Risk factors for postoperative urinary retention in patients underwent surgery for benign anorectal diseases: a nested case-control study.

BACKGROUND: Postoperative urinary retention (POUR) is a common complication of anorectal surgery. This study was to determine the incidence of POUR in anorectal surgery for benign anorectal diseases, identify its risk factors, and establish a nomogram for prediction of POUR. METHODS: A nested case-control study was conducted. The clinical data of patients were collected, and the incidence of POUR was analyzed. Univariate analysis was used to identify the risk factors associated with POUR, and multivariate logistic regression analysis was used to determine independent risk factors for POUR. A nomogram for the preoperative prediction of POUR using a logistic regression model was developed (n = 609). RESULTS: The incidence of POUR after anorectal surgery for benign anorectal diseases was 19.05%. The independent risk factors for POUR were: female (P = 0.007); male with benign prostatic hyperplasia (BPH) (P = 0.001); postoperative visual analogue scale (VAS) score > 6 (P = 0.002); patient-controlled epidural analgesia (PCEA) (P = 0.016); and a surgery time > 30 min (P = 0.039). In the nomogram, BPH is the most important factor affecting the occurrence of POUR, followed by a postoperative VAS score > 6, PCEA, surgery time > 30 min, and sex has the least influence. CONCLUSION: For patients undergoing anorectal surgery for benign anorectal diseases, preventive measures can be taken to reduce the risk of POUR, taking into account the following risk factors: female or male with BPH, severe postoperative pain, PCEA, and surgery time > 30 min. Furthermore, we developed and validated an easy-to-use nomogram for preoperative prediction of POUR in anorectal surgery for benign anorectal diseases. TRIAL REGISTRATION: China Clinical Trial Registry: ChiCTR2000039684, 05/11/2020.

Opioid Utilization in Outpatient Anorectal Surgery: An Opportunity for Improvement.

INTRODUCTION: The opioid epidemic has resulted in close examination of postsurgical prescribing patterns. Little is known about postoperative opioid use in outpatient anorectal procedures. This study evaluated patient opioid use and created prescribing recommendations for these procedures. METHODS: One hundred and four patients undergoing outpatient anorectal procedures from January to May 2018 were surveyed on opioid consumption, surgical experience, and pain satisfaction. Patients were grouped into three tiers based on opioid usage. Multivariable models were used to determine factors associated with poor pain control. RESULTS: Patient satisfaction with pain control was 85.6%. Twenty five percent of patients reported leftover medication and 9.6% of patients requested opioid refills. Opioid prescribing recommendations were generated for each tier using 50th percentile with interquartile ranges. On multivariable modeling, the high-tier group was associated with poorer pain control. CONCLUSIONS: We created opioid quantity prescribing guidelines for common outpatient anorectal procedures. A multimodal approach to pain control utilizing nonopioids may reduce healthcare utilization.

The "hands" teaching methods applied to the anatomy related to anorectal surgery.

AIM: The knowledge of the regional anatomy could assist us in performing various operations very well. However, mastering the regional anatomy very well is often a challenge, especially for a young surgeon. METHOD: "Hands" teaching methods (using gesture to simulate anatomical structure) is a simple, impressive and interesting teaching method in medical education. Our goal is to find some simple gestures that could mimic some important anatomical structures in current anorectal surgery. RESULTS: We have obtained a series of interesting and simple gestures that could exactly mimic many important anatomical structures in current anorectal surgery field, see video. These anatomical structures are involved in many common diseases, such as hemorrhoid, anorectal abscess, anal fistula, pilonidal sinus disease, and rectal cancer etc. CONCLUSION: From a synthetic and practical point of view, these "hands" teaching methods would assist the surgeons in having a better understanding of various anorectal operations. Surgeons could use these "hands" teaching methods anytime, even during surgery.

