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Article: Incidence and Risk Factors for Low Anterior Resection Syndrome following Trans-Anal Total Mesorectal Excision.

Parnasa, Shani Y / Mizrahi, Ido / Helou, Brigitte / Cohen, Adiel / Abu Gazala, Mahmoud / Pikarsky, Alon J / Shussman, Noam

Journal of clinical medicine

2024 Volume 13, Issue 2

Abstract: Background: Trans-anal total mesorectal excision (Ta-TME) is a novel approach for the resection of rectal cancer. Low anterior resection syndrome (LARS) is a frequent functional disorder that might follow restorative proctectomy. Data regarding bowel ... ...

Abstract	Background: Trans-anal total mesorectal excision (Ta-TME) is a novel approach for the resection of rectal cancer. Low anterior resection syndrome (LARS) is a frequent functional disorder that might follow restorative proctectomy. Data regarding bowel function after Ta-TME are scarce. The aim of this study was to evaluate the incidence and risk factors for the development of LARS following Ta-TME. Methods: A prospectively maintained database of all patients who underwent Ta-TME for rectal cancer at our institution was reviewed. All patients who were operated on from January 2018 to December 2021 were evaluated. The LARS score questionnaire was used via telephone interviews. Incidence, severity and risk factors for LARS were evaluated. Results: Eighty-five patients underwent Ta-TME for rectal cancer between January 2018 and December 2021. Thirty-five patients were excluded due to ostomy status, death, local disease recurrence, ileal pouch or lack of compliance. Fifty patients were included in the analysis. LARS was diagnosed in 76% of patients. Anastomosis distance from dentate line was identified as a risk factor for LARS via multivariate analysis ( Conclusion: LARS is a frequent condition following ta-TME, as it is used for other approaches to low anterior resection. Anastomosis distance from dentate line is an independent risk factor for LARS. In this study neo-adjuvant therapy, hand sewn anastomosis and anastomotic leak did not increase the risk of LARS. Further studies with longer follow-up times are required to better understand the functional outcomes following Ta-TME.
Language	English
Publishing date	2024-01-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13020437
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Article: Exploring the Efficacy of the Paula Method of Muscle Exercises in Managing Low Anterior Resection Syndrome Using an Integrative Approach: A Preliminary Study.

Solnica, Amy / Liebergall, Michal / Mizrahi, Ido / Parnasa, Shani Y / Abu-Gazala, Mahmoud / Pikarsky, Alon J / Shussman, Noam

Alternative therapies in health and medicine

2024 Volume 30, Issue 3, Page(s) 10–14

Abstract: Background: Low anterior resection syndrome (LARS) is a post-proctectomy consequence characterized by variable and unpredictable bowel function, including clustering, urgency, and incontinence, which significantly impacts the quality of life. Currently, ...

Abstract	Background: Low anterior resection syndrome (LARS) is a post-proctectomy consequence characterized by variable and unpredictable bowel function, including clustering, urgency, and incontinence, which significantly impacts the quality of life. Currently, there is no established gold-standard therapy for LARS. Primary study objective: This study aimed to evaluate the effectiveness of the Paula method of exercise as part of an integrative treatment approach for patients with LARS. Design: This preliminary study utilized a single-arm pretest-posttest design. Setting: The study was conducted at a tertiary care medical center. Participants: Five patients diagnosed with LARS completed the study. Intervention: Participants underwent twelve weeks of individualized Paula method exercise sessions. Two questionnaires were employed to assess the severity of LARS and quality of life. Primary outcome measures: (1) Low Anterior Resection Syndrome (LARS) Score; (2) Memorial Sloan Kettering Cancer Bowel Function Instrument (MSK-BFI); (3) Global Quality-of-Life (QOLS) Score ‎. Results: All participants completing the 12-week Paula exercise regimen reported no difficulty in engaging with the exercises. Statistically significant improvements were observed in both the LARS score and MSK-BFI (P = .039 and P = .043, respectively, Wilcoxon Rank Sum test). While there were improvements in the global quality-of-life score and functional scales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, these improvements did not reach statistical significance. Conclusions: This preliminary study suggests that patients with LARS can successfully complete a 12-week exercise program using the Paula method, resulting in improved LARS scores. However, further investigation through larger, multicenter, randomized controlled trials is necessary to establish the efficacy of these exercises as a treatment for LARS.
MeSH term(s)	Humans ; Female ; Male ; Middle Aged ; Exercise Therapy/methods ; Quality of Life ; Aged ; Syndrome ; Proctectomy/methods ; Postoperative Complications/therapy ; Surveys and Questionnaires ; Adult ; Treatment Outcome ; Low Anterior Resection Syndrome
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1225073-9
ISSN	1078-6791
ISSN	1078-6791
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Article ; Online: A patient tailored approach to the surgical treatment of hemorrhoids leads to equal satisfaction following hemorrhoidectomy, stapled hemorrhoidopexy or a combination of both.

