Aim Low anterior resection syndrome (LARS) refers to a constellation of bowel symptoms that affect the majority of patients following restorative proctectomy. LARS is associated with poorer quality of life (QoL), and can lead to distress, anxiety and isolation. Peer support could be an important resource for people living with LARS, helping them normalize and validate their experience. The aim of this work is to describe the development of an interactive online informational and peer support app for LARS and the protocol for a randomized controlled trial. Method A multicentre, randomized, assessor‐blind, parallel‐groups pragmatic trial will involve patients from five large colorectal surgery practices across Canada. The trial will evaluate the impact of an interactive online informational and peer support app for LARS, consisting of LARS informational modules and a closed forum for peers and trained peer support mentors, on patient‐reported outcomes of people living with LARS. The primary outcome will be global QoL at 6 months following app exposure. The treatment effect on global QoL will be modelled using generalized estimating equations. Secondary outcomes will include patient activation and bowel function as measured by LARS scores. Results In order to better understand patients' interest and preferences for an online peer support intervention for LARS, we conducted a single institution cross‐sectional survey study of rectal cancer survivors. In total, 35/69 (51%) participants reported interest in online peer support for LARS. Age <65 years (OR 9.1; 95% CI 2.3‐50) and minor/major LARS (OR 20; 95% CI 4.2‐100) were significant predictors of interest in LARS online peer support. Conclusion There is significant interest in the use of online peer support for LARS among younger patients and those with significant bowel dysfunction. Based on results of the needs assessment study, the app content and features were modified reflect patients’ needs and preferences. We are now in an optimal position to rigorously test the potential effects of this initiative on patient‐centered outcomes using a randomized controlled trial.

Introduction The objective of this study was to evaluate the impact of preoperative bowel stimulation on the development of postoperative ileus (POI) after loop ileostomy closure. Methods This was a multicenter, randomized controlled trial (NCT025596350) including adult (≥ 18 years old) patients who underwent elective loop ileostomy closure at 7 participating hospitals. Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group). Bowel stimulation consisted of 10 outpatient sessions within the 3 weeks prior to ileostomy closure and was performed by trained Enterostomal Therapy nurses. The primary outcome was POI, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, on or after postoperative day 3, that either (a) required nasogastric tube insertion; or (b) was associated with two of the following: nausea/vomiting, abdominal distension, or the absence of flatus. Results Between January 2017 and November 2020, 101 patients were randomized, and 5 patients never underwent ileostomy closure; thus, 96 patients (47 stimulated vs. 49 control) were analyzed according to a modified intention-to-treat protocol. Baseline characteristics were well balanced in both groups. The incidence of POI was lower among patients randomized to stimulation (6.4% vs. 24.5%, p = 0.034; unadjusted RR: 0.26, 95% CI 0.078–0.87). Stimulated patients also had earlier median time to first flatus (2.0 days (1.0–2.0) vs. 2.0 days (2.0–3.0), p = 0.025), were more likely to pass flatus on postoperative day 1 (46.8% vs. 22.4%, p = 0.022), and had a shorter median postoperative hospital stay (3.0 days (2.0–3.5) vs. 4.0 days (2.0–6.0), p = 0.003). Conclusions Preoperative bowel stimulation via the efferent limb of the ileostomy reduced POI after elective loop ileostomy closure.

