Pelvic floor and functional bowel disorders refer to a series of symptoms and anatomic findings that effect men and women of all ages. These may include: constipation, difficult evacuation, fecal incontinence, irritable bowel disorders, diarrhea, pelvic organ prolapse, urinary and sexual dysfunction and pain. Although not life threatening, these disorders can severely affect quality of life and individual performance.

Over the past two decades I have dedicated my career to working with other specialists for comprehensive care for individuals with pelvic floor disorders. In July 2017, I joined The Department of Surgery, Division of Colorectal Surgery at Stanford University as the Medical Director of the Pelvic Health Center. I previously spent the prior decade at Cleveland Clinic running a multidisciplinary clinic and performing over 200 combined procedures in conjunction with colleagues in urology and urogynecology. We developed a robotic surgical approach to woman with vaginal and rectal prolapse and performed many surgeries to repair intestinal and rectal fistula (abnormal communications between the intestine and vagina).

Prior to that I established a Pelvic Floor Center at Maimonides Medical Center received a Jahnigan Career Development Award looking at multicompartment prolapse in elderly women. In addition to performing surgery and teaching throughout my career, I have maintained a commitment to long-term follow up of patients after surgery.
Although my training and focus is around surgical techniques and solutions for anorectal disorders and pelvic health, I believe that prevention, non-surgical alternatives, diet, exercise, and behavior management are vitally important to patient success.

One of my many goals is to educate patients, health care providers, and trainees about pelvic floor disorders.
When I am not at work I enjoy quality time with my three teenagers, dog, friends and I practice yoga.

Clinical Focus

  • General Surgery
  • Rectal Prolapse
  • Pelvic Floor Dysfunction
  • Fecal incontinence
  • Slow transit constipation
  • Obstructed defecation syndrome
  • Colovaginal fistula
  • Rectal vaginal fistula
  • Hemorrhoids
  • Anal fistula
  • Robotic Surgery

Administrative Appointments

  • Surgery Department Wellness Department, Stanford (2020 - 2022)

Professional Education

  • Medical Education: Drexel University College of Medicine (1994) PA
  • Residency: Icahn School of Medicine at Mount Sinai Department of Surgery-Division of General Surgery (2000) NY
  • Fellowship: Cleveland Clinic Colon and Rectal Surgery Fellowship (2001) OH
  • Board Certification: American Board of Colon and Rectal Surgery, Colon and Rectal Surgery (2003)
  • Board Certification: American Board of Surgery, General Surgery (2001)

All Publications

  • Use of a footstool improves rectal balloon expulsion in some patients with defecatory disorders. Neurogastroenterology and motility Ulsh, L., Halawi, H., Triadafilopoulos, G., Gurland, B., Nguyen, L., Garcia, P., Sonu, I., Fernandez-Becker, N., Becker, L., Sheth, V., Neshatian, L. 2024: e14781


    Whether patients with defecatory disorders (DDs) with favorable response to a footstool have distinctive anorectal pressure characteristics is unknown. We aimed to identify the clinical phenotype and anorectal pressure profile of patients with DDs who benefit from a footstool.This is a retrospective review of patients with high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) from a tertiary referral center. BET was repeated with a 7-inch-high footstool in those who failed it after 120 s. Data were compared among groups with respect to BET results.Of the 667 patients with DDs, a total of 251 (38%) had failed BET. A footstool corrected BET in 41 (16%) of those with failed BET. Gender-specific differences were noted in anorectal pressures, among patients with and without normal BET, revealing gender-based nuances in pathophysiology of DDs. Comparing patients who passed BET with footstool with those who did not, the presence of optimal stool consistency, with reduced instances of loose stools and decreased reliance on laxatives were significant. Additionally, in women who benefited from a footstool, lower anal pressures at rest and simulated defecation were observed. Independent factors associated with a successful BET with a footstool in women included age <50, Bristol 3 or 4 stool consistency, lower anal resting pressure and higher rectoanal pressure gradient.Identification of distinctive clinical and anorectal phenotype of patients who benefited from a footstool could provide insight into the factors influencing the efficacy of footstool utilization and allow for an individualized treatment approach in patients with DDs.

    View details for DOI 10.1111/nmo.14781

    View details for PubMedID 38488172

  • Durable Approaches to Recurrent Rectal Prolapse Repair May Require Avoidance of Index Procedure. Diseases of the colon and rectum Bordeianou, L., Ogilvie, J. W., Saraidaridis, J. T., Olortegui, K. S., Ratto, C., Ky, A. J., Oliveira, L., Vogler, S. A., Gurland, B. H., Steering Committee for the Pelvic Floor Disorders Consortium Quality Improvement in Rectal Prolapse Surgery Database Pilot 2024


    BACKGROUND: Surgical treatment of recurrent rectal prolapse is associated with unique technical challenges, partly determined by the surgical approach utilized for the index operation. Success rates are variable and data to determine the best approach in patients with recurring prolapse are lacking.OBJECTIVE: To assess current surgical approaches to patients with prior rectal prolapse repairs and to compare short-term outcomes of de novo and redo procedures, including recurrence of rectal prolapse.DESIGN: Retrospective analysis of a prospective database.SETTING: The Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement database. Deidentified surgeons at more than 25 sites (81% high volume) self-reported patient demographics, prior repairs, symptoms of incontinence and obstructed defecation, and operative details, including history of concomitant repairs and prior prolapse repairs.INTERVENTIONS: Incidence and type of repair used for prior rectal prolapse surgery were recorded. Primary and secondary outcomes of index and redo operations were calculated. Patients undergoing rectal prolapse re-repair (redo) were compared to patients undergoing first (de novo) rectal prolapse repair. The incidence of rectal prolapse recurrence in de novo and redo operations was quantified.OUTCOMES: The primary outcome of rectal prolapse recurrence in de novo and redo settings.RESULTS: Eighty-nine (19.3%) of 461 patients underwent redo rectal prolapse repair. On short-term follow-up, redo patients had prolapse recurrence rates similar to those undergoing de novo repair. However, patients undergoing redo procedures rarely had the same operation as their index procedure.LIMITATIONS: Self-reported, de-identified data.CONCLUSIONS/DISCUSSION: Our results suggest that recurrent rectal prolapse surgery is feasible and can offer adequate rates of rectal prolapse durability in the short term but may argue for a change in surgical approach for redo procedures when clinically feasible. See Video Abstract.

    View details for DOI 10.1097/DCR.0000000000003212

    View details for PubMedID 38479014

  • Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association with Dyssynergic Defecation. The American journal of gastroenterology Neshatian, L., Triadafilopoulos, G., Wallace, S., Jawahar, A., Sheth, V., Shen, S., Gurland, B. 2023


    The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades.Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and MR defecography. Association of risk factors on increasing RI grades was assessed using logistic regression.Analysis included a total of 238 women; 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age (p:0.017), vaginal delivery (p: 0.008), and prior pelvic surgery (p: 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades was associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion (p<0.05), linked to diminished anal sphincter. Indeed, increased RI grades was associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension.Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades.Our data suggests that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades; a process that is independent of age, history of vaginal deliveries and/or pelvic surgeries, and perhaps related to dyssynergic defecation.

    View details for DOI 10.14309/ajg.0000000000002605

    View details for PubMedID 37975595

  • Management of full thickness rectal prolapse SEMINARS IN COLON AND RECTAL SURGERY Rajasingh, C. M., Gurland, B. H. 2023; 34 (1)
  • Using AI and computer vision to analyze technical proficiency in robotic surgery. Surgical endoscopy Yang, J. H., Goodman, E. D., Dawes, A. J., Gahagan, J. V., Esquivel, M. M., Liebert, C. A., Kin, C., Yeung, S., Gurland, B. H. 2022


    BACKGROUND: Intraoperative skills assessment is time-consuming and subjective; an efficient and objective computer vision-based approach for feedback is desired. In this work, we aim to design and validate an interpretable automated method to evaluate technical proficiency using colorectal robotic surgery videos with artificial intelligence.METHODS: 92 curated clips of peritoneal closure were characterized by both board-certified surgeons and a computer vision AI algorithm to compare the measures of surgical skill. For human ratings, six surgeons graded clips according to the GEARS assessment tool; for AI assessment, deep learning computer vision algorithms for surgical tool detection and tracking were developed and implemented.RESULTS: For the GEARS category of efficiency, we observe a positive correlation between human expert ratings of technical efficiency and AI-determined total tool movement (r=-0.72). Additionally, we show that more proficient surgeons perform closure with significantly less tool movement compared to less proficient surgeons (p<0.001). For the GEARS category of bimanual dexterity, a positive correlation between expert ratings of bimanual dexterity and the AI model's calculated measure of bimanual movement based on simultaneous tool movement (r=0.48) was also observed. On average, we also find that higher skill clips have significantly more simultaneous movement in both hands compared to lower skill clips (p<0.001).CONCLUSIONS: In this study, measurements of technical proficiency extracted from AI algorithms are shown to correlate with those given by expert surgeons. Although we target measurements of efficiency and bimanual dexterity, this work suggests that artificial intelligence through computer vision holds promise for efficiently standardizing grading of surgical technique, which may help in surgical skills training.

    View details for DOI 10.1007/s00464-022-09781-y

    View details for PubMedID 36536082

  • Does Concomitant Pelvic Organ Prolapse Repair at the time of Rectopexy Impact Rectal Prolapse Recurrence Rates? A Retrospective Review of a Prospectively Collected Pelvic Floor Disorders Consortium Quality Improvement Database. Diseases of the colon and rectum Bordeianou, L., Ogilvie, J., Murphy, M., Hyman, N., Vogler, S., Ky, A., Oliveira, L., Gurland, B. 2022


    Pelvic organ prolapse is reported in 30% of women presenting with rectal prolapse and combined repair is a viable option to avoid the need for future pelvic floor interventions. However, the added impact of adding a modicum of middle compartgment suspension by closing the pouch of Douglas during a rectal prolapse repair has not been studied.We aimed to assess the impact of middle compartment suspension on the durability of the rectal prolapse repair. We also aimed to determine whether adding some form of pouch of Douglas closure to achieve middle compartment suspension leads to any improvements in the rates or the severity of postoperative constipation or in the rates or severity of postoperative fecal incontinence.Retrospective analysis of a prospective database.Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement, database. Deidentified surgeons at >20 sites (75% academic, 81% high volume) self reported patient demographics, prior repairs, symptoms of fecal incontinence and obstructed defecation, and operative details, including addition of concomitant gynecologic repairs, use of mesh, posterior or ventral dissection, and sigmoidectomy.Abdominal rectopexy procedures with and without middle compartment suspension) were compared. Middle compartment suspension was defined as excision and closure of pouch of Douglas with some degree of colpopexy or culdoplasty.The primary outcome of prolapse recurrence and secondary outcomes of incontinence and constipation were calculated via univariate and multivariable regression by comparing those who underwent rectopexy with and without middle compartment suspension.Patients who underwent abdominal repair for rectal prolapse.Of the 198 patients (98% female, age 60.2 ± 15.6 years) who underwent abdominal repairs (59% robotic), 138 (70%) underwent some concomitant middle compartment suspension. Patients who had an added middle compartment suspension appeared to have lower early rectal prolapse recurrences and on multivariable regression to control for age, prior repairs, and the use of mesh, addition of some form of pouch of douglas repair was associated with a decrease in short term recurrences .Our results suggest that some middle compartment suspension at the time of rectal prolapse repair may improve short term durability of rectal prolapse repair.Our data needs to be interpreted cautiously. Future studies are critically needed to further explore this observation, with an a priori, prospective definition of middle compartment suspension, validated measurement of concomitant pathology, and longer follow up. See Video Abstract at

    View details for DOI 10.1097/DCR.0000000000002495

    View details for PubMedID 36102871

  • MRI biomarker of muscle composition is associated with severity of pelvic organ prolapse. Techniques in coloproctology Neshatian, L., Lam, J. P., Gurland, B. H., Liang, T., Becker, L., Sheth, V. R. 2022


    BACKGROUND: The pathophysiology of pelvic organ prolapse is largely unknown. We hypothesized that reduced muscle mass on magnetic resonance defecography (MRD) is associated with increased pelvic floor laxity. The aim of this study was to compare the psoas and puborectalis muscle mass composition and cross-sectional area among patients with or without pelvic laxity.METHODS: An observational retrospective study was conducted on women>age 18years old who had undergone MRD for pelvic floor complaints from January 2020 to December 2020 at Stanford Pelvic Health Center. Pelvic floor laxity, pelvic organ descent, and rectal prolapse were characterized by standard measurements on MRD and compared to the psoas (L4 level) and puborectalis muscle index (cross-sectional area adjusted by height) and relative fat fraction, quantified by utilizing a 2-point Dixon technique. Regression analysis was used to quantify the association between muscle characteristics and pelvic organ measurements.RESULTS: The psoas fat fraction was significantly elevated in patients with abnormally increased resting and strain H and M lines (p<0.05) and increased with rising grades of Oxford rectal prolapse (p=0.0001), uterovaginal descent (p=0.001) and bladder descent (p=0.0005). In multivariate regression analysis, adjusted for age and body mass index, the psoas fat fraction (not muscle index) was an independent risk factor for abnormal strain H and M line; odds ratio (95% confidence interval) of 17.8 (2-155.4) and 18.5 (1.3-258.3) respectively, and rising Oxford grade of rectal prolapse 153.9 (4.4-5383) and bladder descent 12.4 (1.5-106). Puborectalis fat fraction was increased by rising grades of Oxford rectal prolapse (p=0.0002).CONCLUSIONS: Severity of pelvic organ prolapse appears to be associated with increasing psoas muscle fat fraction, a biomarker for reduced skeletal muscle mass. Future prospective research is needed to determine if sarcopenia may predict postsurgical outcomes after pelvic organ prolapse repair.

