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Abstract Introduction Cryptoglandular anal fistulas significantly impair patients’ quality of life (QOL) and sexual well-being. This prospective study evaluates the impact of surgery on QOL and sexual function. Materials and Methods Fifty consecutive patients (42 males, 8 females) underwent preoperative MRI-based classification to guide tailored surgery. QOL scores, sexual QOL scores, and incontinence scores were recorded preoperatively and during follow-up. Surgeries included fistulotomy and fistulectomy with or without primary sphincteroplasty. Statistical analysis employed paired t-tests and McNemar's test. Results 52% had simple, and 48% had complex fistulas. By 8 weeks, 100% of patients reported "very good" QOL (p = 0.02), up from 32% preoperatively. Sexual QOL significantly improved in males (mean score from 42.07 ± 2.64 to 48.14 ± 2.68; p < 0.001), with a non-significant trend in females (22.12 ± 2.75 to 23.75 ± 2.66; p = 0.47). Continence scores reached 0 (i.e., best) by 8 weeks in all patients. Conclusion Surgical intervention for cryptoglandular fistula-in-ano significantly improves both general quality of life and sexual health, while preserving continence.

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Abstract Introduction Colon cancer is a malignant tumor affecting the colon, often arising from polyps. The main risk factors include age, genetics, diet, and lifestyle. It is typically characterized by rectal bleeding, altered bowel habits, and weight loss. Objective This study will analyze the time-based and sequential trends of age-standardized cancer incidence. Materials and Methods The cross-sectional retrospective study included 1204 patients diagnosed with colon cancer over a period extending from 2015 to 2025 at Medical City Hospital in Baghdad, Iraq. Results This cross-sectional study included 1204 patients with tumor of the colon, their age ranged from (14-95) years, mean ± Standard error mean was (55.97 ± 0.392). Males were 56.4% (680 cases) more than females 43.5% (524 cases) (P = 0.000). The majority fall within the 50-69 age group, with 26.81% (50-59) and 27% (60-69) of the total patients. The 30-39 and 40-49 age groups represent moderate portions of them, accounting for 7.81% and 18.18%, respectively. Younger age groups (10-29) have the lowest representation, making up only 5.14% of them. Conclusion The data suggests an aging patient with colon cancer with a higher male representation across most age groups. The highest percentages were in the 50-69 years category, while younger individuals are underrepresented. The trend of a declining male to female ratio in older age groups aligns with general demographic trends, where women tend to have higher life expectancy.

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Abstract Objective Despite different medical and surgical options for the treatment of anal fissure no international consensus has been reached. The aim of this study was to determine current practices and preferences of Turkish surgeons when treating anal fissure. Methods Two groups were formed according to numbers of anal fissure patients treated per year (0-50 or >50 patients) and were then compared in respect of responses to questions about diagnosis, treatment and clinical approaches to anal fissure. Results A total of 300 Turkish surgeons completed the questionnaire: 50.7% in Group 1 (0-50 patients per year) and 49.3% in Group 2 (>50 patients per year). The leading diagnostic method was reported to be physical examination (84.0%). The first approach in treatment was support treatment + topical medical treatment together (82.0%), and when this does not provide recovery, the next option is lateral internal sphincterotomy (LIS) (54.5%). Botulinium toxin injection (BTI) was preferred more by the Group 2 respondents (13.8% vs.23.0%). The use of phlebotonic drugs was lower in Group 2 (45.4% vs.33.1%, p = 0.029). Fetal incontinence is considered in the decision for LIS (82.8%). Limited application of BTI was reported (38.7%) and 17.0% stated that in healthcare facilities in Türkiye there was no institutional treatment protocol for anal fissure. Conclusion Main lines of anal fissure treatment in daily practice in Türkiye are in parallel with current international practice. For the updating and standardization of anal fissure treatment, national meetings and studies must be increased and a national anal fissure treatment algorithm should be prepared.

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Abstract Introduction This study aimed to evaluate the significance of the postoperative inflammatory burden index (IBI) as a prognostic marker and to investigate the clinical outcomes of patients with stage II and III colorectal cancer who underwent colorectal surgery. Methods This retrospective study included 223 patients who underwent colorectal surgery for stage II and III colorectal cancers. The patients were divided into four groups based on postoperative IBI on days 1 and 7 (high or low): Group 1 (low & low, n = 118), Group 2 (high & low, n = 18), Group 3 (low & high, n = 56), and Group 4 (high & high, n = 31). The clinical impact of the postoperative IBI on recurrence-free survival (RFS) and overall survival (OS) was also evaluated. Results High postoperative IBI was significantly associated with decreased RFS and OS. The Kaplan-Meier survival curves for RFS and OS in stage II and III colorectal cancer showed a decline in Groups 2, 3, and 4, with a more pronounced decline observed in Group 4 (p = 0.001 and p = 0.007, respectively). Conclusions This study suggests that the postoperative IBI may be a prognostic marker for RFS and OS in patients with stage II and III colorectal cancer. When postoperative IBI on days 1 and 7 is high, these findings may indicate a high-risk factor for the recurrence of colorectal cancer. Postoperative IBI is useful in establishing postoperative oncological surveillance and adjuvant chemotherapy strategies.