Gefen, Rachel / Handal, Adham / Ben-Ezra, Carmel / Parnasa, Shani Y / Mizrahi, Ido / Abu-Gazala, Mahmoud / Pikarsky, Alon J / Shussman, Noam

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 233

Abstract: Purpose: Up to 20% of patients suffering from symptomatic hemorrhoids will require surgery. Excisional hemorrhoidectomy (EH) and stapled hemorrhoidopexy (SH) are both standard and safe procedures. While SH has a short-term advantage of faster recovery ... ...

Abstract	Purpose: Up to 20% of patients suffering from symptomatic hemorrhoids will require surgery. Excisional hemorrhoidectomy (EH) and stapled hemorrhoidopexy (SH) are both standard and safe procedures. While SH has a short-term advantage of faster recovery and lower postoperative pain, its long-term efficacy is debatable. This study aims to compare the outcomes of EH, SH, and a combined procedure of both. Methods: A retrospective study compared the outcomes of patients treated surgically for hemorrhoids over a 5-year period. Eligible patients were asked by phone to complete a questionnaire evaluating recurrent symptoms, fecal incontinence, satisfaction, and self-assessed improvement in quality of life (QOL). Results: This study included 362 patients, of whom 215 underwent SH, 99 underwent EH, and 48 underwent a combined procedure. No statistically significant differences were found between groups regarding complications, symptoms recurrence, or fecal incontinence. Combined procedure patients had significantly higher self-assessed improvement in QOL (P=0.04). Conclusion: In patients with symptomatic hemorrhoids, a tailored approach to symptomatic hemorrhoids is associated with high satisfaction rates and self-assessed improvement in QOL.
MeSH term(s)	Humans ; Patient Satisfaction ; Hemorrhoidectomy ; Hemorrhoids/surgery ; Quality of Life ; Fecal Incontinence/etiology ; Retrospective Studies
Language	English
Publishing date	2023-06-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-02969-3
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Article ; Online: Pneumatosis Cystoides Coli Presenting as Acute Abdomen in a Patient with Complicated Behcet's Disease: A Case Report.

Gefen, Rachel / Helou, Brigitte / Shussman, Noam / Elia, Anna / Appelbaum, Liat / Pikarsky, Alon / Demma, Jonathan Abraham

The American journal of case reports

2022 Volume 23, Page(s) e937677

Abstract: BACKGROUND Behcet's disease (BD) is defined as vasculitis involving arteries and veins of any size and affecting almost any organ system. Abdominal manifestations of BD are diverse and nonspecific. Mucosal ulcerations can be seen in the gastrointestinal ... ...

Abstract	BACKGROUND Behcet's disease (BD) is defined as vasculitis involving arteries and veins of any size and affecting almost any organ system. Abdominal manifestations of BD are diverse and nonspecific. Mucosal ulcerations can be seen in the gastrointestinal tract. Extensive ulcerations, especially ileocecal lesions, can lead to perforation, strictures, fistulas, and abscesses. Pneumatosis cystoides intestinale is a rare benign condition characterized by multiple submucosal or subserosal, gas-filled cysts in the gastrointestinal tract wall. Pneumatosis cystoides coli (PCC) affects the colon, can present with a wide range of manifestations, and can mimic many different systemic diseases. We describe a case of PCC in a patient with Behcet's disease who presented to the Emergency Department with a clinical suspicion of acute abdomen. CASE REPORT A 40-year-old man with complicated Behcet's disease, treated with high-dose steroids, presented with acute abdomen and CT scan findings highly suggestive of intestinal obstruction due to ileocolic intussusception. He underwent laparoscopic right hemicolectomy. Pathology demonstrated PCC disease. CONCLUSIONS Pneumatosis cystoides coli can present with a broad range of symptoms and can be secondary to many systemic and autoimmune diseases. With radiological evidence and a high level of suspicion, unnecessary surgery can be prevented.
MeSH term(s)	Male ; Humans ; Adult ; Abdomen, Acute/etiology ; Behcet Syndrome/complications ; Behcet Syndrome/diagnosis ; Pneumatosis Cystoides Intestinalis/complications ; Pneumatosis Cystoides Intestinalis/diagnosis ; Colon ; Radiography
Language	English
Publishing date	2022-10-29
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.937677
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Article: Colorectal polyps and polyposis syndromes.