Moxibustion for Managing Postoperative Urinary Retention After Hemorrhoidectomy and Anorectal Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: Common surgical procedures for conditions affecting the anus and rectum such as hemorrhoidectomy are associated with high risks of postoperative urinary retention (POUR). Little is known about the efficacy of moxibustion in managing POUR after such surgical procedures. This systematic review and meta-analysis aimed to review the related literature and synthesize data on the effectiveness of moxibustion in managing POUR after common anorectal surgeries. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: PubMed, EMBASE, CENTRAL, Chinese National Knowledge Infrastructure (CNKI), VIP information, and Wanfang databases were searched to October 1, 2021 using the keywords urinary retention, moxibustion, and moxa. Randomized controlled trials (RCTs) investigating patients who had developed POUR after hemorrhoidectomy or other anorectal surgeries were eligible for inclusion. Patients receiving moxibustion formed the intervention group and the control group received usual care alone. Primary outcomes were markedly effective rate, defined as spontaneous voiding with complete symptom relief within 30 to 60 minutes after treatment; and total effective rate (ie, markedly effective rate plus effective rate, defined as spontaneous voiding with partial relief of symptoms within 60 minutes to 4 hours after treatment). Secondary outcome was time to first urination after treatment. FINDINGS: Thirty-four RCTs met the eligibility criteria. Pooled analysis revealed that the markedly effective rate was significantly higher in the moxibustion group than that in the control group (pooled RR = 2.53, 95% CI = 2.17-2.95), and the total effective rate in the moxibustion group was also higher than that in the control group (pooled RR = 5.02, 95% CI = 4.01-6.28). The intervention group had significantly shorter times to first urination than controls (pooled effect = -2.81, 95% CI = -2.06 to -3.56). CONCLUSIONS: Moxibustion appears superior to usual care in relieving POUR after common anorectal surgeries. Future studies are still warranted to confirm these findings.

Use of Preoperative Laboratory Testing Among Low-Risk Patients Undergoing Elective Anorectal Surgery.

BACKGROUND: Many low-risk patients receive preoperative laboratory testing (PLT) prior to elective outpatient surgery, with no effect on postoperative outcomes. This has not been studied in patients undergoing anorectal surgery. The aim of this study was to determine if PLT in this population was predictive of perioperative complications. MATERIALS AND METHODS: The 2015-2018 National Surgical Quality Improvement Program (NSQIP) databases were queried for elective ambulatory anorectal surgeries. PLT was defined as chemistry, hematology, coagulation, or liver function studies obtained ≤30 days preoperatively. American Society of Anesthesiologists (ASA) class 1 and 2 patients were included who underwent elective, ambulatory, benign anorectal surgery. Patient demographics, comorbidities, and postoperative outcomes were compared between those who did and did not receive PLT. Postoperative outcomes were defined as wound-related, procedure-related, major complications, unplanned readmission, and death occurring within 30 days. Multivariate regression analysis determined patient characteristics predictive of receiving testing. RESULTS: Of 3309 patients studied, 48.6% received PLT. On multivariate analysis, older age, female sex, Black race, ASA class 2, and comorbidities were predictive of receiving testing. The complication rates were similar between patients who did and did not receive testing (4.3% versus 3.5%, P = 0.22). CONCLUSIONS: PLT is performed in over half of low-risk patients receiving elective anorectal surgery. There was no difference in the rate of postoperative complications between patients who received testing or not, nor with normal versus abnormal results. PLT can be used more judiciously in this population.

Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery.

BACKGROUND: Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model. METHODS: A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity. RESULTS: Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014-2016. All face and content validity measures achieved a median score greater than 4 (range 4.0-5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477 s and transverse closure: 79 vs. 192 s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons). CONCLUSIONS: Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study.