    View details for DOI 10.1007/s10151-022-02651-8

    View details for PubMedID 35727428

  • Best approaches to rectal prolapse ANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY Rajasingh, C. M., Gurland, B. H. 2022
  • Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR. American journal of roentgenology Gurland, B. H., Khatri, G., Ram, R., Hull, T. L., Kocjancic, E., Quiroz, L. H., Sayed, R. F., Jambhekar, K. R., Chernyak, V., Paspulati, R. M., Sheth, V. R., Steiner, A. M., Kamath, A., Shobeiri, S. A., Weinstein, M. M., Bordeianou, L., Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders, Ayscue, J., Basilio, P., Chernyak, V., El Sayed, R. F., Gurland, B., Hall, C., Herrmann, K., Jambhekar, K., Kaiser, A. M., Kamath, A., Khatri, G., Kocjancic, E., Rafatzand, K., Rodriguez, L. M., Mishra, K., Neshatian, L., O'Neill, E., Parlade, A., Paspulati, R. M., Ram, R., Sheth, V., Steiner, A., Syan, R., Traugott, A. 2021: 1-13


    The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.

    View details for DOI 10.2214/AJR.21.26488

    View details for PubMedID 34505543

  • Approaching Combined Rectal and Vaginal Prolapse. Clinics in colon and rectal surgery Wallace, S., Gurland, B. 1800; 34 (5): 302-310


    Combined rectal prolapse and pelvic organ prolapse surgery provides significant quality-of-life benefits with improvements in bothersome symptoms of pain, bulge, constipation, urinary retention, as well as bowel and bladder incontinence. Robotic surgery is the ideal tool for a combined surgical repair. It allows enhanced suturing in the deep pelvis, three-dimensional (3D) visualization of the presacral space and easy mobilization of the rectum and dissection of the vagina. Combined procedures can be offered to patients with the advantages of a single operation and concurrent recovery period without increasing complications. In this article, we highlight our approach to combined prolapse repair.

    View details for DOI 10.1055/s-0041-1726351

    View details for PubMedID 35069022

  • Rectal Prolapse: Age-Related Differences in Clinical Presentation and What Bothers Women Most. Diseases of the colon and rectum Neshatian, L., Lee, A., Trickey, A., Arnow, K., Gurland, B. 2021


    BACKGROUND: Rectal prolapse has a diverse symptom profile that affects patients of all ages.OBJECTIVE: We sought to identify bothersome symptoms and clinical presentation that motivated rectal prolapse patients to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms.DESIGN: Retrospective analysis of a prospectively maintained registry.SETTINGS: Tertiary referral academic center.PATIENTS: 129 consecutive women with full thickness rectal prolapse.MAIN OUTCOME MEASURES: Primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age<65 vs. age≥65 years.RESULTS: Cleveland Clinic/Wexner Fecal Incontinence score>9 was more common in older patients (87% vs 60%, p=.002). Obstructed Defecation Syndrome score>8 was more common in younger patients (57% vs 28%, p<.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p=.021) and bleeding (12% vs 2%, p=.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p=.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p=.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p=.056). Upon multivariable regression, increasing age, narcotic use and non-protracting prolapse at rest were associated with reporting pain as a primary complaint.LIMITATIONS: Single center; small sample size.CONCLUSIONS: Rectal prolapse-related bothersome symptoms and healthcare utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at .

    View details for DOI 10.1097/DCR.0000000000001843

    View details for PubMedID 33496475

  • Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. International urogynecology journal Wallace, S. L., Enemchukwu, E. A., Mishra, K. n., Neshatian, L. n., Chen, B. n., Rogo-Gupta, L. n., Sokol, E. R., Gurland, B. H. 2021


    Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence.A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination.Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1).Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.

    View details for DOI 10.1007/s00192-021-04778-y

    View details for PubMedID 33864476

  • Resection Rectopexy Is Still an Acceptable Operation for Rectal Prolapse AMERICAN SURGEON Carvalho e Carvalho, M., Hull, T., Zutshi, M., Gurland, B. H. 2018; 84 (9): 1470–75


    The aim of this study was to compare resection rectopexy (RR) with ventral mesh rectopexy (VMR). This institutional review board-approved retrospective study compared patients with rectal prolapse, who underwent RR or VMR from 2009 to 2016. The primary end point was the comparison of complications and prolapse recurrence rates. Seventy-nine RR and 108 VMR patients qualified. Using propensity score matching, the two groups were not significantly different (P = 0.818). There were no differences regarding gender (female 103 vs 72; P = 0.4) and age (59.3 vs 53.9; P = 0.054). Patients in the VMR group had a greater body mass index (25.5 vs 22.9; P = 0.001) and poorer physical status (American Society of Anesthesiologists 3 57.4% vs 41.8%; P = 0.04). The VMR group had more: robotic approaches (69.4% vs 8.9%; P < 0.001), concomitant urogynecological procedures (63 vs 19; P < 0.001), and longer operative time (269 vs 206 minutes; P < 0.001) but a reduced length of stay (2 vs 5 days; P < 0.001). The median follow-up (16 vs 26 months; P = 0.125) and the median time of recurrence (14 vs 38 months; P = 0.163) were similar. No differences were observed for complications or recurrence (10.2% vs 10.1%; P = 0.43). We failed to identify superiority based on surgical technique.

    View details for Web of Science ID 000445896600052

    View details for PubMedID 30268178

  • Levator ani syndrome: transperineal botox injections TECHNIQUES IN COLOPROCTOLOGY Bolshinsky, V., Gurland, B., Hull, T. L., Zutshi, M. 2018; 22 (6): 465–66

    View details for PubMedID 29850943

  • Should we offer ventral rectopexy to patients with recurrent external rectal prolapse? INTERNATIONAL JOURNAL OF COLORECTAL DISEASE Gurland, B., Carvalho e Carvalho, M., Ridgeway, B., Paraiso, M. R., Hull, T., Zutshi, M. 2017; 32 (11): 1561–67


    For patients with rectal prolapse undergoing Ventral Rectopexy (VR), the impact of prior prolapse surgery on prolapse recurrence is not well described.The purpose of this study was to compare recurrence rates after VR in patients undergoing primary and repeat rectal prolapse repairs.This study is a prospective cohort study.IRB-approved prospective data registry of consecutive patients undergoing VR for full-thickness external rectal prolapse between 2009 and 2015.Rectal prolapse recurrence was defined as either external prolapse through the anal sphincters or symptomatic rectal mucosa prolapse warranting additional surgery. Preoperative and postoperative morbidity and functional outcomes were analyzed. Actuarial recurrence rates were calculated using the Kaplan-Meier method.A total of 108 VRs were performed during the study period. Seventy-two were primary and 36 repeat repairs. Seven cases were open, 23 laparoscopic, and 78 robotic. Six cases were converted from laparoscopic/robotic to open. In 63 patients, VR was combined with gynecological procedures. There were no statistical differences between primary or recurrent prolapse for the following: demographics, operative time, concomitant gynecologic procedures, complications, blood loss, and graft material type. Length of stay was longer in patients with a history of prior prolapse surgery (p = 0.01). Prolapse recurrence rates for primary repairs were reported at 1.4, 6.9, and 9.7% and for recurrent prolapse procedures 13.9, 25, and 25% at 1, 3, and 5 years (p = 0.13). Mean length of follow-up was similar between groups. Time to recurrence was significantly shorter in patients undergoing repeat prolapse surgery 8.8 vs 30.7 months (p = 0.03).VR is a better option for patients undergoing primary rectal prolapse repair.

    View details for PubMedID 28785819

  • The association between vitamin-D deficiency and fecal incontinence. Neurogastroenterology and motility Neshatian, L., Grant, G., Fernandez-Becker, N., Yuan, Y., Garcia, P., Becker, L., Gurland, B., Triadafilopoulos, G. 2024: e14753


    BACKGROUND: Vitamin-D is essential for musculoskeletal health. We aimed to determine whether patients with fecal incontinence (FI): (1) are more likely to have vitamin-D deficiency and, (2) have higher rates of comorbid medical conditions.METHODS: We examined 18- to 90-year-old subjects who had 25-hydroxy vitamin-D levels, and no vitamin-D supplementation within 3months of testing, in a large, single-institutional electronic health records dataset, between 2017 and 2022. Cox proportional hazards survival analysis was used to assess association of vitamin-D deficiency on FI.KEY RESULTS: Of 100,111 unique individuals tested for serum 25-hydroxy vitamin-D, 1205 (1.2%) had an established diagnosis of FI. Most patients with FI were female (75.9% vs. 68.7%, p=0.0255), Caucasian (66.3% vs. 52%, p=0.0001), and older (64.2 vs. 53.8, p<0.0001). Smoking (6.56% vs. 2.64%, p=0.0001) and GI comorbidities, including constipation (44.9% vs. 9.17%, p=0.0001), irritable bowel syndrome (20.91% vs. 3.72%, p=0.0001), and diarrhea (28.55% vs. 5.2%, p=0.0001) were more common among FI patients. Charlson Comorbidity Index score was significantly higher in patients with FI (5.5 vs. 2.7, p<0.0001). Significantly higher proportions of patients with FI had vitamin-D deficiency (7.14% vs. 4.45%, p<0.0001). Moreover, after propensity-score matching, rate of new FI diagnosis was higher in patients with vitamin-D deficiency; HR 1.9 (95% CI [1.14-3.15]), p=0.0131.CONCLUSION & INFERENCES: Patients with FI had higher rates of vitamin-D deficiency along with increased overall morbidity. Future research is needed to determine whether increased rate of FI in patients with vitamin-D deficiency is related to frailty associated with increased medical morbidities.

    View details for DOI 10.1111/nmo.14753

    View details for PubMedID 38316640

  • Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus. Diseases of the colon and rectum Gurland, B. H., Olson, C. H., McCarthy, M. S., Bordeianou, L. G. 2024


    There is wide variation for prolapse care.To determine core descriptor sets for rectal prolapse to enhance outcomes research.Descriptors for patients undergoing rectal prolapse surgery were generated through a systematic review and expert opinion. Stakeholders were recruited internationally via list-serve and social media. Experts were encouraged to consider the minimum descriptors that could be considered during clinical care, and descriptors were grouped into core descriptor sets. Consensus was defined as > 70% agreement.A three-round Delphi process using a 9-point Likert scale based on expert results was distributed via survey. The final interactive meeting used a polling platform.The Pelvic Floor Disorders Consortium interdisciplinary group convened to advance the clinical care of pelvic floor disorders.To achieve expert consensus for core descriptor sets for rectal prolapse using a modified Delphi method.A total of 206 providers participated with survey response rates of 82% and 88% respectively. Responders were from North America 56%, Europe 29%, and Latin America, Asia, Australia, New Zealand, and Africa 15%. Ninety-one percent identified as colorectal surgeons and 80% reported more than 5 years of experience (35% > 15 years). Fifty-seven attendees participated in the final meeting and voted on core descriptor sets. Ninety-three percent agreed that descriptors such as age, body mass index, frailty, nutrition, and American Society of Anesthesiology Score correlated to physiologic status. One hundred percent agreed to include baseline bowel function. 100% reported willingness to complete a synoptic operative report. Follow-up intervals 1,3,5 year after surgery (76%) with a collection of recurrence, and functional outcomes at those time periods reached an agreement.Individual bias, self-identification of experts, and paucity of the knowledge related to rectal prolapse.This represents the first steps toward international consensus to unify language and data collection processes for rectal prolapse. See Video Abstract.

    View details for DOI 10.1097/DCR.0000000000003187

    View details for PubMedID 38231033

  • The international variability of surgery for rectal prolapse BMJ SURGERY INTERVENTIONS & HEALTH TECHNOLOGIES Kelley, J. K., Hagen, E. R., Gurland, B., Stevenson, A. L., Ogilvie, J. W. 2023; 5 (1): e000198


    There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse.A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs.Electronic survey distributed to colorectal surgeons of diverse practice settings.249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting.Responses to questions regarding preoperative workup preferences and clinical scenarios.In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods.There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.

    View details for DOI 10.1136/bmjsit-2023-000198

    View details for Web of Science ID 001105726000001

    View details for PubMedID 38020494

    View details for PubMedCentralID PMC10649678

  • Telehealth Is Effective in Delivering Pelvic Floor Physical Therapy in Patients with Pelvic Floor Disorders Karhu, E., Barten, J., Yi, G., Rajwana, Y. R., Gurland, B., Neshatian, L. LIPPINCOTT WILLIAMS & WILKINS. 2023: S491-S492
  • Age-dependent Microglial Disease Phenotype Results in Functional Decline in Gut Macrophages. Gastro hep advances Bishop, E. S., Namkoong, H., Aurelian, L., McCarthy, M., Nallagatla, P., Zhou, W., Neshatian, L., Gurland, B., Habtezion, A., Becker, L. 2023; 2 (2): 261-276


    Muscularis macrophages (MMs) are tissue-resident macrophages in the gut muscularis externa which play a supportive role to the enteric nervous system. We have previously shown that age-dependent MM alterations drive low-grade enteric nervous system inflammation, resulting in neuronal loss and disruption of gut motility. The current studies were designed to identify the MM genetic signature involved in these changes, with particular emphasis on comparison to genes in microglia, the central nervous system macrophage population involved in age-dependent cognitive decline.Young (3 months) and old (16-24 months) C57BL/6 mice and human tissue were studied. Immune cells from mouse small intestine, colon, and spinal cord and human colon were dissociated, immunophenotyped by flow cytometry, and examined for gene expression by single-cell RNA sequencing and quantitative real-time PCR. Phagocytosis was assessed by in vivo injections of pHrodo beads (Invitrogen). Macrophage counts were performed by immunostaining of muscularis whole mounts.MMs from young and old mice express homeostatic microglial genes, including Gpr34, C1qc, Trem2, and P2ry12. An MM subpopulation that becomes more abundant with age assumes a geriatric state (GS) phenotype characterized by increased expression of disease-associated microglia genes including Cd9, Clec7a, Itgax (CD11c), Bhlhe40, Lgals3, IL-1β, and Trem2 and diminished phagocytic activity. Acquisition of the GS phenotype is associated with clearance of α-synuclein aggregates. Human MMs demonstrate a similar age-dependent acquisition of the GS phenotype associated with intracellular α-synuclein accumulation.MMs demonstrate age-dependent genetic changes that mirror the microglial disease-associated microglia phenotype and result in functional decline.

