International Journal Of Colorectal Disease[JOURNAL]
Sun
200 papers
Electroacupuncture combined with biofeedback for obstructed defecation syndrome: a retrospective cohort study.
Wenhui L, Kun T, Ming L … +2 more , Siyuan L, Qiubing Z
Int J Colorectal Dis · 2026 Apr · PMID 41986806 · Full text
OBJECTIVE: To investigate the therapeutic efficacy of electroacupuncture combined with biofeedback therapy (BFT) in patients with obstructed defecation syndrome (ODS). METHODS: This single-center retrospective cohort stu...
OBJECTIVE: To investigate the therapeutic efficacy of electroacupuncture combined with biofeedback therapy (BFT) in patients with obstructed defecation syndrome (ODS). METHODS: This single-center retrospective cohort study included 296 patients with ODS, who were assigned to either a BFT group (n = 112) or an electroacupuncture plus BFT group (n = 184) according to the treatment modality received. "Post-treatment" outcomes were operationally defined as assessments performed after completion of the 10th BFT session and before initiation of the 11th session. The primary outcome was the responder rate based on mean weekly complete spontaneous bowel movements (CSBMs). Secondary outcomes included the Constipation Scoring System (CSS), Traditional Chinese Medicine (TCM) syndrome score for constipation, quality of life assessed by the Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL), and pelvic floor surface electromyography (sEMG) parameters. Clinical efficacy grade was determined according to the TCM syndrome therapeutic efficacy evaluation criteria. RESULTS: Baseline characteristics were comparable between the two groups (P > 0.05). The overall response rate was significantly higher in the electroacupuncture plus BFT group than in the BFT group (90.76% [167/184] vs. 80.36% [90/112], P < 0.05). Weekly CSBM responder rate was also significantly higher in the combination group (90.8% vs. 69.6%, P < 0.05). After treatment, both groups showed significant improvements in mean weekly CSBM per patient, mean weekly laxative use days, CSS scores, TCM syndrome score for constipation, PAC-QOL scores, and pelvic floor sEMG parameters compared with baseline (all P < 0.01). Improvements in TCM syndrome score for constipation, the coefficient of variation of the pre-resting baseline, post-rapid contraction relaxation time, and endurance contraction coefficient of variation were significantly greater in the combination group than in the BFT group (P < 0.05). Female patients showed smaller improvement in PAC-QOL scores than male patients (β = 4.403, P = 0.004). In the multivariable ordinal model, treatment modality was associated with higher efficacy grades, whereas laxative use during the treatment period was associated with lower efficacy grades (both P < 0.001). In addition, disease duration was positively correlated with improvements in CSS scores. CONCLUSIONS: Electroacupuncture combined with BFT is more effective than BFT alone in alleviating defecatory difficulty and improving quality of life in patients with ODS, suggesting that this combined approach has favorable clinical applicability.
Clinical utility of the Oakland score in rectal bleeding: Implications for admission decisions and cost efficiency.
Çetin MF, Gönüllü ME, Yekenkurul E … +1 more , Gürsoy F
Int J Colorectal Dis · 2026 Apr · PMID 41981318 · Full text
BACKGROUND: Rectal bleeding is a frequent cause of emergency admissions, yet objective criteria for hospitalization remain limited. The Oakland Score was developed to identify low-risk patients suitable for outpatient ma...
BACKGROUND: Rectal bleeding is a frequent cause of emergency admissions, yet objective criteria for hospitalization remain limited. The Oakland Score was developed to identify low-risk patients suitable for outpatient management. METHODS: This retrospective single-center study analyzed 346 patients presenting with rectal bleeding between 2015 and 2025. Patients were categorized as low-risk (Oakland ≤ 8, n = 142) or high-risk (Oakland ≥ 8, n = 204). Clinical parameters, transfusion, tranexamic acid (TXA) use, and total hospital costs were compared. RESULTS: High-risk patients were older (64.2 ± 14.2 vs 52.4 ± 14.1 years, p < 0.001), had lower hemoglobin (10.6 ± 2.2 vs 12.6 ± 1.9 g/dL, p < 0.001), lower systolic pressure (116.1 ± 17.0 vs 124.3 ± 15.2 mmHg, p < 0.001), and higher heart rate (92.5 ± 14.1 vs 83.2 ± 11.6 bpm, p < 0.001). Hospital admission (91.2% vs 40.8%), transfusion (35.3% vs 5.6%), and TXA use (73.5% vs 28.2%) were significantly greater in high-risk patients (all p < 0.001). The Oakland Score correlated positively with total cost (r = 0.55, p < 0.001) and length of stay (r = 0.52, p < 0.001). ROC analysis showed excellent discrimination for hospital admission (AUC = 0.86, p < 0.001). CONCLUSION: The Oakland Score reliably predicts both clinical severity and healthcare burden in patients presenting with rectal bleeding. Integrating this simple and objective tool into emergency department protocols can help physicians identify low-risk patients who may be safely discharged, thereby reducing unnecessary hospitalizations, optimizing resource use, and improving overall cost-effectiveness of care.
