搜索结果：Diseases of the colon and rectum

Robotic-assisted colorectal surgery has matured over the past two decades, driven predominantly by the well-known robotic technology developed in the United States. New evidence also demonstrates improved postoperative recovery, lower conversion rates, and improved oncological resection margins over laparoscopy. However, high acquisition and maintenance costs and a bulky infrastructure have limited global adoption. The recent expiry of a significant number of core foundational intellectual property patents related to USA technology marked a pivotal shift especially in 2019 and reduced barriers of entry for competitors. A Japanese robotic surgical platform was developed domestically in 2020 and received regulatory approval for use in colectomy in 2022. Its similar user interface and structural design to the USA system, comprising an operation unit with 4 integrated operation arms, a surgeon cockpit, and a vision unit allows for easy adaptability and a short learning curve for experienced users of USA robotic system. Its compact profile, unique ergonomic and cost-related advantages may broaden global access to robotic-assisted minimally invasive surgery. Besides its user interface and structural design being comparable to the USA robotic system, unique distinguishing features include a more compact overall system, flexible 3-dimensional viewer, robotic arms with joy stick-type 8 axes of motion and 520 o instrument tip rotation, and an adjustable arm base angle allowing for more arm motion flexibility. Slimmer arm profiles and a docking-free design where the "pivot" position is set by a software removes the need for docking the arm to the trocar, allowing for more working space around the port sites. These features reduce arm interference and make external manipulation easier. Other differences from the USA robotic technology include the absence of integrated indocyanine green fluorescence capability, integrated table motion, and dual-console functionality; it also lacks advanced energy devices and linear staplers. The Japanese Surgical Robot System obtained approval for use in colorectal cancer surgery in Singapore in October 2024. Two minimally invasive colorectal surgeries that were performed with the system are presented. In the first, a 70-year-old man with sigmoid cancer underwent a robotic-assisted anterior resection. Indocyanine-green overlay was utilized. Tumor pathology was pT3N0 stage with clear margins. In the second, a 75-year-old lady woman with rectal prolapse underwent a robotic-assisted ventral mesh rectopexy with Permacol mesh. In both cases, there were no intraoperative complications and the patients were discharged well. The usage of robot-assisted colorectal surgery with the Japanese Surgical Robot System has expanded across Japan in the last 3 years with clinical results now published demonstrating its safety and feasibility with similar short-term outcomes to the USA system. Its superior ergonomics as a robotic-platform over laparoscopy and cost-related advantages suggest potential to broaden access. Long-term follow up of results and a focus on expanding the system's instrument portfolio including integrated advanced energy devices and staplers will be useful for colorectal surgery. See New Technology video.

Large-scale evidence on the role of endoscopy alone as the assessment tool to identify complete response after neoadjuvant therapy in locally advanced rectal cancer, particularly across different neoadjuvant therapy regimens, is scarce. This study aims to evaluate the diagnostic accuracy of endoscopy for predicting luminal complete response after neoadjuvant therapy and compare its performance between patients receiving neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy. Retrospective cohort study. The study was conducted at a teaching hospital. A total of 349 locally advanced rectal cancer patients (223 neoadjuvant chemotherapy, 126 neoadjuvant chemoradiotherapy) who underwent neoadjuvant therapy and restaging endoscopy were included. Three reviewers assessed endoscopic images independently to determine the occurrence of endoscopic complete response. The diagnostic accuracy for predicting pathological luminal complete response (ypT0) was calculated. The overall accuracy of endoscopy for predicting complete response was 92.0% (321/349), with a positive predictive value of 69.6%, sensitivity of 69.6% and specificity of 95.4%. A flat scar was the most predictive feature (positive predictive value = 70.3%). The sensitivity of endoscopic performance was significantly higher in the neoadjuvant chemoradiotherapy group compared to the neoadjuvant chemotherapy group (90.0% vs. 53.8%, p = 0.008), despite comparable overall accuracy and area under the curve. The addition of biopsy did not significantly improve diagnostic ability. Inter-reviewer agreement was substantial to excellent (κ=0.754-0.883). No video or artificial intelligence was involved. Endoscopy is an optional tool for identifying luminal complete response after neoadjuvant therapy. Its sensitivity is lower after neoadjuvant chemotherapy than after neoadjuvant chemoradiotherapy, warranting caution against missed diagnoses. Beyond the flat scar, other features like small flat ulcers also have a non-negligible complete response rate. The role of routine biopsy still needs further exploration. See Video Abstract.

