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Bertucci Zoccali M, Moallem DH, Park H, Uhlemann AC, Church JM, Kiran RP. Role of Microbiome in the Outcomes Following Surgical Repair of Perianal Fistula: Prospective Cohort Study Design and Preliminary Results. World J Surg 2023; 47:3373-3379. [PMID: 37821648 DOI: 10.1007/s00268-023-07212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Anal fistulae are common, predominantly cryptoglandular, and almost invariably require surgical treatment. Recurrences are common for procedures other than fistulotomy regardless of technique and adequacy of repair. Growing evidence supports the pivotal role of specific intestinal bacteria in anastomotic failures after bowel resection. Anal crypts harbor colonic microbiota suggesting that similar mechanisms to anastomotic healing might prevail after anal fistula repair and hence influence healing. This study aims at assessing the potential role of the intestinal microbiome in the clinical outcomes after surgical repair of cryptoglandular anal fistula. METHODS This is a pilot prospective cohort study enrolling patients with anal fistula undergoing endoanal advancement flap. For microbiome analysis, stool samples are taken via rectal swab before the procedure; additionally, a portion of the fistula is collected intraoperatively after fistulectomy. Samples from groups with treatment failure are compared to samples from patients who healed after surgical repair. Alpha and beta diversities and differential abundance of microbial taxa are determined and compared between groups with DADA2 analytical pipeline. RESULTS Five patients have been enrolled to date (one female, four male). At median follow-up of 6 months (2-11), one patient experienced disease recurrence at 3 months. DNA from the 5 rectal swab and tissue samples was extracted, showing increased relative abundance of Enterococcus faecalis in samples from the patient who developed a recurrent fistula but not in those without recurrence. CONCLUSION These very preliminary data suggest that intestinal microbiome may represent a crucial determinant of the surgical outcomes after anal fistula surgery.
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Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian/Columbia University Medical Center, New York, USA.
| | - Dalia H Moallem
- Division of Infectious Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Heekuk Park
- Division of Infectious Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - James M Church
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian/Columbia University Medical Center, New York, USA
| | - Ravi P Kiran
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian/Columbia University Medical Center, New York, USA
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Bertucci Zoccali M, Minko E, Betcher M. Laparoscopic Total Abdominal Colectomy With End Ileostomy. Dis Colon Rectum 2023; 66:e1131-e1132. [PMID: 37579124 DOI: 10.1097/dcr.0000000000002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
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Bertucci Zoccali M, Church JM, Kiran PR. Partial Delorme procedure for the management of recurrent isolated posterior wall prolapse after robotic ventral mesh rectopexy for rectal prolapse. Tech Coloproctol 2023; 27:957-958. [PMID: 37328670 DOI: 10.1007/s10151-023-02832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY, 10032, USA.
| | - James M Church
- Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Pokala R Kiran
- Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY, 10032, USA
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Bertucci Zoccali M, Jabi O. Robotic assisted removal of migrated intrauterine device. Colorectal Dis 2023; 25:1718-1719. [PMID: 37466010 DOI: 10.1111/codi.16663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, New York, USA
| | - Osama Jabi
- Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, New York, USA
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Bhama AR, Zoccali MB, Chapman BC, Davids JS, Eisenstein S, Fish DR, Sherman KL, Simianu VV, Zaghiyan KN. Practice Variations in Chemodenervation for Anal Fissure Among American Society of Colon and Rectal Surgeons Members. Dis Colon Rectum 2021; 64:1167-1171. [PMID: 34192713 DOI: 10.1097/dcr.0000000000002194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anuradha R Bhama
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Brandon C Chapman
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts, Wooster, Massachusetts
| | - Samuel Eisenstein
- Department of Surgery, UC San Diego Health System, La Jolla, California
| | - Daniel R Fish
- Department of Surgery, Baystate Medical Center; Springfield, Massachusetts
| | - Karen L Sherman
- Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
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Abstract
After surgical resection for Crohn's disease (CD) endoscopic recurrence is noted within few weeks and almost 80% of patients will have evidence of endoscopic recurrence at the anastomosis after ileocolic resection at 1 year. With time and if left untreated surgical recurrence will be detected at the preanastomotic segment or at the anastomosis in the vast majority of cases. It has become progressively apparent also based on these historical data that anastomotic configuration plays a major role in the subsequent recurrence of CD in surgically induced remission. In this article, we will review the evidence in the literature to support the different anastomotic configurations and we will discuss the principles of surgical prophylaxis of CD recurrence.