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Abstract Introduction Lower gastrointestinal bleeding (LGIB) is defined as bleeding located below the ligament of Treitz, with colonic diverticular disease (CDD) being the main etiology. Characteristics of LGIB caused by CDD were compared with other etiologies to establish the main differences. Methods This observational, analytical, and prospective study included individuals with signs suggestive of LGIB, after excluding upper gastrointestinal bleeding via endoscopy. Data were recorded during clinical follow-up from March 2023 to December 2024. A significant level of 5% was considered. Results A total of 108 patients was evaluated. The main etiologies were CDD (54.6% - n = 59), hemorrhoidal disease (11.1% - n = 12), angiodysplasia (10.2% - n = 11), and neoplasia (10.2% - n = 11). A significant association was found between CDD and patients over 60 years old (p = 0.035). Patients with CDD sought medical care within two days (p = 0.012), while those in the group with HD, angiodysplasia, and neoplasia sought care after seven days (p = 0.012). Among the patients with CDD, 96.1% were treated clinically, while 65.3% of patients with HD, angiodysplasia, or neoplasia required surgical or endoscopic treatment. HD, angiodysplasia, and neoplasia showed a higher prevalence of hematochezia (58.8%), while CDD showed a higher prevalence of enterorrhagia (71.9%) (p < 0.05). Conclusion CDD is the leading cause of LGIB, typically presenting with self-limited bleeding and associated with enterorrhagia. Other causes include hemorrhoidal disease, angiodysplasia, and neoplasms, which often require endoscopic or surgical intervention and present as hematochezia. No significant differences were observed between groups regarding sex, ethnicity, and comorbidities.

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Abstract Introduction Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) has emerged as an advanced oncological technique for colon cancer surgery. The adoption of minimally invasive approaches—laparoscopic and robotic—has further refined these procedures. However, comparative data on their clinical efficacy remains limited. Methods A total of 41 patients underwent CME + CVL, with 30 undergoing laparoscopic surgery and 11 receiving robotic-assisted procedures. Key variables assessed included operative time, lymph node yield, postoperative complications, hospital stay, and survival outcomes. Results The mean patient age was 70.76 years. Malignant neoplasms of the ascending and transverse colon were the most common diagnoses. While both surgical approaches demonstrated comparable oncological outcomes, robotic surgery was associated with faster recovery and reduced postoperative pain, albeit at a higher cost and longer operative time. The survival rate was 93.1%, with a mortality rate of 6.9%. Common postoperative complications included ileus, pneumonia, and anastomotic leaks. Conclusion Both laparoscopic and robotic CME + CVL are effective for colon cancer treatment. Laparoscopic surgery remains cost-effective and widely accessible, while robotic surgery provides enhanced precision and recovery benefits in select cases. Future research should focus on cost-effectiveness and long-term oncological outcomes.

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Abstract Bariatric surgery has proven effective in managing severe obesity but may lead to complications involving pelvic floor function and anorectal health. This retrospective cohort study examined the effect of pelvic floor physical therapy (PFPT) with surface electromyography (EMG) biofeedback on anorectal alterations in individuals following surgery. The analysis included patients who underwent either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 to 2019 and subsequently experienced proctological complaints. Data on clinical profiles, demographics, and pelvic floor functionality were extracted from medical records. The PFPT protocol consisted of personalized weekly sessions using surface EMG feedback, with pre- and post-treatment EMG data collected for comparison. Out of 1,639 patients who underwent bariatric procedures during the period, 477 (29%) developed proctological symptoms, with constipation being the most frequent (42%). Nevertheless, only 64 (13.42%) were referred to as PFPT. Anorectal manometry assessments showed that most of these individuals had reduced resting and contraction pressures, generally without signs of anismus. Notably, differences in muscle function patterns were observed between surgical techniques. After undergoing PFPT, participants presented increased EMG activity and substantial relief from constipation. These results highlight the frequent occurrence of anorectal dysfunction after bariatric surgery and support PFPT with EMG biofeedback as a valuable non-invasive intervention for symptom relief and functional recovery.

