Explore the vast range of titles available.

Background There are limited data assessing the effectiveness of antibiotics as sole initial therapy in patients with large diverticular abscess. The aim of our study was to compare outcomes of selected patients treated with initial antibiotics alone versus percutaneous drainage. Methods All patients with diverticular abscess ≥3 cm in diameter treated in our institution in 1994–2012 with percutaneous drainage or antibiotics alone followed by surgery were identified from an institutional diverticular disease database. Groups were compared based on patient and disease characteristics, treatment failures and postoperative outcomes. Results Thirty-two patients were treated with antibiotics alone because of either technically impossible percutaneous drainage ( n  = 15) or surgeon preference ( n  = 17) while 114 underwent percutaneous drainage. Failure of initial treatment required urgent surgery in 8 patients with persistent symptoms during treatment with antibiotics alone (25 %) and in 21 patients (18 %) after initial percutaneous drainage ( p  = 0.21). Reasons for urgent surgery after percutaneous drainage were persistent symptoms ( n  = 16), technical failure of percutaneous drainage ( n  = 4) and small bowel injury ( n  = 1). Patients treated with antibiotics had a significantly smaller abscess diameter (5.9 vs. 7.1 cm, p  = 0.001) and shorter interval from initial treatment to sigmoidectomy (mean 50 vs. 80 days, p  = 0.02). The Charlson comorbidity index, initial treatment failure rates, postoperative mortality, overall morbidity, length of hospital stay during treatments, and overall and permanent stoma rates were comparable in the two groups. Postoperative complications following antibiotics alone were significantly less severe than after percutaneous drainage based on the Clavien–Dindo classification ( p  = 0.04). Conclusions Selected patients with diverticular abscess can be initially treated with antibiotics without adverse consequences on their outcomes.

Background Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures. Methods Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP ® ) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI. Results Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2–1.5; p  < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0–1.2; p  = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2–2.1; p  = 0.003] and ascites [aOR 5.6, 95% CI 2.1–15.4; p  = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4–0.5; p  < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4–2.5; p  < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI. Conclusions While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.

Purpose Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse. Methods All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared. Results Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table  1 ). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p  = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14 % ( n  = 11) [Altemeier 2 (9 %) vs. Delorme 9 (16 %) p  = 0.071]. Postoperative complication rate was 12 % ( n  = 9) [Altemeier 5 (22 %) vs. Delorme 4 (7 %), p  = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively ( p  = 0.59), and were not changed by the surgery. Table 1 Patient’s characteristics and procedures outcomes Total ( N  = 75) Altemeier’s ( N  = 22) Delorme’s ( N  = 53) p value Age  Mean (SD) 72 ± 15 75.3 ± 14.1 69.4 ± 15.4 0.14 Sex  Female 70 (93 %) 21 (95 %) 49 (92 %) 0.99 ASA score  1 1 (14 %) 0 1 (2 %) 0.54  2 23 (33 %) 7 (33 %) 16 (33 %)  3 42 (56 %) 11 (52 %) 31 (58 %)  4 8 (11 %) 3 (14 %) 5 (9 %) BMI  Mean (SD) 24.3 ± 7.3 22.4 ± 10.8 25 ± 4.9 0.20 Intraoperative blood loss/ml, median 30 (10–300) 50 (10–200) 25 (10–300) 0.95 Postoperative stool frequency/per day, median 6 (1–40) 4 (1–40) 6 (3–10) 0.78 Pre-op FIQL  Mean (SD) 7.5 ± 4.7 5.3 ± 4.1 7.9 ± 4.8 0.32 Post-op FIQL  Mean (SD) 7.2 ± 5.2 5.9 ± 0.8 7.4 ± 5.6 0.72 Pre-op CSI  Mean (SD) 34.4 ± 14.1 33.5 ± 10.8 34.6 ± 15.1 0.89 Post-op CSI  Mean (SD) 31.3 ± 15.8 40.0 ± 17 29.9 ± 15.9 0.42 Pre-op CGQL   Mean (SD) 0.5 ± 0.3 0.3 ± 0.3 0.5 ± 0.3 0.08 Post-op CGQL  Mean (SD) 0.5 ± 0.3 0.6 ± 0.2 0.5 ± 0.3 0.59 ASA American Society of Anesthesiologists, BMI body mass index, FIQL fecal incontinence QOL, CSI Constipation Severity Index, CGQL Cleveland Global Quality of Life Conclusions In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

