Iranian Journal of Colorectal Research
Volume:10 Issue: 1, Mar 2022

Obesity is a growing worldwide epidemic and its prevalence is in a continuous rise. Bariatric and metabolic surgery is the most effective treatment modality for long-term weight loss and resolution of associated comorbidities. It is well known that obesity increases the overall mortality and the link between obesity and the increased risk of cancer is firmly established, mainly hormone related cancers such as breast cancer and endometrial cancer. On the other hand, the association between intentional weight reduction through bariatric or metabolic surgery and the reduced cancer risk, mainly none hormone mediated cancers remains poorly understood with limited knowledge and conflicting data in the medical literature. Furthermore, the published outcomes regarding the effect of bariatric and metabolic surgery on the risk of colorectal cancer suggest a complex and poorly understood association. We herein review the literature regarding such an association and provide a plausible mechanism behind the increased risk of colorectal cancer after bariatric and metabolic surgery.

To evaluate results after Laparoscopic Sigmoid Resection (LSR) with Inferior Mesenteric Artery Preservartion (IMAP) and Superior Rectal Artery Preservation (SRAP), regarding the incidence of anastomotic leakages , denervation of the hypogastric nerves with consequent genitourinary and defecation alterations.

We have reflectively assessed PUBMED. 23 investigations was evaluated from 2000 to 2020. Consideration standards: english language, complete treatment of pathology from determination to medical procedure and catchphrases “diverticular disease, diverticulitis, inferior mesenteric artery preservation, superior rectal artery preservation, high tie, low tie, laparoscopic left colectomy" was inquired about

A total of 1685 patients with IMAP and SRAP were included in the study.

IMAP / SRAP or not preservation technique were not associated with an significant inferior leak rate as IMAR from colorectal anastomoses after sigmoidectomy for diverticular disease and they are associated with better QoL, good quality of restoration of bowel function, genito-urinary and sexual function respect not IMAP.

Low anterior resection syndrome (LARS) is a common debilitating problem faced by patients who underwent low or ultralow anterior resection. The management of LARS is complicated by the fact that our understanding of the pathophysiology of this disease is as yet unclear. In fact, our limitation in understanding is highlighted by the fact that only in 2020 has there been an international consensus on the definition of LARS (LARS international collaborative group).

A comprehensive review of the current literature on the pathophysiology, risk factors and management of LARS was performed.

In this review, we discuss the suspected pathophysiology of LARS, including damage to anatomy (sphincter, hiatal ligament, conjoint longitudinal ligamaent), loss of physiology (of rectum), and damage to nervous system (damage to hypogastric nerves, denervation of left colon, loss of recto-sigmoid brake). The risk factors for LARS are discussed, including neoadjuvant treatment, TME dissection, rectal stump height, anastomotic leak, as well as the protective role of a pouch formation in reducing the rate of LARS. Management of LARS involves management of symptoms, and management of underlying neurophysiology. The non operative measures include dietary restrictions, medications to reduce motility, pelvic floor exercises, colonic irrigations. Interventional approaches includes sacral nerve stimulation (SNS), and when bowel function becomes too debilitating a stoma may be created.

LARS is a significant and debilitating disorder. It has complex pathophysiology and there are some definite risk factors. Management involves non-operative and operative approaches, trans-anal irrigation and sacral nerve stimulation showing promise.

In some minimally invasive approaches, the cavity of the sacrococcygeal pilonidal cyst is not resected. This condition brings to mind the necessity of pathological examination of this cavity. In this study, we aimed to investigate whether the resected pilonidal cyst should be examined pathologically or not. Four thousand and eighty-five patients who undergone resection for pilonidal cyst were included in the study. Preoperative findings and clinicopathological features were analyzed retrospectively. The median age of the patients was 30 (2-87 years) years. 3256 (79.7%) patients were male. One hundred and sixty-six (4%) patients were over 50 years. The median pathological specimen length was 5 (0.5-6.5 cm) cm. The median time to pathological result was 6 (0-65 days) days. The most common diagnosis was a pilonidal sinus (n=3917, 95.9%). No malignancy was detected after the histopathological examination. The histopathological evaluation of resected pilonidal cyst is unnecessary due to the low malignant rate unless the presence of suspicious clinical findings.

