Abstract in English:

Abstract Introduction Hemorrhoidal disease is an anorectal condition commonly encountered in the clinical practice. Various instruments, such as circular staplers, harmonic scalpels, lasers, and bipolar electrothermal devices, are used in different modalities of hemorrhoidectomy in cases of high-grade hemorrhoids. Objective T compare the results of hemorrhoidectomy using the Ferguson technique and the harmonic scalpel. Materials and Methods The present is a randomized prospective study involving 60 patients submitted to hemorrhoidectomy from February 2022 to January 2024. The patients were randomly grouped: group I was composed of 30 patients who underwent the operation through the conventional Ferguson technique, and group II was composed of 30 patients submitted to hemorrhoidectomy with the use of the harmonic scalpel. Results The demographic and clinical features of the patients in the two groups were identical. We found a significant difference in the mean operative time: for the Ferguson technique, it was of 21.9 ± 4.6 minutes, while for the harmonic scalpel, it was of 17.9 ± 3.1 minutes (p = 0.003). The mean postoperative pain scores on the Visual Analog Scale (VAS) were of 7.1 ± 1.2 points for group I, and of 6.5 ± 0.5 points for group II (p = 0.024). And the mean hospital stay was of 1.23 ± 2.1 days for group I, and of 1.03 ± 0.1 for group II (p = 0.023). No statistical significance was observed regarding the other parameters. Conclusion Hemorrhoidectomy using the harmonic scalpel seems to be a superior approach to treat high-grade hemorrhoids; it has the advantage of reduced hospital stay, decreased postoperative pain, and shorter operative time.

Abstract in English:

Abstract Introduction Anal fistula surgery is often associated with continence disorders due to transection of the anal sphincter muscles. A comprehensive understanding of the anatomy of the anal canal and fistula can help prevent this outcome. Objective To correlate the anatomy of the intersphincteric anal fistula with the patient's sex using three-dimensional endoanal ultrasound (3D-EAUS). Materials and Methods The present is a retrospective observational study, involving an analysis of the medical records of patients seen at the Coloproctology Service of a Public Tertiary Hospital in the state of Maranhão, Brazil, from July 2016 to December 2022. Patients were categorized by sex and assessed for the position of the internal opening (IO), distance from the IO to the anal margin, and amount and percentage of internal anal sphincter (IAS) muscle compromised by the fistulous tract. Results Intersphincteric fistulae were more common in men. The average age among men was of 46.46 years, and, among women, it was of 38.17 years. There was a difference between the sexes in terms of the duration of compromised IAS, which was longer among men. The percentage of compromised IAS was higher in males. The IO was located at a greater distance from the anal margin in male patients compared to female ones. Conclusion Male patients with intersphincteric anal fistula had the internal fistulous opening positioned more distant from the anal margin, with a greater length and percentage of the IAS muscle compromised by the fistulous tract compared to female patients with the same condition.

Abstract in English:

Abstract Objective The present study evaluated the relationship between the incidence of colorectal cancer and colonoscopy in Santa Catarina from 2018 to 2022. Methods Observational study of ecological type, which includes all confirmed cases of CRC in the state of Santa Catarina from 2018 to 2022, across health macro-regions. The data were obtained from SINAN, through TABNET/DATASUS. The variables gender, age group, race, type of care, average cost per hospitalization, days of stay, deaths, and mortality rates were evaluated. Results In the period from 2018 to 2022, there were more than 28,000 cases of CRC in the state of Santa Catarina, with the Grande Oeste region being responsible for the highest incidence throughout the studied period. The main age group is between 70 and 79 years old; As for gender, most cases are predominantly male; about race, white ethnicity is predominant; the nature of service is, for the most part, elective; the average value per hospital stay is 2,355.41; total hospital stay days are 120,924; the number of deaths is 1553 and the mortality rate is (5.44/100.00). Regarding colonoscopy, the largest number of colonoscopies performed was in Grande Florianópolis. Conclusion There is a high incidence of CRC cases in the state of Santa Catarina. Males and those aged 70 to 79 are the most affected by CRC in Santa Catarina. The Grande Oeste region has a higher incidence of cases compared with other health macro-regions.

