BACKGROUND:Functional constipation is a chronic GI disorder that significantly impairs quality of life. OBJECTIVE:To evaluate the beneficial effects of transanal irrigation after 12 and 24 months of treatment in patients with functional constipation. DESIGN:Multicenter, prospective, observational study. SETTINGS:Thirteen gastroenterology centers across Italy. PATIENTS:A total of 216 adults diagnosed with functional constipation were enrolled. INTERVENTION:A transanal irrigation system was used to perform bowel irrigation. Patients completed validated questionnaires at baseline and at 1, 6, 12, and 24 months after the procedure. MAIN OUTCOME MEASURES:The primary end points were to assess improvement in patient satisfaction and quality of life related to bowel function, as well as the safety of the procedure. Secondary outcomes included constipation severity, symptom occurrence, treatment discontinuation rates, and reasons for dropout. RESULTS:Mean satisfaction scores increased from 2.9 ± 2.4 at baseline to 6.5 ± 2.0 in 1 month and remained higher through 24 months ( p < 0.001). The mean quality-of-life total score improved from 2.7 ± 0.6 to 2.0 ± 0.7 in 1 month and remained at about 1.9 thereafter ( p < 0.001). Constipation score severity decreased (Wexner score 17.9 ± 5.8 to 12.5 ± 5.2 at 1 month; maintained to 24 months; p < 0.001), and mean constipation-related symptoms declined from 3.3 to 1.0 per patient at 24 months. Of 175 patients prescribed irrigation, discontinuation occurred in 10.3% at 6 months, 9.1% at 12 months, and 6.3% at 24 months; technical difficulties were uncommon and absent at 24 months, and no serious adverse events were reported. LIMITATIONS:The nonrandomized design may have introduced bias. Outcomes were assessed using validated but subjective self-reported questionnaires, and the study population was unbalanced for sex and comorbidities, although these factors did not significantly affect the primary results. CONCLUSIONS:This study provides the first evidence to support the effectiveness and safety of long-term transanal irrigation in improving bowel function, symptoms, and quality of life in patients with functional constipation across the long term. See Video Abstract . IRRIGACIN TRANSANAL EN EL ESTREIMIENTO FUNCIONAL RESULTADOS A LARGO PLAZO DE UN ESTUDIO NACIONAL ITALIANO:ANTECEDENTES:El estreñimiento funcional es un trastorno gastrointestinal crónico que afecta significativamente la calidad de vida.OBJETIVO:Evaluar los efectos beneficiosos de la irrigación transanal tras 12 y 24 meses de tratamiento en pacientes con estreñimiento funcional.DISEÑO:Estudio multicéntrico, prospectivo y observacional.ÁMBITO:Trece centros de gastroenterología en Italia.PACIENTES:Se incluyeron 216 adultos diagnosticados de estreñimiento funcional.INTERVENCIÓN:Se realizó irrigación transanal mediante un sistema de irrigación transanal. Los pacientes completaron cuestionarios validados al inicio del estudio y a los 1, 6, 12 y 24 meses.PRINCIPALES MEDIDAS DE RESULTADO:Los objetivos primarios fueron evaluar la mejora en la satisfacción del paciente y la calidad de vida relacionada con la función intestinal, así como la seguridad del procedimiento. Los objetivos secundarios incluyeron la gravedad del estreñimiento, la aparición de síntomas, las tasas de abandono del tratamiento y los motivos de abandono.RESULTADOS:La puntuación de satisfacción aumentó de 2,9 ± 2,4 al inicio a 6,5 ± 2,0 al mes y se mantuvo más alta durante 24 meses (p < 0,001). La puntuación total de calidad de vida mejoró de 2,7 ± 0,6 a 2,0 ± 0,7 al mes y alrededor de 1,9 a partir de entonces (p < 0,001). La gravedad de la puntuación de estreñimiento disminuyó (puntuación de Wexner de 17,9 ± 5,8 a 12,5 ± 5,2 al mes; se mantuvo hasta los 24 meses; p < 0,001), y los síntomas relacionados con el estreñimiento promedio disminuyeron de 3,3 a 1,0 por paciente a los 24 meses. De 175 pacientes a los que se les prescribió irrigación, la interrupción ocurrió en el 10,3% a los 6 meses, el 9,1% a los 12 y el 6,3% a los 24; Las dificultades técnicas fueron poco frecuentes y no se presentaron a los 24 meses, y no se notificaron eventos adversos graves.LIMITACIONES:El diseño no aleatorizado podría haber introducido sesgos. Los resultados se evaluaron mediante cuestionarios autoadministrados validados pero subjetivos, y la población del estudio no estaba equilibrada en cuanto a sexo y comorbilidades, aunque estos factores no afectaron significativamente los resultados principales.CONCLUSIONES:Este estudio proporciona la primera evidencia que respalda la eficacia y seguridad de la irrigación transanal a largo plazo para mejorar la función intestinal, los síntomas y la calidad de vida en pacientes con estreñimiento funcional a largo plazo. (AI-generated translation ).