Shussman, Noam / Wexner, Steven D

Gastroenterology report

2014 Volume 2, Issue 1, Page(s) 1–15

Abstract: A polyp is defined as any mass protruding into the lumen of a hollow viscus. Colorectal polyps may be classified by their macroscopic appearance as sessile (flat, arising directly from the mucosal layer) or pedunculated (extending from the mucosa through ...

Abstract	A polyp is defined as any mass protruding into the lumen of a hollow viscus. Colorectal polyps may be classified by their macroscopic appearance as sessile (flat, arising directly from the mucosal layer) or pedunculated (extending from the mucosa through a fibrovascular stalk). Colorectal polyps may also be histologically classified as neoplastic or as non-neoplastic (hyperplastic, hamartomatous, or inflammatory). The neoplastic polyps are of primary importance because they harbor a malignant potential, which represents a stage in the development of colorectal cancer. For this reason, it is essential to identify these polyps at a sufficiently early stage, when a simple outpatient procedure to remove them can interrupt the development of colorectal cancer and prevent disease and death. When invasive carcinoma arises in a polyp, careful consideration must be given to ensuring the adequacy of treatment. Although most neoplastic polyps do not evolve into cancer, it is well accepted that the majority of colorectal carcinomas evolve from adenomatous polyps; the sequence of events leading to this transformation is referred to as the adenoma-to-carcinoma sequence. The presence of a systemic process that promotes the development of multiple gastro-intestinal polyps is termed 'polyposis'. Hereditary gastro-intestinal polyposis syndromes account for approximately 1% of all cases of colorectal cancer and are associated with a broad spectrum of extra-colonic tumors. Early detection and accurate classification of these syndromes are essential, in order to initiate a surveillance program for the early detection of cancer. Several polyposis syndromes have been described, each having its own genetic basis and characteristic polyp distribution, clinical presentation, and malignancy risk. Diagnostic modalities and treatment options for neoplastic polyps-as well as the most prevalent polyposis syndromes-are reviewed below.
Language	English
Publishing date	2014-01-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2710871-5
ISSN	2052-0034
ISSN	2052-0034
DOI	10.1093/gastro/got041
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Article ; Online: Current status of laparoscopy for the treatment of rectal cancer.

Shussman, Noam / Wexner, Steven D

World journal of gastroenterology

2014 Volume 20, Issue 41, Page(s) 15125–15134

Abstract: Surgery for rectal cancer in complex and entails many challenges. While the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe, it is still a debatable topic for ... ...

Abstract	Surgery for rectal cancer in complex and entails many challenges. While the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe, it is still a debatable topic for rectal cancer. The attempt to benefit rectal cancer patients with the known advantages of the laparoscopic approach while not compromising their oncologic outcome has led to the conduction of many studies during the past decade. Herein we describe our technique for laparoscopic proctectomy and assess the current literature dealing with short term outcomes, immediate oncologic measures (such as lymph node yield and specimen quality) and long term oncologic outcomes of laparoscopic rectal cancer surgery. We also briefly evaluate the evolving issues of robotic assisted rectal cancer surgery and the current innovations and trends in the minimally invasive approach to rectal cancer surgery.
MeSH term(s)	Diffusion of Innovation ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/mortality ; Laparoscopy/trends ; Postoperative Complications ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Risk Factors ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Robotic Surgical Procedures/mortality ; Robotic Surgical Procedures/trends ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2014-11-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v20.i41.15125
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Article ; Online: A Rare Benign Gastrointestinal Lesion Identified as a Calcifying Fibrous Tumor.

