Resumo em Inglês:

Abstract Background Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second leading cause of cancer-related death worldwide. The adenoma detection rate (ADR), based on pathology-confirmed adenomas, is a key quality indicator for colonoscopy and a surrogate marker for its effectiveness in CRC prevention. Materials and Methods We conducted a retrospective cross-sectional study of all sedated colonoscopies performed at Mehrgan Hospital, Kerman, Iran, between 1399 and 1403 (2020–2024). Patient demographic data (age, sex) and histopathological findings were recorded. The ADR was calculated as the proportion of colonoscopies with at least one pathology-confirmed adenoma. Associations between ADR and demographic variables were assessed using Chi-squared and independent t-tests, with significance set at p < 0.05. Results A total of 6,428 sedated colonoscopies were reviewed (mean age: 53.5 ± 15.0 years; 47.3% male). The rate of pathology-confirmed ADR was 13.3%, being significantly higher in men than in women, also increasing with age, particularly among patients ≥ 45 years (p < 0.01). Tubular adenomas were the most common histologic subtype, followed by tubulovillous and villous. Conclusion The pathology-confirmed ADR observed in this study was within international quality benchmarks. Male sex and older age were significantly associated with higher detection rates. This underscores the need for targeted screening strategies and, potentially, earlier CRC screening initiation in Iran.

Resumo em Inglês:

Abstract Introduction Surgical site infection (SSI) is a common complication in colorectal surgery and is associated with increased morbidity, prolonged hospital stay, and adverse outcomes. Identifying factors associated with its occurrence is essential for developing effective prevention and treatment strategies. Materials and Methods This prospective observational study was conducted at the Coloproctology Unit of a university hospital and included patients undergoing abdominal colorectal surgery between January and December 2025. Clinical, surgical, and microbiological variables were analyzed for their association with SSI occurrence. Statistical significance was set at p < 0.05. Results The overall SSI rate was 15%. A statistically significant association was observed between it and procedures performed for peritonitis, intestinal transit reconstruction, and stoma closure (p = 0.014). Higher SSI rates were observed in patients with weight loss, smoking, obesity, hypoalbuminemia, elevated glycated hemoglobin levels, emergency surgery, perioperative blood transfusion, and anastomotic leakage, although these associations did not reach statistical significance. Most infections were superficial. The isolated microorganisms were generally susceptible to antimicrobial agents, except for a high resistance rate to amoxicillin–clavulanate. Conclusion As a frequent complication in colorectal surgery, SSI was significantly associated with procedures performed for peritonitis, intestinal transit reconstruction, and stoma closure. These findings highlight the importance of surgical indication and perioperative management in reducing infection risk.

Resumo em Inglês:

Abstract Introduction Ureteral injury during laparoscopic surgery for diverticular disease remains an uncommon but clinically significant issue. Chronic inflammation and fibrosis frequently obscure retroperitoneal anatomy. Objective To describe a workflow-integrated technique using a fully intraluminal indocyanine green (ICG)-emitting ureteral stent that enables on-demand overlay visualization using a single near-infrared (NIR) platform. Materials and Methods A fully intraluminal ICG-emitting ureteral stent was placed cystoscopically before surgery. During laparoscopy, NIR overlay mode was activated selectively at predefined high-risk steps: before peritoneal incision, during medial-to-lateral dissection around the inferior mesenteric vessels, and after colonic mobilization. Fluorescent signals were superimposed on white-light imaging to confirm ureteral position without interrupting dissection. Results Overlay visualization allowed rapid and repeatable confirmation of ureter location. Real-time shared situational awareness was improved for the entire operative team. No intraoperative ureteral injury occurred. Adverse events were limited to those attributable to cystoscopic stent placement. Conclusion On-demand overlay visualization using a fully intraluminal ICG-emitting ureteral stent represents a practical adjunct in laparoscopic surgery for complex diverticular disease. This technique supports organ-preserving surgery by enabling continuous dissection with real-time ureter awareness using a single imaging system.

Resumo em Inglês:

Abstract Introduction Recurrence after surgery for complex perianal fistulas remains common, frequently due to persistent cryptoglandular sepsis originating at the internal opening (IO) and intersphincteric space. Many sphincter-sparing techniques rely on closure or exclusion of the IO and may fail under sustained intraluminal pressure and fecal contamination. Objective To propose a testable, mechanism-based surgical hypothesis for complex perianal fistula management that emphasizes source decompression and continuous drainage, rather than anatomic closure. Materials and Methods Durable healing of complex perianal fistulas can be achieved by controlled decompression of the IO and intersphincteric sepsis, combined with maintenance of continuous, bidirectional drainage, thereby eliminating high-pressure contamination while preserving sphincter function. This treatment integrates limited, precisely controlled internal sphincterotomy with marsupialization of the IO to prevent reocclusion, together with gentle curettage of the residual tract to remove chronic, nonviable tissue. Unlike closure-based procedures, this approach intentionally promotes decompression and sustained flow. Conclusion Grounded in established principles underlying seton drainage and limited fistulotomy, this strategy represents a low-morbidity conceptual alternative suitable for prospective clinical evaluation.