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Objective: To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME). Background: Proctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter phase II taTME trial demonstrated the safety of taTME in patients with stage I to III tumors. Methods: Prospectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence [Fecal Incontinence Quality of Life (FIQL), Wexner], defecatory function [Colorectal Functional Outcome (COREFO)], urinary function (International Prostate Symptom Score), and sexual function (Female Sexual Function Index-female, International Index of Erectile Function-male) were assessed preoperatively (PQ), 3 to 4 months postileostomy closure (FQ1), and 12 to 18 months posttaTME [postoperative questionnaire 2 (FQ2)]. Results: Among 83 patients who responded at all 3 time points, FIQL, Wexner, and COREFO significantly worsened postileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. International Prostate Symptom Score did not change relative to preoperative scores. For females, Female Sexual Function Index declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, International Index of Erectile Function declined with no change between FQ1 and FQ2. Conclusions: Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decisionmaking regarding taTME. [ABSTRACT FROM AUTHOR]

Aim: Although proximal faecal diversion is standard of care to protect patients with high‐risk colorectal anastomoses against septic complications of anastomotic leakage, it is associated with significant morbidity. The Colovac device (CD) is an intraluminal bypass device intended to avoid stoma creation in patients undergoing low anterior resection. A preliminary study (SAFE‐1) completed in three European centres demonstrated 100% protection of colorectal anastomoses in 15 patients, as evidenced by the absence of faeces below the CD. This phase III trial (SAFE‐2) aims to evaluate the safety and effectiveness of the CD in a larger cohort of patients undergoing curative rectal cancer resection. Methods: SAFE‐2 is a pivotal, multicentre, prospective, open‐label, randomized, controlled trial. Patients will be randomized in a 1:1 ratio to either the CD arm or the diverting loop ileostomy arm, with a recruitment target of 342 patients. The co‐primary endpoints are the occurrence of major postoperative complications within 12 months of index surgery and the effectiveness of the CD in reducing stoma creation rates. Data regarding quality of life and patient's acceptance and tolerance of the device will be collected. Discussion: SAFE‐2 is a multicentre randomized, control trial assessing the efficacy and the safety of the CD in protecting low colorectal anastomoses created during oncological resection relative to standard diverting loop ileostomy. Trial registration: NCT05010850. [ABSTRACT FROM AUTHOR]

Aim: Rates of pouch failure after total proctocolectomy with ileal pouch−anal anastomosis (IPAA) range from 5% to 18%. There is little consistency across studies regarding the factors associated with failure, and most include patients who underwent IPAA in the pre‐biologic era. Our aim was to analyse a cohort of patients who underwent IPAA in the biologic era at a large‐volume inflammatory bowel disease institution to better determine preoperative, perioperative and postoperative factors associated with pouch failure. Methods: A retrospective cohort analysis was performed with data from an institutional review board approved prospective database with ulcerative colitis or unclassified inflammatory bowel disease patients who underwent total proctocolectomy with IPAA at Mount Sinai Hospital between 2008 and 2017. Preoperative, perioperative and postoperative data were collected and univariate and multivariate analyses were performed to identify factors associated with increased risk of pouch failure. Results: Out of 664 patients included in the study, pouch failure occurred in 41 (6.2%) patients, a median of 23.3 months after final surgical stage. Of these, 17 (41.4%) underwent pouch excision and 24 (58.5%) had diverting ileostomies. The most common indications for pouch failure were Crohn's disease like pouch inflammation (CDLPI) (n = 17, 41.5%), chronic pouchitis (n = 6, 14.6%), chronic cuffitis (n = 5, 12.2%) and anastomotic stricture (n = 4, 9.8%). On multivariate analysis, pre‐colectomy biologic use (hazard ratio [HR] 2.25, 95% CI 1.09–4.67), CDLPI (HR 3.18, 95% CI 1.49–6.76) and pouch revision (HR 2.59, 95% CI 1.26–5.32) were significantly associated with pouch failure. Conclusions: Pouch failure was significantly associated with CDLPI, preoperative biologic use and pouch revision; however, reassuringly it was not associated with postoperative complications. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: While it has long been supported that faculty development programmes serve as a means to improving practical knowledge, professional skills, and identity formation for faculty, significantly less research is focused on how learning that occurs in faculty development programmes is actually employed in the workplace and ingrained in day‐to‐day activities. The present study qualitatively explored the long‐term impact of the Mentoring and Professionalism in Training (MAP‐IT) programme, a longitudinal, interprofessional faculty development curriculum designed to enhance clinicians' humanistic mentoring skills, specifically nurses and physicians. Method: Participants included 21 former high‐potential mentors and facilitator leaders who had graduated from the MAP‐IT programme from 2014 to 2016. Semi‐structured focus groups and interviews were conducted between August and September of 2017 to collect participant experiences of the impact of MAP‐IT skills on their professional roles (with colleagues and patients) in their clinical environments. Qualitative data were analysed using content analysis methodology. Results: Qualitative analyses using an editing analysis style resulted in nine major themes, including incorporation into clinical practice, self‐care, team building and conflict resolution, mindfulness, mentorship, professionalism, interprofessional collaboration, humanism, and appreciative inquiry. Conclusion: The personal and professional development instilled through the MAP‐IT programme was found to remain important over time, years after participation in the programme had concluded, supporting its "durability." Implications are also discussed. [ABSTRACT FROM AUTHOR]