Background: Ambulatory surgery for anorectal procedures has become widely accepted. Recent reviews recommend a multimodal approach to pain management. However, these recommendations are largely based on single intervention studies. Our goal was to evaluate post-operative pain in patients receiving a multimodal analgesic regimen. Methods: All patients undergoing an ambulatory anorectal procedure between December 2015 and September 2016 received a pain diary. Mean pain throughout the day and pain during defecation where recorded on day 0-14 and day 21 postoperatively using a numeric rating scale-11. Use of oral analgesics was also recorded. Results: Forty-two patients completed the pain diary. The use of local anesthetic infiltration did not result in a significant difference in pain scores in this study. Patients who received written information on postoperative pain management and hygienic measures had higher intake of oral analgesics. Despite receiving multimodal analgesic treatment, patients undergoing surgery for hemorrhoids or anal fissures reported pain scores ≥4 and used analgesics longer. Conclusion: A multimodal analgesic approach consisting of local anesthetic infiltration, multiple oral analgesics and written information seems to be insufficient for certain patient groups after ambulatory anorectal surgery. Especially patients undergoing surgery for hemorrhoids or an anal fissure should receive adequate analgesia. Pain during defecation is problematic and finding a solution for this problem remains challenging. Further research into the combined use of different analgesic modalities is recommended.

Perioperative Management of the Ambulatory Anorectal Surgery Patient.

Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions.

Complications Following Anorectal Surgery.

Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain.

The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery.

BACKGROUND: Given the limited data on the need of mechanical bowel preparation application before anorectal surgeries and the preferred method for bowel preparation, we aimed to compare saline enema and bisacodyl in rectal preparation before anorectal surgery. MATERIALS AND METHODS: This is a randomized clinical trial study. Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula) were recruited by convenient sampling and then randomly allocated to receive 500 cc Saline by rectal enema or six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel. After surgery, surgeons' satisfaction of the surgery and patients' satisfaction of the preparation process were evaluated in the ward using Likert score by a nurse blind to the study. Also, the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0-10 scores. All patients were actively followed-up after discharge for 1 mo concerning postoperative complications. The obtained data were analyzed by SPSS software (version 16), Mann-Whitney, chi-squared, and Fisher exact tests at the significant level of P < 0/0.5. RESULTS: A total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets. No significant differences were observed between the two groups in most variables except for pain after the first defecation (P = 0.032). CONCLUSIONS: According to the results, the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema. Thus, bisacodyl can be suggested as a superior counterpart for enema.

WITHDRAWN: Comparison of the Efficacy of Oral Magnesium with Oral Ketorolac for Postoperative Pain Management in Anorectal Surgery: A Double-blinded Randomized Clinical Trial

The article has been withdrawn at the request of the editor of the journal Reviews on Recent Clinical Trials.Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused.The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php BENTHAM SCIENCE DISCLAIMER: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.

Efficacy of Oral Gabapentin and Acetaminophen for Postoperative Analgesia in Anorectal Surgery: A Fuzzy Logic Evaluation.

Background: The present study attempted to evaluate the effect of oral gabapentin and acetaminophen for postoperative analgesia in anorectal surgery. Methods: This double-blind clinical trial was carried out on 144 patients who were candidates for anorectal surgery. The patients were randomly assigned into three groups of control, acetaminophen 500 mg, and gabapentin 300 mg for two hours before the surgery. Data on pain severity based on the visual analog scale (VAS) were evaluated and analyzed. Results: The results of the current study indicated that in patients taking acetaminophen and gabapentin tablets before surgery, the amount of postoperative pain decreased, and the amount of decrease in postoperative pain in the patients who received acetaminophen and gabapentin tablets compared with the placebo group was significant (P<0.001). Also, an evaluation was done using a proposed fuzzy logic model. Conclusion: Taking acetaminophen and gabapentin tablets one hour before the operation causes a significant reduction in postoperative pain in patients who are candidates for anorectal surgery. The results are promising and encourage one to pay attention to more studies with the goal of possibly using them as a decision-support model in the future.

General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy.