Luques, Lisandro / Atlan, Karine A / Shussman, Noam

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2016 Volume 15, Issue 2, Page(s) A25

MeSH term(s)	Calcinosis/diagnosis ; Calcinosis/pathology ; Calcinosis/surgery ; Cesarean Section ; Female ; Humans ; Incidental Findings ; Intestinal Neoplasms/diagnosis ; Intestinal Neoplasms/pathology ; Intestinal Neoplasms/surgery ; Intestine, Small/surgery ; Neoplasms, Fibrous Tissue/diagnosis ; Neoplasms, Fibrous Tissue/pathology ; Neoplasms, Fibrous Tissue/surgery ; Pregnancy ; Pregnancy Complications, Neoplastic/diagnosis ; Pregnancy Complications, Neoplastic/pathology ; Pregnancy Complications, Neoplastic/surgery ; Young Adult
Language	English
Publishing date	2016-10-17
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2016.10.014
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Article ; Online: Urinary dysfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer.

Chill, Henry H / Parnasa, Shani Y / Shussman, Noam / Alter, Roie / Helou, Briggite / Cohen, Adiel / Pikarsky, Alon J / Shveiky, David

BMC women's health

2021 Volume 21, Issue 1, Page(s) 237

Abstract: Background: Colorectal cancer is a condition which is associated with substantial morbidity and mortality. The aim of this study was to assess urinary dysfunction and its effect on quality of life in women who underwent total mesorectal excision ... ...

Abstract	Background: Colorectal cancer is a condition which is associated with substantial morbidity and mortality. The aim of this study was to assess urinary dysfunction and its effect on quality of life in women who underwent total mesorectal excision compared to women treated by partial mesorectal excision for treatment of rectal cancer. Methods: We performed a retrospective cohort study at a tertiary university hospital between January 2014 and December 2019. A comparison was performed between women who underwent total mesorectal excision as opposed to partial mesorectal excision for treatment of rectal cancer. Pre-operative, intra-operative and post-operative data were compared between groups. Data regarding radiation therapy was recorded and compared as well. Urinary dysfunction and its impact on quality of life were assessed using UDI-6 and USIQ questionnaires. Further univariate and multivariate analyses were performed in the attempt of assessing risk factors for urinary dysfunction. Results: A total of 107 women were included in the study, 73 women underwent partial mesorectal excision as opposed to 34 women who were treated by total mesorectal excision. Twenty-five women in the TME group underwent radiation therapy prior to surgery as opposed to none in the PME group (p < 0.001). Urinary dysfunction following surgery as assessed using the UDI-6 questionnaire did not differ between groups. Similar findings were recorded with regard to the impact of urinary dysfunction on quality of life as assessed using the USIQ questionnaire. Following multivariate analysis longer hospital stay was associated with increased risk of some degree of urinary dysfunction. Conclusions: Women undergoing total mesorectal excision have comparable results to partial mesorectal excision with regard to urinary dysfunction.
MeSH term(s)	Female ; Humans ; Laparoscopy ; Quality of Life ; Rectal Neoplasms/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-06-07
Publishing country	England
Document type	Journal Article
ISSN	1472-6874
ISSN (online)	1472-6874
DOI	10.1186/s12905-021-01381-7
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Article ; Online: Dual energy CT in acute appendicitis: value of low mono-energy.

Lev-Cohain, Naama / Sosna, Jacob / Meir, Yuval / Dar, Gili / Shussman, Noam / Leichter, Isaac / Caplan, Nadia / Goldberg, S Nahum

Clinical imaging

2021 Volume 77, Page(s) 213–218

Abstract: Objectives: To assess the potential role of low monoenergetic images in the evaluation of acute appendicitis.: Methods: A retrospective study of 42 patients with pathology proven acute appendicitis underwent contrast-enhanced-CT conducted on a single- ...