Risk factors and prediction model for post-polypectomy metachronous colorectal adenoma.
Ma J, Zhang Q, Su J … +6 more , Wang Y, Li W, Zhou M, Shi H, Liu K, Wu J
Int J Colorectal Dis · 2026 Apr · PMID 41951907 · Full text
BACKGROUND: Endoscopic resection of colorectal adenomas helps reduce colorectal cancer mortality. However, post-polypectomy metachronous adenomas may reduce the sufficiency of colonoscopy scanning. AIM: To explore the ri...
BACKGROUND: Endoscopic resection of colorectal adenomas helps reduce colorectal cancer mortality. However, post-polypectomy metachronous adenomas may reduce the sufficiency of colonoscopy scanning. AIM: To explore the risk factors for post-polypectomy metachronous colorectal adenoma and establish a risk prediction model. METHODS: This retrospective cohort study included patients who underwent colonoscopy at Beijing Friendship Hospital from January 2013 to January 2023. Data on patients' demographics, laboratory results, colonoscopy findings, and pathology reports were collected. The enrolled patients were randomly divided into a training set and a validation set in a 7:3 ratio. LASSO analysis was employed to identify risk factors for metachronous adenomas. Based on these risk factors, a Cox regression model was used to create a risk prediction model. The C-index was calculated to assess the model's prediction accuracy, while time-dependent ROC (td-ROC) curves and calibration curves evaluated model predictive performance. A Decision Curve Analysis (DCA) was conducted to assess clinical utility. RESULTS: A total of 523 patients meeting the inclusion and exclusion criteria were enrolled and randomly divided into a training set (n = 366) and a validation set (n = 157). Twenty-one clinical and pathological features were included in the LASSO regression analysis. Among these, age, gender, baseline adenoma size, baseline adenoma location, baseline pathological grade, history of hypertension, and serum LDL level were included in the multivariable Cox regression analysis, leading to the establishment of a visualized nomogram model. The C-index of the predictive model was 0.729 (95% CI: 0.686, 0.772) in the training set and 0.724 (95% CI: 0.667, 0.781) in the validation set. The time-dependent ROC curve and calibration curve indicated good reliability of the model, and the DCA curve suggested satisfactory clinical utility. An online webserver was also constructed to visualize the model and facilitate the calculation of metachronous adenoma risk for clinicians (URL: https://colorectal-metachronous-adenoma-prediction.shinyapps.io/DynNomapp/ ). CONCLUSION: A total of 7 risk factors for post-polypectomy metachronous adenoma were identified. A risk prediction model that possesses good prediction accuracy and good clinical utility was established, providing a reliable tool for patient risk stratification.
Analysis of diverting ileostomy for colorectal cancer surgery: stenosis and T4 invasion are risk factors of reoperation due to anastomotic leakage, even when ileostomy is performed.
Takeda K, Yamada T, Ohta R … +8 more , Uehara K, Matsuda A, Shinji S, Yokoyama Y, Takahashi G, Iwai T, Hayashi K, Yoshida H
Int J Colorectal Dis · 2026 Mar · PMID 41910645 · Full text
PURPOSE: In colorectal cancer (CRC), diverting ileostomy prevents the occurrence and severity of anastomotic leakage (AL) during surgery. However, an ileostomy cannot prevent reoperation due to severe AL in some cases, a...
PURPOSE: In colorectal cancer (CRC), diverting ileostomy prevents the occurrence and severity of anastomotic leakage (AL) during surgery. However, an ileostomy cannot prevent reoperation due to severe AL in some cases, and an approach other than ileostomy may be required. This study identified the risk factors of AL and reoperation due to AL in patients with diverting ileostomies. METHODS: Patients diagnosed with CRC who underwent resection surgery accompanied by diverting ileostomy between January 2015 and December 2023 were included. We analyzed the risk factors for AL and reoperation due to AL. Stoma-related complications and perioperative results of stoma reversal surgery were also analyzed. RESULTS: In total, 120 patients were enrolled. AL occurred in 21 (17.5%) patients. Multivariate analysis revealed that tumor location in the lower rectum was the only risk factor for AL (P = 0.0095). Of these 21 patients, four (19.0%) required reoperation, while 17 (81.0%) recovered without reoperation. The rates of T4 tumors (P = 0.022) and stenosis (P < 0.001) were significantly higher in the reoperation group. Among the 120 patients, a high-output stoma was observed in 36 patients (30.0%), and outlet obstruction occurred in 19 patients (15.8%). In stoma reversal surgery, two patients (1.7%) experienced severe complications (Clavien-Dindo grade ≥ III). CONCLUSION: Lower rectal tumors are associated with a high risk of AL, and diverting ileostomy should be considered in such cases. Due to small number of AL patients requiring reoperation, the finding is exploratory. However, in patients with stenosis and T4 invasion, the merits of ileostomy might be restricted.