Introduction: Postoperative pain and complications pose significant challenges following a hemorrhoidectomy. Attaining effective anesthesia with minimal complications is crucial. The ideal anesthesia method for ambulatory hemorrhoidectomy remains uncertain. This study aimed to investigate whether the combination of general anesthesia plus local infiltration (GAL) is associated with lower complications and reduced pain compared to spinal anesthesia (SA) in the context of hemorrhoidectomy. Methods: This retrospective single-center cohort study, conducted in a tertiary medical center in East Asia, evaluated excisional hemorrhoidectomies performed between January 1, 2017, and March 31, 2023, utilizing GAL or SA. Data on the six most common complications-pain, constipation, acute urine retention (AUR), bleeding, nausea, and headache-were extracted from medical records. A total of 550 hemorrhoidectomies were included: 220 in the GAL group and 330 in the SA group. Patient characteristics were comparable between the two groups. Results: The AUR rate was significantly lower in the GAL group compared to the SA group (15.5% vs. 32.1%, P < 0.001). Although the proportion of pain scores ≥4 did not differ significantly between the GAL and SA groups (36.2% vs. 39.8%, P = 0.429), the pain score curve indicated a stable trend. Overall, the GAL group exhibited a lower rate of adverse effects (56.9% vs. 67.4%, P = 0.023). There were no significant differences in the rates of other complications and emergency department readmission between the GAL and SA groups. Discussion: GAL emerges as a favorable choice for anesthesia in hemorrhoidectomy, demonstrating a lower incidence of urine retention and a prolonged analgesic effect in multiple hemorrhoidectomies. These findings support the conclusion that GAL represents an optimal anesthetic method for enhancing the postoperative experience in patients undergoing hemorrhoidectomy.

The compassionate care framework plus quality control group improves the quality of postoperative nursing management for patients in anorectal surgery: An observational study.

OBJECTIVE: This study aimed to investigate the effectiveness of the joint application of the compassionate care framework (CCF) and a quality control (QC) team in improving the quality of postoperative nursing management for patients in anorectal surgery. METHODS: Patients who underwent anorectal surgery at the China-Japan Friendship Hospital between May 2022 and December 2022 were selected by convenience sampling. A digital random generator was used for random grouping. The odd numbers entered the control group (n = 53) and the even numbers entered the study group (n = 53). The control group received postoperative traditional nursing, and the study group received postoperative nursing and QC team management. A questionnaire survey was used to analyse patients' satisfaction with nursing. The two groups were compared for nursing quality scores, patient satisfaction with nursing care and incidence of complications. RESULTS: After management, compared with the control group, the study group scored significantly higher for the nursing process, environmental management, emergency response and safety protection (p < 0.05 for all). The study group also exhibited higher satisfaction scores with the nursing process, nurse-patient relationship and service attitude compared with the control group (p < 0.05 for all). The complication incidence rate in the study group was significantly lower than in the control group (p < 0.05). CONCLUSION: The combined use of the CCF and a QC team can effectively improve the quality of postoperative nursing management for patients in anorectal surgery, reduce the incidence of complications and enhance patient satisfaction with nursing care, thus holding significant potential for wider application.

Study on the application of segmented nursing pathway in daytime anorectal surgery patients.

BACKGROUND: Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. OBJECTIVE: To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. METHODS: A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. RESULTS: The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P< 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P< 0.05). CONCLUSION: Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction.

Major complications of caudal block: A prospective survey of 973 cases in adult anorectal surgery.

Background: We conducted a prospective study of surgical inpatients at a teaching hospital to assess the incidence and potential risk factors for major complications of caudal anesthesia in anorectal surgery. Methods: A total of 973 patients undergoing anorectal surgery under caudal block were included in this prospective, observer-blinded trial after providing consent. Demographic information, detailed perioperative information, anesthesia-related complications and postoperative follow-up information were recorded. Meanwhile, the incidence and risk factors for major caudal anesthesia-related complications were analyzed. Results: A total of 973 patients underwent caudal block. The effective rate was 95.38 % (928 cases). However, there were still 38 (3.91 %) cases with insufficient block and 7 (0.72 %) cases with no block. The major anesthesia-related complications were local anesthetic systemic toxicity (9, 0.92 %), cauda equine syndrome (1, 0.10 %), transient neurological symptoms (3, 0.31 %) and localized pain at the caudal insertion site (30, 3.08 %). The identified risk factor for local anesthetic systemic toxicity was multiple attempts locating the caudal space (OR = 5.30; 1.21-23.29). The identified risk factor for localized pain at the caudal insertion site was multiple attempts locating the caudal space (OR = 10.57; 4.89-22.86). Conclusion: The main complications of caudal block in adult patients are transient neurological symptoms, cauda equine syndrome, serious local anesthetic systemic toxicity and localized pain at the caudal insertion site. Overall, the incidence of complications is low and symptoms are mild. Caudal block is still a safe and reliable method for anesthesia in adult anorectal surgery.

Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study.

The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which used group-based trajectory modeling to estimate postoperative pain and then examined the relationships between sociodemographic or surgical factors and pain trajectories. Three distinct postoperative pain trajectories were determined: hemorrhoidectomy (OR, 0.15), higher anxiety (OR, 3.26), and a higher preoperative pain behavior score (OR, 3.15). In multivariate analysis, they were associated with an increased likelihood of being on the high pain trajectory. The pain trajectory group was related to postoperative analgesic use (p < 0.001), with the high-low group needing more nonsteroidal analgesics. The study showed that there were three obvious pain trajectories after anorectal surgery, including an unreported low-moderate-low type. More than 60% of patients maintained moderate to severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.

Comparison of Different Local Anesthetic Volumes for Saddle Block Anesthesia in Ambulatory Surgery: A Prospective Randomized Trial.

INTRODUCTION: Saddle block anesthesia (SBA) is a frequently preferred method for ambulatory anorectal surgery. This study aimed to observe the effects of two different dose SBAs on discharge times and perioperative block characteristics in patients undergoing ambulatory anorectal surgery. METHODS: The study was conducted as a prospective, randomized controlled study. Patients over the age of 18 who were scheduled for ambulatory anorectal surgery and had American Society of Anaesthesiologists (ASA) physical status I and II were included in the research. Patients were divided into two groups: 5 mg hyperbaric bupivacaine 0.5% (Group I; n=34) and 3 mg hyperbaric bupivacaine 0.5% (Group II; n=34). The primary outcome was discharge time. Characteristics of the spinal block like time to reach S4 blockade, maximum blocked dermatome, regression time of sensorial, first analgesic need time, voiding time, mobilization time, and side effects were the secondary outcomes. RESULTS: Sixty-eight patients were included in the study. The groups were similar in terms of demographic and surgical characteristics (p > 0.05). In Group II, S4 sensory dermatome blockade time was statistically longer (p: 0.007) and the time to the disappearance of the sensory block was statistically shorter (p < 0.001). Also, voiding time and discharge times were statistically shorter in Group II (p: 0.049, p < 0.001, respectively). CONCLUSION: SBA provided adequate anesthesia, and the complication rates were limited. Saddle block can be considered an advantageous technique because of conditions that adversely affect recoveries, such as postoperative cognitive problems, nausea, and vomiting due to general anesthesia. In addition, better recovery results and optimal surgical condition with 3 mg hyperbaric bupivacaine in our study suggest that this dose may be a good alternative.

Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study.

Background: Hemorrhoidal artery ligation (HAL) may reduce postoperative pain and complications and shorten patients' recovery when compared to standard hemorrhoidectomy. It is unclear if the Doppler guide (DG) is useful in reducing recurrence risk. Objective: To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade. Methods: Between January 1, 2014 and January 31, 2021, 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy. Mucopexy was routinely performed. After discharge, patients were subjected to 1-week, 1-, 3-, 6-, and 12-month clinical assessment. Thereafter, they were interviewed by telephone annually. Results: Seventy-six (62.3%) DG-HAL and 46 (37.7%) HAL procedures were performed. Median surgical time was 30 (15-45) minutes for DG-HAL versus 25 (15-40) minutes for HAL (P = 0.005). No intraoperative complications occurred. Postoperative bleeding needing surgery occurred in 2 (1.6%) patients in the DG-HAL group. During a median follow-up of 46 months (6-86), we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574). No cases of incontinence or anal stenosis occurred. No significant difference was observed between the two groups in terms of patients' satisfaction. At multivariate analysis, age ≥ 65 years resulted a protective factor for recurrence (odds ratio 0.31; 95% confidence interval 0.09-0.98; P = 0.047). Conclusions: In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain.

AIM: To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD: Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS: 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS: The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.