Patients with early-onset colorectal cancer (age < 50) are vulnerable to unique psychosocial consequences given their developmental stage in life. Younger adults are often establishing their careers and families, and a cancer diagnosis can contribute to financial and professional instability. However, the lived experiences of patients with early-onset colorectal cancer have largely been underexplored. To characterize the financial and professional experiences of patients with early-onset colorectal cancer. Semistructured interviews with patients with early-onset colorectal cancer. Multicenter study across 7 academic medical centers. Patients diagnosed with colon or rectal cancer before aged 50years. Thematic analysis of financial and professional impacts from early-onset colorectal cancer. Exploration of risk factors and drivers of these effects. Participants described a range of lasting impacts related to professional and financial impacts following early-onset colorectal cancer, from minimal to severe. Financial impacts included treatment costs, indirect expenses, income loss, reduced assets, and debt. Professional impacts included physical, cognitive, psychologic challenges, and career disruptions. Certain protective factors like supportive work environments or good insurance appeared to mitigate the severity the impacts experienced. Limitations include recall, negativity, and survivorship biases. Survivors of early-onset colorectal cancer face persistent financial and professional effects. Many younger adults have variable access to paid leave and public assistance programs, exacerbating the strain of early-onset colorectal cancer. Protective factors, such as a supportive workplace, access to paid time off, and flexible accommodations, must be strengthened and expanded to better care for the growing population of younger adult cancer survivors. See Video Abstract.

Patients, randomized to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed-up at 5 years after surgery. The aim of this study was to compare the long-term results of laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy. A follow-up of randomized, parallel-group, double-blinded, single-center prospective study. From April 2016 to April 2017, a total of 121 patients were included in the study. Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery were interviewed via telephone or online questionnaire. Recurrence of symptoms was the primary outcome; patients' quality of life, fecal incontinence, and patients' evaluation of treatment were secondary outcomes. A total of 102 patients were evaluated at 5 years (34 per group). Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076). While recurrence-free probability was numerically higher in the excisional hemorrhoidectomy and laser hemorrhoidoplasty groups, the timing of events varied across cohorts. Specific recurrences included bleeding in 18% (excisional hemorrhoidectomy), 31% (sutured mucopexy), and 31% (laser hemorrhoidoplasty), and prolapse in 12% (excisional hemorrhoidectomy), 23% (laser hemorrhoidoplasty), and 34% (sutured mucopexy). General health evaluation scores were highest in the laser hemorrhoidoplasty group. Mixed-effect model for repeated measures analysis showed a continued trend of physical and social activity improvement between 1 and 5 years across all groups (p = 0.021). Decision regret was lowest in the sutured mucopexy group (mean score 1.33). This is a single-center study, with relatively small sample size. Patients after excisional hemorrhoidectomy report best outcomes, however laser hemorrhoidoplasty produces only slightly worse results with significantly shorter and less painful postoperative course. See Video Abstract.

Colorectal peritoneal metastases occur in approximately 13% of colorectal cancer cases. median survival with systemic chemotherapy alone is 10 to 18 months. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy can extend survival to approximately 41 months, but judicious patient selection is crucial. To describe outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases patients according to tumor mutational profile (variants BRAF V600E, KRAS G12V and KRAS G12D). A retrospective cohort analysis of colorectal peritoneal metastases patients who underwent this procedure between 2012 and 2024. The study was conducted at Peter MacCallum Cancer Centre, the state-wide peritoneal malignancy center for Victoria and Tasmania, Australia. A total of 256 patients were included, and iterative procedures were excluded. Overall survival and disease-free survival according to molecular stratification were the primary outcomes. Secondary outcomes included length of stay, 90-day morbidity and mortality. The median peritoneal cancer index score was 9 (range, 0 to 39). Median overall survival and disease-free survival for patients with complete cytoreductive clearance (204/256) was 43 and 10 months, respectively. KRAS G12V variant was associated with inferior overall survival relative to the RAS/RAF-wildtype group (median 34 months, p = 0.04). BRAF V600E was associated with inferior disease-free survival relative to the RAS/RAF-wildtype group (median 9 months, p = 0.02). KRAS G12V mutation (p = 0.008) was an independent prognostic factor for poorer overall survival, and BRAF V600E (p = 0.01) was an independent prognostic factor for worse disease-free survival on multivariate analysis. Overall, anastomotic leak occurred in 3.9%, return to theater in 6.3%, and perioperative mortality in 1.2%. This study is limited by its retrospective design and single-center setting. BRAF V600E and KRAS G12V mutations confer poorer disease outcomes in these patients. KRAS G12D mutation appears prognostically neutral. Molecular features alongside clinical and pathological factors should guide patient selection to optimize outcomes. See Video Abstract.