Histological architecture of the intersphincteric region of the anal canal: implications for the anatomical basis of anal fistula pathways.
Muro S, Nakajima Y, Nimura A … +1 more , Akita K
Int J Colorectal Dis · 2026 Mar · PMID 41896428 · Full text
PURPOSE: To clarify the histological architecture of the intersphincteric region of the anal canal by delineating the layer-specific organization and spatial relationships among the anal sphincter complex and associated...
PURPOSE: To clarify the histological architecture of the intersphincteric region of the anal canal by delineating the layer-specific organization and spatial relationships among the anal sphincter complex and associated muscular and connective tissue components. METHODS: Tissue blocks containing the lateral wall of the anal canal were obtained from 11 adult human cadavers donated for anatomical research. Specimens were examined using descriptive histological and immunohistochemical analyses in transverse and coronal planes. The internal and external anal sphincters, longitudinal muscle, levator ani, interbundle gaps, and connective tissue compartments were identified and analyzed with respect to their three-dimensional organization. RESULTS: The intersphincteric region exhibited a heterogeneous and layered architecture rather than a uniform plane. The longitudinal muscle demonstrated a mosaic organization consisting of dense and loose components. The dense component terminated near the mid-height of the internal anal sphincter (mean, 54% of its length), whereas the loose component expanded inferiorly and formed a spacious compartment characterized by sparse smooth muscle fibers and loose connective tissue. Inferiorly, loose longitudinal muscle fibers branched and traversed natural interbundle gaps within the external anal sphincter. In addition, two partially overlapping layers of the levator ani were consistently observed, with interposed gaps contributing to the structural complexity of the intersphincteric region. CONCLUSION: The intersphincteric region of the anal canal is a structurally complex and compartmentalized anatomical entity. Its heterogeneous histological architecture provides an anatomical substrate that may explain the initiation and directional spread of anal fistulas, including pathways described in classical fistula classifications.
Application of the Enhanced Recovery After Surgery (ERAS) programme in elective colorectal resection for diverticular disease: a retrospective propensity score-matched cohort study.
Cassini D, Lauricella S, Brucchi F … +4 more , De Stefano F, Clementi S, Faillace G, Baldazzi G
Int J Colorectal Dis · 2026 Mar · PMID 41840061 · Full text
BACKGROUND: Diverticular disease is one of the most common benign colorectal conditions and often requires elective resection for recurrent or complicated presentations. Enhanced Recovery After Surgery (ERAS) programmes...
BACKGROUND: Diverticular disease is one of the most common benign colorectal conditions and often requires elective resection for recurrent or complicated presentations. Enhanced Recovery After Surgery (ERAS) programmes have demonstrated benefits in mixed colorectal populations; however, evidence in purely benign diverticular cohorts remains limited. This study evaluated the impact of a standardised ERAS pathway on postoperative outcomes following elective colorectal resection for diverticular disease. METHODS: This retrospective multicentre cohort study included consecutive adults undergoing elective left-sided colorectal resection for diverticular disease between 2009 and 2024 in Northern Italy. Patients treated within an ERAS pathway were compared with those receiving conventional care. The primary outcome was length of hospital stay. Secondary outcomes included postoperative morbidity, gastrointestinal recovery, pain, mobilisation, and readmissions. Continuous variables were analysed with the Mann-Whitney U test and categorical variables with χ or Fisher's exact test. A propensity score-matched analysis was performed to account for baseline and temporal confounding. RESULTS: A total of 421 patients were included: 329 in the ERAS group and 92 in the non-ERAS group. Baseline characteristics were similar. ERAS adherence was associated with faster gastrointestinal recovery (median time to first flatus: 1 vs 2 days; stool: 1 vs 2 days), lower pain on POD 1 (VAS 2 vs 4), earlier mobilisation (12 h vs 21 h), and earlier solid diet introduction (POD 1 vs POD 2). Overall morbidity was lower in the ERAS group (6.6% vs 14%), without increases in severe complications or readmissions. Median LOS was reduced (4 vs 6 days). Propensity score matching (88 pairs) confirmed these findings. CONCLUSION: ERAS implementation in elective colorectal resection for diverticular disease is safe, feasible, and associated with accelerated recovery, reduced morbidity, and shorter hospital stay.
Robotic en bloc resection for transverse colon cancer with a malignant colojejunal fistula: a case report.
