Colorectal Disease (Colorectal Dis )

Publisher: Association of Coloproctology of Great Britain and Ireland, Blackwell Publishing

Description

Colorectal Disease is a new journal publishing original research in any discipline relating to colorectal pathology. The journal will further education and inter-professional development by including regular review articles, discussions of current controversies, occasional highly selected case reports, and question and answer features.Colorectal Disease is the official organ of the Association of Coloproctology of Great Britain and Ireland. The journal will report news of the Association and take a major interest in coloproctological matters across Europe as a whole.

  • Impact factor
    2.08
  • 5-year impact
    2.39
  • Cited half-life
    3.90
  • Immediacy index
    0.64
  • Eigenfactor
    0.01
  • Article influence
    0.69
  • Website
    Colorectal Disease website
  • Other titles
    Colorectal disease (Online)
  • ISSN
    1463-1318
  • OCLC
    45907159
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
  • Conditions
    • See Wiley-Blackwell entry for articles after February 2007
    • Publisher version cannot be used
    • On author or institutional or subject-based server
    • Server must be non-commercial
    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com ")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley-Blackwell'
  • Classification
    ​ yellow

Publications in this journal

  • Colorectal Disease 11/2014; 16(11).
  • Colorectal Disease 11/2014; 16(11).
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    ABSTRACT: Dear sir, Parastomal hernia is the most common long-term complication after radical cystectomy and ileal conduit diversion, occurring in approximately 30 percent of patients (1). Most parastomal hernias are asymptomatic and can therefore be treated conservatively. The primary indication for surgical repair is poorly fitting ostomy appliances due to abdominal wall distortion resulting in urine leakage. This leads to regular appliance changes and dramatically affects quality of life in these patients. Surgical repair is challenging and associated with high recurrence rates. The modified Laparoscopic Sugarbaker repair has been shown to have lower recurrence rates compared to other techniques for the repair of parastomal hernias (2). We present a case of a 61-year old male, who underwent a cystoprostatectomy with retroperitoneal lymphadenectomy and formation of an ileal conduit one year before. He was suffering from a progressive parastomal hernia causing regular bag changes throughout the day. A CT-scan showed a fascial defect cranial to the conduit (as is usually the case), and a small umbilical hernia. We performed a laparoscopic modified Sugarbaker repair with a ParietexTM Composite mesh (Covidien, Mansfield, MA, USA) with simultaneous covering of the umbilical defect (see Video S1). The patient had an uneventful post-operative course, and was discharged home on the 5th day post-operatively. A CT-scan after 6 months showed no recurrence. The patient was extremely satisfied with the esthetical result and reported no further problems with urine leakage and stoma appliance problems REFERENCES: 1. Liu NW, Hackney JT, Gullahs PT, Monn MF, Masterson TA, Bihrle R, Gardner TA, House MG, Koch MO. Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion. J Urol. 2014 May;191(5):1313-8. 2. Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg. 2012;255(4):685-95.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimRecent evidence has suggested that a laparoscopic rather then an open approach to reversal of Hartmann's procedure (ROH) may be associated with fewer complications. Much of the data for comparison are historical or based on small case series. The aim of this study was to determine the morbidity and mortality of ROH of ten hospitals in the modern era and identify risk factors for complications.MethodA multicentre study of patients undergoing ROH (2007-2013) was performed. Data were collected retrospectively on patient demographics, pre-operative health databases, laboratory investigations and operative details. Complications were classified as minor (I-II) or major (III-IV) based on the Clavien-Dindo criteria. Risk factors for complications were assessed by multivariate analysis with calculation of odds ratios (OR) with 95% confidence intervals (CI).ResultsTen hospitals in Scotland provided data on 252 patients undergoing ROH. Most operations were open (85%) with 15% started laparoscopically (conversion rate 64%). In the post-operative period 35(14%) had a major complication, including anastomotic leakage in 10 (4%) and postoperative death in one (0.4%). Patients with a complication stayed significantly longer in hospital (12 versus 7 days, p<0.001). On multivariate analysis, a wound complication after the original Hartmann's procedure (OR 3.85, 95% CI 1.08-13.75, p=0.038) was associated with any complication after ROH, but only ASA grade (OR 3.35, 95% CI 1.38-8.09, p=0.007) was independently associated with the development of a major complication.ConclusionROH has a low postoperative mortality but significant morbidity. Most operations are still performed by open surgery and in those attempted laparoscopically, the conversion rate is high.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: We have read with great interest the paper “Completely diverted tube ileostomy (CDTI) compared with loop ileostomy for protection of low colorectal anastomosis: a pilot study.” by Zhou X. et al. [1]. We were pleased to have found this technique similar to the transluminal percutaneous ileostomy by probe proposed by our group, which is now conducting a prospective randomized clinical trial [2-4]. We have found some differences compared to our technique, however, and we would be grateful if the authors would clarify some aspects.