Abstract in English:

Abstract Introduction Stoma placement is a common surgical procedure that can be performed in the context of urgent and elective surgery for benign and malignant conditions, with an estimated morbidity ranging from 21% to 70%. Methods A retrospective cohort analysis to determine the incidence of stoma placement postoperative-related complications and potential associated factors. This study was conducted at a single tertiary care center in Mexico City including all patients who underwent a stoma construction between January 2016 and October 2023. Results A total of 276 patients underwent stoma construction. Eighty-one (29.3%) patients presented morbidity exclusively related to the ostomy. The multivariate analysis showed the following risk factors: advanced age for developing stoma-related complications; obesity for developing parastomal hernia; strangulated hernia and complicated diverticular disease for developing mucocutaneous dehiscence; bowel obstruction and parastomal hernia for developing stomal prolapse; anastomotic leak and preoperative corticosteroid therapy for developing parastomal abscess; and end-colostomy and advanced age for reoperation. Discussion Ostomy creation carries a high morbidity rate. Preoperative features such as advanced age, obesity, corticosteroid therapy, the indication of the surgery, as well as the type of the stoma created must be considered as they could significantly impact the development of adverse outcomes.

Abstract in English:

Abstract Objective The aim of this study is to evaluate the long-term functional outcomes in patients treated by Altemeier's procedure for complete rectal prolapse. Methods Records of 40 patients who underwent Altemeier's procedure for complete rectal prolapse between January 2013 to June 2023 were analyzed. The median duration of post operative follow-up was 48 months (ranges- 6 months to 10 years). Postoperatively, fecal incontinence, constipation and recurrence were analyzed. Results The median age was 45 (13-75) years. The male-to-female ratio was 1.4:1. Among forty patients, five patients had recurrent rectal prolapse. Out of forty, nine patients underwent emergency Altemeier's procedure. The median time taken for the procedure was 120 (80-155) minutes. The median postoperative length of hospital stay was 9 days. Three patients (7.5%) had Grade I anastomosis leak. All patients subsequently developed anastomotic stricture and were managed with periodic anal dilatation. There was no mortality. Postoperatively, constipation reduced from 25% to 7.5% and fecal incontinence reduced from 37.5% to 10%. There was no recurrence in our study. Conclusion The Altemeier procedure is a safe and effective procedure in both elderly and young patients presenting with complete rectal prolapse. It was associated with minimal morbidity and good long-term functional outcomes.

Abstract in English:

Abstract Objective Anorectal abscess is a frequent surgical problem. The objective of our retrospective study is to determine the clinical factors that mitigate complications of anorectal abscesses. Methods Data from a retrospective review of patients of one colorectal surgeon (GP) admitted and operated on for anorectal abscess at the Jersey Shore University Medical Center and Ocean University Medical Center between January 2019 and December 2022 were reviewed. Clinical information was obtained from medical records. Results A total of 48 patients underwent surgery for drainage of anorectal abscess. After a physical examination, 48% of patients (23 of 48) received diagnostic imaging to confirm the nature and location of the abscess. Approximately 73% of patients (36 of 48) presented with an anorectal fistula upon evaluation. Of the 48 patients, thirty (63%) were diagnosed with a perianal abscess. The abscess in the other 18 of the 48 patients was in other areas of the anorectal region. Eleven patients developed a recurrent abscess after undergoing initial drainage. On average, recurrent patients waited 59 days before seeking initial treatment, whereas nonrecurrent patients waited ~21 days. Conclusion Patients who delay seeking medical attention are more likely to develop a recurrent abscess after receiving initial treatment. Diagnostic imaging with ultrasound and computed tomography significantly reduced transit time between the emergency room and the operating room. In both recurrent and nonrecurrent groups, no correlation was found between the size or location of the abscess and the chance of abscess recurrence.