Imaizumi J, Shida D, Azuma Y … +3 more , Ito G, Mukohyama J, Sakuyama N
Int J Colorectal Dis · 2026 Mar · PMID 41831038 · Full text
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SENP3 drives colorectal cancer progression by enhancing GDF15 expression.
Yu Y, Bao W, Chen J … +2 more , Li Y, Gao Y
Int J Colorectal Dis · 2026 Mar · PMID 41824089 · Full text
BACKGROUND: SUMO-specific peptidase 3 (SENP3), as a de-SUMOylating enzyme, renders the process of protein SUMOylation reversible. It has been demonstrated to play either promoting or inhibitory roles in several cancers....
BACKGROUND: SUMO-specific peptidase 3 (SENP3), as a de-SUMOylating enzyme, renders the process of protein SUMOylation reversible. It has been demonstrated to play either promoting or inhibitory roles in several cancers. However, research on its function in colorectal cancer (CRC) remains absent. METHODS: Tissue samples from CRC patients were analyzed to measure the expression level of SENP3. Proliferation and viability assays were performed to assess the role of SENP3 in cell growth. The mouse model was established to evaluate the effect of SENP3 on the growth of xenografts derived from CRC cells. To investigate the mechanisms of SENP3 in CRC, proteomic analysis was conducted. RESULTS: We identified an elevated expression of SENP3 in cancerous tissues, which correlated with a reduced survival rate in CRC patients. SENP3 promoted cell growth in vitro and boosted tumorigenicity in vivo as a potential oncogenic factor. In terms of mechanism, proteomic analysis revealed that growth differentiation factor 15 (GDF15) is a downstream effector of SENP3. Treatment with MG132 confirmed that SENP3 enhances the stability of GDF15. Through a series of cellular functional experiments and mouse model establishment, we demonstrated that SENP3 regulates CRC progression by acting on GDF15. CONCLUSION: Based on our findings, we define a key role for SENP3 in colorectal cancer progression and suggest it as a viable target for therapeutic intervention.
Robot-assisted surgery for colorectal cancer using Weigao versus da Vinci systems: a retrospective comparative study.
Lv L, Zheng J, Shi A … +9 more , Lu J, Zhi H, Jiang Z, Zhang W, Yang X, Chen X, Dong Q, Shen X, Ruan X
Int J Colorectal Dis · 2026 Mar · PMID 41820697 · Full text
BACKGROUND: Robotic surgery is a well-validated treatment option for colorectal cancer (CRC). We aimed to evaluate the efficacy and safety of the Weigao (WG) robotic system compared with those of the da Vinci (DV) platfo...
BACKGROUND: Robotic surgery is a well-validated treatment option for colorectal cancer (CRC). We aimed to evaluate the efficacy and safety of the Weigao (WG) robotic system compared with those of the da Vinci (DV) platform for the surgical resection of CRC. METHOD: We retrospectively analyzed patients with stage I-III CRC who underwent robotic CRC resection using the Weigao or da Vinci Surgical System. Statistical analysis of perioperative clinical data, including preoperative, intraoperative, and postoperative parameters was conducted. RESULT: A total of 103 patients were included and divided into the WG (n = 65) and DV (n = 38) groups. All patients achieved surgical success, and there were no significant differences in preoperative baseline characteristics. However, the WG group demonstrated a significantly longer operative time. Patients in the WG group experienced a shorter time to first flatus and a low incidence of postoperative deep vein thrombosis. Notably, the total hospitalization cost was significantly lower when the Weigao Surgical System was used. CONCLUSION: This study demonstrated that the Weigao robotic system was comparable to the da Vinci system in terms of safety and efficacy for CRC surgery. Moreover, the total hospitalization cost was significantly reduced with the Weigao Surgical System, highlighting its potential as a cost-effective surgical option.
Predictors of increased acute postoperative pain after elective minimally invasive colorectal surgery.
Kaufmann M, Orth V, Dorwarth TJ … +3 more , Herrle F, Reißfelder C, Hardt J
Int J Colorectal Dis · 2026 Mar · PMID 41807812 · Full text
PURPOSE: Postoperative acute pain is a major obstacle to archiving key goals in modern perioperative treatment concepts such as ERAS® (enhanced recovery after surgery). Despite a multimodal pain management concept, some...
