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How the Microbiome is Shaping our Understanding of Cancer Biology and its Treatment
This article highlights the leading theories on the microbial contribution to colorectal tumorigenesis and proposes novel, therapeutic strategies for the future treatment of this disease. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Sara Gaines, Ashley J. Williamson, Neil Hyman, Jessica Kandel Source Type: research

The influence of intestinal microbiome on wound healing and infection
Wound healing problems and surgical site infections are commonly attributed to improper intraoperative technique and perioperative infection control methods. However, overwhelming evidence is emerging to suggest that the intestinal microbiome plays a profound and previously underappreciated role in infectious outcomes of surgery. Surgical stress and perioperative medical interventions alter the community structure and function of the intestinal microbiome. The resultant intestinal dysbiosis exerts overarching effects on the host immune and neuroendocrine systems. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Monika A. Krezalek, John C. Alverdy Source Type: research

The role of the intestinal microbiota in the pathogenesis and treatment of inflammatory bowel diseases
In little over a half century, the incidence and prevalence of inflammatory bowel diseases (IBD) has increased dramatically on a time scale that would be difficult to explain by genetic drift. The impact that IBD has on patients, particularly children and young adults, can be devastating, as there are no cures or preventive therapies. Although some insights have been gained in the conceptual development of IBD pathogenesis, the complexity and interplay of genetic, environmental and microbial factors that converge to trigger and sustain human IBD remain unclear. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Jun Miyoshi, Yuqi Qiao, Eugene B. Chang Source Type: research

Clostridium difficile: What the surgeon needs to know
Clostridium difficile infection (CDI) has become the most common nosocomial pathogen. The diarrheal illness is most typically associated with prior antibiotic use that creates a disruption of the normal colonic microbiome, allowing for proliferation of this anaerobic bacteria. Infection results in colonic inflammation as a result of toxin production. The clinical presentation ranges from mild diarrhea to systemic critical illness with organ failure. An interplay of the host immune response and the role of the microbiome likely plays a role in the pathogenesis of disease, the high rates of recurrence, and the ability to res...
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Katherine Hrebinko, Brian S. Zuckerbraun Source Type: research

Probiotics and fecal microbiota transplantation in surgical disorders
The importance of the gut microbiota in health and disease has led to interest in developing methods to modify it. Probiotics administration and fecal microbiota transplantation (FMT) are two such approaches that can alter the gut microbiota, potentially offering health benefits by blocking gut colonization by pathogenic organisms and preventing a maladaptive immune response. Both methods have been studied in a variety of settings relevant to colorectal surgeons, including colorectal cancer, inflammatory bowel disease, C. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: Andrew Yeh, Michael J Morowitz Source Type: research

Introduction
For generations, surgeons operating on the digestive track have recognized the potential harm that intestinal bacteria can cause to both the wound and anastomosis. Over time, clinicians began to analyze which species were responsible for postoperative infections, and developed rigorous intestinal cleansing and decontamination protocols that, to this day, remain efficacious. Yet looking back, we have come to realize that the knowledge which today forms the basis for our intestinal antisepsis protocols is more than fifty years old and clearly in need of a refresh. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - September 20, 2017 Category: Gastroenterology Authors: John Alverdy, Neil Hyman Source Type: research

Introduction
In the practice of surgery we are constantly striving to develop therapies that alleviate symptoms and improve the quality of life of our patients. Unfortunately the path to new technologies is littered with ideas and products that, while initially promising, eventually prove to have significant limitations. The term “disruptive” in the context of new technology means “innovative or groundbreaking.” Before the introduction of neuromodulation, treatments for fecal incontinence focused on physical therapy to optimize the function of the existing sphincter mechanism or strategies to augment the existing sph incter wit...
Source: Seminars in Colon and Rectal Surgery - July 12, 2017 Category: Gastroenterology Authors: Amy L. Halverson Tags: SI: Sacral Neuromodulation Source Type: research

Sacral neuromodulation for constipation and fecal incontinence in children
Sacral neuromodulation has become an established treatment option for adults with fecal incontinence, but has only been applied to children with defecatory disorders over the past decade. Unlike in adults, the primary cause of fecal incontinence in children is poorly controlled constipation. There is growing evidence that sacral neuromodulation can be effective in the treatment of children with both constipation and fecal incontinence refractory to conventional treatment, and sacral nerve stimulation appears to be a promising treatment for a population of children with limited treatment options and debilitating symptoms. (...
Source: Seminars in Colon and Rectal Surgery - July 6, 2017 Category: Gastroenterology Authors: Peter L. Lu Source Type: research

