Abstract Pilonidal sinus is the term first used by Hodges in 1880 to describe a granulomatous lesion containing hairs. It has been previously described as hair extracted from an ulcer andreferredtoasJeep’s disease, in world war days. Pilonidal sinus is the condition in which a sinus or fistula is situated at a short distance from the anus and generally contains hairs. It is commonly observed in the sacrococcygeal region and a few other sites, such as the axilla, umbilicus, face, etc. Its presence elsewhere is uncommon. Predisposing factors are traumatized, hairy skin, which leads entry of the hair inside the wound, thus forming a sinus. A 31-year-old patient presented with discharging endoanal sinus tract, which, on exploration, turned out to be an endoanal pilonidal sinus containing hair tufts, a rare case. The patient complained of recurrent pus discharge and anal pain for 45 days, reporting history of travelling around 70 km daily in a two-wheeler vehicle. On first physical evaluation, a small endoanal bulge was found. It was located at 1 o’clock in lithotomy position (anterior), with purulent discharge and anterior anal fissure. For confirmation, an endoanal ultrasonography (USG) was performed, which showed a sinus tract containing internal echoes and gas bubbles with a small amount of pus. The sinus was explored, and a wide excision was made and left open for secondary healing. Pilonidal sinus of the anal canal is a rare entity, and it can be found in hairy patients who are used to going on long, daily rides on two wheeled vehicles.

Abstract Introduction and Objective In most cases, due to the failure of nonsurgical methods in the treatment of diseases related to the colon, it is necessary to perform colostomy as the main treatment method. However, this surgery can cause a wide range of physical, social, and psychological problems in patients. Therefore, in order to prevent and treat the complications of colostomy, it is necessary to adopt measures in the field of self-care and continuous education for patients to control the complications of the disease, seek treatment, and experience improvements in their quality of life. Additionally, considering the role of mobile health (mHealth) applications in facilitating continuous and effective training, and improving self-care for these patients, the aim of the present study was to design and evaluate an mHealth application for self-care of colostomy patients. Materials and Methods In the present applied research, first the functional requirements of the software were determined considering the self-care requirements of colostomy patients. Then, the software was designed based on object-oriented analysis, and according to it, the application was coded in Java and developed in the Android Studio environment. Finally, to evaluate the software, the opinions and comments of 5 gastroenterologists and 10 adult colostomy patients in the age range between 27 and 64 years who had at least a high school diploma were used as the basis of judgment at this stage. The instruments used in the evaluation included a checklist, derived from three standard questionnaires (the System Usability Scale [SUS], the mHealth App Usability Questionnaire [MAUQ], and the User Version of the Mobile Application Rating Scale [uMARS]) to measure the user-friendliness indicator, and a researcher-made checklist to measure the performance indicator of the various services provided. Results The services of the software developed include the provision of medical information and self-care instructions regarding colostomy surgery, as well as alerts for the user to schedule an appointment with a doctor and the time to take medications. Based on the results of the evaluation stage, the users were generally satisfied with the interface, services, and general features of the software. In general, the software was evaluated at the “acceptable” level, with a rate of 85%. Discussion and Conclusion Based on the findings of the current research, thesoftware developed can be significantly effective in facilitating the education of colostomy patients and improving their self-care. Proper and continuous self-care and education for colostomy patients is necessary to prevent and control complications resulting from surgery and to improve their quality of life. Therefore, in addition to patients, all health care staff, organizations, and associations which support colostomy patients can also use this software to educate patients and improve the care provided to them.

Abstract Objective To describe the pro file of surgeons who treat patients with inflammatory bowel disease as well as the characteristics of inflammatory bowel disease care, unmet demands, and difficulties. Methods The research participants answered a Google Forms questionnaire. Results Of the 99 surgeons who participated in the survey, 84.5% were coloproctologists, 40% were from the southeastern region of Brazil, and 77.7% were male and had been working for more than 19 years. Regarding the healthcare sector, 63.6% of surgeons worked in both public and private clinics, and most clinically cared for up to 50 patients with inflammatory bowel disease and operated on up to 5 cases per year. Conclusion This is the first national study that aimed to identify the profile of surgeons working with inflammatory bowel disease in Brazil. The vast majority are experienced male coloproctologists, located in the southern and southeastern regions, who perform clinical and surgical treatment of these pathologies, with major surgeries being performed in large centers by a small number of surgeons.