PURPOSE: Postoperative acute pain is a major obstacle to archiving key goals in modern perioperative treatment concepts such as ERAS® (enhanced recovery after surgery). Despite a multimodal pain management concept, some patients continue to suffer from severe pain. The aim of this analysis is to identify predictors of severe postoperative pain following elective minimally invasive intestinal surgery. METHODS: Data from 49 patients, who underwent intestinal resection between April 2021 and March 2022 were used for this purpose. Various pre- and intraoperative characteristics were examined for their influence on pain in the morning in a univariate and multivariate analysis. Increased postoperative pain is defined by a NRS (numerical rating scale) of at least 4 at rest. RESULTS: It was found that patients with severe postoperative pain (n = 16) on the first postoperative day (POD) had a significantly higher BDI (Beck Depression Index) score of 16.1 (± 10.46) compared to patients without severe postoperative pain (n = 33) with 8.89 (± 7.03) (p = 0.007). In the multivariate analysis, the BDI score was also significant with an Odds Ratio of 1.14 (CI 95% 1.02-1.29, p = 0.002). On POD 2, patients with increased pain (n = 10) were significantly younger (53.1 years (± 16.40)) than patients without increased pain (n = 39) (65.8 years (± 12.64)) (p = 0.01). This was also confirmed in the multivariate analysis with an Odds Ratio of 1.12 (CI 95% 1.02-1.24, p = 0.019). CONCLUSION: It was demonstrated that a younger age, higher BDI score and the presence of IBD are significant predictors of severe postoperative pain despite multimodal pain management.
European Delphi consensus on specific training, implementation requirements, and clinical use for the Hugo™ robotic-assisted surgery platform in colorectal procedures.
Arroyo A, Belyaev O, Bianchi PP … +9 more , Brandão P, Collera P, Romero-Marcos JM, Rottoli M, Troller R, Van Den Bossche B, Zimmerman DDE, Pérez-Esteve C, Sánchez-Guillén L
Int J Colorectal Dis · 2026 Mar · PMID 41807800 · Full text
AIM: A new robotic platform, the Hugo™ robotic-assisted surgery (RAS) system, has been introduced to the market, featuring innovations such as modular arms and an open console, distinguishing it from the Da Vinci system....
AIM: A new robotic platform, the Hugo™ robotic-assisted surgery (RAS) system, has been introduced to the market, featuring innovations such as modular arms and an open console, distinguishing it from the Da Vinci system. These differences highlight the need to establish specific, standardized training, credentialing criteria, and clinical guidelines for the use of this platform. To date, this represents the first international expert consensus on the Hugo™ RAS system. METHODS: Eleven European colorectal experts with experience using the Hugo™ RAS platform were invited to participate in this Delphi study. Seventy-seven questions related to this robotic platform were grouped into six domains: (1) required knowledge, (2) technical skills, (3) nontechnical skills, (4) assessment of competency/proficiency during training, (5) credentialing and clinical outcome data, and (6) setups and surgical technique. A three-round Delphi process was conducted. Participants were asked to indicate their agreement or disagreement using a Likert scale (0-5) regarding the proposed themes. Consensus was reached, with a minimum agreement level of 0.80 (80%). RESULTS: All the experts completed the three Delphi rounds, ensuring a 100% response rate throughout the process. Of the 78 statements evaluated, 33 (42%) achieved consensus agreement (> 80%) and were considered consensus recommendations, while 15 statements showed consensus disagreement (< 20%). The remaining items reflected areas of uncertainty. CONCLUSIONS: The first consensus statement on robotic colorectal surgery with the Hugo™ RAS platform, developed by a European panel of experts, represents an important milestone and provides recommendations for colorectal surgeons considering the adoption of this new robotic platform.
Magnetoelectric biofeedback for precision-targeted rectocele management: A randomized controlled trial of phenotype-driven pelvic floor neuromodulation.
Geng HZ, Xu C, Cong J … +1 more , Li Y
Int J Colorectal Dis · 2026 Mar · PMID 41784838 · Full text
PURPOSE: Magnetoelectric biofeedback therapy (MEBFT) is an emerging intervention for moderate rectocele-associated obstructed defecation syndrome (ODS); however, its efficacy and mechanisms remain unclear. This study com...
PURPOSE: Magnetoelectric biofeedback therapy (MEBFT) is an emerging intervention for moderate rectocele-associated obstructed defecation syndrome (ODS); however, its efficacy and mechanisms remain unclear. This study compared MEBFT with conventional biofeedback therapy (BFT) and developed a 3D high-resolution anorectal manometry (HR-ARM)-based predictive model for clinical decision-making. METHODS: In this prospective, single-blind, randomized controlled trial, 68 female patients with defecography-confirmed moderate rectocele-associated ODS were treated in the outpatient department of Tianjin Union Medical Center from January 2019 to June 2024). Patients were randomly assigned in a 1:1 ratio to either the MEBFT or BFT group. Primary outcomes included 3D HR-ARM parameters, Glazer surface electromyography, and patient-reported outcomes (Cleveland Clinic Constipation and Patient Assessment of Constipation Quality of Life scores) at baseline and 3 months. The secondary outcomes included predictive indicators derived from the Hosmer-Rothman model and treatment response stratification. RESULTS: MEBFT significantly improved fast-twitch fiber recruitment, anorectal function, and quality of life compared to BFT (all P < 0.01). The Hosmer-Rothman model identified a negative MRP-MTV interaction (synergy index = 0.20), with the R phenotype (MRP < 80 mmHg-MTV < 135 cc) predicting an 82.35% response to MEBFT after 3 months of treatment (area under the curve [AUC] = 0.72). Phenotypic stratification-guided management: R for MEBFT, R (elevated MRP-MTV) for surgical evaluation, and R/R for extended MEBFT with surgical backup. CONCLUSIONS: MEBFT demonstrated superior clinical effectiveness, anorectal functional recovery, and quality of life compared with BFT after 3 months of treatment. The exploratory Hosmer-Rothman model may provided a moderate-accuracy phenotype-based approach using 3D HR-ARM parameters to stratify treatment response and optimize the individualized management of moderate rectocele-associated ODS. TRIAL REGISTRATION: 1. Date of registration (needs to be before the Date of the First Patient): December 26, 2023. 2. Date of initial participant enrollment: January 9, 2019. 3. Clinical trial identification number: ChiCTR2300079173. 4. URL of the registration site: http://www.chictr.org.cn/.