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimThe modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), to reach a consensus on prioritizing clinical research questions in colorectal disease.Method Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds Two and Three they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority.ResultsFive hundred and two questions were submitted in Round One. Following two rounds of voting and analysis, a list of twenty five priority questions was produced, including fifteen cancer-related and ten non-cancer-related questions.Conclusion It is anticipated that these results will i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, ii) promote development and iii) define funding of new research and prioritise areas of unmet clinical need where the potential clinical impact is greatest.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimMesenteric hypertrophy has been recognised as an indicator of the complicated course of Crohn's disease. The aim of this study was to investigate whether the visceral fat area (VFA) was associated with postoperative clinical and endoscopic recurrence.Methods Computed tomography was used to measure the subcutaneous fat area (SFA) and VFA, and the mesenteric fat index (MFI) was defined as the ratio of the VFA to the SFA. Associations between the body mass index (BMI), SFA, VFA and MFI and postoperative clinical and endoscopic recurrence were investigated.ResultsThe factors associated with postoperative endoscopic recurrence at 6 months after surgery were a high VFA value (p = 0.019) and MFI values above the median (p = 0.008). VFA values were significantly correlated with endoscopic recurrence (r = 0.895, p = 0.040) and endoscopic lesions (r = 0.617, p < 0.0001). Additionally, MFI values correlated well with endoscopic recurrence (r = 0.918, p = 0.02) and endoscopic scores (r = 0.584, p < 0.0001). Multivariate analysis indicated that VFA values above the median (hazard ratio = 2.63; 95% CI (1.03 to 6.74)) were predictive of postoperative clinical recurrence in Crohn's disease.ConclusionA high VFA value is associated with postoperative recurrence of Crohn's disease and has clinical implications with respect to optimising prophylaxis for each individual. However, further studies are needed to confirm the predictive role of this biomarker in a different dataset.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimMost colorectal cancer patients are elderly, but there are few data on the optimal surgical treatment for this age group and most studies are observational. We have reviewed the characteristics of randomised trials reporting laparoscopic surgery for colorectal cancer to determine the degree to which the elderly are represented.MethodA search was conducted of the NIH clinical trial registry and the ISRCTN register for randomized trials on laparoscopic surgery for colorectal cancer. Trial characteristics and end points were extracted from the registry website and supplemented by published results where available.ResultsOf 52 trial protocols the majority did not state any restrictions regarding cardiac (40 [77%]) or pulmonary function (41 [79%]). More than half (30 [58%]) had no restrictions regarding ASA-score. Twenty three (44%) trials excluded the elderly either simply on age or by comorbidity or organ function. When an upper age limit was set, half of the studies had no restriction regarding organ function, indicating that chronologic age rather than physical condition was taken as the reason for exclusion. In 45 (86%) of the trials the average age of participants was less than 70years, and no details of concurrent disease were given.Conclusion Participation of the elderly in trials of laparoscopic surgery for colorectal cancer is very limited. This should be remedied in future trials if adequate information on the majority of patients with colorectal cancer is to be obtained.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: Background Compared to standard laparoscopic (SDL) approaches, less is known about the incidence of hernias after single-site laparoscopic (SSL) colorectal surgery. This study hypothesized that SSL colorectal surgery was associated with an increased risk of hernia development.Methods Institutional retrospective chart review (9/2008-6/2013) identified 276 evaluable patients who underwent laparoscopic colorectal procedures. Demographic data, risk factors for the development of a hernia, operative details and post-operative course including the development of a hernia were collected. Patients were stratified by laparoscopic technique to compare characteristics of those undergoing SDL and SSL. Patients were subsequently stratified by the presence or absence of a hernia to identify associated factors.Results119 patients (43.1%) and 157 patients (56.9%) underwent SDL and SSL procedures, respectively. The development of an incisional hernia was observed in 7.6% (9/119) of SDL patients compared to 17.0% (18/106) of SSL patients (P = 0.03) over a median 18-month follow-up. Similar proportions of patients developed parastomal hernias between both groups (SDL 16.7% [10/60] vs. SSL 15.9% [13/80]). Hernias were diagnosed at a median of 8.1 (SDL) and 6.5 (SSL) months following the index operation and were less likely to be incarcerated in the SSL group (SDL 38.9% [7/18] vs. SSL 6.5% [2/31], P = 0.01).ConclusionsSSL colorectal surgery is associated with an increase in the incidence of incisional hernias but not parastomal hernias. Site of specimen extraction in SSL may contribute to the development of an incisional hernia.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
  • Colorectal Disease 10/2014; 16(10).