AIM: The surgical management of colonic Crohn’s disease (CD) remains controversial, with segmental resections possibly associated with a higher rate of recurrence and postoperative complications, while total proctocolectomy reduces recurrence but increases the risk of permanent stoma formation. This study compares surgical outcomes and complications in CD patients undergoing colonic resections (any colectomy with or without concomitant ileal/ileocaecal surgery) vs non-colonic resections (ileal or ileocaecal resections and/or small-bowel strictureplasties without colectomy), with particular emphasis on intra-abdominal septic complications (IASC), non-IASC events, and length of stay (LOS) in hospital. METHODS: This monocentric observational study analysed consecutive adult patients with histologically confirmed CD who underwent intestinal surgery between January 2012 and April 2024 at Luigi Sacco University Hospital. Patients were divided into two groups according to the index operation. Group A included patients undergoing colonic resection, with or without concomitant ileal or ileocaecal resections and/or small-bowel strictureplasties. Group B included patients undergoing ileal or ileocaecal resection and/or small-bowel strictureplasties without any associated colonic resection. Outcomes included 30-day postoperative complications, LOS, and readmission rates. Statistical analysis was performed using chi-square, Wilcoxon rank-sum tests, and regression models. RESULTS: Of 461 patients, 90 (19.5%) underwent colonic resections (Group A), while 371 (80.5%) had non-colonic resections (Group B). Overall, complications occurred in 36.2% of patients, with significantly higher rates in Group A than in Group B (48.9% vs 33.2%; p = 0.005). IASC were more frequent in Group A (18 out of 90 patients, 20.0%) than in Group B (37 out of 371 patients, 10.0%) (p = 0.008). The median LOS was 11 days overall, with a statistically significant difference between the groups (Group A: 12 days; Group B: 11 days, p = 0.012). In addition, we observed a significantly higher 30-day reoperation rate in Group A compared with Group B (14.4% vs 6.5%; p = 0.012). Thirty-day readmission rates were low and did not differ significantly between the groups (3.3% vs 1.3%, p = 0.365). Colonic resection, disease phenotype, and American Society of Anesthesiologists score were identified as independent risk factors for postoperative complications and prolonged LOS. There were no significant differences in the 30-day readmission rates among the groups, and no 30-day mortality cases were observed. CONCLUSIONS: In this large single-centre cohort, colonic resections were associated with higher postoperative complication rates, increased IASC and longer LOS compared with non-colonic resections. These differences likely reflect greater baseline disease complexity and operative burden in patients requiring colonic resection, rather than a causal effect of the resection site alone, highlighting the need for individualised, phenotype-informed surgical decision-making. Further multicentre research is recommended to refine the surgical management of colonic CD.

Dehydration is a frequent complication among rectal cancer patients after ileostomy, often resulting in hospital readmission. The Dehydration Readmission after Ileostomy Prediction (DRIP) score was used to identify patients at risk of dehydration-related readmission. The aim of this study is to assess the predictive value of the DRIP score for dehydration–electrolyte imbalance (DIE) and hospital readmission in a multicenter Italian cohort. A total of 306 patients with rectal adenocarcinoma who underwent anterior resection with protective ileostomy in 2022 were included. The main outcome measures were the incidence of early and late DIE, hospital readmission due to DIE, and correlations between the DRIP score and other clinical variables. Early DIE occurred in 16.3

This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation. The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75

Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure. A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia. Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27

Purpose Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure. Methods Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications. Results A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 ( p = 0.028), advanced age ( p = 0.048), and previous stoma complications ( p = 0.048) were independently linked to failure of stoma closure; hypertension ( p = 0.036) was found to be a significant independent risk factor for post-operative complications. Conclusion This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care.