Two layers of fascia envelop the pudendal nerve canal: a cadaver study.
Chikazawa K, Muro S, Kuwata T … +1 more , Akita K
Int J Colorectal Dis · 2026 Mar · PMID 41772256 · Full text
PURPOSE: This study aimed to examine the pudendal nerve in the context of tumors involving the pudendal canal and to clarify its anatomical course and the structural composition of Alcock's canal, while elucidating the r...
PURPOSE: This study aimed to examine the pudendal nerve in the context of tumors involving the pudendal canal and to clarify its anatomical course and the structural composition of Alcock's canal, while elucidating the relationships among the obturator internus nerve, sacrotuberous ligament, and fascia of the obturator internus muscle. METHODS: Six cadavers (12 pelvic halves) were dissected. The dissections focused on the pudendal canal, particularly the positions and interrelationships of the fasciae, muscles, ligaments, and surrounding fascial structures from medial and posterior perspectives. RESULTS: The sacrotuberous ligament comprised two distinct layers, with the pudendal canal located within its structure. The proper fascia was distinguishable and situated on the muscle side of the obturator internus muscle. The pudendal nerve was traced within the fascia of the sacrotuberous ligament, whereas the obturator internus nerve coursed between the obturator internus muscle and its proper fascia. Coronal section examination of the right pelvis confirmed that the pudendal nerve was enveloped by fascia. The obturator internus nerve ran along the muscle side of the obturator internus fascia, occupying a layer distinct from that of the pudendal nerve. CONCLUSIONS: The pudendal nerve travels within the fascia derived from the sacrotuberous ligament and does not pass through the fascia of the obturator internus. The proper fascia of the obturator internus muscle is located relatively close to the muscle, and the obturator internus nerve courses between the obturator internus muscle and its own fascia. These findings describe the anatomy of the pudendal canal and may provide a foundation for future surgical investigation.
Correspondence for the article titled: "Metronidazole is an effective method of analgesia following haemorrhoidectomy: a systematic review and meta-analysis".
Xu C, Li H
Int J Colorectal Dis · 2026 Mar · PMID 41764108 · Full text
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Reconsidering the LARS score: a cross-sectional descriptive study exploring complementary screening approaches for low anterior resection syndrome.
Ribas Y, Cayetano L, Ortega-Torrecilla N … +4 more , Espín-Basany E, Bargalló J, Romero C, Marinello F
Int J Colorectal Dis · 2026 Feb · PMID 41762235 · Full text
PURPOSE: The LARS score is a practical tool to screen for bowel dysfunction after rectal cancer surgery. However, clinical experience suggests that it may overlook relevant symptoms and/or overestimate impact in some pat...
PURPOSE: The LARS score is a practical tool to screen for bowel dysfunction after rectal cancer surgery. However, clinical experience suggests that it may overlook relevant symptoms and/or overestimate impact in some patients. This study aimed to explore whether the International Consensus Definition of LARS complements the LARS score in identifying patients with bowel dysfunction. METHODS: We conducted a cross-sectional study including patients treated for rectal cancer across two hospitals between January 2021 and December 2024. Demographic and clinical data were collected retrospectively. Functional outcomes were assessed during outpatient follow-up using both the LARS score and the International Consensus Definition criteria. RESULTS: Sixty-two patients were included. According to the LARS score, 39 (62.9%) had "no LARS", 10 (16.1%) "minor LARS" and 13 (21%) "major LARS". Using the International Consensus Definition, 24 (38.7%) met the criteria for LARS. Nine patients (14.5%) were classified differently by the two tools. Five patients classified as "no LARS" by the LARS score met the International Consensus Definition due to unpredictable bowel function and emptying difficulties with a reported impact on daily life. In contrast, four patients with "minor or major LARS" did not meet the International Consensus Definition criteria because no consequences were reported. CONCLUSION: In this exploratory cross-sectional cohort, the International Consensus Definition did not identify substantially more patients than the LARS score but provided complementary information by linking symptoms to their perceived consequences. Combining both tools may offer a more comprehensive appraisal of LARS until newer multidimensional instruments become available.
