A novel data collection and monitoring system for health status measures in patients undergoing lateral internal sphincterotomy: The Knowledge Program (TKP).

BACKGROUND/OBJECTIVE: The Knowledge Program (TKP) allows prospective data collection during routine clinical practice. The aim of this study was to evaluate the efficacy and feasibility of TKP for capturing and monitoring health status measures in patients undergoing lateral internal sphincterotomy (LIS). METHODS: TKP data of patients undergoing LIS from December 2008 to May 2013 were retrieved. Health status measures including the Cleveland Global Quality of Life (CGQL), European Quality of Life Index (EQ-5D), Fecal Incontinence Severity Index (FISI), anorectal pain scores, and satisfaction questions were evaluated in the study. RESULTS: A total of 500 patients underwent LIS within the study period. Overall patient numbers responding to the health status measures in the pre- and postoperative period were as follows: CGQL: 112 preoperatively, 53 postoperatively; EQ-5D: 112 preoperatively, 55 postoperatively; FISI: 102 preoperatively, 30 postoperatively; and anorectal pain score: 107 preoperatively, 45 postoperatively. Among the responders, the number of patients who completed the health status measures both pre- and postoperatively was as follows: EQ-5D: 31, CGQL: 28, anorectal pain: 24, and FISI: 15. A total of 30 patients completed postoperative satisfaction and recommendation questions. Postoperative earliest (p = 0.02) and most recent (p = 0.01) anorectal pain visual analog scores were significantly lower than the preoperative measurements. The earliest postoperative EQ-5D scores were significantly higher than their preoperative values (p = 0.02). The majority of patients who completed the surveys said they were satisfied (70% and 67%) and would recommended (73% and 70%) LIS to others undergoing postoperative earliest and most recent follow up. CONCLUSION: LIS reduces anorectal pain without worsening quality of life. TKP captures information directly from patients and records it to a database which may reduce the risk of information loss or alteration.

Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population.

BACKGROUND: Data regarding the long-term outcomes of restorative proctocolectomy and ileal pouch anal anastomosis including pouch function and quality of life in the pediatric population are limited in pediatric patients. STUDY DESIGN: Indications for surgery, complications, long-term function, and quality of life were evaluated in pediatric patients undergoing ileal pouch anal anastomosis. Assessment of quality of life was performed using the Cleveland Global Quality of Life score. RESULTS: There were 433 patients with a mean age of 18.04 ± 2.9 years. Final pathologic diagnoses were ulcerative colitis or indeterminate colitis (78.3%), familial adenomatous polyposis (15.7%), Crohn's disease (5.1%), and others (0.9%). There were 237 patients (54.7%) who underwent total proctocolectomy and ileal pouch anal anastomosis; 196 (45.3%) underwent initial subtotal colectomy followed by completion proctectomy with ileal pouch anal anastomosis. Anastomosis was stapled in 352 patients (81.3%) and hand-sewn in 81 (18.7%) patients. Mean follow-up was 108.5 ± 78.4 months. At the most recent follow-up, mean Cleveland Global Quality of Life score was 0.8 ± 0.2 and numbers of daytime and night-time bowel movements were 5.3 ± 3.1 and 1.6 ± 1.3, respectively. The majority of the patients (86.8%) were fully continent or only complained of rare incontinence. Most patients had no seepage (day, 84.3%; night, 72.4%) and did not wear any pads (day, 89.3%; night, 84.3%). Most denied dietary (71.3%), social (84.8%), work (85.7%), or sexual restrictions (87.6%) at the time of last follow-up. There were 92.7% of patients who said they would undergo ileal pouch anal anastomosis again and 95.2% would recommend surgery to others. CONCLUSIONS: Restorative proctocolectomy with ileal pouch anal anastomosis can be performed in pediatric patients with acceptable morbidity and is associated with good long-term results in terms of gastrointestinal function, quality of life, and patient satisfaction.

Transanal endoscopic surgery using a single access port: a practical tool in the surgeon's toybox.