Current guidelines recommend the examination of a minimum of 12 lymph nodes following rectal cancer resection. However, neoadjuvant therapy is associated with reduced yield, questioning the significance of suboptimal nodal count in the era of total neoadjuvant therapy. To evaluate factors associated with inadequate lymph node count and its impact on survival. Retrospective cohort study. The National Cancer Database. Adult patients with single primary Stage II to III rectal adenocarcinoma undergoing oncological resection (2006 to 21). Patients were categorized into 6 treatment groups: mesorectal excision alone, neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy with short-course radiation, neoadjuvant chemoradiotherapy with long-course radiation, total neoadjuvant therapy with short-course radiation, and total neoadjuvant therapy with long-course radiation. The primary outcome was inadequate lymph node harvest. Secondary outcome was overall survival. Of the 44,847 patients, inadequate lymph node harvest occurred in 23%. On multivariable analysis, inadequate lymph node harvest was associated with treatment at community or integrated hospitals, public insurance, lower income area, clinical Stage II disease, poor treatment response, and abdominoperineal resection. Compared with mesorectal excision alone, total neoadjuvant therapy with long-course radiation demonstrated the highest odds of inadequate lymph node harvest (OR 3.94), followed by neoadjuvant chemoradiation with long-course radiation (OR 3.46). Short-course radiation regimens were associated with lower but still increased odds of inadequate lymph node harvest. In the adjusted survival model, inadequate nodal retrieval was independently associated with worse overall survival (hazard ratios 1.19). Retrospective design and lack of granular clinical details. Inadequate lymph node harvest occurred in nearly one-quarter of rectal cancer resections and was associated with patients undergoing long-course radiation-based therapy. Despite treatment-related reduction in lymph node yield, an inadequate count was independently associated with worse prognosis, suggesting that nodal count continues to be a relevant metric in rectal cancer. See Video Abstract.

Primary tumor resection with simultaneous para-aortic lymph node dissection has curative potential in selected patients with isolated infrarenal para-aortic lymph node metastasis secondary to colorectal cancer. However, para-aortic lymph node dissection is technically challenging, and en bloc resection is difficult. Traditional piecemeal removal may increase the risk of missing lymphatic tissue and contribute to local recurrence. A modified "lawn-mowing" technique is introduced for en bloc para-aortic lymph node dissection that simplifies this complex procedure. By initially identifying anatomical boundaries and then systematically removing lymph nodes in a sequential "lawn-mowing" manner, this approach maximizes lymphatic clearance and facilitates appropriate vessel ligation, potentially reducing recurrence and complications. There are 2 steps in the technique: 1) identification of boundaries: establishing the left (left ureter, gonadal vessels, and psoas), distal (left common iliac vein level), right (right ureter, gonadal vessels, and psoas), and proximal (left renal vein) boundaries; and 2) en bloc resection: sequential dissection from distal to proximal and right to left in a "lawn-mowing" pattern, collecting all para-aortic lymph nodes up to the left renal vein and ligating the main lymphatic vessels, superior and inferior to the left renal artery. Key considerations include preserving the sympathetic ganglia and avoiding injury to hemorrhage-prone veins. Successful en bloc para-aortic lymph node resection was achieved in a 26-year-old woman with sigmoid colon cancer and para-aortic metastasis. Surgery last 380 minutes and resulted in approximately 100&#x2009;mL of blood loss. The patient was discharged without complications. Histopathological examination revealed 2 of 23 positive para-aortic lymph nodes. At the 9-month follow-up, there was no recurrence or formation of lymphocysts. En bloc para-aortic lymph node resection using the "lawn-mowing" technique, after identification of boundaries, is feasible and reproducible. This simplified approach reduces the risk of lymphatic residue. Further evaluation in a larger series is required to assess oncological and functional outcomes. See New Technology Report Video.

The metabolic consequences of colon cancer surgery may vary by anatomic resection site, but direct comparisons of right- versus left-sided colectomy are limited. To compare the incidence of new-onset diabetes mellitus, hypertension, and dyslipidemia after right- versus left-sided colectomy for colon cancer. Retrospective population-based cohort study. Nationwide data from the Korean Clinical Data Utilization for Research Excellence project, linking cancer registry, insurance claims, and health screening databases. Adults aged 30 years or older with histologically confirmed colon cancer who underwent colectomy between January 1, 2013, and December 31, 2019. New-onset diabetes mellitus, hypertension, and dyslipidemia occurring after colectomy. Hazard ratios were estimated with Cox models adjusted for demographics, lifestyle factors, body mass index, waist circumference, Surveillance, Epidemiology, and End Results summary stage, and treatment; Fine-Gray subdistribution models accounted for the competing risk of death. Inverse probability of treatment weighting (IPTW) was used to address residual confounding. Among 8,228 patients (mean [standard deviation] age, 58.8 [11.4] years; 4,633 [56.3%] male), 3,253 underwent right-sided and 4,975 underwent left-sided colectomy. During a median follow-up of 4.0 years (interquartile range, 2.5-5.8), 358 patients (4.4%) developed diabetes mellitus, 1,050 (12.8%) developed hypertension, and 1,167 (14.2%) developed dyslipidemia. Right-sided colectomy was associated with a 20% lower risk of incident dyslipidemia compared with left-sided colectomy (adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.91; p = 0.005), with no significant differences for diabetes or hypertension. Observational design using administrative data limits causal inference; direct measurements of bile acids, microbiome composition, or inflammatory markers were unavailable; results from a Korean population may not be generalizable to other ethnic groups. The anatomic laterality of colectomy was differentially associated with metabolic outcomes; right-sided resection was associated with a lower risk of incident dyslipidemia. These findings suggest that surgical laterality may inform postoperative metabolic risk stratification and support incorporating routine lipid monitoring into post-colectomy survivorship care. See Video Abstract.

