John Marks - Academia.edu (original) (raw)
Papers by John Marks
Annals of Surgery
To determine the disease-free survival (DFS) and recurrence after the treatment of patients with ... more To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051. The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months. The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4-84.9) and OPEN 83.2% (95% CI 78.3-88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN.Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21-2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85-3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40-3.79); positive distal margin (HR 2.53, 95% CI 1.30-3.77). Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 24, 2018
Transanal transabdminal-proctosigmoidectomy with a coloanal anastomosis (TATA) is an alternative ... more Transanal transabdminal-proctosigmoidectomy with a coloanal anastomosis (TATA) is an alternative to to abdomino-perineal resection of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA.. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer. this cohort study was conducted in a tertiary referral colorectal center. From a prospectively maintained database which includes 1,093 patients treated for rectal cancer between 1984-2016) we identified those who underwent sphincter-preserving surgery.. Data regarding the incidence, management, and outcomes of neorectal prolapse were analyzed. A total of 409 patients were identified of whom 185 underwent open surgery and 224 minimally invasive procedures. All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n=19) with an incidence of 2.2% in the open and 6.7% in the MIS group (p=0.023), with no difference between MIS technique...
Diseases of the colon and rectum, 2017
Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid c... more Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant. The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy. This is a cross-sectional study. The study was conducted at a tertiary referral colorectal center. Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life. Quality of life, functional outcomes, and patient satisfaction were meas...
Surgical Endoscopy and Other Interventional Techniques, May 6, 2003
Gastrointestinal Endoscopy, Aug 1, 2002
Cancer Treatment Reviews, Jul 1, 2009
Neoadjuvant therapy is widely accepted as the current standard of care for localized rectal cance... more Neoadjuvant therapy is widely accepted as the current standard of care for localized rectal cancer. Downstaging of disease has been significantly improved and pathological complete response rates (pCR) which were historically below 10% with preoperative radiation alone, now range from 15% to 30% with preoperative chemo-radiation. While the availability of new chemotherapeutic drugs (Irinotecan, Oxaliplatin, etc.) and molecular targeted agents (Bevacizamab, Cetuximab, etc.) hold a great deal of promise, results of recent studies indicate that the pCR rate with neoadjuvant therapy appears to have plateaued at 20-30%. The use of more intensive multidrug combinations has, however, significantly increased the toxicity of treatment. New paradigms in neoadjuvant therapy are therefore needed to further improve results of treatment. This review presents strategies for neoadjuvant therapy, with the potential to improve pCR rates and also survival of patients.
Seminars in Colon and Rectal Surgery, 2015
Abdominal Ultrasound for Surgeons, 2014
Surgical Endoscopy, 2016
Natural orifice transluminal endoscopic surgery (NOTES) represents the ultimate expression of min... more Natural orifice transluminal endoscopic surgery (NOTES) represents the ultimate expression of minimally invasive surgery. We have developed and present here an initial feasibility and safety study of transanal total mesorectal excision (TME) with splenic flexure release, high ligation of the IMA and IMV, and side-to-end coloanal anastomosis with temporary diverting ileostomy for rectal cancer. A program of full NOTES TME resection with release of the splenic flexure, high ligation of the IMA/IMV, with side-to-end coloanal anastomosis was performed transanally from December 2013 to July 2014. Demographics, preoperative, perioperative, and postoperative data were prospectively obtained. Operative components were broken into TME, colonic mobilization, splenic flexure release, IMA/IMV transection, transanal extraction of specimen, and coloanal anastomosis for analysis of performance completion. There were 3 women and 1 man on whom we operated. Mean age was 56 (46-65). Mean BMI was 26 (23.8-30.2). The operation was completed entirely transanally in 2 patients. Transanal component completion of the operation was as follows: TME in 3/4; colonic mobilization in 4/4; splenic flexure release in 3/4; IMA/IMV transection in 3/4; transanal specimen extraction in 4/4; coloanal anastomosis in 4/4. Abdominal time for completion of component parts was: splenic flexure release 4:53 (min:s), IMA/IMV 19:43, completion of TME 13:41. Mean EBL was 194 cc (25-500). Aside from stoma site, there were no abdominal incisions. There were no mortalities. Mesorectum was intact in all 4 patients and with negative circumferential and distal margins. This experience supports the feasibility and safety of a true NOTES TME. The critical anatomic views demonstrated on video affirm the potential of this approach for distal rectal cancer. Colorectal surgery represents the most logical application for NOTES. While highly promising, a great deal of work remains to develop the technique and applicability of NOTES colorectal surgery.