    View details for DOI 10.1016/j.gastha.2022.09.006

    View details for PubMedID 36908772

    View details for PubMedCentralID PMC10003669

  • Differential Findings on Anorectal Manometry in Patients with Parkinson's Disease and Defecatory Dysfunction. Movement disorders clinical practice Zhou, W., Triadafilopoulos, G., Gurland, B., Halawi, H., Becker, L., Garcia, P., Nguyen, L., Miglis, M., Muppidi, S., Sinn, D. I., Jaradeh, S., Neshatian, L. 2023; 10 (7): 1074-1081


    Gastrointestinal dysfunction, particularly constipation, is among the most common non-motor manifestations in Parkinson's Disease (PD). We aimed to identify high-resolution anorectal manometry (HR-ARM) abnormalities in patients with PD using the London Classification.We conducted a retrospective review of all PD patients at our institution who underwent HR-ARM and balloon expulsion test (BET) for evaluation of constipation between 2015 and 2021. Using age and sex-specific normal values, HR-ARM recordings were re-analyzed and abnormalities were reported using the London Classification. A combination of Wilcoxon rank sum and Fisher's exact test were used.36 patients (19 women) with median age 71 (interquartile range [IQR]: 69-74) years, were included. Using the London Classification, 7 (19%) patients had anal hypotension, 17 (47%) had anal hypocontractility, and 3 women had combined hypotension and hypocontractility. Anal hypocontractility was significantly more common in women compared to men. Abnormal BET and dyssynergia were noted in 22 (61%) patients, while abnormal BET and poor propulsion were only seen in 2 (5%). Men had significantly more paradoxical anal contraction and higher residual anal pressures during simulated defecation, resulting in more negative recto-anal pressure gradients. Rectal hyposensitivity was seen in nearly one third of PD patients and comparable among men and women.Our data affirms the high prevalence of anorectal disorders in PD. Using the London Classification, abnormal expulsion and dyssynergia and anal hypocontractility were the most common findings in PD. Whether the high prevalence of anal hypocontractility in females is directly related to PD or other confounding factors will require further research.

    View details for DOI 10.1002/mdc3.13755

    View details for PubMedID 37476327

    View details for PubMedCentralID PMC10354598

  • Differential Findings on Anorectal Manometry in Patients with Parkinson's Disease and Defecatory Dysfunction MOVEMENT DISORDERS CLINICAL PRACTICE Zhou, W., Triadafilopoulos, G., Gurland, B., Halawi, H., Becker, L., Garcia, P., Nguyen, L., Miglis, M., Muppidi, S., Sinn, D., Jaradeh, S., Neshatian, L. 2023

    View details for DOI 10.1002/mdc3.13755

    View details for Web of Science ID 000982806800001

  • Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users. Surgical endoscopy Simoncini, T., Panattoni, A., Aktas, M., Ampe, J., Betschart, C., Bloemendaal, A. L., Buse, S., Campagna, G., Caretto, M., Cervigni, M., Consten, E. C., Davila, H. H., Dubuisson, J., Espin-Basany, E., Fabiani, B., Faucheron, J., Giannini, A., Gurland, B., Hahnloser, D., Joukhadar, R., Mannella, P., Mereu, L., Martellucci, J., Meurette, G., Montt Guevara, M. M., Ratto, C., O'Reilly, B. A., Reisenauer, C., Russo, E., Schraffordt Koops, S., Siddiqi, S., Sturiale, A., Naldini, G. 2023


    BACKGROUND: Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion.METHODS: We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons' characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis.RESULTS: The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy.CONCLUSION: Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.

    View details for DOI 10.1007/s00464-023-10001-4

    View details for PubMedID 36952046

  • Anorectal manometry for the diagnosis of pelvic floor disorders in patients with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome. BMC gastroenterology Zhou, W., Zikos, T. A., Halawi, H., Sheth, V. R., Gurland, B., Nguyen, L. A., Neshatian, L. 2022; 22 (1): 538


    INTRODUCTION: Functional gastrointestinal disorders (FGID) including impaired rectal evacuation are common in patients with Hypermobility Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (hEDS). The effect of connective tissue pathologies on pelvic floor function in HSD/hEDS remains unclear. We aimed to compare clinical characteristics and anorectal pressure profile in patients with HSD/hEDS to those of age and sex matched controls.METHODS: We conducted a retrospective review of all FGID patients who underwent high resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET) for evaluation of impaired rectal evacuation. Patients with HSD/hEDS were age and sex matched to a randomly selected cohort of control patients without HSD/hEDS. An abnormal BET was defined as the inability to expel a rectal balloon within 2minutes. Wilcoxon rank sum test and Fisher's exact test were used to make comparisons and logistic regression model for predictive factors for abnormal evacuation.RESULTS: A total of 144 patients (72 with HSD/hEDS and 72 controls) were analyzed. HSD/hEDS patients were more likely to be Caucasian (p<0.001) and nulliparous. Concurrent psychiatric disorders; depression, and anxiety (p<0.05), and somatic syndromes; fibromyalgia, migraine and sleep disorders (p<0.001) were more common in these patients. Rate of abnormal BET were comparable among the groups. HDS/hEDS patients had significantly less anal relaxation and higher residual anal pressures during simulated defecation, resulting in significantly more negative rectoanal pressure gradient. The remaining anorectal pressure profile and sensory levels were comparable between the groups. While diminished rectoanal pressure gradient was the determinant of abnormal balloon evacuation in non HSD/hEDS patients, increased anal resting tone and maximum volume tolerated were independent factors associated with an abnormal BET in HSD/hEDS patients. Review of defecography data from a subset of patients showed no significant differences in structural pathologies between HSD/hEDS and non HSD/hEDS patients.CONCLUSIONS: These results suggest anorectal pressure profile is not compromised by connective tissue pathologies in HSD patients. Whether concurrent psychosomatic disorders or musculoskeletal involvement impact the pelvic floor function in these patients needs further investigation.

    View details for DOI 10.1186/s12876-022-02572-8

    View details for PubMedID 36564719

  • Association of an Online Home-Based Prehabilitation Program With Outcomes After Colorectal Surgery. JAMA surgery Kimura, C. S., Bidwell, S., Gurland, B., Morris, A., Shelton, A., Kin, C. 2022


    This quality improvement study evaluates the association of an online home-based patient prehabilitation program with colorectal surgery outcomes.

    View details for DOI 10.1001/jamasurg.2022.4485

    View details for PubMedID 36322070

  • Mitigating the impact of the year end spike in elective surgery on surgeon and staff well-being: A surgical perspective. Annals of medicine and surgery (2012) Shukla, D., Gilliland, T., Gurland, B., Patel, S., Shanafelt, T. 2022; 75: 103370

    View details for DOI 10.1016/j.amsu.2022.103370

    View details for PubMedID 35242321

  • Utilizing Anorectal Manometry to Predict the Phenotype of Patients Who Will Benefit From a Squatting Assist Stool Ulsh, L., Nguyen, L., Gurland, B., Neshatian, L. LIPPINCOTT WILLIAMS & WILKINS. 2021: S218
  • Sarcopenia Is a Risk Factor for Pelvic Organ Prolapse Independent of Age Sheth, V., Becker, L., Liang, T., Gurland, B., Neshatian, L. LIPPINCOTT WILLIAMS & WILKINS. 2021: S243
  • Adult residual rectourethral fistula and diverticulum presenting decades after imperforate anus repair: acase report. Journal of medical case reports McShane, E. K., Gurland, B., Sheth, V. R., Bruzoni, M., Enemchukwu, E. 2021; 15 (1): 370


    BACKGROUND: This report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40years after imperforate anus repair.CASE PRESENTATION: A 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum.CONCLUSIONS: Although rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.

    View details for DOI 10.1186/s13256-021-02921-3

    View details for PubMedID 34261520

  • Preliminary Report from the Pelvic Floor Disorders Consortium: Large Scale Data Collection through Quality Improvement Initiatives to Provide Data on Functional Outcomes Following Rectal Prolapse Repair. Diseases of the colon and rectum Cavallaro, P. M., Vogler, S. A., Hyman, N. H., Ky, A. J., Savitt, L. R., Tyler, K. M., Gurland, B. H., Bordeianou, L., New England Society of Colorectal Surgery and the Pelvic Floor Disorders Consortium Rectal Prolapse Quality Incentive Workgroup Participants 2021


    BACKGROUND: The surgical management of rectal prolapse is constantly evolving, yet numerous clinical trials and meta-analyses studying operative approaches have failed to make meaningful conclusions.OBJECTIVE: To report on preliminary data captured during a large-scale quality improvement initiative to measure and improve function in patients undergoing rectal prolapse repair.DESIGN: Retrospective analysis of prospectively collected surgical quality improvement data. Settings: This study was conducted at 14 tertiary centers specializing in pelvic floor disorders from 2017 to 2019.PATIENTS: A total of 181 consecutive patients undergoing external rectal prolapse repair.MAIN OUTCOME MEASURES: Preoperative and three-month postoperative Wexner Incontinence Score and Altomare Obstructed Defecation Score.RESULTS: The cohort included 112 patients undergoing abdominal surgery 71 suture rectopexy /56% MIS, 41 ventral rectopexy/93% MIS). Those offered perineal approaches (N=68) were older (median age 75 vs 62, p<0.01) and had more comorbidities (ASA3-4: 51% vs. 24%, p<0.01), but also reported higher pre-intervention rates of fecal incontinence (Wexner 11.4 ± 6.4 vs. 8.6+/-5.8, p<0.01). Patients undergoing perineal procedures had similar incremental improvements in function after surgery as patients undergoing abdominal repair (change in Wexner -2.6 ± 6.4 vs. -3.1 ± 5.6, p= 0.6; change in Altomare -2.9 ± 4.6 vs. -2.7 ± 4.9, p=0.8). Similarly, posterior suture rectopexy and ventral mesh rectopexy patients had similar incremental improvements in overall scores; however, ventral mesh rectopexy patients had a higher decrease in the need to use pads after surgery.LIMITATIONS: Retrospective data analysis and three-month follow up.CONCLUSIONS: Functional outcomes improved in all patients undergoing prolapse surgery. Larger cohorts are necessary to show superiority amongst surgical procedures. Quality improvement methods may allow for systematic, yet practical acquisition of information and data analysis. We call for the creation of a robust database to benefit this patient population. See Video Abstract at .

    View details for DOI 10.1097/DCR.0000000000001962

    View details for PubMedID 33951690

  • Does the Length of the Prolapsed Rectum Impact Outcome of Surgical Repair? Diseases of the colon and rectum Nugent, E., Spivak, A., Gurland, B., Shawki, S., Hull, T., Zutshi, M. 2021


    BACKGROUND: There are many surgical options for the treatment of rectal prolapse with varying recurrence rates reported. The association between rectal prolapse length and recurrence risk has not been explored previously.OBJECTIVE: To determine if length of prolapse predicts a risk of recurrence.DESIGN: Consecutive patients from a prospectively collected IRB approved data registry were evaluated.SETTING: Department of colorectal surgery at the Cleveland Clinic, Ohio.PATIENTS: All patients from 2010 - 2018 who underwent surgical intervention for rectal prolapse.INTERVENTION: Perineal repair including Delorme procedure and Altemeier. Abdominal repair including ventral rectopexy, resection rectopexy and posterior rectopexy.MAIN OUTCOME MEASURES: Prolapse length, recurrence, type of surgery and primary or secondary procedure.RESULTS: In total 280 patients had prolapse surgery over 8 years, mean age 59 years (SD 18) and 92.4% were female. Seventy percent had a prolapse length documented as <5 cm and 30% had prolapse length documented as >5 cm. The mean prolapse length was 4.8 cm (SD 2.9). The overall rate of recurrent prolapse was 18%. There were 51 patients who had a recurrent prolapse after their first prolapse surgery. Factors significant for recurrence on univariate analysis were a perineal approach (p=0.03), previous Delorme procedure (p<0.001) and prolapse length > 5 cm (p=0.04). On multivariate analysis there was significantly increased recurrence with length of prolapse >5 cm (OR 2.2, 95% CI 1.09-4.4, p=0.02) and having a previous Delorme procedure (OR 4, 95% CI 1.6-10.1, p=0.004). For each 1 cm increase in prolapse the odds of recurrence increased by a factor of 2.2.LIMITATIONS: Retrospective study of a heterogenous patient cohort.CONCLUSION: The greater the length of prolapsed rectum the greater the risk of recurrence. The length of prolapse should be considered when planning the most appropriate surgical repair to modify the recurrence risk. See Video Abstract at

    View details for DOI 10.1097/DCR.0000000000001856

    View details for PubMedID 33463998

  • A Collaborative Approach to Multicompartment Pelvic Organ Prolapse. Clinics in colon and rectal surgery Gurland, B., Mishra, K. 2021; 34 (1): 69-76


    Multicompartment pelvic organ prolapse is common yet frequently underreported and unrecognized. Although not life-threatening, the impact on quality of life and daily functioning can be significant. Multidisciplinary evaluation and treatment with specialists in colorectal and female pelvic medicine and reconstructive surgery (FPMRS) help to identify patients who will benefit from surgical treatment of vaginal and rectal prolapse. Both abdominal and perineal combined procedures can be offered to patients with a single operation and concurrent recovery period without increasing complications.