Neurogenic bowel dysfunction is highly prevalent after spinal cord injury and significantly affects quality of life. The pathophysiology in motor-incomplete spinal cord injury remains poorly characterized, despite the availability of physiological tests, such as high-resolution anorectal manometry and colonic transit time. To characterize clinical presentation, high-resolution anorectal manometry findings and colonic transit time in motor-incomplete spinal cord injury, and to compare patients with neurological level &#x2265; T6 versus < T6. Prospective cross-sectional study. Specialized neurorehabilitation center. Fifty-eight consecutively recruited patients with motor-incomplete spinal cord injury (72.4% men; mean age, 51.3 &#xb1; 16.3 years) were included. traumatic etiology was present in 39.7% of cases, with a mean time since injury of 3.9 &#xb1; 1.3 months. A neurological level &#x2265; T6 was observed in 58.6%. Clinical bowel characteristics, colonic transit time measurement and high-resolution anorectal manometry (International Anorectal Physiology Working Group Protocol, London Classification), and their associations. Eighty-one percent of patients had fecal incontinence, constipation, or both. prolonged colonic transit time was observed in 50%, without clear correlation with symptoms. high-resolution anorectal manometry showed a preserved rectoanal inhibitory reflex in all cases. According to the london classification, the most common abnormalities were anal hypocontractility, with or without anal hypotension (63.8%), rectoanal coordination disorders (56.9%) and rectal hyposensitivity (60.3%). No consistent associations were found between physiological findings, symptoms and neurological characteristics. Treatment during assessment, limited normative high resolution anorectal manometry data, small subgroups, and lack of a control group. Neurogenic bowel dysfunction in motor-incomplete spinal cord injury shows substantial pathophysiological heterogeneity, frequently combining anorectal dysfunction and delayed colonic transit time. This may explain the limited ability of symptoms and neurological characteristics to identify underlying mechanisms and supports systematic physiological testing to guide mechanism-oriented management. See Video Abstract.

Surgical management of Crohn's disease of the colon and rectum frequently requires total proctocolectomy with end ileostomy. There is limited data on the need for Crohn's disease-directed therapy and the prevalence of recurrence after surgery. To determine the risk of small bowel Crohn's disease recurrence and evaluate risk factors for postoperative recurrence after total proctocolectomy with end ileostomy. Retrospective cohort study. Multistate tertiary healthcare system. Adult patients with Crohn's disease undergoing total proctocolectomy with end ileostomy between 2014-2023. The primary outcome was small bowel Crohn's disease recurrence. A total of 193 patients with a median age of 45 years (IQR, 34-61) were included. Over half of the patients (n = 102, 52.9%) had a history of small bowel Crohn's disease and the majority (n = 134, 69.4%) received biologic therapy prior to surgery. The median follow-up time was 4.8 years (IQR, 2.0-7.6). Postoperatively, 30.6% of patients (n = 59) received biologic therapy. Thirty-five patients (18.1%) had small bowel Crohn's disease recurrence for an estimated 5-year recurrence-free rate of 80.2% (95% CI, 73.0-85.7). Seven patients (3.6%) developed small bowel Crohn's disease recurrence requiring surgery for an estimated 5-year surgical recurrence-free rate of 94.7% (95% CI, 89.0-97.5). On multivariable analysis, history of small bowel Crohn's disease (HR 2.17; 95% CI' 1.04-4.54) and diagnosis at age <18 years (HR 2.31; 95% CI'1.1-4.86) were associated with small bowel Crohn's disease recurrence. Retrospective design and non-standardized follow-up. Patients undergoing total proctocolectomy with end ileostomy for Crohn's disease have approximately a 20% risk of small bowel recurrence at 5 years but a low risk of requiring surgical intervention. Patients with a history of small bowel Crohn's disease and younger age at diagnosis have a higher risk of recurrence and may warrant consideration of more frequent surveillance and medical prophylaxis. See Video Abstract.