World Journal of Colorectal Surgery, 2010
Colorectal cancer is the most common abdominal visceral cancer diagnosed in men and in women annu... more Colorectal cancer is the most common abdominal visceral cancer diagnosed in men and in women annually and is estimated that about 106,100 new case of colon cancer and 40, 870 cases of rectal cancer would be diagnosed in 2009. Metastasis secondary to colorectal cancer will occur in 10-20% of patients The most common metastatic sites of colorectal cancer include, liver metastases and pulmonary metastases. Metastatic brain tumors from colorectal cancer are relatively rare between 1.03 and 1.8%.
JAMA, Jan 6, 2015
Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularl... more Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013. The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada. A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were randomized after completion of neoadjuvant therapy to laparoscopic or open resection. Standard laparoscopic and open approaches were performed by the credentialed surgeons. The primary outcome assessing efficacy was a composite of circumferential radial margin greater than 1 mm, distal margin without tumor, and completeness of total mesorectal excis...
Complexities in Colorectal Surgery, 2013
Surgical Endoscopy, 2015
The role of laparoscopic TME for rectal cancer is still questioned as a safe and adequate cancer ... more The role of laparoscopic TME for rectal cancer is still questioned as a safe and adequate cancer operation. Currently, multicenter randomized prospective trials are underway to evaluate this. We analyze our long-term results using laparoscopic TME in the treatment of rectal cancer to evaluate its oncologic outcomes. A prospective laparoscopic database was queried to identify all patients operated upon for rectal cancer from April 1997 to September 2007. In total, 151 patients were identified. Metastatic disease excluded 19 patients, leaving 132 patients to be analyzed for perioperative and 5-year oncologic outcomes. Procedures included LAR, n = 35; transanal abdominal transanal proctosigmoidectomy, n = 77; and APR, n = 20. All surgeries were TME or pTME. Laparoscopic TME was performed on 89 men (67 %), mean age 61 (22-85). Preoperative chemoradiation was administered in 119 (90.2 %) with median dose of 5500 cGy (3800-10,080). Mean EBL was 300 ml, and 4.5 % were transfused. Seven patients (5.3 %) underwent conversion, 5 to lap-assisted, with a 1.5 % conversion rate to open. Pathologic stage of disease: complete response: 24 %; I: 36 %; II: 22 %; III: 18 %. There were no mortalities. Overall morbidity was 23.5 %, with no anastomotic leaks and 5 (3.8 %) delayed anastomotic stricture/fistula. There were no port site recurrences. Mean follow-up was 69.4 months (7.6-168.0). Overall LR was 5.3 % (n = 7). There was only one isolated LR (0.8 %). Mean time to local recurrence was 13.9 months. Metastatic rate was 18.2 %. By stage, disease-specific survival was: CR 86.3 %; I: 87.4 %; II: 86.4 %; III: 77.4 %. Overall, 5-year survival was 84.8 %. The long-term data confirm that laparoscopic TME can be performed with lasting low local recurrence (5.3 %) and excellent 5-year survival (84.8 %). This report's importance stems from it representing one of the largest experiences of rectal cancer treated by laparoscopic TME with greater than 5-year follow-up reported in the literature.
Il Giornale di chirurgia, 1997
Local excision of rectal cancer in low-risk patients is appealing but it provides limited control... more Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.