    View details for DOI 10.1055/s-0040-1714289

    View details for PubMedID 33536852

    View details for PubMedCentralID PMC7843949

  • Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Diseases of the colon and rectum Gurland, B. H., Khatri, G., Ram, R., Hull, T. L., Kocjancic, E., Quiroz, L. H., El Sayed, R. F., Jambhekar, K. R., Chernyak, V., Mohan Paspulati, R., Sheth, V. R., Steiner, A. M., Kamath, A., Shobeiri, S. A., Weinstein, M. M., Bordeianou, L., Members of the Expert Workgroup on Magnetic Resonance Imaging of Pelvic Floor Disorders, Ayscue, J., Basilio, P., Hall, C., Herrmann, K., Kaiser, A. M., Rafatzand, K., Rodriguez, L. M., Mishra, K., Neshatian, L., ONeill, E., Parlade, A., Syan, R., Traugott, A. 2021; 64 (10): 1184-1197

    View details for DOI 10.1097/DCR.0000000000002155

    View details for PubMedID 34516442

  • Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. International urogynecology journal Gurland, B. H., Khatri, G., Ram, R., Hull, T. L., Kocjancic, E., Quiroz, L. H., El Sayed, R. F., Jambhekar, K. R., Chernyak, V., Paspulati, R. M., Sheth, V. R., Steiner, A. M., Kamath, A., Shobeiri, S. A., Weinstein, M. M., Bordeianou, L. 2021

    View details for DOI 10.1007/s00192-021-04955-z

    View details for PubMedID 34505921

  • Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Female pelvic medicine & reconstructive surgery Gurland, B. H., Khatri, G., Ram, R., Hull, T. L., Kocjancic, E., Quiroz, L. H., El Sayed, R. F., Jambhekar, K. R., Chernyak, V., Paspulati, R. M., Sheth, V. R., Steiner, A. M., Kamath, A., Shobeiri, S. A., Weinstein, M. M., Bordeianou, L. 2021

    View details for DOI 10.1097/SPV.0000000000001111

    View details for PubMedID 34506350

  • A Collaborative Approach to Multicompartment Pelvic Organ Prolapse CLINICS IN COLON AND RECTAL SURGERY Gurland, B., Mishra, K. 2020
  • IMMUNE PROFILING TO PREDICT RECOVERY OUTCOMES AFTER SURGERY Tsai, E. S., Rumer, K., Wong, K., Warrington, B., Shelton, E., Ganio, E., Verdonk, F., Ando, K., Tingle, M., Folk-Tolbert, M., Shankar, K., Shelton, A., Morris, A., Kirilcuk, N., Gurland, B., Kebebew, E., Kin, C., Angst, M. S., Aghaeepour, N., Gaudilliere, B. LIPPINCOTT WILLIAMS & WILKINS. 2020: 66–67
  • Crohn's disease: failure of a proprietary fluorescent in situ hybridization assay to detect M. avium subspecies paratuberculosis in archived frozen intestine from patients with Crohn's disease. BMC research notes Greenstein, R. J., Su, L., Fam, P. S., Gurland, B., Endres, P., Brown, S. T. 2020; 13 (1): 96


    OBJECTIVES: Although controversial, there is increasing concern that Crohn's disease may be a zoonotic infectious disease consequent to a mycobacterial infection. The most plausible candidate is M. avium subspecies paratuberculosis (MAP) that is unequivocally responsible for Johne's disease in ruminants. The purpose of this study was to evaluate a proprietary (Affymetrix RNA view) fluorescent in situ hybridization (FISH) assay for MAP RNA. Non-identifiable intestine from patients with documented Crohn's disease was assayed according to the manufacturer's instructions and with suggested modifications. Probes were custom designed for MAP and human beta-actin (as the eukaryotic housekeeping gene) from published genomes.RESULTS: Repetitively, false positive signal was observed in our "No-Probe" negative control. Attempts were made to correct this according to the manufacturer's suggestions (by modifying wash solutions, using recommended hydrochloric acid titration and different fluorescent filters). None prevented false positive signal in the "No-Probe" control. It is concluded that when performed according to manufactures instruction and with multiple variations on the manufactures recommended suggestions to correct for false positive signal, that the Affymetrix RNA view cannot be used to detect MAP in pre-frozen resected intestine of humans with Crohn's disease.

    View details for DOI 10.1186/s13104-020-04947-0

    View details for PubMedID 32093770

  • Trends in management of combined rectal and vaginal pelvic organ prolapse Speed, J., Zhang, C., Gurland, B., Enemchukwu, E. WILEY. 2020: S83–S84
  • Do preoperative demographics or symptoms predict recurrence in patients following combined surgical repair for pelvic organ prolapse and rectal prolapse? Syan, R., Wallace, S., Gurland, B., Enemchukwu, E. WILEY. 2020: S174–S175
  • Patient satisfaction improved when patients seen by multiple providers at a multidisciplinary pelvic health center Speed, J., Montalvo, C., Cuevas, J., Gurland, B., Enemchukwu, E. WILEY. 2020: S179–S180
  • Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse. Urology Speed, J. M., Zhang, C. A., Gurland, B. n., Enemchukwu, E. n. 2020


    To examine the rates of surgical repair of comorbid rectal prolapse (RP) and pelvic organ prolapse (POP) over time in a large population-based cohort.We queried Optum®, a national administrative claims database, from 2003-2017. We evaluated female patients age 18 or older with a diagnosis of POP and/or RP. Sociodemographic characteristics, comorbidities, and rates of procedures were collected.We identified 481,051 women diagnosed with RP and/or POP. Only 2.0% of women in the cohort had comorbid POP and RP. While 29.9% of women with RP had dual prolapse, only 2.1% of women with POP had both diagnoses. Overall, 25.8% of women had one or more surgical repairs. Surgical repairs were done in 26.0% of women with POP, 15.0% of women with RP, and 48.2% of women with comorbid POP/RP, though only 19.8% of patients with dual diagnoses had both RP and POP repairs. Over the study period, the rate of multidisciplinary surgical repairs increased by 2.7-fold.The prevalence of comorbid RP and POP among women in our cohort is low (2.0%). Rates of multidisciplinary surgery have increased possibly due to the increased use of imaging, laparoscopic surgery, and awareness of the shared pathophysiology of the disease.

    View details for DOI 10.1016/j.urology.2020.05.010

    View details for PubMedID 32439552

  • Measuring pelvic floor disorder symptoms using patient-reported instruments: proceedings of the consensus meeting of the pelvic floor consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Bordeianou, L. G., Anger, J., Boutros, M., Birnbaum, E., Carmichael, J. C., Connell, K., De, E. B., Mellgren, A., Staller, K., Vogler, S. A., Weinstein, M. M., Yafi, F. A., Hull, T., Bernstein, M., Bhullar, J., Elkadry, E., Garrett, K., Gurland, B., Fraz, A., Lee, P., Lipetskaia, L., Lucia, O., Rogers, R., Thorsen, A., Zutshi, M., Staller, K., Bharucha, A. E., Brenner, D., Kaiser, A., Ogilvie, J., Neto, A., Speranza, J., Stein, S., Brown, H., Cotterill, N., Garfinkle, R., Gupta, A., Hutchinson-Colas, J., Kobashi, K., McNevin, S., Murphy, M., Naranjo Ortiz, C., Warren, G., Birnbaum, E., Connell, K., Bleier, J., Paquette, I., Richter, L., Singla, A., Oliver, J., Wakamatsu, M., Jaffi, F., Bennett, N. E., Hinkle, N. M., Jenkins, L., Mantilla, N., Savitt, L. R., Towe, M., Wexner, S. D., Weinstein, M., Ky, A., Bonnette, H., Hall, C., Keller, D., Lewicky-Gaupp, C., Rogers, R., Schizas, A., Umanskiy, K., Varma, M., Pelvic Floor Disorders Consortium SPRINGER-VERLAG ITALIA SRL. 2020: 5–22

    View details for DOI 10.1007/s10151-019-02125-4

    View details for Web of Science ID 000514318200002

    View details for PubMedID 31823193

  • Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Bordeianou, L. G., Anger, J. T., Boutros, M., Birnbaum, E., Carmichael, J. C., Connell, K. A., De, E. B., Mellgren, A., Staller, K., Vogler, S. A., Weinstein, M. M., Yafi, F. A., Hull, T. L., Bernstein, M., Bhullar, J., Elkadry, E., Garrett, K., Gurland, B., Ahmed, K., Lee, P., Lipetskaia, L., Lucia, O., Rogers, R., Thorsen, A., Zutshi, M., Bharucha, A. E., Brenner, D., Kaiser, A., Ogilvie, J., Neto, A., Speranza, J., Stein, S., Brown, H., Cotterill, N., Elkadry, E., Garfinkle, R., Gupta, A., Harmanli, O., Hutchinson-Colas, J., Kobashi, K., McNevin, S., Murphy, M., Naranjo Ortiz, C., Warren, G., Bleier, J., Paquette, I., Richter, L., Singla, A., Oliver, J., Wakamatsu, M., Jaffi, F., Bennett, N. E., Hinkle, N. M., Jenkins, L., Mantilla, N., Savitt, L. R., Towe, M., Wexner, S. D., Ky, A., Bonnette, H., Hall, C., Keller, D., Lewicky-Gaupp, C., Rogers, R., Schizas, A., Umanskiy, K., Varma, M., Pelvic Floor Disorders Consortium LIPPINCOTT WILLIAMS & WILKINS. 2020: 1–15

    View details for DOI 10.1097/SPV.0000000000000817

    View details for Web of Science ID 000506388300002

    View details for PubMedID 31833996

  • Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery. International urogynecology journal Wallace, S. L., Syan, R. n., Enemchukwu, E. A., Mishra, K. n., Sokol, E. R., Gurland, B. n. 2020


    Our primary objective was to determine rectal prolapse (RP) and pelvic organ prolapse (POP) reoperation rates and postoperative < 30-day complications after combined RP and POP surgery at a single institution.This was an IRB-approved retrospective cohort study of all female patients who received combined RP and POP surgery at a single tertiary care center from 2008 to 2019. Recurrence was defined as the need for subsequent repeat RP or POP surgery at any point after the index surgery. Surgical complications were separated into Clavien-Dindo classes.Sixty-three patients were identified, and 18.3% (12/63) had < 30-day complications (55% Clavien-Dindo grade 1; 27% Clavien-Dindo grade 2; 18% Clavien-Dindo grade 4). Of patients undergoing combined abdominal RP and POP repair, no postoperative < 30-day complications were noted in the MIS group compared to 37.5% of those patients in the laparotomy group (p < 0.01). Overall, in those patients who underwent combined RP and POP surgery, the need for subsequent RP surgery for recurrent RP was 14% and the need for subsequent POP surgery for recurrent POP was 4.8% (p = 0.25).In this cohort of women undergoing combined RP and POP surgery, a higher proportion required subsequent RP surgery compared to those requiring subsequent POP surgery, although this was not statistically significant. Almost one-fifth of patients undergoing combined RP and POP surgery experienced a < 30-day surgical complication, regardless of whether the approach was perineal or abdominal. For those patients undergoing abdominal repair, < 30-day complications were more likely in those patients who had a laparotomy compared to those who had a minimally invasive surgery.

    View details for DOI 10.1007/s00192-020-04394-2

    View details for PubMedID 32577789

  • Effect of a Multimodal Prehabilitation Program Prior to Colorectal Surgery on Postoperative Pain and Pain Medication Use Lee, A., Shelton, E., Bidwell, S., Shelton, A., Gurland, B., Morris, A. M., Kin, C. J. ELSEVIER SCIENCE INC. 2019: S58–S59
  • Surgical Decision-Making for Rectal Prolapse: One Size Does Not Fit All. Postgraduate medicine Lee, A., Kin, C., Syan, R., Morris, A., Gurland, B. 2019


    Background: Surgery remains the only known treatment option for rectal prolapse. Although over 100 abdominal and perineal procedures are available, there is no consensus as to which intervention is best suited for an individual. This retrospective cohort study describes the patient- and disease-related factors involved in making surgical recommendations around rectal prolapse in a single surgeon experience. Methods: 91 consecutive patients ≥18 years old diagnosed with external and/or high grade internal rectal prolapse were assessed and were prospectively entered into an IRB approved registry. Information on patient symptoms, comorbidities, exam findings, surgeon judgement and patient preference was collected. Treatment recommendations (abdominal, perineal, or no operation) were analyzed and compared. Results: Surgical intervention was recommended to 93% of patients. Of those, 66% were recommended robotic abdominal procedures: 75%, robotic ventral mesh rectopexies; 16%, resection rectopexies; and 9%, suture rectopexies. On univariate analysis, patients with older age, higher ASA scores, presence of cardiopulmonary morbidity, pain as a primary rectal prolapse symptom, rectal prolapse always descended, and surgeon concern for frailty and general anesthesia were associated with recommendations for perineal operations (p<0.05 for all). However, on multivariate analysis, only age and concern over prolonged anesthesia remained correlated with recommendation for perineal surgery. Of patients >80 years of age, 15% were recommended an abdominal approach. Conclusions: With multiple options available for treatment of rectal prolapse, treatment recommendations remain surgeon-dependent and may be influenced by many factors. In our practice, robotic ventral mesh rectopexy was the most commonly recommended operation and was offered to carefully selected patients of advanced age. Although robotic surgery and ventral mesh rectopexy may not be accessible to all patients and surgeons, this represents a single surgeon's practice bias. This study reinforces the importance of perineal procedures for higher-risk individuals.