Management of complications of sacral neuromodulation
Sacral neuromodulation is an effective treatment strategy for fecal incontinence. This is a minimally invasive technique that has significant improvement over medical therapy. Complications related to sacral nerve stimulator placement include pocket complications, lead complications, infection, pain, and lack or loss of efficacy. While most complications can be managed by conservative means including medication or reprogramming, the reoperation rate for sacral nerve stimulation can be as high as 39%, including replacement of a lead, battery, or complete explant of the device. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 5, 2017 Category: Gastroenterology Authors: Luanne Force, Giovanna da Silva Source Type: research

Sacral neuromodulation and the low anterior resection syndrome
More than half of patients undergoing a low anterior resection with coloanal anastomosis will experience subsequent bowel dysfunction including symptoms of fecal incontinence and disordered evacuation. This cluster of symptoms is referred to as the low anterior resection syndrome (LARS). Several case series have demonstrated that sacral neuromodulation (SNM) improves various symptoms in individual with LARS, with the greatest degree of improvement in the symptoms of clustering and urgency. Although the mechanism by which SNM therapy was beneficial in a majority of patients with LARS is not clear, SNM warrants serious consi...
Source: Seminars in Colon and Rectal Surgery - July 5, 2017 Category: Gastroenterology Authors: Saleh M Eftaiha, Johan Nordenstam Tags: SI: Sacral Neuromodulation Source Type: research

Quality of life in patients treated with sacral neuromodulation for fecal incontinence
Fecal incontinence, the uncontrolled loss of liquid or solid stool, is a common problem whose prevalence ranges from 2% - 17% in the US. Patients with this condition may suffer from severe embarrassment, shame, or depression, which, in turn, may severely impede daily activities. Sacral neuromodulation (SNM) was first employed for the treatment of fecal incontinence in 1995. Since that time, over 100 case series have been conducted to assess SNM efficacy for the treatment of fecal incontinence. Most of these studies have shown significant improvement in fecal incontinence severity over short and long-term follow-up. (Source...
Source: Seminars in Colon and Rectal Surgery - July 5, 2017 Category: Gastroenterology Authors: Robert N. Goldstone, Liliana G. Bordeianou Source Type: research

Anatomy and Physiology: Neurologic Basis for the Function of Sacral Nerve Stimulation
Sacral neuromodulation (SNM) was originally evaluated in the 1970 ′s for urinary dysfunction. SNS was approved by the Food and Drug Administration (FDA) for urinary urge incontinence in 1997. Observing that patients treated with SNM for urinary incontinence experienced increased anal pressures and symptomatic improvement of fecal incontinence (FI), investigators explored the role of SNM for the treatment of FI. In 2011, FDA approval was received for the indication of FI. Currently, while SNM is an accepted surgical modality for the treatment of FI, the mechanism by which SNM modulates anorectal physiology to improve bowe...
Source: Seminars in Colon and Rectal Surgery - July 4, 2017 Category: Gastroenterology Authors: Brooke Gurland, Erman Aytac Source Type: research

Patient selection and preoperative evaluation for fecal incontinence
Patient selection and preoperative evaluation play a vital role in the application of sacral neuromodulation (SNM) to fecal incontinence (FI). The history and physical should elucidate the nature of the incontinence, including duration, severity, type of leakage, as well as associated pathology (e.g. urinary incontinence, prolapse, etc.). Additionally, the use of a validated incontinence scoring system in obtaining an objective measure is recommended as a way to monitor an individual patient ′s response to treatment over time. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 4, 2017 Category: Gastroenterology Authors: Arjun N. Jeganathan, Joshua I.S. Bleier Source Type: research

Technical considerations for sacral nerve stimulator insertion
Fecal incontinence (FI) is defined as the involuntary passage of stool or flatus. It is a socially and physically debilitating condition affecting up to 15% percent of the adult population. Etiology of the disease is multifactorial, and consequently, disease management warrants a multimodal approach. Initial therapy consists of conservative measures, but when these fail, consideration should be given to surgical management. Sacral neuromodulation (SNM) is an emerging therapy due to its high reported success, long term efficacy, low morbidity, and no reported mortality. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 4, 2017 Category: Gastroenterology Authors: Teresa C. Rice, Ian M. Paquette Source Type: research

Managing expectations of the patient following sacral neuromodulation
Fecal incontinence can have a drastic effect on patients ′ quality of life. Traditional procedures for incontinence have been effective, but are not durable. Sacral nerve stimulation has been shown to be an effective treatment for fecal incontinence with good long term results and low morbidity. As with any procedure, it is important to identify patient expectations of therapy, define patient′s outcome goals and measure outcomes as to how well patients′ goals are achieved. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 4, 2017 Category: Gastroenterology Authors: Kelly A. Garrett Source Type: research