Clinics in colon and rectal surgery, 2008
Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in ... more Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands. Colonic volvulus is a rare cause of large bowel obstruction, but more common than small bowel volvulus. The sigmoid is most frequently involved, with redundant colon as the primary cause. Cecal volvulus most commonly is due to lack of fixation. Colonic volvulus has a specific radiographic appearance; however, small bowel volvulus is difficult to distinguish from other causes of small bowel obstruction by radiographic means. New surgical techniques with minimally invasive surgery are increasingly being applied to this old problem with good results in selected cases.
Intersphincteric Resection for Low Rectal Tumors, 2012
Diseases of the colon and rectum, 2014
Relative contraindications for transanal endoscopic microsurgery include high, anterior-based les... more Relative contraindications for transanal endoscopic microsurgery include high, anterior-based lesions for full-thickness excisions because of worries about entering the peritoneal cavity. Concerns exist regarding safety and oncological outcome. We examined the outcomes of transanal endoscopic microsurgery excisions with entry into the peritoneal cavity and compared them with those that did not to address our hypothesis that entry is safe with no ill infectious or oncological consequences. This single-institution retrospective review uses a prospectively maintained database. This study was conducted at a tertiary colorectal surgery referral center. From 1997 to 2012, we identified 303 patients who underwent transanal endoscopic microsurgery resections, with 26 patients having entrance into the peritoneal cavity. Perioperative data, postoperative morbidities, delayed morbidities, and oncological outcomes were the primary outcomes measured. Of 26 patients, there were 8 women with a mea...
The SAGES Manual of Strategic Decision Making, 2008
The SAGES Manual of Quality, Outcomes and Patient Safety, 2011
... 23. Common Complications and Management David Earle , Elsa B. Valsdottir , and John Marks Acc... more ... 23. Common Complications and Management David Earle , Elsa B. Valsdottir , and John Marks Access ... Vascular Injury Selected Readings 1. Ahmad G, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008, Issue 2. Art. ...
Annals of Surgery
To determine the disease-free survival (DFS) and recurrence after the treatment of patients with ... more To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051. The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months. The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4-84.9) and OPEN 83.2% (95% CI 78.3-88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN.Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21-2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85-3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40-3.79); positive distal margin (HR 2.53, 95% CI 1.30-3.77). Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 24, 2018
Transanal transabdminal-proctosigmoidectomy with a coloanal anastomosis (TATA) is an alternative ... more Transanal transabdminal-proctosigmoidectomy with a coloanal anastomosis (TATA) is an alternative to to abdomino-perineal resection of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA.. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer. this cohort study was conducted in a tertiary referral colorectal center. From a prospectively maintained database which includes 1,093 patients treated for rectal cancer between 1984-2016) we identified those who underwent sphincter-preserving surgery.. Data regarding the incidence, management, and outcomes of neorectal prolapse were analyzed. A total of 409 patients were identified of whom 185 underwent open surgery and 224 minimally invasive procedures. All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n=19) with an incidence of 2.2% in the open and 6.7% in the MIS group (p=0.023), with no difference between MIS technique...
Diseases of the colon and rectum, 2017
Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid c... more Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant. The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy. This is a cross-sectional study. The study was conducted at a tertiary referral colorectal center. Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life. Quality of life, functional outcomes, and patient satisfaction were meas...
Surgical Endoscopy and Other Interventional Techniques, May 6, 2003
Gastrointestinal Endoscopy, Aug 1, 2002
Cancer Treatment Reviews, Jul 1, 2009
Neoadjuvant therapy is widely accepted as the current standard of care for localized rectal cance... more Neoadjuvant therapy is widely accepted as the current standard of care for localized rectal cancer. Downstaging of disease has been significantly improved and pathological complete response rates (pCR) which were historically below 10% with preoperative radiation alone, now range from 15% to 30% with preoperative chemo-radiation. While the availability of new chemotherapeutic drugs (Irinotecan, Oxaliplatin, etc.) and molecular targeted agents (Bevacizamab, Cetuximab, etc.) hold a great deal of promise, results of recent studies indicate that the pCR rate with neoadjuvant therapy appears to have plateaued at 20-30%. The use of more intensive multidrug combinations has, however, significantly increased the toxicity of treatment. New paradigms in neoadjuvant therapy are therefore needed to further improve results of treatment. This review presents strategies for neoadjuvant therapy, with the potential to improve pCR rates and also survival of patients.