Abstract Introduction Surgical site infections (SSIs) remain a significant concern in colorectal surgery, impacting patient outcomes and healthcare costs. Mechanical bowel preparation (MBP) and antibiotic prophylaxis are widely used strategies to reduce the incidence of SSIs. However, their effectiveness and the associated risks continue to be topics of debate within the medical community. This review aims to assess the current evidence on the use of MBP and antibiotics in preventing SSIs during colorectal procedures, highlighting the benefits, controversies, and ongoing discussions in the field. Objective This review evaluates the effectiveness and controversy surrounding the use of mechanical bowel preparation (MBP) and antibiotic prophylaxis in preventing surgical site infections (SSIs) during colorectal procedures. Methodology The review looks at a variety of research, such as meta-analyses and trials, and examines the timing, choice of antibiotics, and various facets of MBP. Findings Prophylactic antibiotic use considerably lowers SSIs; however, resistance issues are raised. MBP works well, but there are debates over the risks involved. With continuous discussions, combined antibiotic-MBP methods are prevalent. Conclusion the evaluation acknowledges the potential for prevention but emphasizes the need for careful use that takes patient variables into account. Optimal techniques are the subject of ongoing study, which emphasizes the dynamic nature of SSI prevention in colorectal surgery.

Abstract Introduction and Objectives Certolizumab Pegol (CZP) is an anti-TNF agent approved in Brazil for Crohn's disease (CD). There is a lack of data in Brazil and Latin America detailing real-world experiences with CZP. The primary objective was clinical remission in weeks 26 and 54. The secondary endpoints were clinical response in weeks 26 and 54, endoscopic remission, biological switch rates, rates of CD-related surgery, persistence with treatment over time, and adverse events. Remission and clinical response were defined as HBI ≤4 and ≥3 points reduction of HBI, respectively. Endoscopic remission was defined as the complete healing of the intestinal mucosa. Methods This observational and retrospective study included patients with CD from 4 Brazilian centers who received CZP during their disease course. Results Forty-five patients were included. The median age was 42.16 years old, 53.3% had perianal involvement, 37.8% had undergone previous surgery, and 71.1% of patients were anti-TNF naïve. Clinical remission was observed in 73.2% and 62.5% of patients at weeks 26 and 54, respectively. Clinical response was observed in 14.63% and 18.75% in weeks 26 and 54, respectively. Endoscopic remission was observed in 36.4% of patients. A switch to biological therapy was performed in 57.8% of patients. Eleven patients underwent abdominal surgery; 62.25% discontinued treatment with CZP, with a median of 16 months, and 22.2% presented drug-related adverse events. Conclusions CZP in CD was associated with clinical remission and response rates compatible with international real-world case series. Most patients needed to switch to biological therapy due to inadequate disease control.

Abstract Introduction The involvement of circular RNAs (circRNAs) in cancer research has been emphasized in recent years due to evidence of their involvement in malignancy pathogenesis. Yet, the involvement of circRNAs in the resistance to cancer treatment remains to be clarified. Circular RNA 0001313 (circ_0001313) has a distinct expression in different cancers, and it is overexpressed in rectal cancer; hence, it could be a promising non-invasive stable biomarker and a therapeutic target for rectal cancer. Yet, its predictive role has not been studied in Egyptian rectal cancer patients. Objective To study the predictive value of circulating circ_0001313 (circ_CCDCC6) in assessing the response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer and its relation to radiological and pathological response. Materials and Methods The present study included 50 patients with locally advanced rectal cancer and 20 healthy subjects as controls. The analysis of the relative circ_CCDCC6 expression was performed using the real-time quantitative polymerase chain reaction (qPCR) method. Results The circ_CCDCC6 was found to be significantly more expressed in rectal cancer patients compared with controls (p < 0.001). Moreover, its expression level was significantly higher in nonresponders to nCRT compared with responders (p < 0.001). Furthermore, a receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of circulating circ_0001313; its sensitivity in predicting the response to treatment was of 93.33%, and its specificity was of 91.43%. Conclusion Significant up-regulation of circ_0001313 in rectal cancer suggests a potential oncogenic role, and higher expression of circ_0001313 among nonresponders suggests that it could be a predictor of the response to nCRT.