Ileal pouch anal anastomosis can be performed via 2- and 3-stage techniques, with similar short- and long-term clinical outcomes. 2-stage ileal pouch anal anastomosis became the predominant approach in the 2000s; whether this trend has continued remains unknown. To compare trends in the utilization of 3-stage, traditional 2-stage, and modified 2-stage IPAA for ulcerative colitis as well as markers of disease severity over time. Retrospective cohort. Privately insured patients from an administrative database. Non-elderly adults with a diagnosis of ulcerative colitis who underwent ileal pouch anal anastomosis between 2007 and 2023 and remained enrolled in their insurance plan for &#x2265; 6 months after surgery. Proportion of patients undergoing 3-stage, traditional 2-stage, and modified 2-stage ileal pouch anal anastomosis; annualized change in disease severity at the time of ileal pouch anal anastomosis creation. Four thousand thirty-nine patients underwent IPAA during the study period (2,179 traditional 2-stage; 1,107 3-stage; and 753 modified 2-stage). The proportion of patients undergoing a traditional 2-stage IPAAs decreased steadily (1.3% points per year [95% CI -1.7 to -0.9]) with a commensurate rise in both 3-stage (0.3% points per year [95% CI -0.02-0.7]) and modified 2-stage operations (0.9% points per year [95% CI 0.6-1.2]). Patients undergoing 3-stage or modified 2-stage IPAA had a more rapid increase in exposure to advanced therapies in the year before surgery (+ 2.9 vs + 2.0% points). Limitations: potential misclassification, generalizability. More patients are undergoing 3-stage and modified 2-stage operations than traditional 2-stage ileal pouch anal anastomosis. This shift parallels an increase in multiple markers of disease severity at IPAA creation, especially exposure to advanced therapies. See Video Abstract.

The colostomy site provides natural access for a single-port Hartmann reversal, making it an ideal scar-sparing procedure. Although single-incision laparoscopic surgery for this purpose is technically challenging, the da Vinci SP robotic platform may overcome single-incision laparoscopic surgery limitations: its wristed instruments and 3-dimesional visualization could enhance the feasibility of a full single-port approach. The robotic single-port approach for Hartmann reversal retains all the advantages of a single-port access through the stoma site while overcoming the technical limitations of single-incision laparoscopic surgery. The single-port approach minimizes tissue trauma, facilitates access to the left hemiabdomen, and restricts adhesiolysis to targeted areas only. A peristomal incision was made to mobilize the colonic stump. After placing the anvil of a 31-mm circular stapler, the single-port robot was docked. Mobilization of the descending colon, splenic flexure, and rectal stump was performed to achieve a tension-free anastomosis. This report details 5 patients (3 women, 2 men), with a mean age of 57 years (range 46-70) and a mean BMI of 28.8 (range 16-44). The mean operating time was 199 minutes (range 140-290). The operations were completed without additional port placement. No intraoperative or major postoperative complications occurred. The mean hospital stay was 4 days (3-8). A fully robotic single-port Hartmann reversal is a feasible and safe option for bowel continuity restoration. This approach minimizes adhesiolysis, reducing tissue trauma and enteric injury risk. The single-port robotic platform enhances visualization and instrument control, overcoming the ergonomic and technical limitations of single-incision laparoscopic surgery. Future integration of advanced devices into the robotic single-port system will likely broaden its use in complex colorectal reconstructions. See New Technology Video.

There is a paucity of knowledge regarding the presentation, surgical management, and short-term outcomes of rectal prolapse in the non-elective setting. The objectives of this study were to evaluate the short-term postoperative outcomes following non-elective surgery for rectal prolapse and to compare those outcomes to patients who underwent elective repair. Retrospective cohort study. Multicenter North American database. Adult (18 years-old or above) who underwent surgery for rectal prolapse. Non-elective surgery (vs. elective surgery). Co-primary outcomes included 30-day postoperative morbidity, mortality, re-operation, and unplanned hospital readmission. In total, 17,836 patients underwent surgery for rectal prolapse and were followed for 30 days postoperatively: 1,636 (9.2%) non-elective and 16,200 (90.8%) elective. Patients who underwent non-elective surgery were older (age 85+: 29.5% vs. 13.9%, p < 0.001), more likely to be functionally dependent (16.8% vs. 6.3%, p < 0.001), and were more likely to undergo a perineal approach (59.7% vs. 40.7%, p < 0.001). On multiple logistic regression, non-elective surgery was independently associated with 30-day postoperative morbidity (aOR: 2.16, 95% CI 1.87-2.48), mortality (aOR: 2.97, 95% CI: 2.10-4.14), re-operation (aOR: 1.89, 95% CI: 1.49-2.39) and unplanned hospital readmission (aOR: 1.87, 95% CI: 1.57-2.20). Furthermore, when stratified by surgical approach (perineal vs. abdominal), non-elective surgery remained associated with a similar increase in postoperative risk across all outcomes. Among 1,636 non-elective cases, 237 (14.5% of non-elective cases) underwent emergent surgery and 1,399 (85.5% of non-elective cases) underwent non-emergent (or urgent) surgery. As compared to non-emergent surgery, emergent surgery for rectal prolapse was associated with an incrementally higher risk of 30-day postoperative morbidity (25.7% vs. 19.6%, p = 0.030) and mortality (6.3% vs. 3.3%, p = 0.022). No data on previous repairs and/or hospital visits related to rectal prolapse. Non-elective rectal prolapse surgery was associated with significantly worse 30-day postoperative outcomes as compared to elective repair. See Video Abstract .