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Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colon and Rectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Alessandro Fichera
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA
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Vigorita V, Bertucci Zoccali M, Martinez Miguez M, Ave Seijas MJ, Fernandez Martin R, Casal Nuñez EJ, De Castro Parga G. Giant Intracystic (Encysted) Papillary Carcinoma of the Breast. Breast J 2015; 21:555-7. [PMID: 26178172 DOI: 10.1111/tbj.12454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vincenzo Vigorita
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Marco Bertucci Zoccali
- General Surgery Unit, Department of Surgery, Catholic University Med. School-"A.Gemelli" Gen. Hospital, Rome, Italy
| | - Marta Martinez Miguez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Maria J Ave Seijas
- Department of Radiology, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | | | - Enrique J Casal Nuñez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
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Bertucci Zoccali M, Biondi A, Krane M, Kueberuwa E, Rizzo G, Persiani R, Coco C, Hurst RD, D'Ugo D, Fichera A. Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis 2015; 30:87-95. [PMID: 25376336 DOI: 10.1007/s00384-014-2062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Perineal wounds after complete proctectomy are at risk for failure, with dramatic consequences on patients' health and quality of life. This study is aimed at identifying risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. METHODS Data from 284 patients undergoing total proctectomy from 2002 to 2012 either at the University of Chicago Medical Center or the Catholic University of Rome Hospital were collected and analyzed. RESULTS Overall, the perineal wound complication rate was 21.8%. Successful conservative management was accomplished in 45.2% of cases. Complications occurred significantly more often in patients with a higher Charlson score index, with the diagnosis of rectal cancer, who had received preoperative radiation and who had a surgical drain placed at the time of initial surgery. Neoadjuvant radiation was the only significant risk factor at multivariate analysis (OR 4.40). In the rectal cancer subgroup, younger age, female gender, and preoperative radiation were predictors of wound complications. Based on that, a 3-point score (radiation, age, and gender (RAG)) was developed. Patients with a score of 3 had a 50% risk of developing a perineal wound complication. CONCLUSIONS Perineal wound complications are a common and burdensome problem after total proctectomy. Preoperative radiation is the single most significant and controllable risk factor predicting perineal wound failure. In the presence of multiple, non-modifiable risk factors, alternative approaches to primary closure should be considered in managing complex perineal defects.
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Affiliation(s)
- Marco Bertucci Zoccali
- Department of Surgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy
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Vigorita V, Ausania F, Bertucci Zoccali M, Alvarez CF, Nadal BDU, Nuñez JEC. Small bowel intussusception secondary to metastatic melanoma 15 years after complete excision of the primary tumor. Int J Surg Case Rep 2014; 6C:26-8. [PMID: 25506846 PMCID: PMC4334886 DOI: 10.1016/j.ijscr.2014.11.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary intestinal melanoma is a rare entity, however the gastrointestinal tract, and particularly the small bowel, is a common site of recurrence from cutaneous melanoma. PRESENTATION OF CASE We report the case of a 48 year old woman with small bowel intussusception secondary to metastatic cutaneous melanoma, 15 years after excision of the primary tumor. The patient underwent an emergency small bowel resection with negative margins on final pathology. DISCUSSION Surgical resection is a palliative, yet necessary, procedure in the setting of small bowel obstruction due to intussusception secondary to intestinal metastatic melanoma. In case of bowel metastasis, presenting symptoms are nonspecific and do not provide significant clues to the differential diagnosis of the underlying disease. In some patients, complete surgical resection of early diagnosed bowel metastases is associated with prolonged survival. Systemic chemotherapy in these patients does not provide survival benefit. CONCLUSION The occurrence of bowel relapse after very long disease free interval, while highly unlikely in most tumors, should always be considered in the differential diagnosis of patients with previous history of cutaneous malignant melanoma presenting with gastrointestinal symptoms.
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Affiliation(s)
- Vincenzo Vigorita
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain.
| | - Fabio Ausania
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Marco Bertucci Zoccali
- General Surgery Unit, Department of Surgery, Catholic University Med. School - "A. Gemelli" Gen. Hospital, Rome, Italy
| | - Cristina Facal Alvarez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Blanca De Urrutia Nadal
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
| | - Jose Enrique Casal Nuñez
- Department of General and Digestive Surgery, University of Vigo - Meixoeiro Hospital, Vigo, Spain
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