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World Journal of Colorectal Surgery
Number of Followers: 4  

  This is an Open Access Journal Open Access journal
ISSN (Online) 1941-8213
Published by Medknow Publishers Homepage  [448 journals]
  • Is a lateral internal sphincterotomy necessary after fistulotomy in a
           fissure–fistula complex?

    • Authors: Sarah E Diaz, Brittney L Morgan, Amanda M McClure, Jon M Hain
      Pages: 1 - 4
      Abstract: Sarah E Diaz, Brittney L Morgan, Amanda M McClure, Jon M Hain
      World Journal of Colorectal Surgery 2021 10(1):1-4
      Background: Fissure–fistula complex is a poorly described condition involving patients with chronic anal fissure and associated fistula-in-ano. Currently, there are no published guidelines on the surgical management of this problem. Objective: The aim of this study was to help establish guidelines for the surgical management of patients with fissure–fistula complex. Design: The study was designed as a retrospective cohort study. Setting: Data were obtained from the operative reports and medical records of patients from two colorectal surgery practices in southeast Michigan from 2000 to 2019. Patients and Methods: Forty-nine patients (47% female, 53% male) with fissure–fistula complexes were included for data analysis. The average age was 45 years. A total of 45 patients (92%) had no previous anorectal surgery, 45 (92%) had a posterior fissure complex, 26 (53%) had an intersphincteric fistula, and 23 (47%) had a low transsphincteric fistula. Although this was a retrospective study, data were described for outcomes of patients who received only a simple fistulotomy as a treatment for fissure–fistula complex. Main Outcome Measures: The primary outcome was the necessity of a lateral internal sphincterotomy after fistulotomy for resolution of the fissure. Sample Size: Forty-nine patients. Results: Three patients (6%) required repeat fistulotomy or abscess drainage during the follow-up period, and only one patient (2%) required a lateral sphincterotomy to resolve the chronic fissure. Forty-five patients (98%) healed their fissures after fistulotomy without sphincterotomy (95% confidence interval [89.1, 99.9]). Conclusions: Our study demonstrated that there is no likely need for a lateral internal sphincterotomy in addition to a fistulotomy in patients with a fissure–fistula complex for resolution of the chronic fissure. Clinical guidelines for the management of this condition should highlight primary fistulotomy as the standard treatment of fissure–fistula complex. Limitations: This study was limited by its retrospective nature and small sample size. Conflict of Interest: None.
      Citation: World Journal of Colorectal Surgery 2021 10(1):1-4
      PubDate: Thu,28 Apr 2022
      DOI: 10.4103/WJCS.WJCS_5_21
      Issue No: Vol. 10, No. 1 (2022)
       
  • Electronic Web-Based Colonoscopy Guidelines: Ease of use and improved
           compliance

    • Authors: Joseph Kong, David Low, David Wardill, Douglas Stupart, Glenn Guest, David Watters
      Pages: 5 - 8
      Abstract: Joseph Kong, David Low, David Wardill, Douglas Stupart, Glenn Guest, David Watters
      World Journal of Colorectal Surgery 2021 10(1):5-8
      Background and Objectives: There is an increasing demand for colonoscopy which tends to exceed service provision. To ensure appropriate referral for colonoscopy, the National Health and Medical Research Council (NHMRC) have developed comprehensive, evidence-based guidelines addressing screening and colonoscopy surveillance. However, some reports suggest that compliance with the guidelines is variable. This study was conducted to determine the compliance rates in our institution and to drive improved adherence to the national guidelines. Patients and Methods: This is a retrospective, observational study of all colonoscopies performed from July 2007 to June 2011. A decision support tool was specifically designed and made available via the World Wide Web. To assess the impact of the decision support tool, we measured compliance rates prospectively in January 2011 and January 2013. Results: Over the two periods of pre- and post-intervention, there were 103 and 98 patients referred to waiting lists for colonoscopy. Following introduction of the web-based decision support tool, the national colonoscopy guidelines compliance rate increased from 70.5% (103/146) to 87.5% (98/112). Critically, all patients who required colonoscopy surveillance had been appropriately listed excluding four patients (2.4%) who were missed before introducing the web-bed decision guide. Conclusion: Using currently available technology, a web-based colonoscopy decision support tool that can generate recommendations according to the NHMRC colonoscopy guidelines was created. This improved the decision-making regarding the need for and timing of diagnostic, screening, or colonoscopy surveillance.
      Citation: World Journal of Colorectal Surgery 2021 10(1):5-8
      PubDate: Thu,28 Apr 2022
      DOI: 10.4103/WJCS.WJCS_37_18
      Issue No: Vol. 10, No. 1 (2022)
       