Abstract in English:

Abstract Introduction Malignant obstruction of the large bowel is a common clinical presentation, particularly in terminal cancer patients. Urgent resection and surgical diversion were the treatments of choice. Objective The aim of the current study was to compare urgent resection of the colon and surgical diversion as conservative management in patients presented with malignant colorectal obstruction regarding short-term, post-operative, prognostic, and long-term oncologic outcomes. Methods 80 patients with clinical and/or radiological evidence of malignant bowel obstruction distal to the ligament of Treitz and patients presented with incurable primary intra-abdominal primary cancer and patients with intra-peritoneal disease were included in the study. Patients were divided into 2 groups. The first group included 20 patients (25%) who underwent conservative management, while 60 patients (75%) underwent definitive surgical management. Results We showed statistically significant findings between both groups regarding the total length of hospital stay, the total amount of costs, the rate, and the interval of re-admission. The duration of staying at hospital and rate of re-admission in the group that was managed by definitive surgery is more than the group of patients that was managed by conservation. We found that the rate of postoperative complications and morbidity in patients who underwent urgent definitive surgical resection was higher than that in those who underwent conservative management. Conclusion In patients with malignant obstruction of the colon selection of definitive surgical management might not improve patients' outcomes and conservative management in addition to chemotherapy might be superior and might improve patients' outcomes and survival.

Abstract in English:

Abstract Objective The objective of this study was to analyze the epidemiological profile of patients to propose measures that facilitate regulation and access to diagnostic imaging exams. Methods Data were collected from 157 scheduled exams for high-suspicion colonoscopy through regulation systems and electronic medical records from January to December 2023. Results: The data showed a higher rate of appointments among females, particularly in older age groups (71–80 years). There was a high rate of non-attendance on the day of the exam scheduled during the coldest months of the year. The most prevalent biopsy location was the colon region, with a predominance of low-grade adenomas and polyps. Conclusion Facilitating access to diagnostic imaging exams includes regionalization in scheduling. Monitoring results allows for the tracking of family members, enabling preventive action and early diagnosis.

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Abstract Objective In recent years, Ligasure hemorrhoidectomy has been preferred in the treatment of grade 3 and 4 hemorrhoids rather than traditional surgery. This study aimed to compare the efficacy of Ligasure hemorrhoidectomy in grade 3 and 4 hemorrhoid treatment. Methods A retrospective examination was made of the files of patients who underwent Ligasure hemorrhoidectomy because of grade 3 or 4 hemorrhoids. The demographic and clinical data of the patients were recorded. To evaluate pain severity after the procedure, a Visual Analog Scale (VAS) was used, and patient satisfaction at 6 months after the procedure was evaluated with a Likert-type scale. Early and late complications were determined in these follow-up examinations. Results The patients included in the study had a mean age of 45 ± 11 years and 82 (75.9%) were male. The mean follow-up period was 18 months (range, 6–44 months). The mean age of patients with grade 4 hemorrhoid was significantly higher than that of those with grade 3 hemorrhoid (p = 0.006). Postoperative early and late (relapse) complications were seen at a higher rate in grade 4 patients compared with grade 3, but the difference was not statistically significant. More successful treatment outcomes were observed in grade 3 patients than in those with grade 4 hemorrhoid, but not to a statistically significant level. Conclusion Ligasure hemorrhoidectomy is safer in terms of postoperative complications and treatment success is greater in patients with grade 3 hemorrhoids compared with those with grade 4 hemorrhoids.

Abstract in English:

Abstract Angiolipomas are benign tumors composed of adipose tissue commonly found in the subcutaneous tissue with vascular proliferation. It is uncommon to find it in the gastrointestinal tract. This report focuses on an angiolipoma found in the sigmoid colon causing intussusception in a young healthy 26-year-old male. We discuss the presentation, workup and surgical management.