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Background:The Inuit people residing in Nunavik, Quebec, are vulnerable to major trauma owing to environmental and social factors; however, there is no systematic data collection for trauma in Nunavik, and, apart from data regarding patients who are transferred to tertiary care centres, no data enter the Quebec trauma registry directly from Nunavik. We performed a study to characterize the epidemiologic fea tures of trauma in Nunavik, and describe indications for transfer and outcomes of patients referred to the tertiary trauma centre. Methods:We collected data retrospectively for all patients with trauma admitted to the Centre de santé Tulattavik de l'Ungava in Kuujjuaq from 2005 to 2014. Socio demographic, injury and health services data were extracted. The data were analyzed in conjunction with coroners' reports on death from trauma in Nunavik.Results: A total of 797 trauma cases were identified. The most common causes of injury were motor vehicle collisions (258 cases [32.4%]), falls (137 [17.2%]) and blunt assault (95 [11.9%]). Onethird of patients (262 [32.9%]) were transferred to the ter tiary care centre in Montréal. The incidence rate of major trauma (Injury Severity Score > 12) was 18.1 and 21.7 per 10 000 personyears in the Kuujjuaq region and the Puvirnituq region, respectively, which translates to a relative risk (RR) of 4 compared to the Quebec population. The disparity observed in trauma mortality rate was even greater, with an RR of 47.6 compared to the Quebec population. Conclusion:The study showed major disparity in trauma incidence and mortality rate between Nunavik and the province of Quebec. Our findings allow for a better understanding of the burden of injury and regional trauma mortality in Nunavik, and recommendations for optimization of the trauma system in this unique setting. Contexte :Le peuple Inuit du Nunavik, au Québec, est sujet à des traumatismes majeurs en raison de facteurs environnementaux et sociaux; or, on ne dispose d'aucun système de collecte des données concernant les traumatismes au Nunavik, et outre les données relatives aux patients transférés dans des établissements de soins tertiaires, aucun renseignement n'est consigné au Registre des traumatismes du Québec directe ment en provenance du Nunavik. Nous avons procédé à une étude pour cerner les caractéristiques épidémiologiques des traumatismes au Nunavik et décrire les indica tions de transfert et l'issue des traumatismes subis par les patients adressés vers des centres tertiaires de traumatologie.Méthodes : Nous avons recueilli les données de manière rétrospective pour tous les patients victimes de traumatismes admis au Centre de santé Tulattavik de l'Ungava, à Kuujjuaq, de 2005 à 2014. Nous avons extrait les données sociodémographiques, ainsi que les données sur les blessures et les services de santé utilisés. Nous avons analysé les données en parallèle avec les rapports des coroners sur les décès des suites de trau matismes au Nunavik.Résultats : En tout, 797 cas de traumatisme ont été recensés. Les causes les plus ...

BACKGROUND: Most rectal cancer patients experience bowel symptoms post-restorative proctectomy. The incidence of mental health disorders post-restorative proctectomy and its association with bowel symptoms are unknown. OBJECTIVES: The objectives of our study are: a) to describe the incidence of mental health disorders in patients who underwent restorative proctectomy for rectal cancer; b) to study the association between incident mental health disorders and bowel dysfunction following surgery. DESIGN: This was a retrospective cohort study using the Clinical Practice Research Datalink and Hospital Episode Statistics databases. SETTINGS: The databases were based in the United Kingdom. PATIENTS: All adult patients who underwent restorative proctectomy for a rectal neoplasm between 1998 and 2018 were included. MAIN OUTCOME MEASURES: The primary outcome was incident mental health disorder. The associations between bowel, sexual, and urinary dysfunction and incident mental health disorders were studied using Cox proportional hazard regression models. RESULTS: In total, 2,197 patients who underwent restorative proctectomy were identified. Of 1,858 patients without preoperative bowel, sexual, or urinary dysfunction, 1,455 individuals also had no preoperative mental health disorders. In this cohort, 466 (32.0%) patients developed incident mental health disorders following restorative proctectomy during 6,333 person-years of follow-up (rate = 7.4 per 100 person-years). On multivariate Cox regression, age (50-59 years-old: aHR 1.37, 95%CI 1.02-1.84; 70-79 years-old: aHR 1.43, 95%CI 1.13-1.82; >80 years-old: aHR 1.59, 95%CI 1.18-2.15; reference age: 60-69 years-old), female gender (aHR 1.30, 95%CI 1.06-1.56), metastatic disease (aHR 1.57, 95%CI 1.14-2.15) and incident bowel (aHR 1.41, 95%CI 1.13-1.77), and urinary dysfunction (aHR 1.57, 95%CI 1.16-2.14) were associated with developing incident mental health disorders post-restorative proctectomy. LIMITATIONS: This study was limited by observational study design and residual confounding. CONCLUSION: Incident mental health disorders following restorative proctectomy for rectal cancer are common. The presence of bowel and urinary functional impairment significantly increases the risk of poor psychological outcomes among rectal cancer survivors. See Video Abstract at.