    View details for DOI 10.1080/00325481.2019.1669330

    View details for PubMedID 31525304

  • Clinical phenotypic presentation of rectal prolapse varies with age Neshatian, L., Lee, A., Wallace, S., Enemchukwu, E., Rogo-Gupta, L., Mishra, K., Garcia, P., Nguyen, L. B., Gurland, B. WILEY. 2019
  • Expert Commentary on Surgical Evaluation and Management of Constipation DISEASES OF THE COLON & RECTUM Gurland, B. 2019; 62 (6): 665–66
  • Expert Commentary on Surgical Evaluation and Management of Constipation. Diseases of the colon and rectum Gurland, B. 2019; 62 (6): 665–66

    View details for PubMedID 31094959

  • Mindfulness-Based Training Improves Technical Skills and Emotional Regulation for Surgical Residents. JAMA network open Gurland, B. 2019; 2 (5): e194087

    View details for DOI 10.1001/jamanetworkopen.2019.4087

    View details for PubMedID 31125093

  • Editorial: Botox for levator ani. Techniques in coloproctology Gurland, B. H., Neshatian, L. 2019

    View details for PubMedID 30993476

  • Editorial: Botox for levator ani TECHNIQUES IN COLOPROCTOLOGY Gurland, B. H., Neshatian, L. 2019; 23 (3): 199–200
  • First Reported Case of Intussusception Caused by Escherichia coli O157:H7 in an Adult: Literature Review and Case Report SURGICAL INFECTIONS Cha, P. I., Gurland, B., Forrester, J. D. 2019; 20 (1): 95–99
  • First Reported Case of Intussusception Caused by Escherichia coli O157:H7 in an Adult: Literature Review and Case Report. Surgical infections Cha, P. I., Gurland, B. n., Forrester, J. D. 2018


    Intussusception is the process by which one segment of intestine "telescopes" into another segment. Escherichia coli O157:H7 is a rare cause of intussusception that uncommonly requires a surgical procedure.Case report and literature review.We reviewed 25 cases of infection with E. coli O157:H7 that resulted in intussusception, all of which involved minors. Our case identifies the first reported adult with intussusception secondary to E. coli infection necessitating surgical intervention. In total, two (8%) required operation. Hemolytic uremic syndrome did not develop in any patient, and there were no deaths.E. coli O157:H7-associated intussusception is rare and does not commonly require operation. If conservative management fails, a surgical procedure may be necessary to resect the pathologic lead point.

    View details for PubMedID 30359547

  • Long-Term Outcomes After Ventral Rectopexy With Sacrocolpo- or Hysteropexy for the Treatment of Concurrent Rectal and Pelvic Organ Prolapse. Female pelvic medicine & reconstructive surgery Jallad, K., Ridgeway, B., Paraiso, M. F., Gurland, B., Unger, C. A. 2017; 24 (5): 336-340


    The primary objective is to describe the long-term anatomic and subjective outcomes in women undergoing ventral rectopexy with sacrocolpo- or hysteropexy. The secondary objective is to describe the perioperative adverse events.This is a retrospective cohort of women who underwent ventral rectopexy with either concurrent sacrocolpo- or hysteropexy at a tertiary care center between 2009 and 2015. A composite outcome for recurrent pelvic organ prolapse and rectal prolapse was defined as subjective failure (vaginal or rectal prolapse symptoms), objective failure (prolapse to or beyond the hymen or full thickness rectal prolapse), or any retreatment for prolapse. Patient's Global Impression of Change was recorded at baseline and at all follow-up visits. Perioperative adverse events were defined a priori and collected up to 6 weeks after surgery.A total of 59 patients underwent a ventral rectopexy, either a sacrocolpopexy (48/59, 81.3%) or sacrohysteropexy (11/59, 18.6%). The median follow-up after surgery for all patients was 17 months (range, 1-76) with a composite success rate for both pelvic organ prolapse and rectal prolapse (estimated by Kaplan-Meier method) of 57.4%. Forty (91%) of 44 patients reported a Patient's Global Impression of Change score of 6 or 7, indicating significant improvement after surgery. Of the patients, 15 (25.4%) experienced a perioperative adverse event. Use of biologic graft was associated with a higher rate of adverse event (40.0% [95% confidence interval, 24.6-57.5] vs 10.3% [95% confidence interval, 3.6-26.3]; P < 0.01).Ventral rectopexy with sacrocolpo- or hysteropexy is associated with significant improvement in anatomic and subjective outcomes. One in 4 women experienced a perioperative adverse event.

    View details for DOI 10.1097/SPV.0000000000000444

    View details for PubMedID 28657998

  • Sacral neuromodulation for the treatment of faecal incontinence following proctectomy. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Mizrahi, I., Chadi, S. A., Haim, N., Sands, D. R., Gurland, B., Zutshi, M., Wexner, S. D., da Silva, G. 2017; 19 (5): O145-O152


    This study assessed the effectiveness of sacral neuromodulation (SNM) for faecal incontinence (FI) following proctectomy with colorectal or coloanal anastomosis.An Institutional Review Board (IRB)-approved database identified patients treated for FI following proctectomy (SNM-P) for benign or malignant disease, who were matched 1:1 according to preoperative Cleveland Clinic Florida Faecal Incontinence Scores (CCF-FIS) with patients without proctectomy (SNM-NP). Primary outcome was change in CCF-FIS.Twelve patients (seven women) were in the SNM-P group and 12 (all women) were in the SNM-NP group. In the SNM-P group, six patients underwent proctectomy for low rectal cancer and five received neoadjuvant chemoradiation. Five patients had handsewn anastomosis, and one had stapled coloanal anastomosis. One lead explantation occurred after a failed 2-week SNM percutaneous trial. Six patients underwent proctectomy for benign conditions. Within-group analyses revealed significant improvement in CCF-FIS in the SNM-P group (reduction from a score of 18 to a score of 14; P = 0.02), which was more profound for benign disease (reduction from 14.5 to 8.5) than for rectal cancer (reduction from 19.5 to 15). SNM was explanted in 66% and 33% of patients after proctectomy for malignant and benign conditions, respectively. In the SNM-NP group, 41% underwent overlapping sphincteroplasty. One patient received chemoradiation for anal cancer. Within-group analysis for the SNM-NP group showed significant improvement in CCF-FIS (a reduction from 17.5 to 4.0; P = 0.003). There was significant improvement in CCF-FIS in patients without previous proctectomy (mean delta CCF-FIS: 11.1 vs 4.7; P = 0.011). Analysis of covariance (ANCOVA) reaffirmed that controls outperformed proctectomy patients (P = 0.006).SNM for FI after proctectomy appears less effective than SNM in patients without proctectomy, with high device explantation rates, particularly after neoadjuvant chemoradiation and proctectomy for low rectal cancer.

    View details for DOI 10.1111/codi.13570

    View details for PubMedID 27885800

  • Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Rodrigues, F. G., Chadi, S. A., Cracco, A. J., Sands, D. R., Zutshi, M., Gurland, B., Da Silva, G., Wexner, S. D. 2017; 19 (5): 456-461


    Sphincteroplasty (SP) is used to treat faecal incontinence (FI) in patients with a sphincter defect. Although sacral nerve stimulation (SNS) is used in patients, its outcome in patients with a sphincter defect has not been definitively evaluated. We compared the results of SP and SNS for FI associated with a sphincter defect.Patients treated by SNS or SP for FI with an associated sphincter defect were retrospectively identified from an Institutional Review Board approved prospective database. Patients with ultrasound evidence of a sphincter defect were matched by age, gender and body mass index. The main outcome measure was change in the Cleveland Clinic Florida Faecal Incontinence Score (CCF-FIS).Twenty-six female patients with a sphincter defect were included in the study. The 13 patients in each group were similar for age, body mass index, initial CCF-FIS and the duration of follow-up. No differences were observed in parity (P = 1.00), the rate of concomitant urinary incontinence (P = 0.62) or early postoperative complications. Within-group analysis showed a significant reduction of the CCF-FIS among patients having SNS (15.9-8.4; P = 0.003) but not SP (16.9-12.9; P = 0.078). There was a trend towards a more significant improvement in CCF-FIS in the SNS than in the SP group (post-treatment CCF-FIS 8.4 vs 12.9, P = 0.06). Net improvement in CCF-FIS was not significantly different between the groups (P = 0.06).Significant improvement in CCF-FIS was observed in patients treated with SNS but not SP patients. A trend towards better results was seen with SNS.

    View details for DOI 10.1111/codi.13510

    View details for PubMedID 27620162

  • Rectovaginal fistula repair with episioproctotomy and sphincteroplasty - a video vignette. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Aytac, E., Gurland, B. 2017; 19 (3): 305

    View details for DOI 10.1111/codi.13619

    View details for PubMedID 28160386

  • Optimizing Treatment for Rectal Prolapse. Clinics in colon and rectal surgery Hrabe, J., Gurland, B. 2016; 29 (3): 271-6


    Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement.

    View details for DOI 10.1055/s-0036-1584505

    View details for PubMedID 27582654

    View details for PubMedCentralID PMC4991961

  • Multidisciplinary Approach to the Treatment of Concomitant Rectal and Vaginal Prolapse. Clinics in colon and rectal surgery Jallad, K., Gurland, B. 2016; 29 (2): 101-5


    Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to treat concomitant rectal and vaginal prolapse. Combining the two procedures adds little operative time and offers complete pelvic floor repair. The choice of minimally invasive abdominal prolapse repair versus perineal repair depends on the patient's comorbidities, previous surgeries, preference to avoid mesh, and physician's expertise. Surgeons should at least be able to identify these patients and provide the appropriate treatment or refer them to specialized centers.

    View details for DOI 10.1055/s-0036-1580721

    View details for PubMedID 27247534

    View details for PubMedCentralID PMC4882172

  • Outcomes of Sacral Neurostimulation Lead Reimplantation for Fecal Incontinence: A Cohort Study. Diseases of the colon and rectum Cracco, A. J., Chadi, S. A., Rodrigues, F. G., Zutshi, M., Gurland, B., Wexner, S. D., DaSilva, G. 2016; 59 (1): 48-53


    Adverse events and complications have been reported after sacral neurostimulation for fecal incontinence, which may result in surgical revision and device explantation. Lead reimplantation may be feasible; however, available data regarding outcomes are less robust.The aim of this study was to determine the outcomes of sacral neurostimulation lead reimplantation for fecal incontinence.This was a retrospective review of prospectively collected data.The study was conducted at 2 clinical sites from a single institution.Patients with fecal incontinence who underwent sacral neurostimulation implantation or reimplantation between 2011 and 2014 were included in the study.Sacral neurostimulation reimplantation was the included intervention.Change in the Cleveland Clinic Florida Fecal Incontinence Score (0 best; 20 worst) in reimplantation as compared with index implantation controls was the main measure. Secondary outcomes included the frequency and type of adverse events and complications.A total of 112 patients underwent either sacral neurostimulation implantation or reimplantation between 2011 and 2014. Ninety-seven patients underwent an index percutaneous nerve stimulation trial, 93 of whom also underwent a stimulator implantation. Fifteen patients underwent lead reimplantation, with 5 performed before stimulator implantation and 10 after stimulator implantation. The index implanted and reimplanted groups had similar demographics, comorbidities, and complication profiles including explantation rates. The most common reason for reimplantation was lead related (6/15), including 4 lead migrations, 1 lead fracture, and 1 lead erosion. Significant decreases in the incontinence score were achieved in each group (index implantation: p < 0.001; reimplantation: p = 0.006). When comparing the efficacy of sacral neurostimulation therapy in decreasing the fecal incontinence score from baseline in each group, patients with an index implantation were found to have a more significant improvement in their incontinence score as compared with the reimplantation group (p = 0.047).This was a retrospective study. A large number of patients with incomplete functional assessment data were excluded from analysis.The improvements in fecal incontinence are significantly better after index implantation than after reimplantation.

    View details for DOI 10.1097/DCR.0000000000000505

    View details for PubMedID 26651112

  • Is Botox for anal pain an effective treatment option? Postgraduate medicine Bibi, S., Zutshi, M., Gurland, B., Hull, T. 2016; 128 (1): 41-5


    The aim of this study was to evaluate the efficacy of Botulinum toxin-A (Botox) in relieving anal pain associated with anal fissure (AF) and Levator ani syndrome (LS).All patients with medically refractory AF or LS from 2005 to 2012 and treated with Botox injections were included.One hundred and three patients [66 patients (53 female) with AF and 37 patients (26 female) with LS] were evaluated. The minimum/maximum dose of Botox was 20/100 units for AF and 50/200 units for LS. Thirteen (19.7%) patients with AF and 14 (38%) patients with LS received > 1 Botox treatment. The time interval between injections varied from 1 to 12 months. Mean follow-up was 6.4 months for AF and 9 months for LS. Relief of anal pain was noted in 59% of AF and 43% of LS patients. Significant changes in pre- and post-op pain scores were noted in both groups. Nine out of 12 patients with failed sphincterotomy were relieved after Botox treatment. Temporary fecal incontinence was reported in 2/66 (3%) AF patients and 4/37 (10%) of LS patients. Overall, 66% patients' recommended Botox treatment and 72% were happy with the treatment as per telephone interview results.Botox relieves pain more effectively in AF than in LS. It is an effective option in medically refractory cases of LS. Higher doses of Botox are safe to use in LS; however, this needs to be evaluated. Botox injections have an overall low complication rate.