Abstract in English:

Abstract Granular cell tumors (GCTs) are rare benign neoplasms that can occur anywhere in the body but are most commonly found in the head and neck region. These tumors are often asymptomatic and are incidentally discovered during routine rectal examination. In some cases, symptoms may include bleeding, pain, and a palpable mass. Imaging studies such as colonoscopy, ultrasound, magnetic resonance imaging (MRI), or computed tomography can be used to characterize and measure the tumor. Treatment typically involves local resection, with or without adjuvant radiotherapy, depending on the size, location, and pathological characteristics of the tumor. The prognosis for GCTs of the anal canal is generally good, with few cases of recurrence or metastasis reported, but long-term follow-up is recommended due to the potential for late recurrence or malignant transformation. The present study reports a 39-year-old female patient who presented with anal itching associated with protrusion of a perianal mass and who underwent treatment between November 2022 and December 2023. The MRI scan revealed a nodular image in its caudal aspect with involvement of the internal sphincter between 12 and 5 o'clock, which was successfully resected. Histopathology was compatible with GCT, and the patient had a satisfactory recovery and was discharged. In conclusion, GCTs of the anal canal are rare and extremely unusual tumors that can be difficult to diagnose and manage, requiring a multidisciplinary approach for optimal management.

Abstract in English:

Abstract Clostridioides difficile infection (CDI) is a common hospital-acquired infection, typically presenting with watery diarrhea and colitis. Most cases are managed with clinical support and antibiotics. Recently, more virulent strains have been associated with life-threatening infections. Surgery plays a role for complicated cases failing clinical treatment or with complications, such as bowel perforation and peritonitis. The present study reports the case of a 62-year-old female with CDI and fulminant colitis requiring urgent surgery. Surgeons should be aware of this presentation and involved early in the care of these patients, as clinical deterioration can occur very rapidly.

Abstract in English:

Abstract Introduction A patient using tacrolimus for hepatocyte transplantation (HT) was diagnosed with Crohn disease (CD) with mainly colonic involvement, despite drug immunosuppression due to the previous transplant. Upon routine colonoscopy, a lateral growth lesion was detected, which was endoscopically unresectable. Therefore, it was decided to perform a total colectomy with burial of the rectum and terminal ileostomy. During surgery, thickening of the terminal ileum and cecum was visualized, along with "fat-wrapping" and thickening of the entire mesocolon. Discussion Immunosuppression in patients with HT should control the activity of autoimmune diseases. However, the literature shows evidence of some reports of inflammatory bowel disease (IBD) activity after liver transplantation (LT). A review article from 2015 highlighted 92 cases of IBD after LT in the literature, with only 14 being CD, demonstrating that this is a rare phenomenon. Among the hypotheses, cytomegalovirus infection is related to the increased disease activity in patients with IBD and HT. In addition, several studies show an association between the drugs used in immunosuppression after LT and relapsed IBD, important data in patients receiving tacrolimus. Conclusion The occurrence of CD after LT is rare and seems to have a direct association with the immunosuppression used to prevent rejection of the transplanted organ.

Abstract in English:

Abstract The comparison between the current state of these lifestyle disorders and the prevalence of adult lifestyle diseases including diabetes and cancer in India, as reported by NFHS-4 and NFHS-5. Cancer is still the second greatest cause of death worldwide, despite recent advancements in technology and medicine. Northeast India has a greater cancer burden than the rest of the nation, according to a 2020 study released by the Indian National Cancer Registry. In India, an estimated 77 million individuals had diabetes in 2019, and by 2045, that number is expected to rise to over 134 million Program. In accordance with the 2020 WHO study, India had a 30% higher number of cancer-related fatalities (850,000 versus 610,000 deaths) while only reporting 1.32 million new instances of the disease, compared with 2.28 million in the United States of America. In the globe, cancer of the breast is among the most common carcinomas in women to be diagnosed, and it also ranks top in terms of cancer-related deaths. Around the world, the prevalence of cancer of the breast is steadily rising. The primary focus of this study is the high incidence of lifestyle illnesses in the adult Indian population, as measured by NFHS-4 and NFHS-5, including diabetes and cancer. Based on data from the NFHS-4 and NFHS-5 Survey, we discovered that there are growing trends in the percentage of mouth cancer among males (both urban and rural), whereas there are declining trends in the percentage of cervical, oral, and breast cancer in the case of women.