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Article ; Online: Endoscopic-Assisted Transanal Minimally Invasive Surgery to Restore Patency of a Benign Colorectal Anastomotic Stricture.

Cheong, Ju Yong / Connelly, Tara M / Duraes, Leonardo C / Gorgun, Emre

2023 Volume 66, Issue 11, Page(s) e1129–e1130

Language	English
Publishing date	2023-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002728
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Article ; Online: How to Do It: Laparoscopic Total Abdominal Colectomy with Complete Mesocolic Excision (CME) for Transverse Colon Cancer in Ulcerative Colitis.

Kessler, Hermann / Cheong, Ju Yong / Connelly, Tara M

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 27, Issue 3, Page(s) 636–639

Abstract: Background: Ulcerative colitis (UC) is a chronic mucosal inflammatory bowel disease of the colon and rectum. After 10 years of having the disease, there is a significant risk of dysplasia or cancer in the affected colon and rectum, and because of the ... ...

Abstract	Background: Ulcerative colitis (UC) is a chronic mucosal inflammatory bowel disease of the colon and rectum. After 10 years of having the disease, there is a significant risk of dysplasia or cancer in the affected colon and rectum, and because of the often aggressive biology of these tumors, frequent endoscopic surveillance is warranted. Over a third of patients with UC will ultimately require an operation, and although for specific cases alternative operations can be pursued, most patients prefer an ileal pouch-anal anastomosis (IPAA) with J-pouch construction. Case: A staged IPAA removes the affected colon and rectum treating UC and also restores intestinal continuity. However, the standard colectomy for UC includes low ligations of the main colonic vascular pedicle branches (ileocolic, right colic, middle colic and inferior mesenteric) that does not address a proper oncologic operation. A high ligation of the named vessels as well as a proper resection of the affected colon with its mesentery and lymph node package are needed to treat colon cancer. Analogous to a total mesorectal exicision for rectal cancer, a more radical procedure to remove the tumor and lymph node packet for colon cancer is described as a complete mesocolic exision (CME) in efforts to increase disease free survival. Discussion: We demonstrate a laparoscopic subtotal colectomy for UC, with an oncologic complete mesocolic excision for a left transverse colon carcinoma in the setting of chronic mucosal inflammation secondary to chronic UC as the first procedure in a 3-staged IPAA. In the video, it is also demonstrated how the lymph node dissection is extended towards the greater gastric curvature and comprising omentum and gastrocolic ligament. There were no postoperative complications in the 44-year old male patient.
MeSH term(s)	Male ; Humans ; Adult ; Colon, Transverse/surgery ; Colon, Transverse/pathology ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/surgery ; Colic/surgery ; Laparoscopy/methods ; Colonic Neoplasms/pathology ; Lymph Node Excision/methods ; Mesocolon/surgery ; Colectomy/methods
Language	English
Publishing date	2022-12-16
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05526-3
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Article: Crohn's of the Pouch: Now What?

Connelly, Tara M / Lincango, Eddy / Holubar, Stefan D

Clinics in colon and rectal surgery

2022 Volume 35, Issue 6, Page(s) 475–486

Abstract: Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the gold standard surgical treatment for the majority (∼90%) of ulcerative colitis (UC) patients. In cases of carefully selected Crohn's colitis patients without small bowel or perianal ... ...

Abstract	Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the gold standard surgical treatment for the majority (∼90%) of ulcerative colitis (UC) patients. In cases of carefully selected Crohn's colitis patients without small bowel or perianal involvement an "intentional IPAA" may be a viable option for disease resection and restoration of intestinal continuity. More commonly, Crohn's is incidentally found either in the resection specimen or, more commonly, when inflammatory complications subsequently arise after pouch construction for UC or indeterminate colitis. These incidental Crohn's pouches may be diagnosed early or late period post-IPAA. Crohn's may manifest within the pouch, in the proximal small bowel, and/or distally in the rectal cuff or anus. Like intestinal Crohn's, Crohn's disease of the pouch may be of an inflammatory, fibrostenosing, or fistulizing phenotype. Treatment depends on the phenotype and includes medical treatment, most commonly in the form of tumor necrosis factor inhibitor medications; however, the newer small molecules offer a potential treatment for these patients. Surgery first entails treating the sequelae of Crohn's and is typically staged. In up to 60% of Crohn's pouches, particularly in fistulizing disease and/or recalcitrant perianal disease, the pouch fails and must be defunctioned or excised. In patients with Crohn's pouches in situ long term, outcomes including quality of life are comparable to patients who underwent IPAA for UC.
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0042-1758139
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Article ; Online: Lymph node recurrence after right colon resection for cancer: evidence for the utilisation of complete mesocolic excision.