Surgeons and ostomy nurses receive a high volume of stoma photos from patients. This study aimed to develop and validate an automated and scalable artificial intelligence pipeline for identification and triage of patient-submitted intestinal ostomy photos. Retrospective derivation and validation study with stakeholder engagement to guide model design. Clinical teams reviewed photos in duplicate and categorized them into: (a) obstructed view, (b) healthy stoma, (c) suitable for conservative management, or (d) requiring in-person review. Pre-trained neural networks including MobileNetV4, ResNet50, ViT and CLIP-ViT were fine-tuned with 5-fold cross-validation. Nine Mayo Clinic hospitals (2019-2022). Adult patients (&#x2265;18 years) undergoing surgery who submitted images within 30 days after surgery. Model performance was evaluated with area under the receiver operator curve, precision, recall, and F1-scores. In this study, 538 photos of abdominal ostomies were sent in by 191 patients (median age 52 years, IQR 40-63; 60.4% female). Expert consensus triaged 236 (43.9%) photos as having an obstructed view, 30 (5.6%) as healthy, 177 (32.9%) for conservative management, and 95 (17.7%) for in-person review. All models achieved area under the receiver operator curve >0.97 for identifying stomas. The CLIP-ViT model performed best at triage (macro- area under the receiver operator curve 0.94 &#xb1; 0.06; F1 0.77 &#xb1; 0.10). End-to-end detection and triage using CLIP-ViT achieved area under the receiver operator curve of 0.99 &#xb1; 0.01, precision of 0.87 &#xb1; 0.08, recall of 0.93 &#xb1; 0.04, and F1 of 0.89 &#xb1; 0.07. Attention maps showed that models focused on stomas to determine classification. Low sample size and lack of prospective validation. A vision language model pipeline accurately detected and triaged patient-submitted ostomy photos. Prospective evaluation is now needed to support integration into multidisciplinary digital workflows. See Video Abstract.

Sexual dysfunction is common following pelvic pouch surgery for ulcerative colitis. Despite this, little work has been done to explore the degree of sexual distress this causes in patients. To determine the proportion of patients with ulcerative colitis who experience sexual distress following pelvic pouch surgery and to explore the effects of social demographics, age, bowel function, anxiety, and depression on sexual distress. A cross-sectional survey that was emailed to patients. A large tertiary care teaching hospital. Patients who underwent pelvic pouch surgery for ulcerative colitis from 1980-2022. Validated questionnaires included the 13-item Sexual Distress Scale, Hospital Anxiety and Depression Scale, and Colorectal Functional Outcome questionnaire. The primary outcome was the proportion of patients meeting established thresholds for sexual distress. Multivariable regression was used to evaluate associations between sexual distress and operative factors, age, sex, income, education, ethnicity, sexual orientation, and relationship status. Of 1830 eligible patients, 497 responded and were included in the analysis. Overall, 194 patients (39%) screened positive for sexual distress. Women were disproportionately affected, with more than half reporting clinically significant distress (141/243, 57.8%). Female gender was the only independent preoperative predictor of sexual distress on multivariable analysis (odds ratio = 4.796, 95% CI: 3.119, 7.374, p < 0.001). Poor bowel function, anxiety, and depression were all significantly more prevalent among patients with sexual distress (all p < 0.001). Cross-sectional design limits causal inference. Selection and response bias are possible. Sexual distress is common following pelvic pouch surgery for ulcerative colitis, particularly among women, and is strongly associated with bowel dysfunction, anxiety, and depression. These findings highlight the importance of holistic pre- and postoperative counselling and consideration of psychological screening in follow-up care. Further research is needed to elucidate underlying mechanisms and develop targeted interventions. See Video.

The recent advent of the Kono-S anastomosis has raised the question of the impact of anastomotic configuration on recurrence following ileocecectomy for Crohn's disease. Determining if there is a superior configuration is an opportunity for improvement in optimization in surgical care for Crohn's disease patients. At the University of Chicago, we perform a variety of anastomotic configurations, including side-to-side, end-to-end, end-to-side, side-to-end and Kono-S. Determine if there is a difference in recurrence between anastomotic configurations following ileocecectomy for Crohn's disease at a high volume IBD center. Retrospective chart review. The University of Chicago Medical Center. Two hundred thirty-nine patients who underwent ileocecectomy for Crohn's disease from January 1, 2018, through December 31, 2022. Endoscopic recurrence rate for each anastomotic configuration. 239 patients with Crohn's disease who underwent ileocecectomy were included. The anastomotic configurations were similar in terms of patient characteristics. The end-to-side anastomoses were associated with lower blood loss and shorter OR times. On multivariable analysis, elective surgery and end-to-side anastomotic configuration were associated with lower recurrence of Crohn's disease at an average follow-up of 32 months. Study is retrospective in nature and conducted at a single institution. End-to-side anastomosis configuration is a safe, technically easy to perform reconstruction method that may reduce the rate of disease recurrence. See Video Abstract.

