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El Registro de Cáncer Colorrectal Hereditario es uno de los registros más antiguos y más grandes de su tipo. Incluye a los pacientes con todos los síndromes hereditarios de cáncer colorrectal, utilizando los tres enfoques básicos, la atención al paciente, la educación y la investigación. Este artículo resume la estructura y función del registro, y da ejemplos de sus contribuciones al manejo de los pacientes afectados. ACTIVIDAD: En el año 2016 el registro atendió a más de 1000 familias con poliposis adenomatosa familiar, 224 familias con síndrome de Lynch, 61 con poliposis asociada a MYH y 146 con poliposis hamartomatosa. En el año 2016 hubo 1009 visitas de pacientes con 80 nuevos pacientes y 879 endoscopías. Se realizaron más de 60 cirugías. RESUMEN: Se describe el enfoque de “Cleveland Clinic” para el cáncer colorrectal hereditario. Esto es multidisciplinario, involucrando varias especialidades y así como servicios de asesoramiento genético y de salud mental dentro del registro.

To demonstrate the safety and feasibility of combined robotic ventral rectopexy and sacrocolpopexy for the treatment of concomitant pelvic organ prolapse and rectal prolapse. We present a video case demonstration highlighting the use of combined robotic ventral rectopexy and sacrocolpopexy for treatment of concomitant rectal and pelvic organ prolapse. The patient was taken to the operating room and placed in dorsal lithotomy position with her hands tucked by her sides. She was prepped and draped in the sterile fashion. After direct laparoscopic entry she was placed in Trendelenburg position and the robotic console was docked. Our patient is a 79-year-old female with rectal prolapse and fecal incontinence and coexisting cystocele and uterine fibroids. Combined robotic assisted laparoscopic ventral rectopexy and sacrocolpopexy. The patient underwent a successful combined rectal prolapse and pelvic organ prolapse repair, utilizing a multidisciplinary approach between colorectal surgery and urogynecology. Combined robotic ventral rectopexy and sacrocolpopexy using a single lightweight mesh is a safe and feasible alternative for the treatment of coexisting rectal and pelvic organ prolapse in a single patient. This shift towards the combined surgical management of these two conditions involving the collaboration between urogynecology and colorectal surgery allows for not only more patient-centered management of these two coexisting conditions, but also can alleviate patient symptoms and improve functional outcomes. [ABSTRACT FROM AUTHOR]

This systematic review aimed to assess the effects of upper gastrointestinal (UGI) dysmotility on outcomes of surgical treatment of colonic inertia (CI). This PRISMA-compliant systematic review and meta-analysis searched PubMed, Scopus, Google Scholar, and clinicaltrials.gov through October 2023 for studies that assessed outcomes of CI patients who underwent colectomy while putting data on UGI motility in context. The primary outcome was postoperative persistence or recurrence of constipation. Secondary outcomes were postoperative complications, continence, and quality of life (QoL) improvements. The revised tool to assess the risk of bias in nonrandomized studies of interventions was used to assess the risk of bias, and the certainty of evidence was graded using the GRADE approach. Eight studies (1991 to 2013) included data on UGI evaluation of CI patients; 12.8 to 24.3% were tested for concomitant GI dysmotility. High rates of motility abnormalities were in the small bowel (31.4%), stomach (34.1%), and esophagus (48.5%). Patients with UGI dysmotility and CI were more likely to experience constipation recurrence (OR: 10.71, 95% CI: 2.17; 52.87, P =0.004) and less likely to have postoperative QoL improvements (OR: 0.16, 95% CI: 0.04; 0.65, P =0.010) compared with patients with CI and no abnormal UGI testing. There were no differences in postoperative complications (OR: 1.59, 95% CI: 0.64; 4.267, P =0.542) or continence (OR: 0.29, 95% CI: 0.06; 1.47, P =0.0136) rates. Large subsets of CI patients with concomitant UGI dysmotility may be preoperatively underdiagnosed. UGI dysmotility may be associated with a higher risk of postoperative recurrence of constipation and suboptimal improvements in QoL. We recommend routine UGI evaluation before surgery for CI., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Rectal cancer surgery is technically demanding, especially in males. Robotic assistance may help overcome these challenges. This study aimed to identify factors associated with robotic-assisted proctectomy in rectal cancer., Methods: Retrospective case-control analysis of patients with clinical stage I-III rectal adenocarcinoma who underwent proctectomy from the National Cancer Database (2010-2019) was conducted. Univariable and multivariable binary logistic regression analyses were conducted to determine predictive factors of robotic-assisted proctectomy in rectal cancer., Results: 67 145 patients (60.9% male; mean age: 61.15 ± 12.49 years) were included. 44.7% had stage III disease and 66.2% received neoadjuvant radiation. The surgical approach was laparotomy (n = 29 725), laparoscopy (n = 21 657), and robotic-assisted proctectomy (n = 15 763). Independent predictors for the use of robotic-assisted proctectomy were age <50 years (OR: 1.06; P = .032), male sex (OR: 1.07, P < .001), Asian race (OR: 1.25; P < .001), private insurance (OR: 1.25; P < .001), rectal cancer treatment between 2015 and 2019 (OR: 3.52; P < .001), stage III disease (OR: 1.06; P = .048), neoadjuvant radiation (OR: 1.26; P < .001), and pull-through coloanal anastomosis (OR: 1.15; P < .001). Robotic-assisted surgery was less often used in Black (OR: .857, P < .001) and American Indian patients (OR: .62, P = .002) and those with a Charlson score = 3 (OR: .818, P = .002), living in rural areas (OR: .865, P = .033), who were uninsured (OR: .611, P < .001), and undergoing pelvic exenteration (OR: .461, P < .001)., Conclusions: Demographic and insurance disparities of robotic-assisted proctectomy are Black and American Indian patients and those with higher Charlson comorbidity index scores and uninsured patients were less likely to undergo robotic-assisted proctectomy. While patients with advanced disease and/or received neoadjuvant radiation were more likely to undergo robotic-assisted proctectomy, robotic-assisted surgery was less often performed in pelvic exenteration., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: None of the authors reports any relevant financial disclosures. Dr Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, and Virtual Ports; is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang; and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc, and Unique Surgical Solutions, LLC. Dr Emile is a consultant for Becton, Dickinson and Company.

