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Abstract Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions affecting the digestive tract. This study examines 188 IBD patients in a private healthcare service in Canoas/RS, Brazil, aiming to understand their clinical profiles. Most patients were young adults, primarily white, with more women affected. Both CD and UC patients commonly experienced diarrhea, but blood in stools was more prevalent in UC. CD mostly affected the small intestine, while UC involved the rectum or extended through the colon. The diagnosis was prompt, with most CD cases diagnosed within six months and UC cases within twelve months of symptom onset. Family histories of IBD and colorectal cancer were observed, particularly in CD patients. Extraintestinal manifestations were more frequent in CD. Elevated CRP levels were common in CD, while FC values were elevated in both groups. Treatment approaches differed, with 5-ASA primarily used in UC and immunomodulators in CD. Biological therapy was less commonly employed initially. This study aligns with global IBD trends in demographics, symptoms, and disease locations. Early diagnosis likely results from specialized private healthcare, emphasizing the importance of timely diagnosis and tailored treatment.

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Abstract Introduction Ulcerative colitis (UC) is an inflammatory bowel disease that causes long-lasting inflammation and ulcers within the digestive tract. This study aims to determine the histochemical alteration of Salvia officinalis (sage), an anti-inflammatory and antioxidant herbal agent on UC. Materials and Methods The disease was induced in 37 Sprague-Dawley rats with 2 mL of 3% acetic-acid (AA) enema. The rats were divided into five groups: a control group (AA), two 5-aminosalicylic (5-ASA) groups treated either orally (AO) or rectally (AR) with a dose of 100 mg/kg, and two salvia groups treated with 300mg/kg salvia orally (SO) or rectally (SR). Histopathological analyses of the colon were done on day 7, and markers such as C-reactive protein (CRP), superoxide dismutase (SOD), and complete blood count were measured. Result In macroscopic evaluation, the AO group demonstrated the lowest involvement, followed by the SO, SR, AR, and AA groups, respectively (p = 0.01). There was no significant difference between the SO and AO groups (p = 0.10), and the SR and AR groups (p = 0.58). Regarding microscopic histopathological findings, the AO and SO group demonstrated the most satisfactory results, with no significant difference between the AO versus SO, and AR versus SR groups. Inflammation was resolved in all of the AO and SO subjects. Conclusion Salvia can be beneficial in the treatment course of UC by inhibiting inflammatory responses, increasing the growth and viability of intestinal mucosa, and its antioxidant effects. Therefore, we propose the prescription of salvia as an adds-on or alternative therapy in the management of UC.

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Abstract Introduction The involvement of circular RNAs (circRNAs) in cancer research has been emphasized in recent years due to evidence of their involvement in malignancy pathogenesis. Yet, the involvement of circRNAs in the resistance to cancer treatment remains to be clarified. Circular RNA 0001313 (circ_0001313) has a distinct expression in different cancers, and it is overexpressed in rectal cancer; hence, it could be a promising non-invasive stable biomarker and a therapeutic target for rectal cancer. Yet, its predictive role has not been studied in Egyptian rectal cancer patients. Objective To study the predictive value of circulating circ_0001313 (circ_CCDCC6) in assessing the response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer and its relation to radiological and pathological response. Materials and Methods The present study included 50 patients with locally advanced rectal cancer and 20 healthy subjects as controls. The analysis of the relative circ_CCDCC6 expression was performed using the real-time quantitative polymerase chain reaction (qPCR) method. Results The circ_CCDCC6 was found to be significantly more expressed in rectal cancer patients compared with controls (p < 0.001). Moreover, its expression level was significantly higher in nonresponders to nCRT compared with responders (p < 0.001). Furthermore, a receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of circulating circ_0001313; its sensitivity in predicting the response to treatment was of 93.33%, and its specificity was of 91.43%. Conclusion Significant up-regulation of circ_0001313 in rectal cancer suggests a potential oncogenic role, and higher expression of circ_0001313 among nonresponders suggests that it could be a predictor of the response to nCRT.

