Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourthdegree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented.

Background Diabetes mellitus is associated with an increased incidence of colorectal cancer, but the impact of diabetes on colorectal cancer prognosis is not clear. Objective We conducted a meta-analysis of observational studies to examine the association between pre-existing diabetes and colorectal cancer all-cause mortality, cancer-specific mortality and recurrence. Data Sources Medline and Embase were searched through August 22, 2012. Study Selection We included studies reporting all-cause mortality, cancer-specific mortality, disease-free survival, or recurrence in colorectal cancer patients according to diabetic status. Intervention Meta-analyses performed using random effects models. Main Outcome Measures All-cause mortality, cancer-specific mortality, diseases free survival. Results Twenty-six articles met our inclusion criteria. Colorectal cancer patients with diabetes had a 17% increased risk of all-cause mortality (RR = 1.17; 95% CI: 1.09-1.25) and a 12% increased risk of cancer-specific mortality (RR = 1.12; 95% CI: 1.01-1.24) compared to those without diabetes. Those with diabetes also had poorer disease-free survival (RR = 1.54; 95% CI: 1.08-2.18) compared to their non-diabetic counterparts. In subgroup analyses, diabetes was associated with all-cause mortality in both rectal (RR = 1.24; 95% CI: 1.07-1.29) and colon cancer patients (RR = 1.17; 95% CI: 1.07-1.29). Sensitivity analyses including only patients with non-metastatic disease identified stronger associations between diabetes and both all-cause (RR = 1.32; 95% CI: 1.21-1.44) and cancer-specific (RR = 1.27; 95% CI: 1.06-1.52) mortality. Limitations Some studies had short follow-up or did not report mean or median follow-up. The included studies were heterogeneous in study population, diabetes diagnostic criteria and outcome ascertainment. Conclusion Colorectal cancer patients with diabetes are at greater risk for all-cause and cancer-specific mortality and have worse disease-free survival compared to those without diabetes. Studies are warranted to determine if proper treatment could attenuate the excess mortality among diabetic colorectal cancer patients.

Stapled transanal rectal resection achieved acceptable results at the cost of a high reoperation rate. Patients with puborectalis dyssynergia and lower bowel frequency may do worse because surgery does not address the causes of their constipation. Patients with large rectoceles, enteroceles, digitation, and a sense of incomplete evacuation may have more advanced pelvic floor disease for which stapled transanal rectal resection, which simply removes redundant tissue, may not be adequate. This, together with the complications observed in patients referred after stapled transanal rectal resection, suggests that this procedure should be performed by colorectal surgeons and in carefully selected patients.

Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation.

Colorectal cancer is one of the most common cancers worldwide. However, it is unclear what influence body mass index (BMI) has on colorectal cancer prognosis. We conducted a systematic review and meta-analysis of observational studies to examine the association of BMI with colorectal cancer outcomes. We searched MEDLINE and EMBASE databases from inception to February 2015 and references of identified articles. We selected observational studies that reported all-cause mortality, colorectal cancer-specific mortality, recurrence and disease-free survival according to BMI category. Random-effects meta-analyses were conducted to combine estimates. We included 18 observational studies. Obese patients had an increased risk of all-cause mortality [relative risk (RR) 1.14; 95 % confidence interval (CI) 1.07-1.21], cancer-specific mortality (RR 1.14; 95 % CI 1.05-1.24), recurrence (RR 1.07; 95 % CI 1.02-1.13) and worse disease-free survival (RR 1.07; 95 % CI 1.01-1.13). Underweight patients also had an increased risk of all-cause mortality (RR 1.43; 95 % CI 1.26-1.62), cancer-specific mortality (RR 1.50; 95 % CI 1.20-1.87), recurrence (RR 1.13; 95 % CI 1.05-1.21) and worse disease-free survival (RR 1.27; 95 % CI 1.13-1.43). Overweight patients had no increased risk for any of the outcomes studied. Both obese and underweight patients with colorectal cancer have an increased risk of all-cause mortality, cancer-specific mortality, disease recurrence and worse disease-free survival compared to normal weight patients.