    View details for DOI 10.1080/00325481.2015.1081047

    View details for PubMedID 26308909

  • Does Stool Leakage Increase in Aging Pouches? Diseases of the colon and rectum Kim, H., Sun, L., Gurland, B., Hull, T., Zutshi, M., Church, J. 2015; 58 (12): 1158-63


    Restorative proctocolectomy with IPAA is the standard surgical option for patients with ulcerative colitis. Although ileal pouches have been shown to have acceptable functional outcomes, some patients experience fecal incontinence.The purpose of this study was to evaluate the incidence of fecal leakage and the way it may change over time in patients with an ileoanal pouch.This study used a retrospective design.The study was conducted at a tertiary care center.Patients who received an IPAA for ulcerative colitis between 1983 and 2008 were accessed from a prospectively maintained database. We excluded patients with cancer, colonic dysplasia, and missing record of ileostomy closure and without long-term functional data.We defined fecal leakage as leakage of stool more than once per day. Univariate and multivariate analyses were performed to identify associations with and possible risk factors for fecal leakage.A total of 1228 patients were included in this study. There were 656 men, with a mean age of 38.7 years. The median follow-up time was 158 months. The fecal leakage rates at 5, 10, and >15 years were 24.6%, 25.7%, and 27.4% (p = 0.66). Patients with fecal leakage were significantly older at the time of surgery (p < 0.001), had longer disease duration before surgery (p = 0.04), underwent more 2-stage surgery (p = 0.04), included more women (p < 0.01), and showed lower preoperative maximum anal squeeze pressure (p = 0.008). On multivariate analysis, the only significant factor predisposing to fecal leakage was older age at the time of pouch surgery (OR = 1.07 (95% CI, 1.02-1.12); p = 0.005).The study was limited by its retrospective and non-randomized nature.The occurrence of fecal leakage in patients with IPAA does not change with time. However, increased age at the time of surgery may increase the chances of patients with IPAA having fecal leakage.

    View details for DOI 10.1097/DCR.0000000000000493

    View details for PubMedID 26544813

  • Rectal Prolapse in Octogenarians: Does Surgery Impact Daily Activity? The American surgeon Bibi, S., Zutshi, M., Gurland, B., Hull, T. 2015; 81 (11): E371-2

    View details for PubMedID 26672569

  • Case-matched Comparison of Robotic Versus Laparoscopic Colorectal Surgery: Initial Institutional Experience. Surgical laparoscopy, endoscopy & percutaneous techniques Gorgun, E., Aytac, E., Gurland, B., Costedio, M. M. 2015; 25 (5): e148-51


    Robotic colorectal surgery is an emerging technique. In this study, we aimed to compare outcomes of robotic colorectal operations to laparoscopy. Patients undergoing robotic colorectal surgery between November 2010 and July 2013 were case matched to laparoscopic counterparts based on diagnosis and operation type. Perioperative and short-term postoperative outcomes were compared. There were 57 patients who underwent robotic colorectal surgery. American Society of Anaesthesiologists score was higher in patients who underwent robotic surgery (2 vs. 3, P=0.01). Blood loss (200 vs. 300 mL, P=0.27) and conversion rate to open surgery (6 vs. 5, P=0.75) were similar between the groups. Operating time was longer in robotic surgery (172 vs. 267 min, P<0.0001). Time to first bowel movement (3 vs. 3 d, P=0.38), hospital stay (5 vs. 6 d, P=0.22), and postoperative complications were comparable between the groups. In the early learning curve period, robotic colorectal surgery shows similar short-term outcomes with longer operating time compared with conventional laparoscopy.

    View details for DOI 10.1097/SLE.0000000000000197

    View details for PubMedID 26429057

  • Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Techniques in coloproctology Elagili, F., Gurland, B., Liu, X., Church, J., Ozuner, G. 2015; 19 (9): 521-5


    Data comparing surgical outcomes and quality of life (QOL) following perineal repair of rectal prolapse are limited. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse.All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared.Seventy-five patients (93% female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. Sixty-six percentage of patients were ASA grade III or IV (Table 1). The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14% (n = 11) [Altemeier 2 (9%) vs. Delorme 9 (16%) p = 0.071]. Postoperative complication rate was 12% (n = 9) [Altemeier 5 (22%) vs. Delorme 4 (7%), p = 0.04]. There was no mortality. The Cleveland Global Quality of Life scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively (p = 0.59), and were not changed by the surgery.In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum.

    View details for DOI 10.1007/s10151-015-1337-y

    View details for PubMedID 26341686

  • Actual versus estimated length of stay after colorectal surgery: which factors influence a deviation? American journal of surgery Ahmed Ali, U., Dunne, T., Gurland, B., Vogel, J. D., Kiran, R. P. 2014; 208 (4): 663-9


    The aim of this study was to determine factors associated with deviation in length of hospital stay (LOS) from that determined by diagnosis-related groups.A cohort study from a prospectively collected database was conducted, including consecutive patients undergoing surgery in a high-volume colorectal surgery department in 2009.For 1,461 included patients, average expected and actual LOS were 8.17 days (interquartile range, 4.7 to 11.9 days) and 8.31 days (interquartile range, 4 to 10 days), respectively. The most prominent factors associated with an increase of LOS from expected were parenteral nutrition (5.11 days), emergency room admittance (3.67 days), and ileus (3.45 days) (P ≤ .001 for all). Other independently associated factors included blood transfusion, anastomotic leak, sepsis, pulmonary embolism, and surgeon. Patients with higher severity illness indexes and longer postoperative intensive care stay had lower than expected LOS.After colorectal surgery, several modifiable factors are associated with deviation of LOS from expected. An opportunity hence exists to reduce both LOS and financial burden for hospitals in an era of pay for performance.

    View details for DOI 10.1016/j.amjsurg.2013.06.004

    View details for PubMedID 25241954

  • An electronic safety screening process during inpatient computerized physician order entry improves the efficiency of magnetic resonance imaging exams. Academic radiology Schneider, E., Ruggieri, P., Fromwiller, L., Underwood, R., Gurland, B., Yurkschatt, C., Kubiak, K., Obuchowski, N. A. 2013; 20 (12): 1592-7


    Delays between order and magnetic resonance (MR) exam often result when using the conventional paper-based MR safety screening process. The impact of an electronic MR safety screening process imbedded in a computerized physician order entry (CPOE) system was evaluated.Retrospective chart review of 4 months of inpatient MR exam orders and reports was performed before and after implementation of electronic MR safety documentation. Time from order to MR exam completion, time from MR exam completion to final radiology report, and time from first order to final report were analyzed by exam anatomy. Length of stay (LOS) and date of service within the admission were also analyzed.We evaluated 1947 individual MR orders in 1549 patients under an institutional review board exemption and a waiver of informed consent. Implementation of the electronic safety screening process resulted in a significant decrease of 1.1 hours (95% confidence interval 1.0-1.3 hours) in the mean time between first order to final report and a nonsignificant decrease of 0.8 hour in the median time from first order to exam end. There was a 1-day reduction (P = .697) in the time from admission to the MR exam compared to the paper process. No significant change in LOS was found except in neurological intensive care patients imaged within the first 24 hours of their admission, where a mean 0.9-day decrease was found.Benefits of an electronic process for MR safety screening include enabling inpatients to have decreased time to MR exams, thus enabling earlier diagnosis and treatment and reduced LOS.

    View details for DOI 10.1016/j.acra.2013.09.006

    View details for PubMedID 24200487

  • Surgical complications impact patient perception of hospital care. Journal of the American College of Surgeons Gurland, B. H., Merlino, J., Sobol, T., Ferreira, P., Hull, T., Zutshi, M., Kiran, R. P. 2013; 217 (5): 843-9


    Public reporting of the Hospital Consumer Assessment of Healthcare Providers and Systems survey is designed to produce data on patients' perceptions of the quality of hospital care. The aim of this study was to assess the impact of complications on patient responses to Hospital Consumer Assessment of Healthcare Providers and Systems "top-box" (most favorable) scores.All patients who underwent a colorectal procedure from October 2009 to June 2012 at a single center were included. Patient complications were categorized as major, minor, or no complications and "surgical technique" or "medical." Chi-square and Wilcoxon rank sum tests were used to compare binary and ordinal top-box scores, respectively.One thousand four hundred and nine surveys were collected for 1,233 patients (mean age 53 ± 15.7 years; 701 [52.2%] females) who underwent 955 (67.8%) major abdominal, 114 (8.1%) anorectal, and 340 (24.1%) stoma-related operations. There were 195 (13.8%) major and 396 (28.1%) minor complications. There were 159 (11.3%) technique complications and 411 (29.2%) medical complications. Patients without any complications were more likely to recommend the hospital than those with complications (p = 0.023) irrespective of type of complication (minor vs major; p = 0.72 or technique vs medical; p = 0.5). Responsiveness of hospital staff was also reported as higher for patients without complications (p = 0.0003) and the type of complication did not influence this assessment (minor vs major; p = 0.71 and technique vs medical; p = 0.95).The occurrence of any complication after colorectal surgery adversely impacts patients' self-reported perceptions of hospital care as measured by Hospital Consumer Assessment of Healthcare Providers and Systems. An instrument that more accurately reflects patients' assessment of quality in the context of variations in patient, disease, and surgical factors is required.

    View details for DOI 10.1016/j.jamcollsurg.2013.06.015

    View details for PubMedID 24035448

  • Colectomy for slow transit constipation: effective for patients with coexistent obstructed defecation. International journal of colorectal disease Reshef, A., Alves-Ferreira, P., Zutshi, M., Hull, T., Gurland, B. 2013; 28 (6): 841-7


    Patient selection is a crucial step when considering total abdominal colectomy and ileorectal anastomosis (TAC/IRA) for refractory constipation.This study aimed to evaluate the results of short- and long-term outcomes for patients with pure slow transit constipation (STC) compared to those with slow transit and features of obstructive defecation (STC + OD).This study included all patients who underwent TAC/IRA for constipation from 1999-2010. Patients were divided into two groups: group A (STC) and group B (STC + OD) based on abnormal physiology or motility testing in addition to the surgeon's clinical impression of symptomatic obstructive defecation. Demographics, operative variables, and short-term outcomes were collected by retrospective chart review and were compared between groups. Long-term functional outcomes were assessed by telephone survey. This included: number of bowel movements, use of laxatives, antidiarrheal medications, and surgery satisfaction. Validated questionnaires were collected postoperatively.One hundred forty-four patients (143 females; mean age, 40 (18-68) years old) underwent TAC/IRA by either laparoscopic (63 (44 %)) or open (81 (56 %)) techniques. One hundred three patients had pure STC and 41 had STC + OD. Four patients underwent TAC with end ileostomy at first procedure. Seven patients underwent surgery after a trial of diverting ileostomy. One patient died unexpectedly, 2 days after uneventful surgery. Median follow-up was 43 (IQR, 16-75) months. Five (5 %) patients in group A and two (5 %) in group B underwent subsequent ileostomy for poor functional outcomes. Eighty-eight (68 %) patients were available by telephone. Short- and long-term outcomes were equivalent in both groups as well as patient satisfaction (89 vs. 85 %, p = 0.7).Total abdominal colectomy can be offered to selective patients with slow transit constipation and obstructive defecation with equivalent long-term results.

    View details for DOI 10.1007/s00384-012-1498-3

    View details for PubMedID 23525467

  • Colectomy with ileorectal anastomosis has a worse 30-day outcome when performed for colonic inertia than for a neoplastic indication. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Reshef, A., Gurland, B., Zutshi, M., Kiran, R. P., Hull, T. 2013; 15 (4): 481-6


    Whether bowel related dysfunction adversely affects postoperative recovery after total colectomy with ileorectal anastomosis (C + IRA) for colonic inertia (CI) has not been previously well evaluated. This study compared the early postoperative outcome of C + IRA for CI and for other noninflammatory indications.Patients undergoing elective C + IRA from 1999 to 2010 were identified from a prospectively maintained database. Since inflammation in the rectum or small bowel may influence the outcome, patients with inflammatory bowel disease were excluded. Patients undergoing surgery for CI (group A) were compared with patients having the operation for other benign noninflammatory diseases (group B). Demographics, American Society of Anesthesiologists (ASA) score, body mass index (BMI), surgical procedure and 30-day complications were assessed.The study population consisted of 333 patients undergoing elective C + IRA (99 men, mean age 39 ± 16 years). The procedure was laparoscopic in 163 (49%) patients. Groups A (n = 131) and B (n = 202) had similar age and ASA score (39 ± 11 vs 39 ± 19 years, P = 0.4; 2.2 ± 0.5 vs 2.4 ± 0.7). Group A patients had lower BMI (25 ± 5 vs 28 ± 8 kg/m(2) , P = 0.002), more women (99 vs 51%, P < 0.001) and fewer laparoscopic procedures (43 vs 53%, P = 0.04). Compared with group B, group A had a greater incidence of postoperative ileus (32 vs 19%, P = 0.009), higher overall morbidity (36 vs 15%, P < 0.001) and increased length of stay (8.4 ± 6 vs 7.2 ± 5 days, P < 0.006). These differences persisted when subgroups of patients who underwent laparoscopic or open surgery were compared.Although CI is considered a 'benign' condition, patients undergoing C + IRA for this indication have significant morbidity compared with patients having the operation for other noninflammatory benign conditions.

    View details for DOI 10.1111/codi.12058

    View details for PubMedID 23061597

  • Perineal descent does not imply a more severe clinical disorder. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Alves-Ferreira, P. C., Gurland, B., Zutshi, M., Hull, T. 2012; 14 (11): 1372-9


    There is poor consensus in the literature about measuring perineal descent. We aimed to assess symptoms and quality of life in constipated patients with abnormal perineal descent.Constipated patients were categorized into those with obstructed defaecation, colonic inertia, mixed disorders and irritable bowel syndrome constipation types. Anal physiology was performed. KESS score, Irritable Bowel Syndrome Quality of Life and SF-12 questionnaires were completed. The position of the perineum was measured by defaecography. Patients were divided into two groups according to the position of the perineal descent at rest: group 1 (normal < 3.5 cm) and group 2 (abnormal > 3.5 cm).Fifty-eight patients were identified, 23 (40%) in group 1 and 35 (60%) in group 2. Patients in group 2 were older (P = 0.007), had a higher body mass index (BMI; P = 0.003), a higher rate of hysterectomy (P = 0.04) and more vaginal deliveries (P = 0.001). Obstructed defaecation was the predominant subtype of constipation. Group 1 had more difficulty in initiating defaecation and group 2 presented more cases with intussusception and enterocele (P = 0.03 for both). Group 2 had a lesser degree of perineal descent between rest and straining. Rectal compliance was greater in group 2 (P = 0.03). Symptoms and quality of life scores were similar between the groups.Radiologically determined excessive perineal descent is not indicative of worse symptoms or quality of life. This radiological finding does not warrant further investigation.