The Laser Haemorrhoidoplasty (LHP) procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of this study was to assess the safety of laser haemorrhoidoplasty and to study long term recurrence rates and other complications. In this retrospective, single-centre study, 250 consecutive symptomatic patients of internal haemorrhoids of grade I-IV underwent laser haemorrhidoplasty. The procedure was done using 15 W,1470 Nm diode laser machine (Lasotronix). All the preoperative and postoperative variables were analyzed, with special emphasis on post-procedural pain, complications and recurrence rate. Follow-up was scheduled at 4th,7th and 30thday and then at 3, 6 and 12 months, and once a year thereafter. Complications were recorded. There were 250 patients ( 134 male and 116 female; mean age: 43.72 18.34 years, range 16-85 years). Short-term follow-up was achieved for all patients. Patient satisfaction in terms of pain at rest and post-defaecation pain was 100%. Twenty eight patients (11.2 %) had complications.10 patients (4%) had postoperative bleeding,3 patients (1.2 %) had infection,1 patient (0.4 %) developed a fistula-in-ano,1 patient (0.4 %) developed a thrombosed haemorrhoid,1 patient (0.4 %) had prolapsed haemorrhoid,5 patients (2 %) had incomplete regression,1 patient (0.4 %) had fissure in ano. Ulceration occurred in 1 patient (0.4 %) and 2 patients (0.8 %) developed recurrence. No anal stenosis or faecal incontinence occurred in any of the patients. This study shows that LHP gave 100% patient satisfaction in terms of post-procedure pain at rest and post-defaecation pain. With standardisation, LHP is a safe procedure with good short term and long term results with minimal recurrence rate.

Surgical site infection (SSI) has been associated with increased hospital stay and subsequent increased burden on health care. Recognition of risk factors might be helpful to prevent it.

Patients referring to colorectal department of Imam Khomeini Hospital Complex for elective or emergent surgery have been evaluated during January 2018 and 2019. All the variables known to be associated with SSI have been investigated.

Total number of 473 patients with mean ± SD of age, 55.6 ± 13.9 years (range 18-88 years) and male to female ratio of 1.4 were evaluated. 103 patients developed SSI within 30 days after surgery with the incidence rate of 21.7%. Seventy seven percent of patients with SSI were in the age group under 65 years, 42% were female, and 58% were male. There were 89 cases of superficial (86%), 11 cases of deep (10%), and 3 cases of organ/space surgical site infection (3%).The risk factors significantly associated with SSI development were diabetes mellitus, operation on rectum, emergency surgery, history of neoadjuvant chemotherapy, laparoscopy approach changed to laparotomy approach, colostomy /ileostomy implantation or closure, blood transfusion after surgery, anastomotic leakage, and surgery lasting more than 200 minutes. After multivariate analysis, neo-adjuvant chemo-radiotherapy, emergent surgery, operation on rectum, postoperative blood transfusion, and prolonged operation to discharge periods remained significantly associated with a remarkably higher SSI risk.

SSI is devastating condition, compromising surgical outcomes. Preventive measures should be applied in every surgical facilities to prevent incidence and lessen complications related to SSI.

Colon cancer is one of the leading cancers in the world that cause death. Some studies show that personality characteristics play an important role in coping with colon cancer. The aim of this study was to explore the association between personality characteristics and quality of life in colon cancer. A cross-sectional study was conducted on a sample of 200 subjects at the Oncology Clinic of the University Clinical Hospital Mostar. Data were collected in the period between April 2019 and June 2021. A socio-demographic questionnaire specifically designed for this study, the Eysenck Personality Questionnaire for assessing personality characteristics, and a WHOQOL-BREF questionnaire for assessing quality of life were used for collecting data. There was a significant positive correlation between extraversion and psychological health, social relations and the environment, as well as with the overall quality of life. A statistically significant negative correlation of neuroticism with physical health, mental health, and social relationships was found. A statistically significant negative correlation of psychoticism with the domains of mental health and the environment was found. Neuroticism contributed statistically significantly negatively to the level of physical health, mental health and social relations. Extraversion positively contributes to the level of quality of life in colon cancer patients. Neuroticism and psychoticism negatively contribute to the level of quality of life in colon cancer patients.

Many technique has been announced in managing the internal haemorrrhoid cases, HAL-RAR is safe and almost painless technique and it has very good results in the control of haemorrhoidal symptoms. This procedure should be considered as an effective first treatment option for haemorrhoids. The most common problem which should be discussed was the cost of this procedure, especially in routine clinical practice. We would reported the safety and effectiveness of the HAL-RAR with no Doppler guided on stage III internal haemorrhoid in single centre teaching hospital. As a modification from the standard HAL-RAR procedure with doppler guided, we will evaluated the clincal outcome of this technique on grade III of internal hemorrhoid patients. All patients with no previous hemorrhoid surgery will be included on this study. The patients whose associated with procititis and colorectal cancer will be excluded. We reported our first 61 patients with grade III internal haemorhoid managed using modified HAL-RAR technique without Doppler guided performed during the procedure. This technique was acceptable well by the patients, pain controlled could be achieved early in the first post operative day. The average pain score (using Visual Analog Score) before discharged was 1,77 and the average length of stay was 1,36 days with no post operative bleeding found during follow up period. HAL-RAR with no Doppler guided technique was safe and effective in reducing pain and the length of stay with tolerable pain controlled.