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  1. Article ; Online: State of the Art: Pouch Surgery in the 21st Century.

    Maspero, Marianna / Hull, Tracy L

    Diseases of the colon and rectum

    2024  

    Abstract: Background: An ileoanal pouch with ileal pouch-anal anastomosis is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience ... ...

    Abstract Background: An ileoanal pouch with ileal pouch-anal anastomosis is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations.
    Objective: To review the main changes in pouch surgery during the last two decades, with focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration.
    Results: The decision on the number of stages depends on the patient's conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open in the hostile pelvis. The J pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn's disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications.
    Conclusions: Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each individual patient. See video from symposium.
    Language English
    Publishing date 2024-03-05
    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.0000000000003326
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical approach to patients with an ileal pouch.

    Maspero, Marianna / Hull, Tracy L

    Abdominal radiology (New York)

    2023  Volume 48, Issue 9, Page(s) 2918–2929

    Abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis is the procedure of choice to maintain intestinal continuity when a total proctocolectomy is a required. It is a technically challenging operation that may be burdened by several nuanced ... ...

    Abstract Restorative proctocolectomy with ileal pouch-anal anastomosis is the procedure of choice to maintain intestinal continuity when a total proctocolectomy is a required. It is a technically challenging operation that may be burdened by several nuanced complications both in the immediate postoperative period and in the long term. Most patients with a pouch and any kind of complication will undergo radiological studies, thus multidisciplinary collaboration between surgeons, gastroenterologists, and radiologists is paramount to their timely and accurate diagnosis. When treating pouch patients, radiologists should be familiar with regular pouch anatomy and its appearance in imaging studies, as well as with the most common complications that can occur in this population. In this review, we examine the clinical decision-making process at each step before and after pouch creation, as well as the most common complications associated with pouch surgery, their diagnosis, and their management.
    MeSH term(s) Humans ; Anastomosis, Surgical/adverse effects ; Colonic Pouches ; Proctocolectomy, Restorative/methods ; Postoperative Complications/epidemiology ; Treatment Outcome
    Language English
    Publishing date 2023-04-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2839786-1
    ISSN 2366-0058 ; 2366-004X
    ISSN (online) 2366-0058
    ISSN 2366-004X
    DOI 10.1007/s00261-023-03888-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Patient-Reported Outcomes in Colorectal Surgery.

    Maspero, Marianna / Hull, Tracy

    Clinics in colon and rectal surgery

    2023  Volume 36, Issue 4, Page(s) 240–251

    Abstract: Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an ... ...

    Abstract Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an intervention will have on the quality of life of patients. Endpoints that take into account the patient's perspective are defined as patient-reported outcomes (PROs). PROs are assessed through patient-reported outcome measures (PROMs), usually in the form of questionnaires. PROs are especially important in colorectal surgery, whose procedures can often be associated with some degree of postoperative functional impairment. Several PROMs are available for colorectal surgery patients. However, while some scientific societies have offered recommendations, there is no standardization in the field and PROMs are seldom implemented in clinical practice. The routine use of validated PROMs can guarantee that functional outcomes are followed over time; this way, they can be addressed in case of worsening. This review will provide an overview of the most commonly used PROMs in colorectal surgery, both generic and disease specific, as well as a summary of the available evidence in support of their routine utilization.
    Language English
    Publishing date 2023-02-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2048635-2
    ISSN 1531-0043
    ISSN 1531-0043
    DOI 10.1055/s-0043-1761607
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: ASO Author Reflections: A Green Eye on Lymphadenectomy for Gastric Cancer.

    Sposito, Carlo / Maspero, Marianna / Mazzaferro, Vincenzo

    Annals of surgical oncology

    2023  Volume 30, Issue 11, Page(s) 6812–6813

    MeSH term(s) Humans ; Stomach Neoplasms/surgery ; Lymph Node Excision
    Language English
    Publishing date 2023-07-18
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-13949-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Patient-Reported Outcomes in Colorectal Surgery

    Maspero, Marianna / Hull, Tracy

    Clinics in Colon and Rectal Surgery

    (Defining and Measuring Quality in Colorectal Surgery)

    2023  Volume 36, Issue 04, Page(s) 240–251

    Abstract: Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an ... ...

    Series title Defining and Measuring Quality in Colorectal Surgery
    Abstract Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an intervention will have on the quality of life of patients. Endpoints that take into account the patient's perspective are defined as patient-reported outcomes (PROs). PROs are assessed through patient-reported outcome measures (PROMs), usually in the form of questionnaires. PROs are especially important in colorectal surgery, whose procedures can often be associated with some degree of postoperative functional impairment. Several PROMs are available for colorectal surgery patients. However, while some scientific societies have offered recommendations, there is no standardization in the field and PROMs are seldom implemented in clinical practice. The routine use of validated PROMs can guarantee that functional outcomes are followed over time; this way, they can be addressed in case of worsening. This review will provide an overview of the most commonly used PROMs in colorectal surgery, both generic and disease specific, as well as a summary of the available evidence in support of their routine utilization.
    Keywords patient-reported outcomes ; patient-reported outcome measures ; colorectal surgery
    Language English
    Publishing date 2023-02-08
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2048635-2
    ISSN 1530-9681 ; 1531-0043
    ISSN (online) 1530-9681
    ISSN 1531-0043
    DOI 10.1055/s-0043-1761607
    Database Thieme publisher's database

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  6. Article ; Online: Third Time's the Charm? Indications and Outcomes for Redo-Redo IPAA.

