Diseases of the colon and rectum
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Endoscopic balloon dilation is used to treat ileocolic anastomotic stricture attributed to recurrent Crohn's disease. ⋯ Although endoscopic dilation is a valid option for ileocolic anastomotic stricture attributed to recurrent Crohn's disease, the need for surgery is common. The nomogram can identify patients who might benefit from upfront surgery.
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Since the introduction of laparoscopic colectomy, experience and technology continue to improve. Although accepted for many colorectal conditions, its use and outcomes in complex procedures are less understood. ⋯ A laparoscopic approach for total abdominal and transverse colectomies has similar mortality rates and slightly higher complications than the more established laparoscopic colectomy procedures and improved perioperative outcomes when compared with an open technique (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A178).
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Urinary retention after rectal resection is common and managed prophylactically by prolonging urinary catheterization. However, because indwelling urinary catheterization is a well-established risk factor for urinary tract infection, the ideal timing for urinary catheter removal following a rectal resection is unknown. ⋯ In patients undergoing rectal resection, we found that urinary catheter removal on or before postoperative day 2 was associated with urinary retention (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A172).
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Antegrade colonic enemas are used in selected adult patients with defecatory disorders. Conduit stenosis requiring revisional surgery is common. ⋯ With the use of the indwelling antegrade continence enema catheter, appendicostomy and cecostomy stenosis requiring revisional surgery was avoided. Antegrade colonic irrigation failed in about one-third of cases; in the 65% who continued to irrigate, satisfactory functional outcome was achieved.
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A positive circumferential resection margin has been associated with a high risk of local recurrence and a decrease in survival in patients who have rectal cancer. ⋯ Circumferential resection margin is an important measurement in rectal cancer pathology, but the correlation to local recurrence is much less than previously stated, probably because of oncological treatment and surgery that respects the mesorectal fascia and, when required, en bloc resections. Circumferential resection margin should not be used as a prognostic marker in the modern multidisciplinary management of rectal cancer.