    View details for DOI 10.1111/j.1463-1318.2012.03018.x

    View details for PubMedID 22390340

  • Functional outcomes and quality of life after anorectal surgery. The American surgeon Grucela, A., Gurland, B., Kiran, R. P. 2012; 78 (9): 952-6


    There is a paucity of information examining quality of life (QOL) and functional results after anorectal surgery. We aim to prospectively evaluate postoperative QOL, pain, functional outcomes, and satisfaction for a large cohort of patients undergoing anorectal surgery. Data were prospectively accrued for consecutive patients undergoing anorectal operations from June 2009 to September 2010. Preoperative and postoperative electronic questionnaires were completed. QOL was evaluated by the European QOL index (EQ-5D) and functional results with the Fecal Incontinence Severity Index (FISI). Satisfaction was assessed: 1) Are you satisfied with surgery? 2) Would you recommend surgery to others? Responses were reported: 1 to 5 (1 = not at all; 5 = a lot). Pain was scored: 1 (no pain) to 10 (worst). One hundred ninety-five patients, 111 (56.9%) females, median age 44 years (range, 18 to 93 years), underwent anorectal surgery for abscess, condyloma, fissure, fistula, hemorrhoids, incontinence, pilonidal disease, pouch problems, tumors, and prolapse. Overall, pain improved significantly with improved QOL (P = 0.03). This correlated with overall postoperative satisfaction (92.4%). A total of 87.7 per cent of patients would recommend their surgery to others. The FISI was similar pre- and postoperatively (P = 0.18) and did not worsen postoperatively irrespective of surgical indication and procedure. Most patients were satisfied after anorectal surgery, which correlated with improved pain and QOL. Functional outcomes did not worsen. This will help counsel patients preoperatively and allay anxiety about postoperative function.

    View details for PubMedID 22964203

  • Biological implants in sphincter augmentation offer a good short-term outcome after a sphincter repair. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Zutshi, M., Ferreira, P., Hull, T., Gurland, B. 2012; 14 (7): 866-71


    Long-term results of the overlapping sphincter repair (OSR) have been disappointing, attributed to poor tissue quality that deteriorates with time. Biological grafts enforce tissues. The aim was to compare functional outcome and quality of life at 1 year with and without Permacol reinforcement to evaluate short-term benefit.From November 2007 to November 2008, women undergoing OSR using Permacol (group 1, n = 10) under institutional review board approval (safety trial) were age matched with patients from an institutional review board approved database (group 2, n = 10) who underwent the traditional OSR. Permacol mesh was placed under the two overlapped muscles. Group 2 underwent traditional repair. Preoperative and postoperative management of the groups was similar. The Fecal Incontinence Severity Index (FISI), the Cleveland Clinic Incontinence Score (CCFIS) and the Fecal Incontinence Quality of Life (FIQL) scale were used preoperatively and 1 year post-surgery.No significant differences in demographics, symptom duration, number of vaginal deliveries, comorbidities and symptom severity were noted. Group 2 underwent concomitant procedures. Group 1 reported no complications. Group 2 reported urinary retention and dehiscence. A significant difference was found in preoperative and postoperative FIQL subscales of coping/behaviour between groups. However, comparing the pre and post scores, significant improvements on FISI (P = 0.02), the CCFIS (P = 0.005) and two subscales of FIQL (coping/behaviour, P = 0.02, and embarrassment, P = 0.01) were found in group 1. Patient satisfaction was higher in group 1.Biologic tissue enhancers (Permacol) do not add morbidity. Sphincter augmentation results in significant improvement in continence and quality of life scores compared with the preoperative scores in the short term over traditional repair. Long-term studies are needed to determine if this effect is sustained.

    View details for DOI 10.1111/j.1463-1318.2011.02808.x

    View details for PubMedID 21895926

  • Anal encirclement with sphincter repair (AESR procedure) using a biological graft for anal sphincter damage involving the entire circumference. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Zutshi, M., Hull, T., Gurland, B. 2012; 14 (5): 592-5


    The effect of a biological material to support an overlapping sphincter repair was investigated in patients with damage to the entire circumference of the external sphincter due to radiation or trauma.A tunnel is created under the damaged external anal sphincter muscle to encircle the anal canal. A biological graft (Surgisis™; 6 ply, 2×20 cm) is then inserted through the tunnel and sutured to the muscle after being pulled firmly to close the patulous anus. An overlapping repair is then carried out. Between January 2009 and June 2010, 13 patients underwent this procedure.The average age at surgery was 68.6 years. The mean follow up was 16.3 (range 6-24) months. The average length of stay was 1 day. No complications were reported. Postoperatively, incontinence severity scores and quality of life scales [39.22 (±16.1) to 9.66 (±11.9)] showed improvement. Incontinence episodes were markedly decreased to one per week.Anal encirclement using a biological graft with sphincter augmentation may achieve continence in patients with circumferential anal sphincter damage.

    View details for DOI 10.1111/j.1463-1318.2011.02675.x

    View details for PubMedID 21689344

  • Overlapping sphincter repair: does age matter? Diseases of the colon and rectum El-Gazzaz, G., Zutshi, M., Hannaway, C., Gurland, B., Hull, T. 2012; 55 (3): 256-61


    The predictors of the outcomes following anal sphincteroplasty have not been well documented.The aim was to evaluate age as a predictor of functional outcome and quality of life after overlapping sphincter repair.This study is a retrospective review of chart review followed by a prospective evaluation by the use of validated questionnaires.Patients were assigned to group A (≤ 60 years old) or group B (>60 years).Included were patients with obstetric sphincter injuries who underwent overlapping sphincteroplasty between 1996 and 2007.The Fecal Incontinence Quality of Life Scale, Fecal Incontinence Severity Index, the Cleveland Global Quality of Life scale, and a patient satisfaction questionnaire were used to assess outcome.Three hundred twenty-one women underwent sphincteroplasty and 197 responded to this study, 146 (74.1%) patients in group A and 51 (25.9%) patients in group B. Median follow-up was 7.7 years (range, 4.7-10.0). The mean overall Fecal Incontinence Quality of Life Scale was 11.0 ± 3.5. Median Fecal Incontinence Severity Index score was 29.8 ± 15.9. Mean Cleveland Global Quality of Life scale was 0.7 ± 0.2. The 2 groups were comparable for BMI (p = 1.0), ethnic background (p = 0.8), smoking (p = 0.8), and follow-up duration (p = 0.9). Intergroup comparison showed no significant difference in the Fecal Incontinence Quality of Life Scale scores (p = 0.5) in all subscales: lifestyle (p = 0.8), coping behavior (p = 0.5), depression and self-perception (p = 0.2), and embarrassment (p = 0.1). No significant differences were noted in Fecal Incontinence Severity Index (p = 0.2), Cleveland Global Quality of Life scale (p =1.0), or postoperative satisfaction (p = 0.6).The study was limited by its retrospective nature.Comparable long-term Fecal Incontinence Severity Index score and Fecal Incontinence Quality of Life Scale scores following overlapping sphincter repair suggest that age is not a predictor of outcome for overlapping sphincter repair. This procedure can be offered to both young and older patients.

    View details for DOI 10.1097/DCR.0b013e31823deb85

    View details for PubMedID 22469791

  • Ventral rectopexy for rectal prolapse and obstructed defecation. Clinics in colon and rectal surgery Cullen, J., Rosselli, J. M., Gurland, B. H. 2012; 25 (1): 34-6


    Ventral rectopexy has gained popularity in Europe to treat full-thickness rectal external and internal prolapse. This procedure has been shown to achieve acceptable anatomic results with low recurrence rates, few complications, and improvements of both constipation and fecal incontinence. The authors review the principles, techniques, and outcomes of ventral rectopexy.

    View details for DOI 10.1055/s-0032-1301757

    View details for PubMedID 23449032

    View details for PubMedCentralID PMC3348728

  • Total abdominal colectomy has a similar short-term outcome profile regardless of indication: data from the National Surgical Quality Improvement Program. The American surgeon Alves-Ferreira, P. C., de Campos-Lobato, L. F., Zutshi, M., Hull, T., Gurland, B. 2011; 77 (12): 1613-8


    The purpose of this study was to evaluate the 30-day postoperative complications rate in patients undergoing elective total abdominal colectomy (TAC) for chronic constipation, neoplastic disorders, and inflammatory bowel disease (IBD) using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP). The 2007 ACS-NSQIP sample was used to identify the Current Procedural Terminology codes for TAC and International Classification of Diseases, 9th Revision codes for chronic constipation, neoplasia, and IBD. Preoperative and intraoperative variables and postoperative complications were compared among the three diagnosis groups. Wilcoxon rank sum and Fisher exact tests were used for analysis. P < 0.05 was considered significant. Seven hundred forty-four patients were identified; chronic constipation was found in 107 (14.4%) patients, neoplasia in 312 (42.3%), and IBD in 322 (43.3%). Patients with constipation were predominantly females (85.2%). The neoplastic group was older and had greater body mass index when compared with the other groups. Patients with IBD presented greater use of steroids, lower albumin and hematocrit levels, and higher morbidity probability. Constipated patients had more neurologic and renal complications when compared with the IBD group (P = 0.01). None of the other categories of complications were statistically different among the diagnosis groups. With the exception of urinary tract infection being higher in the constipation patients compared with IBD (10 vs 4%, P = 0.03), there were no statistically significant differences among the other short-term specific complications. The 30-day complication rate after TAC is similar for chronic constipation, neoplasia, and IBD.

    View details for PubMedID 22273218

  • Robotic sacrocolpoperineopexy with ventral rectopexy for the combined treatment of rectal and pelvic organ prolapse: initial report and technique. Journal of robotic surgery Reddy, J., Ridgeway, B., Gurland, B., Paraiso, M. F. 2011; 5 (3): 167-73


    The objective of our study is to describe the peri-operative and early postoperative surgical outcomes following robotic sacrocolpoperineopexy with ventral rectopexy for the combined treatment of rectal and pelvic organ prolapse. This was a retrospective cohort study of ten women with symptomatic Stage 2 or greater pelvic organ prolapse and concomitant rectal prolapse who desired combined robotic surgery, at a single institution. The mean age of the subjects was 55.3 ± 19.2 years (range 19-86)  and the mean body mass index was 25.8 ± 5.7 kg/m(2). Preoperatively, the women had Stage 2 or greater pelvic organ prolapse and the average length of rectal prolapse was 2.1 ± 1.9 cm. There were no conversions to conventional laparoscopy or laparotomy. The mean operating room time was 307 ± 45 min with an estimated blood loss of 144 ± 68 ml. The average length of stay was 2.4 ± 0.8 days. Preliminary data suggest that robotic sacrocolpoperineopexy with ventral rectopexy is a feasible procedure with minimal operative morbidity for the combined treatment of rectal and pelvic organ prolapse. Longer follow-up is needed to ensure favorable long-term subjective and objective outcomes.

    View details for DOI 10.1007/s11701-011-0257-8

    View details for PubMedID 27637703

  • Doppler-guided hemorrhoidal artery ligation: the experience of a single institution. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Szmulowicz, U. M., Gurland, B., Garofalo, T., Zutshi, M. 2011; 15 (5): 803-8


    This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy.Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors.The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21-81 years). The mean follow up was 15 months (3-35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids.DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences.

    View details for DOI 10.1007/s11605-011-1460-7

    View details for PubMedID 21359596

  • Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin. Diseases of the colon and rectum Hull, T. L., El-Gazzaz, G., Gurland, B., Church, J., Zutshi, M. 2011; 54 (1): 54-9


    Closure of rectoanovaginal fistula from a cryptoglandular or obstetrical origin can be difficult. Multiple techniques exist and none are perfect. Although episioproctotomy offers the advantage of a simultaneous repair of the sphincter complex, it is a more extensive procedure. A rectal-advancement flap appears less traumatic and divides no perineal tissue or sphincter. The aim of this study was to evaluate the results of episioproctotomy and rectal-advancement flap on healing, postoperative continence, and sexual function.Data were retrospectively collected regarding 87 women with cryptoglandular or obstetrical rectoanovaginal fistula treated from June 1997 to 2009, who underwent episioproctotomy or rectal-advancement flap at the discretion of the treating surgeon. Healing, use of seton or stoma, number of previous procedures, smoking, age, body mass index, dyspareunia, SF-12 health survey, the IBD Quality of Life, and the Fecal Incontinence Quality of Life, and the Female Sexual Function Index were obtained from our database and via telephone interviews. The Fisher exact probability and χ tests were used.The mean age of these 87 women was 42.8 ± 10.5 years. Mean follow-up was 49.2 ± 39.2 months. Fifty (57.5%) patients underwent episioproctotomy and 37 (42.5%) underwent rectal-advancement flap. Thirty-nine (78%) patients healed after episioproctotomy vs 23 (62.2%) patients after rectal-advancement flap (P = .1). Episioproctotomy was associated with significantly better fecal (P < .001) and sexual (P = .04) function. There was no significant difference in other studied variables between the 2 techniques.Despite episioproctotomy being a more extensive procedure, healing rates were comparable between episioproctotomy and rectal-advancement flaps. In this select population, episioproctotomy may provide better continence and may confer better sexual function compared with rectal-advancement flap. In appropriate patients surgeons should not hesitate to perform episioproctotomy on cryptoglandular or obstetrical-associated rectoanovaginal fistula.

