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Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

Aim: Despite the increasing popularity of minimally invasive surgery (MIS) in recent years, its efficacy in treating T4 colon cancer remains a subject of ongoing debate. This study aimed to assess the perioperative and oncological outcomes of MIS for T4 colon cancer in comparison with open surgery (OP). Method: We conducted a retrospective cohort analysis on 181 consecutive patients who underwent a T4 colon cancer resection through either MIS or OP between December 2014 and September 2021. Converted patients were evaluated in the MIS group according to the intention-to-treat principle. Propensity score matching (PSM) was employed based on age, gender, American Society of Anesthesiologists score, and the T-stage subgroup (T4a and T4b) to control for potentially confounding factors. Demographics short-term and long-term oncological outcomes were evaluated and compared between the two groups. Results: Post-PSM resulted in 49 patients in each group. Both groups were comparable in terms of patient demographics, clinical stage at diagnosis, and postoperative morbidity. The median operative time was longer in the MIS group (167 vs. 132 minutes, p

Aim:Although there are clinical differences in colon cancer according to the location of the tumor, the differences between right and left colon cancers (CC) in terms of survival are not clear. Our aim was to analyze the clinicopathological differences between right and left CC and to investigate the effect of primary tumor location on recurrence and survival.Method:The data of 330 patients who underwent curative surgery for right (n=155) or left (n=175) colon cancer between 2011 and 2018 were retrospectively analyzed. Demographic characteristics, surgical data, pathological data, recurrence and survival rates of the patients were examined and the two groups were compared in terms of these parameters.Results:Male to female ratio was significantly higher and operative time was significantly longer in the left CC than in the right CC. The mean number of harvested lymph nodes was significantly higher in the right CC than the left CC (32±3 and 27±9, respectively, p=0.001). Compared to patients with left CC, those with right CC had higher tumor diameter and tumor volume, had more poorly differentiation and tended to have more mucinous and medullary type cancer. As a result of a median follow-up of 54 months, it was determined that the 5-year overall survival in stage I-III patients was worse in the right CC than in the left CC. Especially in stage III patients, both overall and disease-free survival rates were found to be statistically significantly lower in the right CC compared to the left CC (In stage III disease, overall survival was 66.9% in right CC and 81.8% in left CC, p=0.03; disease-free survival was 54.2% in right CC and 70.6% in left CC, p=0.04).Conclusion:There may be clinicopathological and prognostic differences in CC depending on the location of the tumor. As a result of the long followup period in our case series, the prognosis in the right CC was worse, especially in stage III patients.

PURPOSEIn this study, we aimed to analyze the repeatability of quantitative multiparametric rectal magnetic resonance imaging (MRI) parameters with different measurement techniques.METHODSAll examinations were performed with 3 T MRI system. In addition to routine sequences for rectal cancer imaging protocol, small field-of-view diffusion-weighted imaging and perfusion sequences were acquired in each patient. Apparent diffusion coefficient (ADC) was used for diffusion analysis and ktrans was used for perfusion analysis. Three different methods were used in measurement of these parameters; measurements were performed twice by one radiologist for intraobserver and separately by three radiologists for interobserver variability analysis. ADC was measured by the lowest value, the value at maximum wall thickness, and freehand techniques. Ktrans was measured at the slice with maximum wall thickness, by freehand drawn region of interest (ROI), and at the dark red spot with maximum value.RESULTSA total of 30 patients with biopsy-proven rectal adenocarcinoma were included in the study. The mean values of the parameters measured by the first radiologist on the first and second measurements were as follows: mean lowest ADC, 721.31±147.18 mm2/s and 718.96±135.71 mm2/s; mean ADC value on the slice with maximum wall thickness, 829.90±144.24 mm2/s and 829.48±149.23 mm2/s; mean ADC value measured by freehand ROI on the slice with maximum wall thickness, 846.56±136.31 mm2/s and 848.23±144.15 mm2/s; mean ktrans value on the slice with maximum wall thickness, 0.219±0.080 and 0.214±0.074; mean ktrans by freehand ROI technique (including as much tumoral tissue as possible), 0.208±0.074 and 0.207±0.069; mean ktrans measured from the dark red foci, 0.308±0.109 and 0.311±0.105. Intraobserver agreement was very good among diffusion and perfusion parameters obtained with all three measurement techniques. Interobserver agreement was very good, except for one of the measurement techniques. As far as interobserver variability is considered, only ADC value measured on the slice with maximum wall thickness differed significantly.ConclusionMultiparametric MRI of rectum, using ADC as the diffusion and ktrans as the perfusion parameter is a repeatable technique. This technique may potentially be used in prediction and evaluation of neoadjuvant treatment response. New studies with larger patient groups are needed to validate the role of multiparametric MRI.

MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.

