Colon and Rectal Surgeons, we discuss the management of pilonidal disease in four aspects, including etiology, diagnoses, nonoperative and operative management.

Retrorectal tumors in adults: magnetic resonance imaging findings.

AIM: To retrospectively evaluate the magnetic resonance imaging (MRI) features of adult retrorectal tumors and compare with histopathologic findings. METHODS: MRI features of 21 patients with preoperative suspicion of retrorectal tumors were analyzed based on the histopathological and clinical data. RESULTS: Fourteen benign cystic lesions appeared hypointense on T1-weighted images, and hyperintense on T2-weighted images with regular peripheral rim. Epidermoid or dermoid cysts were unilocular, and tailgut cysts were multilocular. Presence of intracystic intermediate signal intensity was observed in one case of tailgut cyst with a component of adenocarcinoma. Six solid tumors were malignant lesions and showed heterogeneous intensity on MRI. Mucinous adenocarcinomas showed high signal intensity on T2-weighted and mesh-like enhancing areas on fat-suppressed T2-weighted images. There was a fistula between the mass and anus with an internal opening in mucinous adenocarcinomas arising from anal fistula. Gastrointestinal stromal tumors displayed low signal intensity on T1-weighted images, and intermediate to high signal intensity on T2-weighted images. Central necrosis could be seen as a high signal on T2-weighted images. CONCLUSION: MRI is a helpful technique to define the extent of the retrorectal tumor and its relationship to the surrounding structures, and also to demonstrate possible complications so as to choose the best surgical approach.

Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure.

OBJECTIVE: The aim of this review is to systematically analyze the prospective randomized controlled trials on the efficacy of botulinum toxin injection (Botox) vs. lateral internal sphincterotomy (LIS) for the treatment of chronic anal fissure (CAF). MATERIALS AND METHODS: A systematic review of the literature was undertaken. The prospective randomized controlled trials on the effectiveness of Botox vs. LIS for the management of CAF were selected according to specific criteria and analyzed to generate pooling data. RESULTS: Four studies encompassing 279 patients were qualified for the meta-analysis. There was a statistically significant higher healing in LIS group compared with Botox group (RR 1.31[1.57, 1.50] 95% CI, z = 4.11, p < 0.0001). Absolute benefit increase rate (ABI) is 23% for LIS group compared with Botox group. The recurrence rate was statistically significantly higher in Botox groups than in LIS groups (RR 5.83[2.96, 11.49] 95% CI, z = 5.09, p < 0.00001).LIS was associated with a high rate of minor anal incontinence as compared to Botox (RR 0.08[0.01, 0.59] 95% CI, z = 2.47, p = 0.01). CONCLUSION: Botulinum toxin injection was associated with a higher rate of recurrent disease. LIS was more effective in healing chronic anal fissure.

Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from single institution.

BACKGROUND: Mucinous adenocarcinoma arising from a chronic anorectal fistula is rare, with few reports in the literature. Such lesions can be misdiagnosed for the more common benign perianal abscess or fistula. METHODS: From our retrospective chart review, we identified three patients with chronic perianal fistula-in-ano who were subsequently found to have developed perianal mucinous adenocarcinoma on biopsy. We recorded the symptomatology, subsequent management and further follow-up of each patient. RESULTS: Two of three patients who received irradiation and chemotherapy were still alive during 28 and 24 months of follow-up, respectively without any evidence of distant metastasis. One patient with inguinal lymph node metastases died due to distant metastasis 6 months after diagnosis. CONCLUSIONS: Fistula-associated perianal mucinous adenocarcinoma is an uncommon malignant transformation of chronic fistula-in-ano. MRI can provide important diagnostic information on patient with this suspicious inflammatory condition. Although radical resection of the tumour with abdominoperineal resection remains the surgical treatment of choice. Combined chemoradiotherapy may be appropriate for these patients with promising results.

[Application of magnetic resonance imaging in the diagnosis of complex anal fistula].

OBJECTIVE: To evaluate the value of magnetic resonance imaging (MRI) in the diagnosis of complex anal fistula. METHODS: The preoperative digital examination and MRI with the phased-array coil were implemented for 28 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results. RESULTS: Twenty-five patients were diagnosed as complex anal fistula, 1 presacral cyst and 2 chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI,while the patients with presacral cyst and perianal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients were suffered from trans-sphincteric fistula, 10 intersphincteric, 5 supra- sphincteric and 7 extra-sphincteric. The diagnosis rates of the internal opening with digital examination and MRI were 48% and 84%, the rates of the primary tract were 76% and 100%, and the rates of the secondary extensions were 57.9% and 94.7% respectively. The differences in detection of internal opening, primary tract and secondary extensions between MRI and digital examination were significant (P<0.01). CONCLUSION: MRI with the phased-array coil can correctly orient the internal opening and direction of the complex anal fistula, and find the relationship between anorectal sphincters and the complex fistula.