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Abstract Introduction Circular RNAs are stable non-coding RNAs that regulate key biological processes. Hsa_circ_0001666 was shown to be involved in several cancers and in chronic inflammatory diseases. It is overexpressed in Crohn's Disease (CD) and is associated with cell migration, invasion, epithelial-mesenchymal transition (EMT), and fibrosis. Hsa_circ_0001666 acts as a sponge for multiple microRNAs (miRNAs). Some of these miRNAs regulate the expression of ETS variant transcription factor 4 (ETV4), a protein regulating critical genes implicated in inflammation, invasion, and EMT. Objectives To assess the plasma relative expression levels of hsa_circ_0001666 and the ETV4 protein levels to evaluate their contribution to CD development and the possibility of utilizing them as potential non-invasive biomarkers for diagnosis of CD and assessment of the disease activity. Material and Methods The present study included 25 patients with active CD, 25 patients with inactive CD, and 25 healthy subjects as controls. The analysis of the relative expression of hsa_circ_0001666 in plasma was performed using the real-time quantitative polymerase chain reaction (qPCR) method. The ETV4 concentration in plasma was measured using an enzyme-linked immunosorbent assay (ELISA). Results Plasma expression levels of hsa_circ_0001666 and ETV4 protein were significantly higher in active and inactive CD patients than the healthy controls, and in active CD patients than in patients with inactive disease. Furthermore, there was a significant positive correlation between hsa_circ_0001666 to ETV4 expression in the three studied groups. Conclusion Higher levels of hsa_circ_0001666 and ETV4 in CD patients suggest their role in disease development and activity, and their potential use as diagnostic biomarkers and therapeutic targets for CD management.

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Abstract Introduction Anal stenosis is a very annoying complication after anorectal surgery. Moderate and severe cases often need surgery. Objectives The aim of the study is to evaluate the efficacy and outcomes of an anoplasty technique (V-Y advancement flap) for management of moderate to severe post- hemorrhoidectomy anal stenosis. Methods This is a randomized clinical study that was performed on 25 patients with post- hemorrhoidectomy anal stenosis and treated with anoplasty (V-Y advancement flaps) technique in the department of general surgery in a well specialized center from December 2023 to December 2024. Patients were monitored for Pain levels scoring and postoperative complications were analyzed. Results The mean age of the study contributors was 36.4 ± 5.25. The gender distribution showed a higher number of males (16) as compared to females (9). 5 patients had severe anal stenosis, while 20 patients had moderate anal stenosis. Mean preoperative VAS score was 6.2 ± 1.4. Follow up at 1, 3 and 6 months showed decrease in VAS score with significant improvement of symptoms. As regards post-operative complications, there was only one patient (4.0%) who presented with postoperative mild bleeding, also one patient (4.0%) suffered from urine retention, two patients (8.0%) had wound dehiscence, one patient (4.0%) patient presented by transient gas incontinence and one patient (4.0%) presented by mild restenosis. Conclusion V-Y flap anoplasty is a safe, simple and effective procedure for management of moderate and severe post-hemorrhoidectomy anal stenosis with marked improvement of patient symptoms and low complication rates.

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Abstract Colonoscopy is an essential procedure in colorectal cancer screening and treatment, and high-quality exams are crucial for maximizing diagnostic efficacy. Technical proficiency in colonoscopy is a key factor for the quality of the procedures and, so, for patient safety. This study analyzes the colonoscopy learning curve of coloproctology residents, using cecal intubation time as a metric. Cecal intubation time was analyzed in 216 exams performed by first- and second-year coloproctology residents at a university hospital in Rio de Janeiro/RJ, over a period of 10 months. The results revealed a learning curve with a significant reduction in cecal intubation time over the course of the training, particularly in first-year residents, who began their training in an environment with more frequent exams. These results align with earlier studies, emphasizing the importance of repetitive practice for developing the technical skills needed for competent colonoscopy. The findings of this study demonstrate that conducting between 100 and 150 colonoscopies suggests a suitable benchmark for achieving competence in this procedure.

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Abstract Introduction Hemorrhoids are common anorectal conditions characterized by swollen and inflamed veins in the rectal and anal regions. They are classified as internal, external, or mixed, and may present with rectal bleeding, pain, itching, and prolapse. Chronic constipation, prolonged straining, and increased intra-abdominal pressure are frequent etiological factors. Management strategies range from conservative measures, such as dietary modifications and topical agents, to surgical procedures including hemorrhoidectomy and stapled hemorrhoidopexy. Objective To describe the therapeutic potential of hyaluronic acid (HA) in the management of hemorrhoids and to report clinical outcomes in patients treated with HA infiltration. Results Five patients with hemorrhoids underwent HA infiltration. Treatment was associated with significant symptom relief, reduced edema, and improved post-surgical recovery. The mechanism of action involved enhanced fibroblast activity, decreased inflammatory cytokines, and improved mucosal hydration. Conclusion Hyaluronic acid demonstrates promising results as a safe and effective option for hemorrhoid management. Its hydrating, anti-inflammatory, and wound-healing properties support its role as a versatile therapeutic agent in both conservative and surgical settings, contributing to improved patient outcomes.