Aim: Fecal incontinence is still continuing to be a complex disorder for colorectal surgeon’s practice. Nerve stimulation and bulking agent injection are two different minimal invasive methods for its treatment. Our aim was to compare the short-term effectiveness of percutaneous tibial nerve stimulation (PTNS) and bulking agent injection in treating fecal incontinence. Method: A total of 41fecal incontinance patients, who were treated with PTNS or bulking agent (polyacrylnitrile) injection (PI) at the Istanbul Faculty of Medicine, were enrolled. Demographic data, the etiology of fecal incontinence, anal physiological test results, Wexner Fecal Incontinence Score and Modified Fecal Incontinence Quality of Life-Scale score were evaluated. These questionnaires were performed before and 12 months after the end of treatment. Results: Twenty-four patients (59%) were female, and 17 of them (41%) were male. The median age was 50 years (25-71), and the mean body mass index was 27.7 kg/m2 (20-41). Twenty-two (54%) patients underwent PTNS whereas 19 (46%) patients underwent PI. Both groups were found similar in terms of demographic data and pre-treatment measures for fecal incontinence. When the fecal incontinence and quality of life score of the patients were evaluated before and after the procedure, both methods were found efficient in fecal incontinence treatment (p

Aim: Desmoid tumors,which originate from musculoaponeurotic tissue, progress locally and agresively, but they do not make distant metastasis. Its frequency rises up with polyposis coli syndrome. In this article, we aim to evaluate the results of the patients treated for desmoid tumors. Method: Fifteen patients, who were diagnosed with desmoid tumors between 2000-2013, were evaluated in terms of demographical and clinical data, surgical interventions, complication and long terms folllow-up. Results: : The avarage age of patients was 35 (20-51) and 9 (%60) of them were women. Thirteen patients underwent colorectal surgery because of polyposis syndrome [6 (%40) restorative proctocolectomy, 5 (%33) total colectomy and ileorectal anastomosis]. Two patients were inoperable at the time of diagnosis. The mean time of occuring desmoid tumor after the surgery for polyposis coli were 24,5 (4-48) months. The most common location of tumor was intra-abdomen with 11 cases. Eight (%54) patients were evaluated as inoperable, whereas 7 patient underwent surgical resection, but all of them had recurrence in their follow-up. Mortality rate was found 74% (n=11) and the survival was 79,7 months (5-312). One patient was performed multivisceral organ transplantation. Conclusion: After performing proflactic colectomy/proctocolectomy in early decades, desmoid tumor has been becoming the most common reason of the mortality in polyposis syndrome. At the time of diagnosis, most patients are inoperable because of the invasion to adjacent organs espacially small-bowel meso. Although multivisceral organ transplantation is one of the most complicated surgical procedure, it seems a convenient treatment option for desmoid tumor patients.

Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

BackgroundAnastomotic leakage is a major complication in colorectal surgery, resulting in significant morbidity and mortality rates. Despite substantial progress in surgical technique, anastomotic leakage rates remain stable. An early diagnosis of anastomotic leaks was proven to reduce adverse outcomes and improve survival.ObjectiveThis study aims to find a novel scoring system for detecting anastomotic leaks using inflammatory and nutritional indicators after colorectal surgery. Our purpose was to analyze the diagnostic accuracy of leak scores ((CRPPOD3)(CRPPOD1)∗preoperativealbuminlevel) in predicting postoperative complications.DesignThe study included colorectal cancer patients who underwent curative surgery at Koc University Hospital between 2014 and 2018. Patients were categorized into two groups depending on the presence of anastomotic leaks and compared in terms of preoperative albumin levels, CRP levels in postoperative days 1 and 3, anastomotic leakage rates, length of hospital stay, and CRP quotient, which was calculated by dividing POD 3 CRP level to POD 1 CRP level. The bedside leak score is calculated by dividing the CRP quotient by the preoperative albumin level. The predictive value of bedside leak score, CRP quotient, and preoperative albumin levels in estimating anastomotic leakage was analyzed, and a cutoff value for the leak score was calculated.ResultsA total of 184 patients were included in the study. The leak score, CRP POD 3–1 ratio, and preoperative albumin levels were found to successfully detect anastomotic leakage. The area under the curve for the leak score was calculated as 0.78. The optimal cutoff value was found to be 50.3 for the bedside leak score, which shows 90.9% sensitivity and 59.3% specificity.ConclusionThe leak score may represent a valuable diagnostic tool for detecting patients at risk for anastomotic leakage after colorectal surgery and planning a better strategy to reduce morbidity and mortality rates and associated costs. However, further multicenter studies with large cohorts are necessary to confirm these results.

Situs inversus totalis (SIT) is a rare condition. In this case, a patient who underwent laparoscopic anterior resection for repeated sigmoid colon diverticulitis with SIT was presented. Laparoscopy surgery in patients with this condition has some important technical differences than standard laparoscopic procedures. Therefore, it may be more appropriate to request surgical experience to perform safe laparoscopic surgery in patients with SIT.

OBJECTIVE: To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies. METHODS: The data of 225 patients requiring loop ileostomies from 2002 to 2007 were retrospectively evaluated. The patients underwent partial small-bowel resections and either handsewn or stapled anastomoses for the ileostomy closures. They were followed up postoperatively with routine surgical examinations. RESULTS: The study group consisted of 124 men and 101 women with a mean age of 49.12 years. The ileostomy closure was performed with handsewn in 129 patients and with stapled in 96 patients. The mean time to the first postoperative flatus was 2.426 days in the handsewn group and 2.052 days in the stapled group (p