BACKGROUND:Low Anterior Resection Syndrome (LARS) is a debilitating condition post-surgery, requiring long-term management. AIM:To evaluate the benefits of long-term transanal irrigation (TAI) treatment (up to 24 months) for LARS patients. METHODS:A multicenter study across 13 centers included 159 patients to assess satisfaction with TAI for bowel control and quality of life (QoL). Secondary objectives included evaluating symptom improvement, dropout rates, and TAI characteristics (frequency, water volume, duration). Validated questionnaires were administered at baseline (T0) and after 1 (T1), 6 (T6), 12 (T12), and 24 (T24) months. Statistical analyses included signed rank sum tests for score differences, F-tests for symptom frequency, mixed-effects models for LARS category changes. RESULTS:TAI significantly improved satisfaction and QoL (p < 0.001). At T0, 84.8 % of patients had major LARS, decreasing to 16.5 % at T24. Mean LARS score improved by 19.8 ± 12.3 points from baseline to T24, showing a sustained and significant long-term improvement (p < 0.001). Symptom frequency decreased from 4.3 events per patient at T0 to 0.5 at T24 (p < 0.001). Dropouts occurred in 5 (11.4 %) cases by T6, 9 (6.8 %) by T12, and 12 (8.9 %) by T24. CONCLUSION:This study confirmed for the first time that long-term TAI treatment benefits LARS patients by improving symptoms, satisfaction, and QoL, with effects sustained over 24 months.

Extended lymph node dissection for rectal cancer, is it still under debate

Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses. From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications. In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8

Background: Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. Methods: A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Results: Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. Conclusion: In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.

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The diagnosis of colonic fistulae is crucial in defining the best therapeutic approach. Fistulae can be suspected from clinical history or specific symptoms, but imaging plays a key role in confirming the diagnosis. Previous studies described conventional studies with barium as methods of choice for the diagnosis; more recently intestinal ultrasound, CT and MR have been considered promising tests. CT Colonography is the best radiologic test to evaluate the colon, but only few case reports described its role in this setting. Aim of this paper is to highlight the potentials of CT colonography in evaluating patients with suspected colonic fistulae.

Colonic diverticulitis can be treated conservatively, but some cases require surgery. Patients can undergo Hartmann’s procedure (H) or resection with primary anastomosis (RA), with or without diverting stoma. This multicenter observational retrospective study aims to evaluate the adherence to current guidelines by assessing the rate of RA and H in Lombardy, Italy, and to analyze differences in patients’ features. This study included data collected from nine surgical units performing emergency surgery in Lombardy, in 2019 and 2021. Data for each year were retrospectively collected through a survey among Italian Society of Colorectal Surgery (SICCR) Lombardy members. Additional data were about: Hinchey’s classification, laparoscopic (VLS) or converted procedures, procedures with more than two operators, procedures in which the first operator was older than 40 years, night or weekend procedures, older-than-80 patients, COVID-19 positivity (just 2021). The total number of operations performed was 254, 115 RA and 130 H (45.3% and 51.2%, diff. 12%, p = 0.73), and 9 (3.5%) other procedures. RAs were more frequent for Hinchey 1 and 2 patients, whereas Hs were more frequent for Hinchey 3 and 4. RAs without ileostomy were significantly less than Hs (66 vs. 130, p = 0.04). Laparoscopy was more used for RA compared to H (57 vs. 21, p = 0.03), whereas no difference was found between RA and H with respect to conversion rate, the presence of more than two operators in the team, the presence of a first operator older than 40 years, night or weekend operations, and for older-than-80 patients. This study confirms the adherence to current guidelines for the treatment of acute colonic diverticulitis in Lombardy, Italy. It can be considered as a preliminary survey with interesting results that may open the way to a further prospective observational study to clarify some aspects in the management of this disease.

To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Background The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding.Material and methods A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript.Conclusion Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.