Background Wound dehiscence is a known complication following abdominoperineal resection (APR) and can have a negative impact on recovery and outcome. The aim of this study was to determine the predictors of post-APR 30-day abdominal and/or perineal wound dehiscence, readmission, and reoperation, and to assess the impact of wound dehiscence on 30-day mortality. Methods All patients undergoing APR between 2005 and 2012 were analyzed using the American College of Surgeons National Surgical Quality Improvement Program. Results There were 5161 patients [male = 3076 (59.6 %)] with a mean age of 61.9 ± 14.3 years. Mean body mass index was 27.4 ± 6.6 kg/m 2 . The most common indication for surgery was rectal cancer (79.1 %), followed by inflammatory bowel disease (8.2 %). The overall rate of wound dehiscence was 2.7 % ( n  = 141). Older age ( p  = 0.013), baseline dyspnea ( p  = 0.043), smoking history ( p  = 0.009), and muscle flap creation ( p  ≤ 0.001) were independently associated with the risk of dehiscence. No association was observed between omental flap creation and dehiscence risk ( p  = 0.47). The 30-day readmission rate (15.6 vs. 5.6 %, p  ≤ 0.001) and need for reoperation (39 vs. 6.6 %, p  ≤ 0.001) were significantly higher in patients who experienced dehiscence. Dehiscence was an independent risk factor for 30-day mortality [OR = 2.69 (1.02–7.08), p  = 0.045)]. Conclusions Older age, baseline dyspnea, smoking, and the use of muscle flap were associated with higher risk of wound dehiscence following APR. Patients with wound dehiscence had a higher rate of readmission and need for reoperation, and an increased risk of 30-day mortality.

Intussusception of the appendix is an uncommon condition, and the diagnosis is rarely made preoperatively. Making an accurate diagnosis before laparotomy is important in providing the optimal treatment for the patient. We present the clinical and endoscopic features of two cases of intussusception of the appendix and review the literature. Diagnosis was made preoperatively by colonoscopy in these cases and an elective appendectomy was performed. Appendiceal intussusception should be considered in the differential diagnosis of abdominal pain. Colonoscopy can be a valuable tool in establishing this diagnosis and in selecting the appropriate management.

Strictureplasty is a well-accepted technique in the management of selected patients with Crohn's disease. To determine the safety and optimal clinical setting for performing Strictureplasty, perioperative complications and long-term outcomes need to be analyzed. We retrospectively reviewed the charts of 162 patients (87 men, 75 women) with Crohn's disease who underwent Strictureplasty between June 1984 and July 1994. Medical and surgical history, including medications and laboratory data, intraoperative findings, perioperative complications, and long-term follow-up data were recorded. These patients underwent 698 strictureplasties (Heineke-Mikulicz procedures, 617; Finney procedures, 81). Median hospital stay was 8 days. Perioperative septic complications were noted in 8 patients (5%); however, reoperation for sepsis was needed only in 5 patients. Five percent of patients developed prolonged ileus after Strictureplasty. Symptomatic improvement after Strictureplasty was achieved in 98% of patients. Restricture or new stricture or perforative disease was seen in 5% and 17% of patients, respectively, during a 42-month median follow-up period. Our findings show that Strictureplasty is a good surgical option for stenosing small-bowel Crohn's disease, particularly in patients with multiple obstruction and in those vulnerable to short-bowel syndrome. Perioperative complications are few, and long-term results are gratifying.