Connelly, Tara M / Clancy, Cillian / Steele, Scott R / Kessler, Hermann

BMJ case reports

2022 Volume 15, Issue 5

Abstract: Complete mesocolic excision (CME) of colon cancer is a resection performed along embryological planes to include the completely intact mesentery surrounding the tumour with a high central vascular ligation. The aim is to remove all lymph nodes draining ... ...

Abstract	Complete mesocolic excision (CME) of colon cancer is a resection performed along embryological planes to include the completely intact mesentery surrounding the tumour with a high central vascular ligation. The aim is to remove all lymph nodes draining the cancer. Proponents of the technique cite the significantly decreased local recurrence and improved 5-year survival rates associated with CME versus conventional colectomy. Although increasingly performed in many centres, it has not yet gained widespread acceptance as it is technically more challenging and can incur an increased bleeding risk. A man in his 80s underwent a conventional right hemicolectomy for a pT4aN2aM0 ascending colon cancer at another institution. This was followed by chemotherapy. He presented to our institution 2 years later with an isolated 3.7×3.2 cm mesenteric tumour adjacent to his anastomosis. There was no intraluminal recurrence. He then underwent a repeat extended right colectomy with CME. Pathology confirmed lymph node recurrence. His case demonstrates the importance of CME in reducing carcinoma recurrence risk.
MeSH term(s)	Colectomy/methods ; Colonic Neoplasms/pathology ; Colonic Neoplasms/surgery ; Humans ; Laparoscopy/methods ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Male ; Mesocolon/pathology ; Mesocolon/surgery
Language	English
Publishing date	2022-05-12
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-247904
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Article ; Online: A giant colonic lipoma.

Connelly, Tara M / Clancy, Cillian / Hu, Shaomin / Sommovilla, Joshua

ANZ journal of surgery

2022 Volume 93, Issue 1-2, Page(s) 428–429

MeSH term(s)	Humans ; Colonic Neoplasms/diagnosis ; Colonic Neoplasms/surgery ; Colonoscopy ; Lipoma/diagnostic imaging ; Lipoma/surgery
Language	English
Publishing date	2022-07-01
Publishing country	Australia
Document type	Case Reports
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17880
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Article ; Online: An incidental infiltrating colonic lesion found during colonoscopy in a woman in her 30s.

Lincango, Eddy P / Connelly, Tara M / Cheong, Ju Yong / Kessler, Hermann

ANZ journal of surgery

2022 Volume 93, Issue 4, Page(s) 1050–1051

MeSH term(s)	Humans ; Female ; Colonoscopy/adverse effects ; Colonic Diseases/pathology ; Colonic Neoplasms/diagnosis ; Colonic Neoplasms/pathology ; Incidental Findings ; Colonic Polyps/pathology
Language	English
Publishing date	2022-10-14
Publishing country	Australia
Document type	Case Reports
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18093
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Article ; Online: The development and evaluation of a homemade laparoscopic endotrainer using the IDEAL framework and MISTELS scoring system: a pilot study.

Malik, Muhammad Usman / Connelly, Tara M / Awan, Naila Akhtar / Bhatti, Fatima Rizwan / Hayat, Rana Saddaqat / Awan, Hafiz Riaz Hussain

ANZ journal of surgery

2024 Volume 94, Issue 1-2, Page(s) 84–88

Abstract: Background: A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines.: Methods: The validated modified ( ... ...

