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Extending the Indications: Transanal Endoscopic Surgery for Fistula, Stricture, and Rare Tumors
The role of transanal endoscopic surgery (TES) in the management of rectal neoplasm is well established. TES offers many advantages over traditional transanal approaches, in particular excellent visualisation and a stable platform for precise instrumentation. These features facilitate reliable and accurate surgical treatment and have been exploited in managing other rectal pathologies by TES, such as fistulae, strictures and rare tumors. The effectiveness of TES means that radical surgery can be avoided in favour of organ-preserving approaches with considerable advantage to patients. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: Helen Jones, Chris Cunningham Tags: Chapter 10 Source Type: research

Transanal minimally invasive surgery (TAMIS): PROS and cons of this evolving procedure
Transanal endoscopic surgery (TES) enables the intraluminal excision of rectal lesions with specialized equipment that maintains a stable pneumorectum, enables magnified visualization of target lesions along with the capacity for using precise instrumentation for tissue resection and re-apposition. The requirement for generalizable, cost effective access modalities for the local excision of rectal lesions combined with the existing skill set applied to single incision laparoscopic surgery led to transanal minimally invasive surgery (TAMIS). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 20, 2014 Category: Gastroenterology Authors: John P. Burke, Matthew Albert Source Type: research

Complications of transanal endoscopic surgery
Over the past decade, transanal endoscopic surgery (TES) has gained worldwide popularity for its role in the excision of benign and favorable malignant rectal lesions. Compared to the traditional transanal excision, TES provides better visualization, less specimen fragmentation and improved outcomes based on negative margin status and decreased recurrence rates. Although TES has significantly less morbidity and mortality than radical surgery, complications can occur in up to 5-25% of cases. Based on an extensive examination of the literature, this comprehensive review will outline the most common encountered complications ...
Source: Seminars in Colon and Rectal Surgery - October 18, 2014 Category: Gastroenterology Authors: Vanessa A. Talbott, Mark H. Whiteford Source Type: research

Functional outcomes following transanal rectal surgery
Transanal rectal surgery and particulary transanal endoscopic microsurgery are becoming increasingly utilized in a variety of settings. In well-selected cases, oncologic outcomes are comparable to more radical techniques and operative complications are decreased with the less invasive procedures. Due to the necessity for anal dilation during transanal approaches however, concern over functional outcomes has developed. As the medical community focused on these functional results however, it became clear that compared to radical resection, transanal surgery compares favorably; disturbances due to pelvic nerve injury are nota...
Source: Seminars in Colon and Rectal Surgery - October 18, 2014 Category: Gastroenterology Authors: Joseph Platz, Peter Cataldo Source Type: research

Transanal endoscopic surgery as a pathway to NOTES
At the vanguard of colorectal minimally invasive surgery is transanal natural orifice transluminal surgery (NOTES). Building on extensive pre-clinical research, transanal NOTES innovators have extended the capacity of established endorectal surgical platforms to achieve safe and efficacious endoscopic colorectal resection for both benign and malignant disease. Transanal TME (taTME) for rectal cancer is the fastest growing clinical application of transanal NOTES, with nearly 100 cases now reported. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 18, 2014 Category: Gastroenterology Authors: Lillias Maguire, Patricia Sylla Source Type: research

Transanal surgery for cT1 rectal cancer: Patient selection, technique, and outcomes
Although evidence has repeatedly shown transanal excision (TAE) to be an oncological compromise compared with standard resection for early rectal cancers, the use of TAE and other local approaches has steadily increased over the past decade. This trend is especially evident for cT1 tumors. An increased risk of local recurrence and worse disease-free survival and overall survival are balanced by the markedly decreased surgical risk associated with TAE, as well as its potential benefit with respect to patient values and priorities. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 17, 2014 Category: Gastroenterology Authors: Oliver S. Chow, Jesse Joshua Smith, Marc J. Gollub, Julio Garcia-Aguilar Source Type: research

Transanal surgery for cT2T3 rectal cancer: Patient selection, adjuvant therapy, and outcomes
Local excision alone is not adapted for cT2T3 rectal cancer, because it is associated with a high local recurrence rate (23% for T2 and 38% for T3) and postoperative therapy after local excision is not efficient to prevent local recurrence. By contrast, neoadjuvant therapy proposes to permit local excision for cT2T3 because the patients are selected by the tumor response. Patients with cT2N0 and small cT3 tumors ≤4cm are the best indications for this strategy. Local excision permits to select the good pathologic responders ypT0–1 as the optimal candidate for surveillance and to propose radical surgery for the bad respo...
Source: Seminars in Colon and Rectal Surgery - October 17, 2014 Category: Gastroenterology Authors: Eric Rullier, Quentin Denost Source Type: research