Abstract Introduction Intestinal ostomy represents the externalization of the intestine to the abdominal wall. Objective To analyze the clinical and epidemiological profile of patients who underwent intestinal ostomy construction from 2010 to 2023 at the Hospital Universitario Santa Terezinha (HUST) in Joaçaba, Santa Catarina. Method This is a quantitative study with a cross-sectional approach through access to medical records of patients undergoing intestinal ostomy surgery from 2010 to 2023. Descriptive and association analyses were performed using JASP 0.18.1 software. Results Three hundred and seventy-one (371) patients, predominantly male (58.8%), were included in this study. At the time of surgery, the average age was 60.4 years. The younger patient was 13 years old, while the older patient was 97 years old. Most of the hospitalizations were due to neoplasms, with emphasis on colorectal neoplasia (39.6%), with a predominance of ileostomies (54.4%). A significant increase of this type of surgery (p = 0.013) was noted, coincidently with the SARS-CoV-2 virus pandemic. Conclusions Males and elderly people who underwent ileostomy due to colorectal neoplasia, were predominant, most of which were permanent. There was an increase in the number of ostomy cases during the SARS-CoV-2 pandemic in the region. Such conditions may be associated with gastrointestinal complications, with a high potential for enteral surgery under unfavorable conditions.

Abstract Many technical propositions have been incorporated to the surgical management of hemorrhoidal disease during the recent decades. Besides that, escisional techniques are still considered the best option to control symptoms and reduce recurrence. The present manuscript aims to propose a technical modification of the classical closed hemorrhoidectomy described by Ferguson in America. Our proposition is to perform two sutures to close the wound resulting from hemorrhoidal resection. The first one consists of an anchored continuous suture using a very thin (4–0 or 5–0) monofilamentar thread coming from inside to the outside skin. After tying the stitch, a simple continuous second suture is made over the previous suture only for mucosal approximation, from outside to inside. Finally, the stich that initiated the first suture is tied up to the stich used for the second suture, and the knot remains located above the dentate line, not to disturb the patient. The confection of two layers aims to reinforce the closing of the wound and avoid dehiscence. The idea is that this modification influences postoperative outcomes by reducing symptoms such as wound discharge and pain, and thus improving healing and esthetics. In a next step research, a comparison with the classical technique may bring new insights to this issue.

Abstract Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions affecting the digestive tract. This study examines 188 IBD patients in a private healthcare service in Canoas/RS, Brazil, aiming to understand their clinical profiles. Most patients were young adults, primarily white, with more women affected. Both CD and UC patients commonly experienced diarrhea, but blood in stools was more prevalent in UC. CD mostly affected the small intestine, while UC involved the rectum or extended through the colon. The diagnosis was prompt, with most CD cases diagnosed within six months and UC cases within twelve months of symptom onset. Family histories of IBD and colorectal cancer were observed, particularly in CD patients. Extraintestinal manifestations were more frequent in CD. Elevated CRP levels were common in CD, while FC values were elevated in both groups. Treatment approaches differed, with 5-ASA primarily used in UC and immunomodulators in CD. Biological therapy was less commonly employed initially. This study aligns with global IBD trends in demographics, symptoms, and disease locations. Early diagnosis likely results from specialized private healthcare, emphasizing the importance of timely diagnosis and tailored treatment.

Abstract Granular cell tumors are rare soft tissue tumors with neural origin that present malignant potential. Perianal granular cell tumors with only subcutaneous involvement are uncommonly presented in the literature. Herein, we present the case of a 49-year-old female patient with perianal granular cell tumor of the buttock. The patient underwent successful surgical resection and remains under close postoperative follow-up. There is no standard diagnostic algorithm for these tumors, and imaging provides little benefit. Histopathology and immunohistochemical staining are necessary for the accurate diagnosis of granular cell tumors.

Abstract Objective To present a rare case of anal squamous cell carcinoma (SCC) in a young pregnant woman. Material and Methods The information was collected based on the clinical record after obtaining the informed consent of the patient. Results This is the case of a 34-year-old pregnant woman with stage IIIB anal SCC. She was treated with chemotherapy before delivery, followed by cesarean section and chemoradiotherapy after birth. The patient experienced complete clinical and imaging regression after treatment, but she presented early tumor regrowth requiring abdominoperineal amputation, with negative surgical margins. Discussion The treatment of anal cancer in pregnant women is based on a multidisciplinary approach, adapting current clinical guidelines. It establishes a challenge from an ethical point of view that must consider the impact on the health of the mother and the fetus. Anal screening in carriers of cervical pathology due to papilloma virus would be a good tool for early detection.