Seminars in Colon and Rectal Surgery, 2015
Abdominal Ultrasound for Surgeons, 2014
Surgical Endoscopy, 2016
Natural orifice transluminal endoscopic surgery (NOTES) represents the ultimate expression of min... more Natural orifice transluminal endoscopic surgery (NOTES) represents the ultimate expression of minimally invasive surgery. We have developed and present here an initial feasibility and safety study of transanal total mesorectal excision (TME) with splenic flexure release, high ligation of the IMA and IMV, and side-to-end coloanal anastomosis with temporary diverting ileostomy for rectal cancer. A program of full NOTES TME resection with release of the splenic flexure, high ligation of the IMA/IMV, with side-to-end coloanal anastomosis was performed transanally from December 2013 to July 2014. Demographics, preoperative, perioperative, and postoperative data were prospectively obtained. Operative components were broken into TME, colonic mobilization, splenic flexure release, IMA/IMV transection, transanal extraction of specimen, and coloanal anastomosis for analysis of performance completion. There were 3 women and 1 man on whom we operated. Mean age was 56 (46-65). Mean BMI was 26 (23.8-30.2). The operation was completed entirely transanally in 2 patients. Transanal component completion of the operation was as follows: TME in 3/4; colonic mobilization in 4/4; splenic flexure release in 3/4; IMA/IMV transection in 3/4; transanal specimen extraction in 4/4; coloanal anastomosis in 4/4. Abdominal time for completion of component parts was: splenic flexure release 4:53 (min:s), IMA/IMV 19:43, completion of TME 13:41. Mean EBL was 194 cc (25-500). Aside from stoma site, there were no abdominal incisions. There were no mortalities. Mesorectum was intact in all 4 patients and with negative circumferential and distal margins. This experience supports the feasibility and safety of a true NOTES TME. The critical anatomic views demonstrated on video affirm the potential of this approach for distal rectal cancer. Colorectal surgery represents the most logical application for NOTES. While highly promising, a great deal of work remains to develop the technique and applicability of NOTES colorectal surgery.
World Journal of Colorectal Surgery, 2010
Colorectal cancer is the most common abdominal visceral cancer diagnosed in men and in women annu... more Colorectal cancer is the most common abdominal visceral cancer diagnosed in men and in women annually and is estimated that about 106,100 new case of colon cancer and 40, 870 cases of rectal cancer would be diagnosed in 2009. Metastasis secondary to colorectal cancer will occur in 10-20% of patients The most common metastatic sites of colorectal cancer include, liver metastases and pulmonary metastases. Metastatic brain tumors from colorectal cancer are relatively rare between 1.03 and 1.8%.
JAMA, Jan 6, 2015
Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularl... more Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013. The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada. A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were randomized after completion of neoadjuvant therapy to laparoscopic or open resection. Standard laparoscopic and open approaches were performed by the credentialed surgeons. The primary outcome assessing efficacy was a composite of circumferential radial margin greater than 1 mm, distal margin without tumor, and completeness of total mesorectal excis...