Surgical management of anal stenosis following hemorrhoid treatment: a single-center case series.
Do TT, Pham PK, Nguyen TL … +5 more , Pham TTH, Le NH, Nguyen DT, Nguyen NA, Rickard MJ
Int J Colorectal Dis · 2026 Feb · PMID 41748755 · Full text
OBJECTIVE: To describe the clinical characteristics, causes, classification, and surgical techniques used to treat anal stenosis following hemorrhoid surgery, as well as to evaluate the treatment outcomes based on specif...
OBJECTIVE: To describe the clinical characteristics, causes, classification, and surgical techniques used to treat anal stenosis following hemorrhoid surgery, as well as to evaluate the treatment outcomes based on specific clinical criteria. SUBJECTS AND METHODS: This retrospective case series included 13 patients with anal stenosis after hemorrhoidectomy. All underwent surgical treatment at Viet Duc University Hospital between January 2022 and June 2024. Surgical techniques applied were fibrotic ring release alone, fibrotic ring release with rectal mucosal advancement, fibrotic ring release with horizontal suturing of the rectal mucosa, and fibrotic ring release with V-Y flap reconstruction. Outcomes were assessed based on patients' ability to achieve normal defecation, stool caliber, and the absence of anal pain or bleeding postoperatively. Successful treatment was defined as normalized stool passage without pain or the need for stool softeners. RESULTS: Surgical outcomes were favorable in 12 out of 13 patients (92.3%), with an average healing time of 2.0 ± 1.1 months. The mean follow-up was 13.3 months (range 6-24 months; minimum 6 months). Patients treated with fibrotic ring release alone experienced the longest healing time, while those who underwent mucosal advancement or V-Y flap reconstruction had shorter recovery periods. Recurrence occurred in one patient who required reoperation. CONCLUSION: Anal stenosis is a rare but serious complication following hemorrhoid surgery. Surgical interventions, including fibrotic ring release and anoplasty, appeared to be effective and safe, with favorable short-term outcomes in most patients.
Effectiveness and safety of 3% polidocanol foam sclerotherapy in hemorrhoidal disease: a multicenter, prospective study.
Yu Z, Zhou T, Yu Y … +15 more , Tang X, Zhang S, Peng L, Ge Z, Guan Z, Zhang X, Liu Y, Sun X, Xu Y, Yang W, Wang R, Hu X, Gao J, Xin S, Li X
Int J Colorectal Dis · 2026 Feb · PMID 41748745 · Full text
AIM: To evaluate the effectiveness and safety of 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy in the treatment of hemorrhoidal disease (HD) compared with rubber band ligation (RBL). METHOD: This was a...
AIM: To evaluate the effectiveness and safety of 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy in the treatment of hemorrhoidal disease (HD) compared with rubber band ligation (RBL). METHOD: This was a multicenter, open-label, prospective, observational study that enrolled 222 patients with Goligher grade I, II, or III HD (internal or mixed), who were treated with 3% PFS or RBL, which depended on the physician's assessment and the patient's willingness. The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4 weeks post-treatment. RESULTS: A total of 222 patients from 14 centers participated in the study, with 127 patients receiving PFS and 95 patients receiving RBL. Among the effectiveness analysis set (EAS), the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05). The PFS group showed quicker and better improvement in hemorrhage score post-treatment than the RBL group, with the mean (SD) changes from baseline in hemorrhage score of the two groups (P < 0.001) at 1, 4, and 12 weeks being -3.44 (1.99) vs. -1.70 (2.19), -3.85 (1.80) vs. -2.75 (2.02), and -3.81 (1.84) vs. -2.89 (2.10), respectively. The incidences of adverse events (AEs) were 2.36% (3/127) in the PFS group and 3.16% (3/95) in the RBL group, respectively, and no serious adverse events (SAEs) occurred in both groups. CONCLUSION: Patients treated with PFS showed similar effectiveness and safety as those treated with RBL under anoscopy, and a quick improvement trend in hemorrhage score post-treatment was observed in patients treated with PFS, but it needs further verification. TRIAL REGISTRATION: This study has been registered on the website of Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ), registration number: ChiCTR2200060325.
Prognostic value of preoperative anorectal manometry parameters for anastomotic leakage after sphincter-preserving surgery for rectal cancer.
Chang JG, Kim EB, Kim CW … +4 more , Yoon YS, Lee JL, Park IJ, Lim SB
Int J Colorectal Dis · 2026 Feb · PMID 41741876 · Full text
PURPOSE: Anastomotic leakage (AL) remains a serious complication following low anterior resection (LAR) for rectal cancer. Although several risk factors for AL have been identified, the role of preoperative anal sphincte...