    Maspero, Marianna / Lavryk, Olga / Holubar, Stefan D / Lipman, Jeremy M / Steele, Scott R / Hull, Tracy

    Diseases of the colon and rectum

    2024  Volume 67, Issue 6, Page(s) 805–811

    Abstract: Background: Up to 20% to 40% cases of redo IPAA procedures will result in pouch failure. Whether to offer a second redo procedure to maintain intestinal continuity remains a controversial decision.: Objective: To report our institutional experience ... ...

    Abstract Background: Up to 20% to 40% cases of redo IPAA procedures will result in pouch failure. Whether to offer a second redo procedure to maintain intestinal continuity remains a controversial decision.
    Objective: To report our institutional experience of second redo IPAA procedures.
    Design: This was a retrospective review. Patient-reported outcomes were compared between patients undergoing second redo procedures and those undergoing first redo procedures using propensity score matching to balance the 2 cohorts.
    Settings: Tertiary referral center.
    Patients: Patients who underwent second redo IPAA procedures between 2004 and 2021 were included in this study.
    Interventions: Second redo IPAA.
    Main outcome measures: Pouch survival and patient-reported outcomes were measured using the Cleveland Global Quality of Life survey.
    Results: Twenty-three patients were included (65% women), 20 (87%) with an index diagnosis of ulcerative colitis and 3 (13%) with indeterminate colitis. The final diagnosis was changed to Crohn's disease in 8 (35%) cases. The indication for pouch salvage was the same for the first and second redo procedures in 21 (91%) cases: 20 (87%) patients had both redo IPAAs for septic complications. After a median follow-up of 39 months (interquartile range, 18.5-95.5 months), pouch failure occurred in 8 (30%) cases (7 cases due to sepsis, of whom 3 never had their stoma closed, and 1 case due to poor function); all patients who experienced pouch failure underwent the second redo procedure due to septic complications. Overall pouch survival at 3 years was 76%: 62.5% in patients with a final diagnosis of Crohn's disease versus 82.5% in patients with ulcerative/indeterminate colitis ( p = 0.09). Overall quality-of-life score (0-1) was 0.6 (0.5-0.8). Quality of life and functional outcomes were comparable between first and second redo procedures, except incontinence, which was higher in second redo procedures.
    Limitations: Single-center retrospective review.
    Conclusions: A second pouch salvage procedure may be offered with acceptable outcomes to selected patients with high motivation to keep intestinal continuity. See Video Abstract .
    La tercera es la vencida indicaciones y resultados de la rereconfeccion de la anastomosis anal con bolsa ileal: ANTECEDENTES:Hasta un 20-40% de los casos de rehacer anastomosis anal con bolsa ileal (IPAA) resultarán en falla de la bolsa. La posibilidad de ofrecer un segundo procedimiento para mantener la continuidad intestinal sigue siendo una decisión controvertida.OBJETIVO:Reportar nuestra experiencia institucional de una segunda re-confección de la anastomosis anal con bolsa ileal.DISEÑO:Revisión retrospectiva; los resultados informados por los pacientes se compararon entre los pacientes que se sometieron a una segunda re-confeccion con los de los pacientes que se sometieron a una la primera re-confeccion utilizando el puntaje de propensión para equilibrar las dos cohortes.AJUSTES ENTORNO CLINICO:Centro de referencia terciario.PACIENTES:Pacientes que se sometieron a una segunda re-confeccion de de la anastomosis anal con bolsa ileal entre 2004 y 2021.INTERVENCIONES:Segunda re-confeccion de la anastomosis anal con bolsa ileal.PRINCIPALES MEDIDAS DE RESULTADO:Supervivencia de la bolsa, resultados informados por los pacientes medidos mediante la encuesta Cleveland Global Quality of Life.RESULTADOS:Se incluyeron veintitrés pacientes (65% mujeres), 20 (87%) con diagnóstico inicial de colitis ulcerosa y 3 (13%) con colitis indeterminada. El diagnóstico final se cambió a enfermedad de Crohn en ocho (35%) casos. La indicación para el rescate de la bolsa fue la misma para la primera y segunda re-confeccion en 21 (91%) casos: 20 (87%) pacientes tuvieron ambas re-confecciones de la anastomosis anal con bolsa ileal por complicaciones sépticas. Después de una mediana de seguimiento de 39 meses (RIC 18,5 - 95,5), se produjo falla de la bolsa en 8 (30%) casos (7 casos debido a sepsis, de los cuales 3 nunca cerraron el estoma y 1 caso debido a una mala función); todos los pacientes que experimentaron falla de la bolsa se sometieron a una segunda re-confeccion debido a complicaciones sépticas. La supervivencia global de la bolsa a los 3 años fue del 76%: 62,5% en pacientes con diagnóstico final de enfermedad de Crohn, versus 82,5% en colitis ulcerativa/indeterminada ( p = 0,09). La puntuación general de calidad de vida (0 -1) fue 0,6 (0,5 - 0,8). La calidad de vida y los resultados funcionales fueron comparables entre la primera y la segunda re-confeccion, excepto la incontinencia, que fue mayor en la segunda re-confeccion.LIMITACIONES:Revisión retrospectiva de un solo centro.CONCLUSIONES:Se puede ofrecer un segundo procedimiento de rescate de la bolsa con resultados aceptables a pacientes seleccionados con alta motivación para mantener la continuidad intestinal. (Traducción- Dr. Francisco M. Abarca-Rendon ).
    MeSH term(s) Humans ; Female ; Reoperation/statistics & numerical data ; Male ; Retrospective Studies ; Proctocolectomy, Restorative/methods ; Proctocolectomy, Restorative/adverse effects ; Adult ; Colonic Pouches/adverse effects ; Quality of Life ; Middle Aged ; Colitis, Ulcerative/surgery ; Crohn Disease/surgery ; Patient Reported Outcome Measures ; Postoperative Complications/epidemiology ; Propensity Score
    Language English
    Publishing date 2024-02-16
    Publishing country United States
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000003165
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Reply: Acute rejection after transplantation of machine perfused livers-We have barely scratched the surface.