Abstract	Background: A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. Methods: The validated modified (MISTELS) score was used to test the reliability of a low-cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1-6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. Results: 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test-retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895-0.981) and 0.64 (95% CI, 0.35-0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. Conclusion: It is possible to assemble a low-cost, reliable trainer at home to enhance laparoscopic skills during residency.
MeSH term(s)	Humans ; Male ; Young Adult ; Adult ; Female ; Pilot Projects ; Reproducibility of Results ; Prospective Studies ; Clinical Competence ; Laparoscopy ; Internship and Residency
Language	English
Publishing date	2024-01-15
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18865
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Article ; Online: The use of laparoscopy for T4a and T4b colon cancer: are we playing with fire?

Duraes, Leonardo C / Steele, Scott R / Valente, Michael A / Abdelaziz, Tareq / Connelly, Tara M / Kessler, Hermann

Surgical endoscopy

2023 Volume 37, Issue 7, Page(s) 5679–5686

Abstract: Background: The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, and particularly for T4b tumors when local invasion to adjacent structures occurs, remains controversial. This study aimed to compare ... ...

Abstract	Background: The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, and particularly for T4b tumors when local invasion to adjacent structures occurs, remains controversial. This study aimed to compare short and long-term outcomes in patients undergoing laparoscopic vs. open resection for T4a and T4b colon cancers. Methods: A prospectively maintained, single-institution database was queried to identify patients with pathological stage T4a and T4b colon adenocarcinomas electively operated on between 2000 and 2012. Patients were divided into two groups based on the use of laparoscopy. Patient characteristics, perioperative, and oncologic outcomes were compared. Results: One hundred and nineteen patients [41 laparoscopic (L), 78 open surgeries (O)] met the inclusion criteria. No difference was observed in age, gender, BMI, ASA, and procedure between groups. Tumors treated by L were smaller than O (p = 0.003). No difference was observed in morbidity, mortality, reoperation, or readmission between the groups. Length of hospital stay was shorter in L than O (6 vs. 9 days, p = 0.005). Conversion to open was necessary in 22% of all T4 tumors laparoscopic cases. However, when tumors were subdivided by pT4 classification, conversion was necessary for 4 of 34 (12%) pT4a patients vs. 5 of 7 (71%) pT4b patients (p = 0.003). In the pT4b cohort (n = 37), more tumors were treated by the open approach (30 vs. 7). For pT4b tumors, the R0 resection rate was 94% (86% in L vs. 97% in O, p = 0.249). The use of laparoscopy did not impact overall survival, disease-free survival, cancer-specific survival, or tumor recurrence overall in all T4 or T4a and T4b tumors. Conclusions: Laparoscopic surgery can be safely performed in pT4 tumors with similar oncologic outcomes as compared to open surgery. However, for pT4b tumors, the conversion rate is very high. The open approach may be preferable.
MeSH term(s)	Humans ; Neoplasm Recurrence, Local/surgery ; Colonic Neoplasms/pathology ; Disease-Free Survival ; Laparoscopy/methods
Language	English
Publishing date	2023-03-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-09944-5
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Article ; Online: Surgery for young onset diverticulitis: is it curative?

Connelly, Tara M / Cheong, Ju Yong / Lincango, Eddy P / Foley, Niamh / Duraes, Leonardo C / Kessler, Hermann

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 195

Abstract: Purpose: Previously considered a disease of old age, diverticular disease is increasingly prevalent in younger populations. Guidelines on surgical resection have shifted from recommending resection for all young onset patients to an individualized ... ...