Abstract	Objectives: To assess the potential role of low monoenergetic images in the evaluation of acute appendicitis. Methods: A retrospective study of 42 patients with pathology proven acute appendicitis underwent contrast-enhanced-CT conducted on a single-source-DECT before surgery. Attenuation, SNR, and CNR were calculated on both monoenergetic and conventional images and compared to 24 abdominal CT-scans with normal appendix. Representative conventional and monoenergetic images were randomized and presented side-by-side to three abdominal radiologists to determine preferred images for detecting inflammation. Additionally, six individual acute inflammatory characteristics were graded on a 1-5 scale to determine factors contributing to differences between conventional and monoenergetic images by 2 abdominal radiologists. Paired t-tests, Wilcoxon and McNemar tests, and intra-observer error statistics were performed. Results: For the inflamed appendixes monoenergetic images had overall increased attenuation (average ratio 1.7; P < 0.05), signal-to-noise-ratio (6.7 ± 3.1 vs 4.2 ± 1.6; P < 0.001) and contrast-to-noise-ratio (12.1 ± 3 vs 9 ± 2.1; P < 0.001). Moreover, this increase was not found in normal appendixes (P < 0.001 vs p = 0.28-0.44). Subjectively, radiologists showed significant preferences towards monoenergetic images (P < 0.001), with inter-reader agreement of 0.84. Two parameters, diffuse bowel wall and mucosal enhancement, received significantly higher scores on monoenergetic images (average 4.3 vs. 3.0; P < 0.001 and 2.8 vs. 2.3 P < 0.03 respectively, with interobserver agreements of 62% and 52%). Conclusion: Increased bowel wall conspicuity from enhanced attenuation, SNR, and CNR on low monenergetic CT images results in a significant preference by radiologists for these images when assessing acute inflamed appendixes. Thus, close inspection of low monoenergetic images may improve the visualization of acute inflammatory bowel processes.
MeSH term(s)	Appendicitis/diagnostic imaging ; Contrast Media ; Humans ; Radiography, Dual-Energy Scanned Projection ; Retrospective Studies ; Signal-To-Noise Ratio ; Tomography, X-Ray Computed
Chemical Substances	Contrast Media
Language	English
Publishing date	2021-04-20
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1028123-x
ISSN	1873-4499 ; 0899-7071
ISSN (online)	1873-4499
ISSN	0899-7071
DOI	10.1016/j.clinimag.2021.04.007
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Article ; Online: Urinary dysfunction in women following total mesorectal excision versus partial mesorectal excision for treatment of rectal cancer

Henry H. Chill / Shani Y. Parnasa / Noam Shussman / Roie Alter / Briggite Helou / Adiel Cohen / Alon J. Pikarsky / David Shveiky

BMC Women's Health, Vol 21, Iss 1, Pp 1-

2021 Volume 6

Abstract: Abstract Background Colorectal cancer is a condition which is associated with substantial morbidity and mortality. The aim of this study was to assess urinary dysfunction and its effect on quality of life in women who underwent total mesorectal excision ... ...

Abstract	Abstract Background Colorectal cancer is a condition which is associated with substantial morbidity and mortality. The aim of this study was to assess urinary dysfunction and its effect on quality of life in women who underwent total mesorectal excision compared to women treated by partial mesorectal excision for treatment of rectal cancer. Methods We performed a retrospective cohort study at a tertiary university hospital between January 2014 and December 2019. A comparison was performed between women who underwent total mesorectal excision as opposed to partial mesorectal excision for treatment of rectal cancer. Pre-operative, intra-operative and post-operative data were compared between groups. Data regarding radiation therapy was recorded and compared as well. Urinary dysfunction and its impact on quality of life were assessed using UDI-6 and USIQ questionnaires. Further univariate and multivariate analyses were performed in the attempt of assessing risk factors for urinary dysfunction. Results A total of 107 women were included in the study, 73 women underwent partial mesorectal excision as opposed to 34 women who were treated by total mesorectal excision. Twenty-five women in the TME group underwent radiation therapy prior to surgery as opposed to none in the PME group (p < 0.001). Urinary dysfunction following surgery as assessed using the UDI-6 questionnaire did not differ between groups. Similar findings were recorded with regard to the impact of urinary dysfunction on quality of life as assessed using the USIQ questionnaire. Following multivariate analysis longer hospital stay was associated with increased risk of some degree of urinary dysfunction. Conclusions Women undergoing total mesorectal excision have comparable results to partial mesorectal excision with regard to urinary dysfunction.
Keywords	Rectal cancer ; Total mesorectal excision ; Partial mesorectal excision ; Urinary dysfunction ; Gynecology and obstetrics ; RG1-991 ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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