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Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence. The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed. The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry. The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty. In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy. Trial Registration Number: IRCT201206039936N1 [ABSTRACT FROM AUTHOR]

Background: The gold standard of the management of rectal cancer in the middle and lower parts is low anterior resection with coloanal anastomosis. About 50% of the patients undergoing this procedure might experience some complications because of the low capacity of the neorectum. The aim of this study was to evaluate ileal J-pouch interposition as a neorectum between the anal canal and the remaining colon in comparison to coloanal anastomosis and transverse coloplasty. Methods: Twelve dogs, weighing 23-27 kg, were divided into three groups. After laparotomy, the volume of the primary rectum was measured so that it could be compared with that of the neorectum at the end of the study. After rectal resection in Group A, the colon was directly anastomosed to the anus. In Group B, a 5-cm longitudinal incision was made 2 cm proximal to the anastomosis and was sutured transversely (coloplasty). In Group C, a 5-cm ileal J-pouch was interposed between the colon and anus. After 8 weeks, the neorectum was evaluated for volume, radiology, and pathology. Results: All the samples were alive until the end of the study. The healing of the anastomotic lines was acceptable (pathologically) in all. The mean volume expansion was 20.9% in Group A, 21.7% in Group B, and 118.2% in Group C, with the latter being significantly higher than that of the other groups (P=0.03). Colon J-pouch and coloplasty after proctectomy in some situations have not been performable. This study evaluated the performance of ileal J-pouch interposition. Conclusion: This study showed that ileal J-pouch interposition might produce an acceptable reservoir function and that it seems feasible and safe in selected cases. [ABSTRACT FROM AUTHOR]

Background: Understanding the prognostic factors affecting the recurrence-free survival (RFS) of patients with rectal cancer (RC) is the mainstay of care. The present study aimed to identify factors affecting both short- and long-term RFS of patients with RC using semiparametric mixture cure models. Methods: The data were obtained from the database of the Colorectal Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, which was collected during 2007-2017. To determine the factors affecting recurrence, cure models were applied to short-term and long-term RFS of patients with RC separately. The cure rate was calculated using the smcure package in R 3.5.1 (2018-07-02) software. P<0.05 was considered statistically significant. Results: Out of the 376 eligible patients with RC, 75.8% of men and 74.5% of women were long-term survivors. The mean age of the patients was 57.0±13.8 years. Lymph node ratio (LNR)≤0.2 increased the probability of short-term RFS. The prominent factors affecting long-term RFS were body mass index (BMI)<25 kg/m² (OR=1.98, P=0.047), tumor-nodemetastasis (TNM) stage (OR=6.48, P<0.001), abdominal pain (OR=2.15, P=0.007), and computed tomography (CT) scan detected pelvic lymph nodes (OR=3.40, P=0.01). Over a 9-year follow-up period, the empirical and estimated values of cure rates were 75.3% and 83.9%, respectively. Conclusion: The results showed that factors affecting shortterm RFS might be different from long-term RFS. A lower BMI was related to a poorer prognosis in patients with RC. Early diagnosis leads to a lower TNM stage and could increase the probability of long-term RFS. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy is one of the most important factors which results in negative effects on wound healing and increases anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis in cases of colorectal cancer with a history of neoadjuvant radiotherapy to decrease the chance of leakage. Considering the side effects of diverting loop ileostomy, the objective of the present study is to investigate the effect of human amniotic membrane (HAM) on colorectal anastomosis leakage after neo-adjuvant radiotherapy. Methods: In this experimental animal study, 20 crossbreed rabbits were randomly divided into two groups (case group: 13 rabbits, control group: 7 rabbits) after receiving an equal dose of external beam radiation. Four weeks after irradiation, resection of 4 cm of colorectal segment and end-to-end single layer anastomosis were conducted. In the case group, a 2x2 cm wrap of HAM applied around the site of anastomosis. Eight weeks later, all the survived rabbits were sacrificed. A segment of anastomotic sites was resected in all expired and survived rabbits and sent for pathological evaluation. Mann-Whitney U Test (SPSS for Windows, Ver. 16, Chicago, IL) was applied to analyze healing scores between the two groups. Results: Due to anastomosis dehiscence, 5 rabbits expired in the control group, but all the 13 rabbits (case group) survived after 8 weeks and showed no leakage. In addition, pathological evaluation revealed significant epithelialization and neovascularization in the case group. Statistically, healing score was higher in the case group rather than the control group (P<0.001). Conclusion: To prevent post irradiation colorectal anastomosis leakage, the use of HAM might play a significant role and a feasible technical approach. [ABSTRACT FROM AUTHOR]