Abstract	Purpose: Previously considered a disease of old age, diverticular disease is increasingly prevalent in younger populations. Guidelines on surgical resection have shifted from recommending resection for all young onset patients to an individualized approach. Therefore, we aim to determine demographics and outcomes including radiographic and surgical recurrence rates in patients < 40 years old undergoing resection for diverticular disease. Methods: A retrospective, single center study was performed. All patients ≤ 39 years undergoing operative intervention for left-sided diverticular disease between Jan 2010 and July 2017 were included. Recurrence was determined by individual review of imaging and operative reports. Results: Overall, 147 (n = 107/72.8% male, mean age = 34.93 ± 4.12 years) patients were included. The majority were ASA 1 or 2 (n = 41/27.9% and n = 82/55.8%). The most common surgical indication was uncomplicated diverticulitis (n = 77, 52.4%) followed by perforation (n = 26/17.7%). The majority (n = 108/73.5%) of cases were elective. Seventy-nine (57.3%) of all cases were performed laparoscopically. Primary anastomosis without diversion was the most common surgical outcome (n = 108/73.5%). Median length of stay was 5 (4, 7) days. There was no mortality. There were three (2.0%) intraoperative and 38 (25.9%) postoperative complications. The most common complication was anastomotic leak (n = 6/4.1%). The majority (n = 5) of leaks occurred after elective surgery. Two neoplastic lesions (1.3% of cohort) were found (1 adenoma with low-grade dysplasia/1 polyp cancer). Over a mean follow-up of 96 (74, 123) months, only 2 (1.3%) patients experienced a surgical or radiological recurrence. Conclusion: Both neoplasia and recurrence after resection for diverticular disease in young onset patients are rare. Leaks after primary anastomosis even in the elective setting warrant careful consideration of a defunctioning ileostomy.
MeSH term(s)	Humans ; Male ; Adult ; Female ; Retrospective Studies ; Diverticulitis/surgery ; Colectomy/methods ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Elective Surgical Procedures/adverse effects ; Diverticulitis, Colonic/surgery ; Diverticulitis, Colonic/complications ; Treatment Outcome
Language	English
Publishing date	2023-07-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-023-04479-6
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Article ; Online: Creating a Surgical Biobank: The Hershey Medical Center Experience.

Mankarious, Marc M / Connelly, Tara M / Harris, Leonard / Deiling, Sue / Yochum, Gregory S / Koltun, Walter A

Diseases of the colon and rectum

2023 Volume 66, Issue 9, Page(s) 1174–1184

Abstract: Background: Tissue harvesting at the time of surgery offers surgeons and scientists a unique opportunity to discover and better understand disease pathophysiology. Tissue biobanking presents challenges in patient consents, specimen collection, ... ...

Abstract	Background: Tissue harvesting at the time of surgery offers surgeons and scientists a unique opportunity to discover and better understand disease pathophysiology. Tissue biobanking presents challenges in patient consents, specimen collection, preparation, and storage, but the potential for scientific discovery justifies the effort. Although the number of tissue biobanks is increasing worldwide, information regarding necessary infrastructure, process flow, and management of expected obstacles is lacking. Objective: To provide a framework and motivation for clinician scientists intending to start an intestinal tissue biobank under their direction. Data sources: The Carlino Family Inflammatory Bowel and Colorectal Diseases Biobank is housed at the Milton S. Hershey Medical Center. Study selection: Review. Intervention: Implementation of a surgical tissue biobank at a large tertiary care institution. Main outcome measures: Assess critical challenges and obstacles over the years as well as keys to the success of the program. Results: Over 2 decades, the institutional biobank grew from an IBD biobank to one which now incorporates thousands of surgical specimens representing numerous colorectal diseases. This was done through a process of refinement focusing on patient recruitment and an efficient consenting and specimen management process. The biobank's success is further insured by institutional, external, and philanthropic support; scientific collaborations; and sharing of biological specimens with other groups of dedicated researchers. Limitations: This is a single-center experience in collecting surgically resected colorectal specimens. Conclusions: Surgical specimen biobanks are essential in studying disease cause using genomics, transcriptomics, and proteomic technologies. Therefore, surgeons, clinicians, and scientists should build biobanks at their institutions to promote further scientific discovery and improve specimen diversity.
MeSH term(s)	Humans ; Biological Specimen Banks ; Proteomics ; Specimen Handling ; Hospitals ; Colorectal Neoplasms
Language	English
Publishing date	2023-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002944
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