Perineal complications are a major source of morbidity following extralevator abdominoperineal resection for low rectal cancer, especially after neoadjuvant (chemo)radiotherapy. Biological mesh reconstruction can reduce perineal hernia formation, but its cost-effectiveness remains unclear. To evaluate the cost-effectiveness of biological mesh reconstruction compared with primary perineal closure following extralevator abdominoperineal resection in patients with low rectal cancer. Long-term economic evaluation conducted alongside a multicenter, parallel-group, randomized controlled trial. Eleven hospitals in the Netherlands and one hospital in the United Kingdom, including non-teaching, teaching, and university centers. Adult patients with primary low rectal cancer. Primary layered perineal closure versus pelvic floor reconstruction using a biological, non-cross-linked porcine dermal mesh. Total healthcare costs from a healthcare payer perspective, incorporating surgery, hospitalization, outpatient care, wound management, readmissions, and reinterventions; and patient health outcomes measured as quality-adjusted life years calculated from standardized health utility scores. Of 104 randomized patients, 101 were included in the final analysis (53 primary closure, 48 biological mesh). Mean total healthcare costs were higher in the mesh group (&#x20ac;57,991 vs &#x20ac;56,232; mean difference &#x20ac;1,571; 95% CI: -&#x20ac;9,840 to &#x20ac;12,981; p = 0.785). Perineal complications significantly reduced quality of life, but wound complication rates and quality of life gains were modest for mesh, with no significant differences between groups over time. The study sample size limited precision in cost and subgroup estimates. Biological mesh reconstruction increases procedural and hospitalization costs without improving long-term patient outcomes. Routine use cannot be recommended from a cost-effectiveness perspective. (See Video Abstract).

The incidence of rectal adenocarcinoma is rising in patients < 50 years old compared to those > 50. Nonoperative management and active surveillance have become a standard of care in rectal cancer treatment for those who achieve a complete response to neoadjuvant therapy; however, the use, safety and efficacy of this approach in different age groups has not been well described. Examine oncological outcomes in patients with rectal adenocarcinoma managed by nonoperative management according to patient age. Retrospective cohort study. Comprehensive cancer center in New York. Patients with rectal adenocarcinoma diagnosed between January 2006 and December 2020. Local regrowth, recurrence-free survival, distant metastasis-free survival, overall survival rates. A cohort of 430 patients with rectal adenocarcinoma who were treated with neoadjuvant therapy and entered watch-and-wait were included. Patients were divided into 3 groups according to age at diagnosis: early-onset (age < 50, n = 98), middle-aged (50-64, n = 163), and late-onset (65+, n = 169). No differences were noted in tumor distance from the anal verge (p = 0.345) between groups. More patients in the early-onset cohort received induction chemotherapy with chemoradiation than late-onset patients, who more often received chemoradiation alone and had clinical stage I disease (p = 0.015). Median follow-up time was 4.0years (IQR 2.6-5.5). The 3-year local regrowth rates in each group were 23.8% (95% CI: 15.2-32.4), 33.0% (95% CI: 25.6-40.4), and 26.1% (95% CI: 19.4-32.8) in the early, middle-aged, and late-onset patients, respectively (p = 0.395). No associated differences in 5-year distant metastasis-free or recurrence-free survival rates were noted between the 3 age groups. The early-onset cohort had an associated superior disease-specific survival from the late-onset cohort. Retrospective nature. Early-onset rectal cancer patients have at least similar oncological outcomes compared to those in older age groups when treated non-operatively. These data provide reassurance when offering a watch-and-wait approach to patients with early-onset rectal cancer. See Video Abstract.