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Abstract Introduction Vascular Ehlers-Danlos Syndrome (VEDS) is a rare disorder caused by pathogenic variants in COL3A1 that cause a type III collagen abnormality or deficiency. Intestinal perforation is a known complication in this syndrome. Objective The purpose of this meta-analysis is to quantify the risk of VEDS-associated intestinal perforation. Materials and Methods A literature search was performed in August 2023 by PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE identifying VEDS-related intestinal perforation publications. The search produced 615 articles with 530 articles screened. Two independent reviewers and a third reviewer for conflict resolution performed data extraction. Included studies discussed patients with VEDS and intestinal perforation. Reviews, case reports/series, expert opinions, consensus guidelines and abstracts only were excluded. Certainty of evidence was assessed by the Grading Recommendations, Assessment, Development and Evaluations framework. All data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Statistical R© software was used to calculate rates of colonic perforation and re-perforation. Results Four non-randomized studies were selected for the meta-analysis, which consisted of 721 patients with VEDS. The pooled colonic perforation rate was 15% (n = 111), and reperforation rate 33% (n = 29). Bowel perforation preceded the diagnosis of VEDS in 72% of patients. Considering the rarity of VEDS, limitations include lack of available data for patients. Given the small sample size, a large heterogeneity index was reported. Conclusions While patients with VEDS have high colonic perforation and subsequent reperforation risks, many VEDS diagnoses are not made until after the inciting event. No consensus guidelines exist for the surgical management of VEDS-related bowel perforations.

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Abstract Introduction Transanal hemorrhoidal dearterialization (THD) has emerged as a minimally invasive alternative to conventional hemorrhoidectomy, often performed with Doppler guidance (DGHAL) to facilitate arterial ligation. However, some studies suggest that digitally guided THD (HAL) may offer comparable outcomes with reduced costs. This systematic review and meta-analysis aim to compare the efficacy and safety of DGHAL versus HAL in patients with hemorrhoidal disease. Methods Following PRISMA 2020 guidelines, a systematic review was registered in PROSPERO (CRD42024625878). Searches in PubMed, EMBASE, and Cochrane Library identified randomized controlled trials (RCTs) comparing DGHAL and HAL. Primary outcomes included prolapse recurrence, postoperative bleeding, pain, and operative time. Statistical analyses were performed using RevMan 5.4, with odds ratios (OR) and mean differences (MD) at 95% confidence intervals (CI). Risk of bias was assessed using Cochrane RoB 2. Results Ten RCTs with 961 patients were included. No significant differences were found between DGHAL and HAL in late bleeding (OR 1.38, 95% CI 0.68–2.79, P = 0.62), prolapse recurrence at one year (OR 1.60, 95% CI 0.62–4.13, P > 0.05), intermediate pain (MD 0.78, 95% CI −0.51–2.07, P = 0.24), or operative time (MD 3.87 min, 95% CI −18.94–26.67, P > 0.05). Conclusion Digitally guided THD appears to be a cost-effective alternative to Doppler-guided THD, with comparable outcomes in terms of bleeding, prolapse recurrence, postoperative pain, and operative time. These findings suggest that the additional cost of Doppler guidance may not be justified in routine clinical practice. Further studies focusing on specific patient subgroups may help refine indications for each technique.

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Abstract Objectives Transanal total mesorectal excision (TaTME) in the management of patients with low rectal cancer have been increasingly adopted. Laparoscopically assisted two-team TaTME has been utilized by the majority to reduce operative time. As the procedure requires several operators working simultaneously, it remains mainly in the scope of practice of large colo-rectal centers. We propose a modified two-team approach with a reduced number of surgeons and assistants to be suitable for lower resource facilities, such as community hospitals. Methods A modified two team approach to laparoscopically assisted TaTME was utilized in eight patients with stage II and III rectal cancer treated by multidisciplinary team at our community hospital from 2023 to 2025. Results TaTME were successfully completed in all eight patients. The mean operative (OR) time was 325.5 minutes. The median length of hospital stay (LOS) was 2 days. R0 resection with intact mesorectal envelop and adequate resection margin distance was achieved in all patients. Three patients had complete pathological response. One patient had presacral absence managed endoscopically. All patients underwent ileostomy reversal and reported good functional outcomes. Conclusion Modified two team approaches to laparoscopically assisted TaTME could be safe and feasible for utilization in lower resource facilities. The early results of this short series are encouraging, yet longer case series will be needed to confirm wider applicability of this method.