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Background Methods Results Conclusions Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas.We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD.A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife‐cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral.The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate the association of MIS approaches for rectal cancer with long-term postoperative bowel dysfunction., Materials and Methods: This was an Institutional Review Board-approved observational cohort study including consecutive patients with rectal or rectosigmoid cancer who underwent surgical resection between 2007 and 2017. The primary exposure was surgical approach, defined as open surgery or MIS (laparoscopy or robotic surgery). The primary outcome was major LARS, defined as a LARS score of ≥30. Subgroup analyses were performed by tumor height and type of MIS approach., Results: Among 749 potentially eligible patients, 514 (68.6 %) responded to the survey and were included for analysis. In total, 195 (37.9 %) patients underwent an MIS approach - 117 (60.0 %) laparoscopic and 78 (40.0 %) robotic. At a median follow-up of 6.1 (3.7-9.6) years from surgery, 222 patients (43.2 %) had major LARS (MIS: 41.0 % vs. open: 44.5 %, p = 0.44). On multivariable logistic regression, surgical approach had no association with major LARS (MIS, aOR: 1.21, 0.79-1.86). Older age (aOR: 1.03, 1.01-1.04), female sex (aOR: 1.75, 1.16-2.67), TME (aOR: 1.74, 1.01-3.02), diverting ileostomy (aOR: 2.74, 1.49-5.02) and radiation therapy (aOR: 2.63, 1.60-4.33) were all associated with major LARS. On subgroup analysis of patients with mid and low rectal cancers (n = 197), there remained no association between surgical approach and major LARS (MIS, aOR: 1.50, 0.68-3.33)., Conclusions: MIS approach to rectal cancer surgery was not associated with decreased risk of major LARS and should not be touted as a reason to offer MIS., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)