Background: Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer., Methods: This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus., Results: The present study included 270 patients with a mean age of 68.7 years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2 years, P = .158), emergency colectomy (11.1% vs 3.9%, P = .082), extended hemicolectomy (19.4% vs 6.8%, P = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, P = .114), and longer operative time (177.9 vs 160.4 minutes, P = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, P = .003)., Conclusions: Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: None of the authors reports any relevant financial conflicts of interest. Dr. Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, and Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang, and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC.

Aim: Anastomotic stricture occurs in up to 30% of colorectal resections; however, evidence on risk factors and preventive measures remains scarce. This study aimed to identify technical factors responsible for increasing the risk for colorectal and coloanal anastomotic strictures., Method: This was a retrospective cohort study of patients with anastomotic stricture who underwent resection and/or redo anastomosis between January 1, 2011 and August 1, 2021 in a tertiary referral centre. Patients with anastomotic stricture were compared with an equal number of randomly selected patients without anastomotic complications, who were operated on during the same time period. The main outcome measures were technical risk factors of anastomotic stricture., Results: Each group included 50 patients who were similar for age, sex, American Society of Anesthesiologists score, distance of anastomosis to the dentate line and indication for surgery. Median follow-up was significantly longer in the non-stricture group (38.6 months vs. 12.6 months, p = 0.04). Splenic flexure mobilization [hazard ratio (HR) = 0.18 [2], 95% CI: 0.08-0.39, p < 0.001], high ligation of the inferior mesenteric artery (HR = 0.22, 95% CI: 0.09-0.5, p < 0.001) and high ligation of the inferior mesenteric vein (HR = 0.21, 95% CI: 0.09-0.50, p < 0.001) were associated with a lower likelihood of anastomotic stricture. Conversely, use of a 25-mm-diameter circular stapler (HR = 22.69, 95% CI: 2.69-191.10, p < 0.001), clinically significant anastomotic leak (HR = 3.94, 95% CI: 2.04-7.64, p < 0.001), firing the stapler more than once for rectal division (HR = 24.75, 95% CI: 6.85-89.38, p < 0.001) and diverting stoma (HR = 3.087, 95% CI: 1.736-5.491, p < 0.0001) were predictive of an anastomotic stricture., Conclusion: Failure to mobilize the splenic flexure and to perform high ligation of the inferior mesenteric vessels were associated with higher odds of anastomotic stricture. A small-diameter circular stapler and multiple distal stapler firings were also associated with anastomotic stricture. These data support routine splenic flexure ligation and high ligation of the inferior mesenteric vessels as well as avoidance of both multiple  stapler firings for rectal transection and a 25-mm circular stapler for anastomosis., (© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)