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Abstract Introduction Colorectal cancer (CRC) is the third most prevalent tumor. Right colon cancer (RCC) comprises one-third of CRC cases and is associated with poorer outcomes, emphasizing the need for optimized treatment strategies. The present study aims to explore the nuances in the management of RCC across Portugal, focusing on surgical approaches and multidisciplinary treatment. Materials and Methods The CodiReal-PT was a cross-sectional survey-based study adhering to the guidelines of the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), focusing on current practices in RCC oncological surgery. The survey comprised 31 questions divided into 4 sections (demographics, multidisciplinary approach, surgery practices regarding RCC, and postoperative management). It was made available via e-mail to all active members of the Portuguese Society of Surgery (Sociedade Portuguesa de Cirurgia, SPCIR, in Portuguese), and data collection lasted from November to December 2022. Results Data from 69% of Portuguese public hospitals was obtained. All the participant hospitals had multidisciplinary team meetings to manage CRC cases. However, 17% (n = 6) did not discuss all elective-setting cases during their meetings. Dedicated colorectal surgical teams were present in 86% (n = 31) of hospitals. Furthermore, the presence of these dedicated teams was associated with better practices, namely a higher volume of right colectomies (mean: 51.8 ± 32.6 versus 23.8 ± 4.8; p = 0.001), a preference for the laparoscopic approach (93.5 versus 60.0%; p = 0.021), and standardization of anastomotic techniques (83.9 versus 40.0%; p = 0.029). Conclusion The present nationwide survey-based study provides a comprehensive landscape of RCC management practices across Portugal, underscoring the significant role of dedicated colorectal surgical teams and the need for further practice standardization. Nevertheless, multidisciplinary team meetings in all surveyed hospitals are an important indicator of improved RCC care. Future research should focus on the impact of specific surgical techniques on oncological outcomes and the potential benefits of centralizing care to high-volume centers.

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Abstract Introduction Despite the high prevalence and severity of colorectal cancer (CRC), the public is mostly unaware of its prevention and screening. Objective To determine the level of knowledge regarding CRC prevention and screening among staff at a reference cancer center. Materials and Methods A cross-sectional study was conducted in a reference cancer center. Employees aged 18 and up who had worked at the oncology center for at least one year were given a questionnaire containing sociodemographic and evaluative questions about CRC prevention and screening. Results The sample comprised 266 employees, with a median age of 45 (53.00–35.75) years of age. Most of the staff (76.3%) were female, had at least a year of experience at the health facility (74.1%), and agreed on the definition of CRC. Inflammatory bowel illness was the least commonly recognized risk factor (67.6%). Most of the sample (56%) recognized all 5 warning flags. Colonoscopy was the most popular screening test (98.7%). Although the health center does not offer official CRC education, most of the staff (42.1%) reported learning about CRC while working. There was no difference in perceptions of the optimal age to begin screening between employees 45 years or older and those younger (p = 0.729). Higher-educated employees were more knowledgeable about CRC (p = 0.001). Conclusion In a reference cancer center, the staff members who work directly with patients as well as those with higher levels of schooling have a satisfactory level of knowledge regarding CRC prevention and screening.

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Abstract Introduction and Objectives Certolizumab Pegol (CZP) is an anti-TNF agent approved in Brazil for Crohn's disease (CD). There is a lack of data in Brazil and Latin America detailing real-world experiences with CZP. The primary objective was clinical remission in weeks 26 and 54. The secondary endpoints were clinical response in weeks 26 and 54, endoscopic remission, biological switch rates, rates of CD-related surgery, persistence with treatment over time, and adverse events. Remission and clinical response were defined as HBI ≤4 and ≥3 points reduction of HBI, respectively. Endoscopic remission was defined as the complete healing of the intestinal mucosa. Methods This observational and retrospective study included patients with CD from 4 Brazilian centers who received CZP during their disease course. Results Forty-five patients were included. The median age was 42.16 years old, 53.3% had perianal involvement, 37.8% had undergone previous surgery, and 71.1% of patients were anti-TNF naïve. Clinical remission was observed in 73.2% and 62.5% of patients at weeks 26 and 54, respectively. Clinical response was observed in 14.63% and 18.75% in weeks 26 and 54, respectively. Endoscopic remission was observed in 36.4% of patients. A switch to biological therapy was performed in 57.8% of patients. Eleven patients underwent abdominal surgery; 62.25% discontinued treatment with CZP, with a median of 16 months, and 22.2% presented drug-related adverse events. Conclusions CZP in CD was associated with clinical remission and response rates compatible with international real-world case series. Most patients needed to switch to biological therapy due to inadequate disease control.