PURPOSE: Anastomotic leakage (AL) remains a serious complication following low anterior resection (LAR) for rectal cancer. Although several risk factors for AL have been identified, the role of preoperative anal sphincter function remains unexplored. We hypothesized that elevated maximum resting pressure (MRP) and maximum squeeze pressure (MSP), measured preoperatively via anorectal manometry (ARM), might increase AL risk by inducing functional outlet obstruction. METHODS: This single-center retrospective cohort study included patients who underwent LAR without a diverting stoma between January 2010 and December 2015. We analyzed the associations between preoperative ARM parameters and early major AL events. Independent predictors of AL were also identified. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of ARM parameters for AL. RESULTS: Among 1,396 patients, early major AL occurred in 41 (2.9%). Patients with AL demonstrated significantly higher median MRP (55.7 vs. 42.6 mm Hg, p = 0.001) and MSP (186.5 vs. 150.3 mm Hg, p = 0.008) values. Multivariable analysis revealed that higher MRP (odds ratio [OR], 1.021 per mm Hg increase; 95% confidence interval [CI], 1.004-1.039; p = 0.017) and shorter tumor distance from the anal verge (OR, 0.815 per cm; 95% CI, 0.718-0.925; p = 0.002) were independent predictors of AL. An optimal MRP cutoff value of 55.65 mm Hg yielded 53.7% sensitivity and 75.1% specificity (area under the curve, 0.657). CONCLUSION: Preoperative MRP is an independent predictor of early major AL after LAR. Elevated resting anal pressure may create functional outlet obstruction, increasing intraluminal pressure at the anastomotic site and compromising healing. Preoperative ARM could identify high-risk patients who may benefit from protective interventions.
Correction to: Tolerability and impact on postoperative morbidity of preoperative bowel preparation in Crohn's disease patients: results of prospective observational study.
Iesalnieks I, Schmitz A, Hinrichs N … +4 more , Ivanecka D, Kala Z, Grolich T, Kunovsky L
Int J Colorectal Dis · 2026 Feb · PMID 41735644 · Full text
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Mapping fibrosis in colorectal liver metastases (CRLM) with gadobenate dimeglumine-enhanced MRI: prognostic implications and imaging biomarkers.
Morawska I, Pasicz K, Cieszanowski A
Int J Colorectal Dis · 2026 Feb · PMID 41711984 · Full text
PURPOSE: Development of fibrosis in treated colorectal liver metastases (CRLM) could be supposedly used for the estimation of both treatment response and prognosis. This study aimed to investigate the association between...
PURPOSE: Development of fibrosis in treated colorectal liver metastases (CRLM) could be supposedly used for the estimation of both treatment response and prognosis. This study aimed to investigate the association between post-chemotherapy, fibrosis-related progressive gadolinium enhancement of CRLM on MRI and overall survival. MATERIAL AND METHODS: A retrospective study of 97 CRLM patients (68 M, mean age 62.3 ± 10.71 years) who underwent between 2017 and 2022 preoperative gadobenate dimeglumine (Gd-BOPTA) - enhanced MRI after chemotherapy. Tumor and liver enhancement were quantified using Signal Intensity Change Percentages (SICP) across 5-min and 60-min delay phases, along with the Tumor-to-Liver Enhancement Index (TLEI) to estimate fibrosis within CRLM. A subset of 18 patients was evaluated for radiologic-pathologic correlation. Cox regression, Kaplan-Meier analysis, and multivariate models were used to assess overall survival (OS). RESULTS: High SICP (≥ 90.3%) in the 60-min delayed phase was associated with significantly lower OS (median: 37 vs. 66 months; p = 0.023). TLEI was significantly elevated in non-survivors (1.25 vs. 1.10; p = 0.007). Histopathologic correlation, available in 18 patients, confirmed fibrosis in lesions with elevated SICP, though limited sample size precluded statistical validation. In multivariate analysis, both high TLEI and elevated SICP were independent predictors of reduced OS (HR 1.38 [1.05-1.82], p = 0.023; HR 1.01 [1.00-1.01], p = 0.043, respectively). Notably, aflibercept- and FOLFOX-4-treated patients showed higher fibrosis-associated enhancement. CONCLUSION: Gd-BOPTA-enhanced MRI, specifically SICP and TLEI in the delayed phase, may serve as non-invasive imaging biomarkers of fibrosis in CRLM. Contrary to prior assumptions, increased fibrosis was associated with worse prognosis, suggesting fibrosis-mediated tumor microenvironment alterations. Prospective studies with robust radiologic-pathologic validation are needed to clarify the mechanistic and prognostic implications.
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