The history of transanal endoscopic surgery
Transanal endoscopic microsurgery was pioneered by Professor Gerhard Buess at a time when surgeons were just beginning to experiment with minimally invasive technology. TEM and the other platforms which perform transanal endoscopic surgery share certain features, they use insufflated carbon dioxide, long shafted instruments, and high definition optics to do endoluminal surgery through a natural orifice. The main clinical experience is in removing selected rectal neoplasms, although potentially any rectal pathology can be addressed with this instrumentation. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 17, 2014 Category: Gastroenterology Authors: Theodore J Saclarides Source Type: research

Transanal surgery for cT1 rectal cancer: Patient selection, technique and outcomes
Although evidence has repeatedly shown transanal excision (TAE) to be an oncological compromise compared with standard resection for early rectal cancers, the use of TAE and other local approaches has steadily increased over the past decade. This trend is especially evident for cT1 tumors. An increased risk of local recurrence and worse disease-free survival and overall survival are balanced by the markedly decreased surgical risk associated with TAE, as well as its potential benefit with respect to patient values and priorities. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 17, 2014 Category: Gastroenterology Authors: Oliver S. Chow, J. Joshua Smith, Marc J. Gollub, Julio Garcia-Aguilar Source Type: research

Transanal Surgery for cT2-T3 Rectal Cancer: Patient Selection, Adjuvant Therapy and Outcomes
Local excision alone is not adapted for cT2T3 rectal cancer because it is associated with a high local recurrence rate (23% for T2 and 38% for T3) and postoperative therapy after local excision is not efficient to prevent local recurrence. By contrast, neoadjuvant therapy proposes to permit local excision for cT2T3 because the patients are selected by the tumor response. Patients with cT2N0 and small cT3 tumors ≤ 4cm are the best indications for this strategy. Local excision permits to select the good pathologic responders ypT0-1as the optimal candidate for surveillance and to propose radical surgery for the bad responde...
Source: Seminars in Colon and Rectal Surgery - October 17, 2014 Category: Gastroenterology Authors: Eric Rullier, Quentin Denost Source Type: research

Imaging of Anal Fistulas
There are many radiological imaging techniques for perianal fistulas, the choice of modality may depend on several factors other than simply diagnostic accuracy. Equipment availability and financial constraints vary between healthcare systems.Inexperienced clinical assessment may miss secondary extensions; the resulting recurrence is expensive and upsetting for patients.Fistulography no longer has a role in fistulas arising from the anus itself, but may be useful in identifying extra-sphincteric tracts arising from abdominal organs, such as appendix, terminal ileum and sigmoid colon. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 28, 2014 Category: Gastroenterology Authors: Nuha A. Yassin, Nicholas Day, Robin K.S. Phillips Source Type: research

The LIFT Procedure
The Ligation of Intersphincteric Fistula Tract (LIFT) procedure is a recent sphincter preserving procedure added to the surgical armamentarium of managing anal fistulas. It has gained popularity for its simple, easy-to-learn technique and success rate reliably exceeding 70%. Studies using validated continence scores have verified its advantage in preserving continence. The procedure is aimed at the cryptoglandular source of infection within the intersphincteric space. This is achieved through a small incision parallel to the intersphincteric groove and corresponding to the internal opening. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 28, 2014 Category: Gastroenterology Authors: Sharon Zhi-Ling, Charles Bih-Shiou Source Type: research

Perianal fistulas in patients with inflammatory bowel disease
Fistula in ano represents a challenging pathology for both the patient and clinician, and management can be made even more difficult in the setting of Crohn’s Disease. Up to 54% of patients with Crohn’s Disease will suffer from anorectal involvement which can have a profound impact on quality of life. Treatment of Crohn’s related fistulas, however, can be fraught with complications including delayed wound healing, persistent fistula, and fecal incontinence. As such, a thoughtful, moderated and well-informed approach is necessary when evaluating and treating a Crohn’s-related anal fistula. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 28, 2014 Category: Gastroenterology Authors: Radhika K. Smith, E. Carter Paulson Source Type: research

Future Directions in the management of anal fistula
While evolution of surgical therapies is inevitable over time, it is not to say that all changes are helpful. Yet, many of the changes witnessed to date in the development and progression of fistula surgery have played a role in both minimizing morbidity, and maximizing outcomes. Yankee’s catcher Yogi Berra once said, “It’s tough to make predictions, especially about the future.” It is, however, clear that fistulas will continue to be a part of every colorectal surgeon’s practice going forward. As such, we need to maintain efforts to improve outcomes, especially for recurrent and recalcitrant disease. (Source: Se...
Source: Seminars in Colon and Rectal Surgery - August 28, 2014 Category: Gastroenterology Authors: Mia DeBarros, Vance Y. Sohn, Scott R. Steele Source Type: research

Anal fistula plug: Where were we, where are we now?
This article will discuss the use of the anal fistula plug (AFP) from its inception, evolution of technique, and its predictors of success, while summarizing the literature on the bioprosthetic anal fistula plugs in the management of anal fistulas. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - August 27, 2014 Category: Gastroenterology Authors: Skandan Shanmugan, Bradley J. Champagne Source Type: research