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    ABSTRACT: We present a case of a 59 year old female with a history of diverticulitis complicated by a stricture in her right ureter. She underwent a sigmoid colectomy and ultimately developed a colonic ureteral fistula. After radiologic and endoscopic evaluation and diagnosis, a robotic natural orifice repair was performed.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimConversion rates from laparoscopic to open colectomy and associated factors are traditionally reported in clinical trials or reviews of outcomes from experienced institutions. Indications and selection criteria for laparoscopic colectomy may be more narrowly defined in these circumstances. With the increased adoption of laparoscopy, conversion rates using national data need to be closely examined. The purpose of this study was to use data from ACS-NSQIP to identify factors associated with conversion of laparoscopic to open colectomy on a national scale.Method The ACS-NSQIP Participant Use Data Files for 2006-2011 were used to identify patients who had undergone laparoscopic colectomy. Converted cases were identified using open colectomy as the primary procedure and laparoscopic colectomy as “other procedure”. Preoperative variables were identified and statistics were calculated using SASv9.3. Logistic regression was used to model the multivariate relationship between patient variables and conversion status.ResultsLaparoscopy was successfully performed in 41,585 patients, of whom 2,508 (5.8%) required conversion to an open procedure. On univariate analysis the following factors were significant: age, BMI, ASA class, presence of diabetes, smoking, COPD, ascites, stroke, weight loss, and chemotherapy (p<0.05). The following factors remained significant on multivariate analysis: age, BMI, ASA class, smoking, ascites and weight loss.Conclusions Multiple significant factors for conversion from laparoscopic to open colectomy were identified. A novel finding was the increased risk of conversion for underweight patients. As laparoscopic colectomy is become increasingly utilized, factors predictive of conversion to open procedures should be sought via large, national cohorts.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimRectovaginal fistula (RVF) repair is associated with high recurrence. For this reason gracils muscle interposition is increasingly being used . The aim of this systematic review was to evaluate the efficacy of this procedure for RVF repair.MethodA search of PubMed and Medline databases was performed in November 2013 using the text terms and MESH headings “rectovaginal fistula/fistulation”, and “gracilis muscle”, spanning 1980-2013. The search strategy was restricted to articles written in English with available abstracts. Sample size, aetiology of RVF, previous repair attempts, follow-up period, healing rates and complications were recorded and analysed.ResultsSeventeen studies involving 106 patients were analysed. The cause of RVF included IBD (37 [34.9%]; Crohn's disease [34] and ulcerative colitis [3]), pelvic surgery (37, [34.9%]), obstetric injury (9 [8.5%]), malignancy (7 [6.6%]), trauma (5 [4.7%]), miscellaneous [idiopathic, endometriosis, radiation [11 {10.4%)}]). Patients had undergone a median number of two previous unsuccessful repairs. At a median follow up of 21 months, healing had occurred in 33%-100% (median 100%) with the largest studies reporting rates between 60% and 90%. Thirteen studies did not report any complications with the remainder reporting only minor morbidity.Conclusion Gracilis interposition appears to have a reasonable success rate for RVF repair with acceptable morbidity. It may be considered as one of the first line treatment options for recurrent RVF.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimRadiologically assessed muscle mass has been suggested as a surrogate marker of functional status and frailty and may predict patients at risk of postoperative complications. We hypothesise that sarcopenia negatively impacts on postoperative recovery and is predictive of complications.Method One hundred patients undergoing elective resection for colorectal carcinoma were included in this study. Lean muscle mass was estimated by measuring the cross sectional area of the psoas muscle at the level of the third lumbar vertebra identified on a pre-operative computed tomography scan, normalising for patient height. Peri-operative morbidity was scored according to the Clavien-Dindo classification. All statistical data analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20.0.Results15% of patients were identified as sarcopenic. There were no deaths in the study group.Sarcopenia was associated with a significantly increased risk of developing major complications (grade ≥3, OR 5.41 [C95% I 1.45-20.15] p=0.01). Sarcopenia did not predict length of stay, critical care dependency or time to mobilisation.Conclusion Sarcopenia, as a marker of frailty, is an important risk factor in surgical patients, but difficult to estimate using bedside testing. CT scans performed for pre-operative staging provide an opportunity to quantify lean muscle mass without additional cost or exposure to radiation and eliminates the inconvenience of further investigations.