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Abstract Introduction Intestinal ostomy represents the externalization of the intestine to the abdominal wall. Objective To analyze the clinical and epidemiological profile of patients who underwent intestinal ostomy construction from 2010 to 2023 at the Hospital Universitario Santa Terezinha (HUST) in Joaçaba, Santa Catarina. Method This is a quantitative study with a cross-sectional approach through access to medical records of patients undergoing intestinal ostomy surgery from 2010 to 2023. Descriptive and association analyses were performed using JASP 0.18.1 software. Results Three hundred and seventy-one (371) patients, predominantly male (58.8%), were included in this study. At the time of surgery, the average age was 60.4 years. The younger patient was 13 years old, while the older patient was 97 years old. Most of the hospitalizations were due to neoplasms, with emphasis on colorectal neoplasia (39.6%), with a predominance of ileostomies (54.4%). A significant increase of this type of surgery (p = 0.013) was noted, coincidently with the SARS-CoV-2 virus pandemic. Conclusions Males and elderly people who underwent ileostomy due to colorectal neoplasia, were predominant, most of which were permanent. There was an increase in the number of ostomy cases during the SARS-CoV-2 pandemic in the region. Such conditions may be associated with gastrointestinal complications, with a high potential for enteral surgery under unfavorable conditions.

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Abstract Granular cell tumors are rare soft tissue tumors with neural origin that present malignant potential. Perianal granular cell tumors with only subcutaneous involvement are uncommonly presented in the literature. Herein, we present the case of a 49-year-old female patient with perianal granular cell tumor of the buttock. The patient underwent successful surgical resection and remains under close postoperative follow-up. There is no standard diagnostic algorithm for these tumors, and imaging provides little benefit. Histopathology and immunohistochemical staining are necessary for the accurate diagnosis of granular cell tumors.

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Abstract Objective To present a rare case of anal squamous cell carcinoma (SCC) in a young pregnant woman. Material and Methods The information was collected based on the clinical record after obtaining the informed consent of the patient. Results This is the case of a 34-year-old pregnant woman with stage IIIB anal SCC. She was treated with chemotherapy before delivery, followed by cesarean section and chemoradiotherapy after birth. The patient experienced complete clinical and imaging regression after treatment, but she presented early tumor regrowth requiring abdominoperineal amputation, with negative surgical margins. Discussion The treatment of anal cancer in pregnant women is based on a multidisciplinary approach, adapting current clinical guidelines. It establishes a challenge from an ethical point of view that must consider the impact on the health of the mother and the fetus. Anal screening in carriers of cervical pathology due to papilloma virus would be a good tool for early detection.

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Abstract Introduction Surgical site infections (SSIs) remain a significant concern in colorectal surgery, impacting patient outcomes and healthcare costs. Mechanical bowel preparation (MBP) and antibiotic prophylaxis are widely used strategies to reduce the incidence of SSIs. However, their effectiveness and the associated risks continue to be topics of debate within the medical community. This review aims to assess the current evidence on the use of MBP and antibiotics in preventing SSIs during colorectal procedures, highlighting the benefits, controversies, and ongoing discussions in the field. Objective This review evaluates the effectiveness and controversy surrounding the use of mechanical bowel preparation (MBP) and antibiotic prophylaxis in preventing surgical site infections (SSIs) during colorectal procedures. Methodology The review looks at a variety of research, such as meta-analyses and trials, and examines the timing, choice of antibiotics, and various facets of MBP. Findings Prophylactic antibiotic use considerably lowers SSIs; however, resistance issues are raised. MBP works well, but there are debates over the risks involved. With continuous discussions, combined antibiotic-MBP methods are prevalent. Conclusion the evaluation acknowledges the potential for prevention but emphasizes the need for careful use that takes patient variables into account. Optimal techniques are the subject of ongoing study, which emphasizes the dynamic nature of SSI prevention in colorectal surgery.

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Abstract Many technical propositions have been incorporated to the surgical management of hemorrhoidal disease during the recent decades. Besides that, escisional techniques are still considered the best option to control symptoms and reduce recurrence. The present manuscript aims to propose a technical modification of the classical closed hemorrhoidectomy described by Ferguson in America. Our proposition is to perform two sutures to close the wound resulting from hemorrhoidal resection. The first one consists of an anchored continuous suture using a very thin (4–0 or 5–0) monofilamentar thread coming from inside to the outside skin. After tying the stitch, a simple continuous second suture is made over the previous suture only for mucosal approximation, from outside to inside. Finally, the stich that initiated the first suture is tied up to the stich used for the second suture, and the knot remains located above the dentate line, not to disturb the patient. The confection of two layers aims to reinforce the closing of the wound and avoid dehiscence. The idea is that this modification influences postoperative outcomes by reducing symptoms such as wound discharge and pain, and thus improving healing and esthetics. In a next step research, a comparison with the classical technique may bring new insights to this issue.