Iranian Journal of Colorectal Research
Volume:12 Issue: 1, Mar 2024

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical procedure performed on patients with ulcerative colitis (UC) to avoid the need for permanent stoma. The objective of this study was to assess the quality of life and fecal incontinence in UC patients after IPAA and compare the quality of life among different subgroups.

This cross-sectional study included all UC patients who had underwent IPAA between 2017 and 2021 at Shahid Faghihi Hospital, Iran. Data were collected from medical records and through direct contact with the patients. Fecal incontinence was evaluated using Wexner questionnaire, while quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Patients were categorized into groups based on the severity of their fecal incontinence, classified as no/mild (0-4) or moderate to severe (≥5), according to their Wexner scores.

A total of 138 patients completed the Wexner questionnaire, and 119 completed the IBDQ questionnaire. The mean age of participants at the time of questionnaire completion was 43.39 years (±11.16). Among the included patients, 19% experienced moderate to severe fecal incontinence. These patients had lower scores across all domains and the total score of IBDQ compared to patients with no/mild fecal incontinence. Additionally, those who underwent IPAA more than four years ago had significantly lower scores in the social function domain (P-value=0.047) and total score of IBDQ (P-value=0.027).

Patients with fecal incontinence and those who have undergone IPAA for a longer duration have better quality of life scores.

ObjectiveMinimally invasive treatment approaches for pilonidal disease have been described as controlled tissue damage of the sinus cavity via chemical agents or lasers. Although silver is a widely used chemical for healing wounds, there are limited studies about pilonidal disease management. The aim of this study was to evaluate the efficacy of silver nitrate on pilonidal disease.Patients and MethodsPatients who were diagnosed with pilonidal disease were treated with silver nitrate application. Silver nitrate was applied in the sinus tract following the excision of the sinus orifice with a small incision and debridement of the sinus cavity. Silver nitrate sticks were used to obtain controlled damage in the tissue of the sinus cavity for three sessions on the 0, 1st, and 7th days.ResultsForty-two patients with pilonidal disease were included in this study, and silver nitrate treatment was applied in our institute. The median age of the patients was 24 (16-56), and all of the treatment procedures were applied in the operating room. Thirthy-one of the patients (78.6%) was accepted as treated at the end of the 12-month follow-up duration.ConclusionsSilver nitrate treatment is a simple, safe, and inexpensive minimally invasive treatment technique for pilonidal disease. This treatment can be an alternative treatment choice to other minimally invasive techniques. It is easy to perform in outpatient clinics, and the results of this study might be promising.

Anastomotic leakage (AL) is the main complication of colorectal surgeries. Recent studies haveassessed the effects of the ghost ileostomy on preventing complications related to a defunctioning stoma (DS)in high-risk anastomoses. In this study, we aimed to review patients who underwent ghost ileostomy and assesstheir colon leakage score (CLS) and Dutch leakage score (DULK) to evaluate their preoperative AL risk andpost-operative AL diagnostic score, respectively. We examined whether the suggested cut-off points of thesescores (>11 for CLS and >4 for DULK) could be appropriate criteria for determining when to insert ghostileostomy and when to convert it to a DS.

All patients from three referral hospitals in Shiraz, Iran who underwent colorectal surgery withghost ileostomy during 2019-2020 were enrolled in this retrospective case series. We calculated preoperativeCLS and post-operative DULK scores for all patients and assessed what diagnostic and therapeutic measureswere performed for them based on their scores.

AL was diagnosed in two of 34 patients. Eight patients had a total CLS score of 11 and above, butonly one of them experienced AL. The other case of AL had a CLS score of 10. The DULK score of these twopatients increased during hospitalization.

Because of the importance of accurately identifying high-risk patients for ghost ileostomy, itis imperative to undertake additional research aimed at determining the optimal cut-off value for CLS ordevising alternative valid scoring systems. DULK score could be an appropriate post-operative monitoring toolto reduce morbidity.

Context:

 The inclusion of minimally invasive techniques to colorectal surgery brought many advantages to patient’s recovery. However, conventional techniques for laparoscopic-assisted colectomy (LAC) still require a small abdominal incision for specimen extraction.

Evidence acquisition: 

The present manuscript aimed to review the technical details, results and advantages of colorectal resections using different approaches to extract the resected specimen, including the abdominal wall, the vagina or the rectum. In order to analyse this data, we searched the literature for recent and important results concerning the use of different approaches to extract the specimen in minimally invasive colorectal procedures.

Besides the proved feasibility and safety associated with the Natural Orifice Specimen Extraction Surgery (NOSES) in colorectal surgery, there remain some unresolved issues to be unified and standardized. These issues are mainly represented by surgical technique and indications. Morbidity is not a common problem, although potentially there may be complications to affect quality of life.

So far, the most important indication remains the management of intestinal endometriosis, as it is not a malignant disease and the specimen is not too large. Nevertheless, surgical experience and appropriate counselling are fundamental requirements when dealing with cancer patients. Eventual complications should be discussed with patients

The management of extensive perineal defects resulting from aggressive tumor resections, such as abdominoperineal resections for advanced pelvic malignancies, can be a complex and demanding process in the treatment journey. The primary options for reconstructing perineal defects are vertical rectus abdominis myocutaneous (VRAM) and anterolateral thigh (ALT) flaps. While both flaps are commonly used in reconstructive surgery, VRAM is often preferred due to several advantages. These include the ability to provide ample tissue to fill large perineal defects, as well as the convenience of harvesting this type of flap through a midline incision. This approach allows for a more cosmetically favorable scar location compared to other techniques. Overall, VRAM is a superior choice for perineal reconstruction due to its versatility and effectiveness in addressing complex defects. In this article, we describe our experience with utilizing a vertical rectus abdominis myocutaneous flap to close a 20 x 10 cm perineal defect that arose after an abdominoperineal resection performed due to extensive rectal melanoma in a 46-year-old male. We found that the vertical rectus abdominis myocutaneous flap was an exceptional choice for covering this substantial defect in our case.

Cystic echinococcosis (CE) is a parasitic disease caused by the larval stages of taeniid cestodes of the genus Echinococcus which is considered a neglected disease of public health worldwide. CE primarily affects the liver and demonstrates distinctive radiological findings in computed tomography and ultrasonography. Surgery is considered the mainstay of CE treatment.

The patient was a 17-year-old man who was admitted to the Emergency Department of Shahid Faghihi Hospital affiliated with the Shiraz University of Medical Science with dull right upper quadrant abdominal pain, loss of appetite, abdominal distention, and fullness. Abdominal computed tomography (CT) scan revealed a giant hepatic cyst measuring about 24 × 20 × 15 cm in the RHL with a pressure effect on the right kidney, pancreas, and bowel loops and another smaller one measuring 9× 8 × 8 cm in the left liver lobe. Semi-chevron incision was done and the patient underwent partial precystectomy with capitonnage and omentoplasty. Our case was the 5th rank according to the size of the recorded published cases in the literature.

When dealing with a huge liver cyst, a high index of suspicion for echinococcal etiology becomes important in endemic areas like Iran. The choice of treatment for giant hepatic cysts substantially seems to be radical surgery by surgical ablation in general to mitigate the mortality and morbidity rate, because they are at risk of rupture, anaphylaxis, and so forth.