Multistage Rectal Polypectomy: An Alternative to Proctectomy in Patients With Familial Adenomatous Polyposis.

INTRODUCTION: When patients with familial adenomatous polyposis have a severely affected rectum, it is usually assumed that endoscopic control is impossible or unwise. The standard approach is proctectomy with either an end ileostomy or an IPAA. Here we show that application of aggressive, multistage snare polypectomy to this situation can be effective and allow the patient to avoid surgery, at least in the short term. TECHNIQUE: Standard polypectomy using snare excision with coagulation is used, taking 2 or 3 sessions, and beginning with the largest polyps. The procedures are performed with the patient under general anesthesia. Endoscopic mucosal resection technique with fluid injection to lift polyps is not necessary. RESULTS: Complete control of the rectal polyps, sustained for at least 2 years, is possible without functional sequelas. CONCLUSIONS: Patients with familial adenomatous polyposis with severe rectal polyposis can be offered multistage rectal polypectomy and safely avoid proctectomy.

Effects of Colorectal Surgery Classification on Reported Postoperative Surgical Site Infections.

BACKGROUND: Current procedural terminology (CPT) for colon and rectal surgery lacks procedural granularity and misclassification rates are unknown. However, they are used in performance measurement, for example, in surgical site infection (SSI). The objective of this study was to determine whether American College of Surgeons National Surgical Quality Improvement Program (NSQIP) abstraction methods accurately classify types of colorectal operations and, by extension, reported SSI rates. MATERIALS AND METHODS: This was a retrospective study conducted at a single tertiary care center. The colectomy- and proctectomy-targeted NSQIP database from January 2011 to July 2016 was used to perform a semiautomated reclassification (SAR) of all colectomy and proctectomy cases performed by colorectal surgeons. The primary outcome was the difference in perioperative SSI rates by case classification method. RESULTS: Thousand sixty-three patients underwent a colectomy or proctectomy during the study period with a mean age of 55.7 (SD = 16.7) years. Use of the NSQIP classification scheme resulted in 849 colectomy and 214 proctectomy cases. Use of the SAR method resulted in 650 colectomy cases and 413 proctectomy cases (P < 0.001), a 23.4% reclassification of colectomy cases. The group of cases classified as colectomy by SAR had a lower rate of deep/organ space infections than those classified as colectomy by NSQIP (4.5% versus 7.1%, P = 0.034). CONCLUSIONS: These findings highlight the challenges of CPT code-based patient classification and subsequent outcomes analysis. Expanding the CPT system to more accurately represent colorectal operations would allow for more representative reported outcomes, thus enabling benchmarking and quality improvement.