Rectal prolapse recurrence after surgical repair remains a major limitation. Prior research surrounding recurrence risk has yielded inconsistent results and assessed a limited range of factors. To evaluate whether preoperative magnetic resonance defecography, anorectal manometry, or balloon expulsion testing could identify biomarkers associated with rectal prolapse recurrence after rectopexy. Retrospective cohort study from a prospectively maintained rectal prolapse registry. Single tertiary institution analysis. A total of 155 patients (145 female patients) underwent rectopexy for prolapse between 2017 and 2025. Clinical, technical, and imaging parameters were compared between patients with and without prolapse recurrence. All procedures were performed robotically and included ventral (n&#x2009;=&#x2009;126; 75%), suture (n&#x2009;=&#x2009;21; 12.5%), and resection rectopexy (n&#x2009;=&#x2009;8; 4.8%). The recurrence rate was 10.3% (n = 16) during a median follow-up of 1295 days. On univariable analysis, the only clinical factor associated with recurrence was diabetes mellitus (recurrence 31.3% vs no recurrence 5.8%, p&#x2009;<&#x2009;0.001). On magnetic resonance defecography (female patients) the presence of a cul-de-sac hernia (recurrence 75% vs no recurrence 42.9%, p&#x2009;=&#x2009;0.015), enterocele (recurrence 43.8% vs no recurrence 16.7%, p&#x2009;=&#x2009;0.018), and the mean cross-sectional area of the psoas muscle (recurrence median 12.3&#x2009;cm2 vs no recurrence median 14.3&#x2009;cm2, p&#x2009;=&#x2009;0.04) were significantly associated with recurrence. This study is limited by its retrospective nature and would benefit from multicenter collaboration to improve statistical power. This study is the first to integrate MRI findings with clinical factors in evaluating recurrence risk. Some measures of low muscle mass (sarcopenia), an enterocele or cul-de-sac hernia, and diabetes mellitus may be associated with recurrence. Diabetic control and sarcopenia are potentially modifiable through lifestyle interventions, highlighting opportunities for preoperative optimization. Larger-scale studies are warranted to validate these predictors and guide risk-stratified management. See Video Abstract. ANTECEDENTES:La recurrencia del prolapso rectal tras la reparaci&#xf3;n quir&#xfa;rgica sigue constituyendo una limitaci&#xf3;n importante. Las investigaciones previas sobre el riesgo de recurrencia han arrojado resultados inconsistentes y han evaluado un rango limitado de factores.OBJETIVO:Evaluar si la defecograf&#xed;a por resonancia magn&#xe9;tica preoperatoria, la manometr&#xed;a anorrectal o la prueba de expulsi&#xf3;n del bal&#xf3;n podr&#xed;an identificar biomarcadores asociados a la recurrencia del prolapso rectal tras la rectopexia.DISE&#xd1;O:Estudio de cohortes retrospectivo a partir de un registro de prolapso rectal mantenido de forma prospectiva.&#xc1;MBITO:An&#xe1;lisis realizado en una &#xfa;nica instituci&#xf3;n de nivel terciario.PACIENTES:Un total de 155 pacientes (145 mujeres) se sometieron a una rectopexia por prolapso entre 2017 y 2025.PRINCIPALES MEDIDAS DE RESULTADO:Se compararon los par&#xe1;metros cl&#xed;nicos, t&#xe9;cnicos y de imagen entre los pacientes con y sin recurrencia del prolapso.RESULTADOS:Todos los procedimientos se realizaron mediante cirug&#xed;a rob&#xf3;tica e incluyeron: rectopexia ventral (n = 126; 75%), con sutura (n = 21; 12,5%) y con resecci&#xf3;n (n = 8; 4,8%). La tasa de recurrencia fue del 10,3% (n = 16) durante un seguimiento mediano de 1295 d&#xed;as. En el an&#xe1;lisis univariante, el &#xfa;nico factor cl&#xed;nico asociado a la recurrencia fue la diabetes mellitus (recurrencia: 31,3% frente a no recurrencia: 5,8%; p < 0,001). En la defecograf&#xed;a por RM (en pacientes mujeres), la presencia de una hernia del fondo de saco (recurrencia: 75% frente a no recurrencia: 42,9%; p = 0,015), de un enterocele (recurrencia: 43,8% frente a no recurrencia: 16,7%; p = 0,018) y el &#xe1;rea de secci&#xf3;n transversal media del m&#xfa;sculo psoas se asociaron significativamente con la recurrencia (mediana en casos de recurrencia: 12,3 cm&#xb2; frente a mediana en casos sin recurrencia: 14,3 cm&#xb2;; p&#x2009;=&#x2009;0,04).LIMITACIONES:Este estudio se ve limitado por su naturaleza retrospectiva y se beneficiar&#xed;a de una colaboraci&#xf3;n multic&#xe9;ntrica para mejorar su potencia estad&#xed;stica.CONCLUSIONES:Este estudio es el primero en integrar los hallazgos de la RM con los factores cl&#xed;nicos para evaluar el riesgo de recurrencia. Algunos indicadores de baja masa muscular (sarcopenia), el enterocele o hernia del fondo de saco, y la diabetes mellitus podr&#xed;an estar asociados con la recurrencia. El control de la diabetes y la sarcopenia son factores potencialmente modificables mediante intervenciones en el estilo de vida, lo que pone de relieve las oportunidades para la optimizaci&#xf3;n preoperatoria. Se requieren estudios a mayor escala para validar estos predictores y orientar un manejo estratificado seg&#xfa;n el riesgo. (AI-generated translation).