    View details for DOI 10.1097/01.dcr.0000388926.29548.36

    View details for PubMedID 21160314

  • Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract El-Gazzaz, G., Hull, T. L., Mignanelli, E., Hammel, J., Gurland, B., Zutshi, M. 2010; 14 (11): 1758-63


    Rectovaginal fistula (RVF) repair can be challenging. Additionally, women may experience sexual dysfunction and psychosocial ramifications even after a successful repair. The aim of this study was to investigate variables looking for predictors of healing/failure and examine long-term quality-of-life (QOL) and sexual function in women with low RVF from obstetrical or cryptoglandular etiologyFrom June 1997-2009, 268 women underwent RVF repair. Of those, 100 with obstetric or cryptoglandular etiology agreed to participate in this study. Healing, type of procedure, use of seton or stoma, number of previous procedures, smoking, age, body mass index (BMI), dyspareunia, QOL using SF-12, FIQL, IBS-QOL, and female sexual function index was obtained from our prospective database and telephone contact. Fisher's exact test, chi-square test, and multivariable-logistic-regression model were used to identify the variables associated with healing/failure.Mean follow-up was 45.8 ± 39.2 months; mean age 42.8 ± 10.5 years; and BMI was 28.8 ± 7.6. Sixty (60%) fistulas were obstetric and 40 (40%) cryptoglandular and 68/100 patients (68%) healed. On multivariate analysis, treatment failure was related to a heavier BMI (p = 0.001) and number of repairs (p = 0.02). Looking at each type of repair, episioproctotomy had significant healing compared to the other choices (but was not significant on multivariate analysis). Forty-seven women were sexually active at follow-up and 12/47 (25.5%) reported dyspareunia. Fecal incontinence was reported preoperatively in 42 women, more often in those with obstetric-related RVF (76% vs. 24% p < 0.05). Healing was not affected by age, smoking, co-morbidities, preoperative seton, or stoma use. Fecal and sexual function and QOL were comparable between women with healed and unhealed RVF.Patients with higher BMI and more repairs had a decreased healing rate following RVF repair. Despite surgical outcome, QOL and sexual function were surprisingly similar regardless of fistula healing.

    View details for DOI 10.1007/s11605-010-1259-y

    View details for PubMedID 20593308

  • Using technology to improve data capture and integration of patient-reported outcomes into clinical care: pilot results in a busy colorectal unit. Diseases of the colon and rectum Gurland, B., Alves-Ferreira, P. C., Sobol, T., Kiran, R. P. 2010; 53 (8): 1168-75


    Patient-reported outcomes are traditionally collected through paper questionnaires. This process is labor intensive and costly. The aim of this study was to assess the feasibility of using tablet computing technology to streamline the questionnaire intake process and integrate patient-reported outcomes into electronic health records for access at the point of care.Response-driven electronic questionnaires for patients with colorectal disorders were designed. The impact of this technology on clinical workflow and questionnaire response rates was assessed. Historical data on paper questionnaire response rates over a similar time period were compared with the electronic data.From June through July 2009, data from 103 patient visits to 2 surgeons over 8 clinic days were included. Females comprised 69.7% of the sample with a median age of 49 (range, 18-84) years. When patients checked in 30 minutes early, 82% completed the forms by their scheduled visit time. The questionnaires response rate was 96%. Scores were calculated automatically and included in the electronic health record. Median questionnaire completion time was 15 (interquartile range, 8-21) minutes. Conversely, collection rates of historical data for the same surgeons over a 2-month period revealed that 152 patient visits yielded 38 paper questionnaires, a response rate of 25%.Collection of patient-reported outcomes by use of tablet technology and automatic transmission into the electronic chart with data storage for later use is feasible. This process can overcome many of the inefficiencies associated with paper questionnaires.

    View details for DOI 10.1007/DCR.0b013e3181d87468

    View details for PubMedID 20628281

  • Transvaginal sacrospinous rectopexy: initial clinical experience. Techniques in coloproctology Gurland, B., Garrett, K. A., Firoozi, F., Goldman, H. B. 2010; 14 (2): 169-73


    There is a wide range of surgical procedures available to treat rectal prolapse that differ in approach as well as in principle. The current perineal approaches available involve mucosal or full thickness resection. There are currently no accepted procedures combining rectal fixation without resection using the perineal approach. We present our initial report of transvaginal sacrospinous rectopexy for the treatment of rectal prolapse.A longitudinal incision was made in the posterior wall of the vagina. The rectum and sacrospinous ligament were identified. Two sutures were placed in the sacrospinous ligament and brought through a piece of Surgisis mesh previously anchored to the anterior surface of the rectum. This was performed bilaterally. These sutures were tied to complete the rectal suspension, and the posterior wall of the vagina was closed.Transvaginal sacrospinous rectopexy was performed in all seven cases. In the first two cases, a Delorme procedure was performed concurrently. Two patients had rubber band ligation for symptomatic internal hemorrhoids, one patient had a sphincter plication, and one patient had an anal encirclement procedure with Surgisis. Six of the seven patients had concomitant urologic procedures. The average operative time was 163 min, and the average blood loss was 107 mL. None of the cases required conversion to an open procedure. There was one full thickness recurrence at 18 weeks.Transvaginal sacrospinous rectopexy is a safe, minimally invasive, technically feasible technique for the treatment of rectal prolapse.

    View details for DOI 10.1007/s10151-010-0567-2

    View details for PubMedID 20309717

  • Analysis of function and predictors of failure in women undergoing repair of Crohn's related rectovaginal fistula. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract El-Gazzaz, G., Hull, T., Mignanelli, E., Hammel, J., Gurland, B., Zutshi, M. 2010; 14 (5): 824-9


    Crohn's-related rectovaginal fistulae have significant impact on quality of life including sexual function. The aim of this study was to obtain long-term follow-up of Crohn's related rectovaginal fistulae to assess variables that influence surgical success and determine its effects on quality of life and sexual function.All women with Crohn's-related rectovaginal fistulas who underwent surgical repair from 1997 to 2007 were contacted for long-term follow-up. Variables assessed were age, body mass index, smoking, presence of active Crohn's disease, type of surgical procedure performed, use of perioperative seton or stoma, number of previous procedures, time interval between last repair and current repair, use of immunomodulators, and steroids. SF-12, Fecal Incontinence Quality-of-Life Scale, and Female Sexual Function Index were used to assess quality of life and sexual function. Multivariable logistic regression model was used to identify variables associated with surgical failure.Sixty-five women were identified at median follow-up of 44.6 months (interquartiles, 13.1-79.1) of which 30 patients (46.2%) were successfully healed. Methods of repair included advancement flap (n = 47), episioproctotomy (n = 8), colo-anal anastomosis (n = 7), and fibrin glue or plug (n = 3). Twenty-eight women (43.1%) were sexually active at follow-up, and of those, nine complained of dyspareunia, all within the unhealed group of patients. On multivariate analysis, only immunomodulators were associated with successful healing (p = 0.009). Smoking and steroids were associated with failure (p = 0.04). Sexual function and quality-of-life scores were comparable between healed and unhealed groups.Crohn's-related rectovaginal fistulae are difficult to treat. Healing increased with use of immunomodulators; however, smoking and steroids were predictors of failure. Dyspareunia was higher in unhealed women.

    View details for DOI 10.1007/s11605-010-1167-1

    View details for PubMedID 20232172

  • A primer on endoscopic electronic medical records. Clinics in colon and rectal surgery Atreja, A., Rizk, M., Gurland, B. 2010; 23 (1): 5-9


    Endoscopic electronic medical record systems (EEMRs) are now increasingly utilized in many endoscopy centers. Modern EEMRs not only support endoscopy report generation, but often include features such as practice management tools, image and video clip management, inventory management, e-faxes to referring physicians, and database support to measure quality and patient outcomes. There are many existing software vendors offering EEMRs, and choosing a software vendor can be time consuming and confusing. The goal of this article is inform the readers about current functionalities available in modern EEMR and provide them with a framework necessary to find an EEMR that is best fit for their practice.

    View details for DOI 10.1055/s-0030-1247850

    View details for PubMedID 21286284

    View details for PubMedCentralID PMC2850160

  • Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clinics in colon and rectal surgery Gurland, B., Hull, T. 2008; 21 (3): 157-66


    Fecal incontinence may be due to postpartum anal sphincter injuries or neurological damage even in the absence of obvious perineal trauma. Anal physiologic testing with transrectal ultrasound, manometry, and pudendal nerve terminal latency studies help to identify those patients with anal sphincter injuries who might benefit from anal sphincter repair. In this article, the authors discuss the specific tests that are available and how to interpret them.

    View details for DOI 10.1055/s-2008-1080995

    View details for PubMedID 20011414

    View details for PubMedCentralID PMC2780206

  • Does rectal wall tumor eradication with preoperative chemoradiation permit a change in the operative strategy? Diseases of the colon and rectum Zmora, O., Dasilva, G. M., Gurland, B., Pfeffer, R., Koller, M., Nogueras, J. J., Wexner, S. D. 2004; 47 (10): 1607-12


    Preoperative chemoradiation may downstage locally advanced rectal cancer and, in some cases, with no residual tumor. The management of complete response is controversial and recent data suggest that radical surgery may be avoided in selected cases. Transanal excision of the scar may determine the rectal wall response to chemoradiation. This study was designed to assess whether the absence of tumor in the bowel wall corresponds to the absence of tumor in the mesorectum, known as true complete response.A retrospective review of the medical records of patients who underwent preoperative chemoradiation for advanced mid (6-11 cm from the anal verge) and low (from the dentate line to 5 cm from the anal verge) rectal cancer (uT2-uT3) followed by radical surgery with total mesorectal excision was undertaken. Patients in whom the pathology specimen showed no residual tumor in the rectal wall (yT0, "y" signifies pathologic staging in postradiation patients) were assessed for tumoral involvement of the mesorectum.A total of 109 patients underwent preoperative, high-dose radiation therapy (94 percent with 5-fluorouracil chemosensitization), followed by radical surgery for advanced rectal cancer. Preoperatively, 47 patients were clinically assessed to have potentially complete response. After radical rectal resection, pathology did not reveal any residual tumor within the rectal wall (yT0) in 17 patients. In two (12 percent) of these patients, the mesorectum was found to be positive for malignancy: one had positive lymph nodes that harbored cancer; one had tumor deposits in the mesorectal tissue.Compete rectal wall tumor eradication does not necessarily imply complete response, because the mesorectum may harbor tumor cells. Thus, caution should be exercised when considering the avoidance of radical surgery. Reliable imaging methods and clinical predictors for favorable outcome are important to allow less radical approaches in the future.

    View details for PubMedID 15540288

  • Is routine pouchogram prior to ileostomy closure in colonic J-pouch really necessary? Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland da Silva, G. M., Wexner, S. D., Gurland, B., Gervaz, P., Moon, S. D., Efron, J., Nogueras, J. J., Weiss, E. G., Vernava, A. M., Zmora, O. 2004; 6 (2): 117-20


    Colonic J-pouch with coloanal anastomosis has gained popularity in the surgical treatment of middle and lower rectal pathologies. If a diverting ileostomy is performed, a pouchogram is frequently performed prior to ileostomy closure. The aim of this study was to assess the routine use of pouchogram prior to ileostomy closure in patients with colonic J pouch-anal anastomosis.All patients who underwent a colonic J pouch-anal anastomosis between 1990 and 2000 were retrospectively reviewed. Patients with temporary loop ileostomy who had pouchogram prior to ileostomy closure were included. Pouchogram results were compared to the patient's post ileostomy closure clinical outcome. Sensitivity, specificity and predictive values of pouchogram were assessed.Eighty-four patients had a pouchogram prior to ileostomy closure. Radiological abnormalities were evident in 6 patients, including 4 strictures, 1 pouch-vaginal fistula and 1 leak. Of these findings, 4 were false positives (3 strictures and 1 leak) and two were true positives (1 stricture and 1 pouch-vaginal fistula). The actual rate of pouch complications was 9.5% (8 complications) including 3 anastomotic leaks, all with normal pouchogram, 3 strictures requiring dilatation under anaesthesia, only one detected by pouchogram, and 2 pouch-vaginal fistulas, only one diagnosed by pouchogram. The sensitivity and specificity of pouchogram, respectively, was 0 and 98% for anastomotic leak, 33 and 96% for stricture, and 50 and 100% for pouch-vaginal fistula. Overall, pouchogram changed the management in only 1 of 84 patients.Pouchogram has a low sensitivity in predicting complications following ileostomy closure in patients after colonic J-pouch anal anastomosis and rarely changes the management of these patients. The use of pouchogram prior to ileostomy closure may be unnecessary and should be reserved in cases of clinical suspicion of complications.

    View details for PubMedID 15008910

  • Laparoscopic surgery for inflammatory bowel disease: results of the past decade. Inflammatory bowel diseases Gurland, B. H., Wexner, S. D. 2002; 8 (1): 46-54


    Laparoscopic colectomy is one of the most difficult laparoscopic procedures. Surgeons attempting to perform laparoscopic surgery for inflammatory bowel disease (IBD) must have significant experience with IBD and advanced laparoscopic skills. Surgical management for IBD may be treated with a range of laparoscopic procedures that vary in complexity. After 10 years of experience, studies comparing laparoscopy versus laparotomy are favoring laparoscopy when evaluating reduction in postoperative ileus, pain, and length of hospitalization, disability, and cosmesis. The indications and contraindications for laparoscopic surgery for IBD are evolving as surgical expertise and equipment improve.

    View details for PubMedID 11837938