  • Multiple scale of complexity for anorectal fistulas

    • Authors: Ingrid M Melo, Elvis D Vargas, Julimar del C Briceño, Daniel Chiantera, Mariangela C Pérez, Eliana C Bonilla, Jenils D Coacuto, Patricia Zarza
      Pages: 9 - 15
      Abstract: Ingrid M Melo, Elvis D Vargas, Julimar del C Briceño, Daniel Chiantera, Mariangela C Pérez, Eliana C Bonilla, Jenils D Coacuto, Patricia Zarza
      World Journal of Colorectal Surgery 2021 10(1):9-15
      Background: Anorectal fistulas are common and difficult to manage. Objective: To create a scale of complexity through the identification, description of medical history, clinical and ultrasonographic findings. To reduce the rate of recurrence and complications in fistulas is the treatment goal. Patient's inherent traits increase the complexity of anorectal fistulas with the risks of incontinence, delayed healing, infections, and requiring difficult surgeries. The aim of this study was to create a scale of complexity through identification, description of medical history, and clinical and ultrasonography (USG) findings. Patients and Methods: Retrospective study of a prospectively maintained database conducted at two Venezuelan hospitals. All patients who underwent anorectal USG examination at our institutions between 2010 and 2017 were investigated and included in the numerical scoring system, which categorizes the risk of fistula into simple, intermediate, and complex. The Chi-square test of the Statistical Program of Social Sciences (SPSS) was used to establish the significance level, P < 0.005. One thousand one hundred and seventy-three patients were evaluated, and perianal fistula was identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate, and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of the fistula may not be obvious in routine thorough clinical evaluation, requiring complementary studies. Using the scale avoids excluding factors that indicate complexity, with a statistically significant difference with the classification based exclusively on tracts. Limitation: The limitation of this study is that it is a retrospective single medical group study.
      Citation: World Journal of Colorectal Surgery 2021 10(1):9-15
      PubDate: Thu,28 Apr 2022
      DOI: 10.4103/WJCS.WJCS_19_19
      Issue No: Vol. 10, No. 1 (2022)
       
  • Surveillance Colonoscopy Revealing Asymptomatic Low-Grade Appendiceal
           Mucinous Neoplasm

    • Authors: Jagmeet S Grewal, Elliot Berger, Jacob Garner, Jennifer S Beaty
      Pages: 16 - 19
      Abstract: Jagmeet S Grewal, Elliot Berger, Jacob Garner, Jennifer S Beaty
      World Journal of Colorectal Surgery 2021 10(1):16-19
      Appendiceal mucinous neoplasms are a collection of rare tumors with diverse clinical presentations and pathologic potential, which can pose diagnostic and therapeutic challenges. Generally, these neoplasms are either diagnosed by radiologic imaging or identified during surgery; however, they may be rarely diagnosed during an endoscopic procedure. In this case report, we present the rare case of a 62-year-old white male who was undergoing routine surveillance colonoscopy for a history of colonic neoplasia. During the colonoscopy, a submucosal, nonbleeding, 1-cm mass of benign appearance was observed in the appendix. Further workup suggested that the mass could be a mucocele, and hence surgical consultation was recommended. The patient denied any symptoms suggestive of a mucinous neoplasm prior to or during the evaluation. A laparoscopic appendectomy was subsequently performed, and the histopathology reports confirmed the diagnosis of a low-grade appendiceal mucinous neoplasm. The patient recovered without any complications and continued to deny any symptoms during his postoperative course and follow-up care. The identification of appendiceal mucinous neoplasms remains difficult because of their rare incidence and unpredictable nature. The wide spectrum of unique presentations and modalities for diagnosis is illustrated by discovering a low-grade mucinous neoplasm in an asymptomatic patient via colonoscopy.Number of similar cases published: Nil
      Citation: World Journal of Colorectal Surgery 2021 10(1):16-19
      PubDate: Thu,28 Apr 2022
      DOI: 10.4103/WJCS.WJCS_7_21
      Issue No: Vol. 10, No. 1 (2022)
       
 
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