Complexities in Colorectal Surgery, 2013
Surgical Endoscopy, 2015
The role of laparoscopic TME for rectal cancer is still questioned as a safe and adequate cancer ... more The role of laparoscopic TME for rectal cancer is still questioned as a safe and adequate cancer operation. Currently, multicenter randomized prospective trials are underway to evaluate this. We analyze our long-term results using laparoscopic TME in the treatment of rectal cancer to evaluate its oncologic outcomes. A prospective laparoscopic database was queried to identify all patients operated upon for rectal cancer from April 1997 to September 2007. In total, 151 patients were identified. Metastatic disease excluded 19 patients, leaving 132 patients to be analyzed for perioperative and 5-year oncologic outcomes. Procedures included LAR, n = 35; transanal abdominal transanal proctosigmoidectomy, n = 77; and APR, n = 20. All surgeries were TME or pTME. Laparoscopic TME was performed on 89 men (67 %), mean age 61 (22-85). Preoperative chemoradiation was administered in 119 (90.2 %) with median dose of 5500 cGy (3800-10,080). Mean EBL was 300 ml, and 4.5 % were transfused. Seven patients (5.3 %) underwent conversion, 5 to lap-assisted, with a 1.5 % conversion rate to open. Pathologic stage of disease: complete response: 24 %; I: 36 %; II: 22 %; III: 18 %. There were no mortalities. Overall morbidity was 23.5 %, with no anastomotic leaks and 5 (3.8 %) delayed anastomotic stricture/fistula. There were no port site recurrences. Mean follow-up was 69.4 months (7.6-168.0). Overall LR was 5.3 % (n = 7). There was only one isolated LR (0.8 %). Mean time to local recurrence was 13.9 months. Metastatic rate was 18.2 %. By stage, disease-specific survival was: CR 86.3 %; I: 87.4 %; II: 86.4 %; III: 77.4 %. Overall, 5-year survival was 84.8 %. The long-term data confirm that laparoscopic TME can be performed with lasting low local recurrence (5.3 %) and excellent 5-year survival (84.8 %). This report's importance stems from it representing one of the largest experiences of rectal cancer treated by laparoscopic TME with greater than 5-year follow-up reported in the literature.
Il Giornale di chirurgia, 1997
Local excision of rectal cancer in low-risk patients is appealing but it provides limited control... more Local excision of rectal cancer in low-risk patients is appealing but it provides limited control of the disease. Postoperative radiation therapy may improve results. The Authors report on their experience with preoperative high dose radiation therapy for rectal cancer patients; more recently, chemoradiation was used. Local excision is advised only for those patients with minimal or no residual disease. The results obtained in 34 cases are encouraging; moreover, a better control of the disease seems to be offered combining chemo- and radiotherapy.
Clinics in colon and rectal surgery, 2008
Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in ... more Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands. Colonic volvulus is a rare cause of large bowel obstruction, but more common than small bowel volvulus. The sigmoid is most frequently involved, with redundant colon as the primary cause. Cecal volvulus most commonly is due to lack of fixation. Colonic volvulus has a specific radiographic appearance; however, small bowel volvulus is difficult to distinguish from other causes of small bowel obstruction by radiographic means. New surgical techniques with minimally invasive surgery are increasingly being applied to this old problem with good results in selected cases.
Intersphincteric Resection for Low Rectal Tumors, 2012
Diseases of the colon and rectum, 2014
Relative contraindications for transanal endoscopic microsurgery include high, anterior-based les... more Relative contraindications for transanal endoscopic microsurgery include high, anterior-based lesions for full-thickness excisions because of worries about entering the peritoneal cavity. Concerns exist regarding safety and oncological outcome. We examined the outcomes of transanal endoscopic microsurgery excisions with entry into the peritoneal cavity and compared them with those that did not to address our hypothesis that entry is safe with no ill infectious or oncological consequences. This single-institution retrospective review uses a prospectively maintained database. This study was conducted at a tertiary colorectal surgery referral center. From 1997 to 2012, we identified 303 patients who underwent transanal endoscopic microsurgery resections, with 26 patients having entrance into the peritoneal cavity. Perioperative data, postoperative morbidities, delayed morbidities, and oncological outcomes were the primary outcomes measured. Of 26 patients, there were 8 women with a mea...
The SAGES Manual of Strategic Decision Making, 2008
The SAGES Manual of Quality, Outcomes and Patient Safety, 2011
... 23. Common Complications and Management David Earle , Elsa B. Valsdottir , and John Marks Acc... more ... 23. Common Complications and Management David Earle , Elsa B. Valsdottir , and John Marks Access ... Vascular Injury Selected Readings 1. Ahmad G, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008, Issue 2. Art. ...