BACKGROUND: Large polyps and early carcinomas of the rectum may be excised with transanal endoscopic surgery (TES). Single-port techniques are emerging in the field of colorectal surgery and have been adapted to many colorectal procedures so far. In this article, we aimed to present our initial experience with TES using a single access port with its technical details. PATIENTS AND METHODS: Patients undergoing TES using a single access port between July 2010 and January 2013 were included in the study. Patient demographics, operative technique, and both operative and postoperative outcomes were evaluated and presented. RESULTS: A total of 12 patients (ten males) were included in our study. The median age was 63.5 years (50-84), median American Society of Anesthesiologists (ASA) score was 3 (2-4), and median body mass index was 28.8 kg/m(2) (17.4-55.6). Median operating time was 79 min (43-261). Histopathological diagnoses were as follows: tubulovillous adenoma (n = 6), tubular adenoma (n = 4), adenocarcinoma (n = 1), and neuroendocrine tumor (n = 1). Five patients were sent home on the day of surgery and the median postoperative hospital stay was 1 day (0-38). Median estimated blood loss was 22.5 ml (5-150). A transient urinary retention was developed in one patient postoperatively, and two patients had postoperative bleeding. The first of these patients with a long history of anticoagulant usage had rectal bleeding 13 days after surgery, which was successfully managed with medical treatment. The second patient was morbidly obese, had multiple comorbidities, and had rectal bleeding on postoperative day 7 which was managed with local epinephrine injection. He suffered unrelated cardiac death on postoperative day 38. CONCLUSIONS: TES is safe and feasible when using a single port and in the standard laparoscopic setting. The single-port technique may play a major role in the widespread utilization of TES as a treatment for large adenomas and early rectal cancers.

Anal transitional zone neoplasia in patients with familial adenomatous polyposis after restorative proctocolectomy and IPAA: incidence, management, and oncologic and functional outcomes.

BACKGROUND: Restorative proctocolectomy and IPAA in patients with familial adenomatous polyposis may leave residual anal transitional zone mucosa that is prone to neoplasia. OBJECTIVE: The aim of this study was to evaluate the long-term control of neoplasia at the IPAA, the functional outcomes, and the influence of anastomotic technique on these results. DESIGN: : This research is a retrospective cohort study from a prospective database. SETTING: The investigation took place in a high-volume specialized colorectal surgery department. PATIENTS: Patients with familial adenomatous polyposis who underwent IPAA between 1983 and 2010 were included. MAIN OUTCOME MEASURES: The primary outcomes measured were functional outcomes, quality of life, and the incidence of neoplasia in the anal transitional zone. RESULTS: Eighty-six patients underwent mucosectomy and 174 underwent stapled anastomosis with mean 155 ± 99 and 95 ± 70 months follow-up. Eighteen patients (20.9%) in the mucosectomy group and 59 patients (33.9%) in the stapled group developed anal transitional zone adenomas (p = 0.03). One of 86 (1.2%) patients undergoing mucosectomy and 3 of 174 (1.7%) patients undergoing stapled anastomosis developed cancer in the anal transitional zone (p > 0.05). Three of these patients underwent an abdominoperineal resection, but one who refused abdominoperineal resection underwent transanal excision with neoileoanal anastomosis. Patients undergoing a mucosectomy had a significantly higher rate of anastomotic stricture, but other complications were similar. Incontinence, seepage, and pad usage were higher in the mucosectomy group. Cleveland global quality-of-life score was 0.8 ± 0.2 in patients with handsewn anastomoses and 0.8 ± 0.3 in patients with a stapled anastomoses (p > 0.05). LIMITATIONS: This study was limited by its nonrandomized retrospective design. CONCLUSIONS: Risk for the development of adenomas in the anal transitional zone is higher after a stapled IPAA than after a mucosectomy with handsewn anastomosis. However, control of anal transitional zone neoplasia results in a similar risk of cancer development. Because the stapled procedure is associated with better long-term functional outcomes than a mucosectomy, stapled IPAA is the preferable procedure for most patients with familial adenomatous polyposis.