    Maspero, Marianna / Hashimoto, Koji / Fairchild, Robert L / Schlegel, Andrea

    Hepatology (Baltimore, Md.)

    2023  Volume 78, Issue 4, Page(s) E69–E71

    MeSH term(s) Liver ; Liver Transplantation ; Perfusion ; Graft Rejection/prevention & control
    Language English
    Publishing date 2023-05-26
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 604603-4
    ISSN 1527-3350 ; 0270-9139
    ISSN (online) 1527-3350
    ISSN 0270-9139
    DOI 10.1097/HEP.0000000000000483
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  8. Article ; Online: Reply: Acute rejection after liver transplantation with machine perfusion versus static cold storage: A systematic review and meta-analysis.

    Maspero, Marianna / Hashimoto, Koji / Fairchild, Robert L / Schlegel, Andrea

    Hepatology (Baltimore, Md.)

    2023  Volume 79, Issue 2, Page(s) E32

    MeSH term(s) Liver Transplantation ; Kidney Transplantation ; Kidney ; Perfusion ; Liver
    Language English
    Publishing date 2023-10-09
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 604603-4
    ISSN 1527-3350 ; 0270-9139
    ISSN (online) 1527-3350
    ISSN 0270-9139
    DOI 10.1097/HEP.0000000000000630
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  9. Article ; Online: Reply: Acute rejection in liver transplantation: Time for uniform definitions.

    Maspero, Marianna / Hashimoto, Koji / Fairchild, Robert L / Schlegel, Andrea

    Hepatology (Baltimore, Md.)

    2023  Volume 78, Issue 3, Page(s) E53–E54

    MeSH term(s) Humans ; Liver Transplantation ; Liver ; Time Factors ; Graft Rejection ; Acute Disease
    Language English
    Publishing date 2023-06-05
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 604603-4
    ISSN 1527-3350 ; 0270-9139
    ISSN (online) 1527-3350
    ISSN 0270-9139
    DOI 10.1097/HEP.0000000000000500
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  10. Article ; Online: Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis.

    Maspero, Marianna / Otero Piñeiro, Ana / Steele, Scott R / Hull, Tracy L

    Diseases of the colon and rectum

    2023  Volume 66, Issue 5, Page(s) 631–645

    Abstract: Background: A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several ... ...

    Abstract Background: A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established, and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, which is the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulas, but literature on the subject is scarce, mainly consisting of small case series.
    Objective: This study aimed to assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula.
    Data sources: MEDLINE, Embase, Cochrane Library, and Web of Science.
    Study selection: Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions was applied.
    Intervention: Gracilis muscle interposition.
    Main outcome measures: The primary outcome is the fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, and sexual function.
    Results: Twenty studies were included for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53%-74%; range, 33%-100%). Risk factors for failure were smoking, underlying Crohn's disease, and more than 2 previous repairs, whereas stoma formation was associated with improved outcomes. Postoperative complications ranged from 0% to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, but impairment of sexual function was common.
    Limitations: Most of the included studies were small case series.
    Conclusions: Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent rectovaginal fistula.
    Registration no: CRD42022319621.
    MeSH term(s) Female ; Humans ; Rectovaginal Fistula/etiology ; Gracilis Muscle ; Quality of Life ; Treatment Outcome ; Postoperative Complications
    Language English
    Publishing date 2023-02-03
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002739
    Database MEDical Literature Analysis and Retrieval System OnLINE

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