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: Germline mutations in at least 16 genes have been implicated in hereditary colorectal cancer. The genes and their syndromes are listed in Table 1. The current approach to testing for the presence of a mutation of one of these genes involves the identification of a suggestive tumour, individual or family phenotype (see Table 1), selection of the gene(s) most likely to be mutated, and facilitation of genetic testing via blood or saliva.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: Dr Segelman and colleagues (Colorectal Dis 2014; 16: 359-67) have provided us with a practical tool that may predict and allow for the early detection and treatment of metachronous colorectal peritoneal metastases (1). It is now widely accepted that surgical intervention in the form of cytoreductive surgery combined with hyperthermic intra-peritoneal chemotherapy (HIPEC) in appropriately selected patients with resectable peritoneal disease can improve outcome. Furthermore, intervention when disease volume is low is associated with a greater likelihood of complete resection and improved survival. This predictive tool may help us to identify patients with peritoneal metastases at an early stage when surgical intervention may be maximally beneficial.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: The idea of increasing anal sphincter strength for preventing faecal incontinence by a magnetic device reminds us of a previously published idea for avoiding gastroesophageal reflux [1] developed and perfected as the “magnetic collar” [2]. The “collar”,was adapted to reinforce the anal sphincter in patients with faecal incontinence, but the first results have not been exciting. In fact the preliminary report [3] showed an improvement at six months in only 5 of 14 patients with an average increase of only 12 mmHg in anal resting pressure, and in another study [4] the Wexner score decreased only of about 50% in 19 patients assessed at 6 months.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: We thank Drs Bugiantella et al for their interest in our article recently published in Colorectal Disease [1]. Concerning the first point about preoperative bowel preparation, it remains controversial. Elective colonic resection without mechanical bowel preparation (MBP) has been demonstrated [2, 3].This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimSeveral studies have suggested an increased lymph node yield, reduced loco-regional recurrence and increased disease-free survival (DFS) after complete mesocolic excision (CME) for colorectal cancer. This review was undertaken to assess the use of CME for colon cancer by evaluating the technique and its clinical outcome.MethodA literature search of publications was performed using Pubmed and Medline. Only studies published in English were included. Studies assessed for quality and data were extracted by two independent reviewers. Endpoints included numbers of lymph nodes per patient, quality of the plane of mesocolic excision, postoperative mortality and morbidity, 5 year locoregional recurrence and 5-year cancer-specific survival.ResultsThere were 34 articles comprising 12 retrospective studies, nine prospective studies, 13 original articles including case series, observational studies and editorials. Of the prospective studies, four reported an increased lymph node harvest and a survival benefit. The others reported an improvement in the quality of the specimen as assessed by histopathological examination. Laparoscopic CME has the same oncological outcome when compared with open surgery but completeness of excision during laparoscopy may be compromised for tumours in the transverse colon.Conclusion Studies demonstrate that CME removes significantly more tissue around the tumour including maximal lymph node clearance. There is little information on serious adverse events after CME and a long-term survival benefit has not been proven.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimA study was carried out with the aim of identifying potential factors which might influence the fate patients undergoing faecal diversion by stoma in perianal Crohn's disease.Method Patients with severe perianal CD undergoing faecal diversion between 1994 and 2012 were identified and factors associated with stoma closure were assessed using univariate and multivariate analysis.ResultsOut of 138 diverted patients, 30 (22%) achieved stoma closure, 45 (33%) had a stoma with the rectum left in situ and 63 (45%) underwent proctectomy with permanent stoma formation after a mean follow-up of 5.7 years. Univariate analysis demonstrated that synchronous colonic (p=0.004) or rectal (p=0.021) disease involvement and an increased frequency of loose seton placement (p=0.001) adversely affected successful stoma closure rates. Multivariate analysis indicated a significant association between the inability to achieve stoma closure and persisting rectal involvement (OR=7.5, 95% CI: 2.4 – 33.4), one or two placements of a loose seton (OR=3.3, 95% CI: 1.4 – 8.8) and more than two placements (OR=6.9, 95% CI: 1.2 – 132.5). No specific medical management was associated with an improved stoma closure rate, including biologic agents when these were available (p=0.25).Conclusion The fate of temporary faecal diversion in patients with perianal Crohn's disease is adversely affected by aggressive disease characteristics. No particular treatment, including biological therapy was associated with an improved outcome.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;