Abstract Introduction Colorectal cancer (CRC) is the third most prevalent tumor. Right colon cancer (RCC) comprises one-third of CRC cases and is associated with poorer outcomes, emphasizing the need for optimized treatment strategies. The present study aims to explore the nuances in the management of RCC across Portugal, focusing on surgical approaches and multidisciplinary treatment. Materials and Methods The CodiReal-PT was a cross-sectional survey-based study adhering to the guidelines of the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), focusing on current practices in RCC oncological surgery. The survey comprised 31 questions divided into 4 sections (demographics, multidisciplinary approach, surgery practices regarding RCC, and postoperative management). It was made available via e-mail to all active members of the Portuguese Society of Surgery (Sociedade Portuguesa de Cirurgia, SPCIR, in Portuguese), and data collection lasted from November to December 2022. Results Data from 69% of Portuguese public hospitals was obtained. All the participant hospitals had multidisciplinary team meetings to manage CRC cases. However, 17% (n = 6) did not discuss all elective-setting cases during their meetings. Dedicated colorectal surgical teams were present in 86% (n = 31) of hospitals. Furthermore, the presence of these dedicated teams was associated with better practices, namely a higher volume of right colectomies (mean: 51.8 ± 32.6 versus 23.8 ± 4.8; p = 0.001), a preference for the laparoscopic approach (93.5 versus 60.0%; p = 0.021), and standardization of anastomotic techniques (83.9 versus 40.0%; p = 0.029). Conclusion The present nationwide survey-based study provides a comprehensive landscape of RCC management practices across Portugal, underscoring the significant role of dedicated colorectal surgical teams and the need for further practice standardization. Nevertheless, multidisciplinary team meetings in all surveyed hospitals are an important indicator of improved RCC care. Future research should focus on the impact of specific surgical techniques on oncological outcomes and the potential benefits of centralizing care to high-volume centers.

Abstract Introduction Despite the high prevalence and severity of colorectal cancer (CRC), the public is mostly unaware of its prevention and screening. Objective To determine the level of knowledge regarding CRC prevention and screening among staff at a reference cancer center. Materials and Methods A cross-sectional study was conducted in a reference cancer center. Employees aged 18 and up who had worked at the oncology center for at least one year were given a questionnaire containing sociodemographic and evaluative questions about CRC prevention and screening. Results The sample comprised 266 employees, with a median age of 45 (53.00–35.75) years of age. Most of the staff (76.3%) were female, had at least a year of experience at the health facility (74.1%), and agreed on the definition of CRC. Inflammatory bowel illness was the least commonly recognized risk factor (67.6%). Most of the sample (56%) recognized all 5 warning flags. Colonoscopy was the most popular screening test (98.7%). Although the health center does not offer official CRC education, most of the staff (42.1%) reported learning about CRC while working. There was no difference in perceptions of the optimal age to begin screening between employees 45 years or older and those younger (p = 0.729). Higher-educated employees were more knowledgeable about CRC (p = 0.001). Conclusion In a reference cancer center, the staff members who work directly with patients as well as those with higher levels of schooling have a satisfactory level of knowledge regarding CRC prevention and screening.

Abstract Introduction Ulcerative colitis (UC) is an inflammatory bowel disease that causes long-lasting inflammation and ulcers within the digestive tract. This study aims to determine the histochemical alteration of Salvia officinalis (sage), an anti-inflammatory and antioxidant herbal agent on UC. Materials and Methods The disease was induced in 37 Sprague-Dawley rats with 2 mL of 3% acetic-acid (AA) enema. The rats were divided into five groups: a control group (AA), two 5-aminosalicylic (5-ASA) groups treated either orally (AO) or rectally (AR) with a dose of 100 mg/kg, and two salvia groups treated with 300mg/kg salvia orally (SO) or rectally (SR). Histopathological analyses of the colon were done on day 7, and markers such as C-reactive protein (CRP), superoxide dismutase (SOD), and complete blood count were measured. Result In macroscopic evaluation, the AO group demonstrated the lowest involvement, followed by the SO, SR, AR, and AA groups, respectively (p = 0.01). There was no significant difference between the SO and AO groups (p = 0.10), and the SR and AR groups (p = 0.58). Regarding microscopic histopathological findings, the AO and SO group demonstrated the most satisfactory results, with no significant difference between the AO versus SO, and AR versus SR groups. Inflammation was resolved in all of the AO and SO subjects. Conclusion Salvia can be beneficial in the treatment course of UC by inhibiting inflammatory responses, increasing the growth and viability of intestinal mucosa, and its antioxidant effects. Therefore, we propose the prescription of salvia as an adds-on or alternative therapy in the management of UC.

Abstract Introduction Appendicitis is the surgical disease with the highest prevalence in emergency rooms. Its clinical and/or surgical complications are associated with the time course of symptoms, age, comorbidities, and stages of the disease. Objectives To analyze the demographic and clinical data of patients who underwent appendectomy for acute appendicitis in a tertiary referral hospital in the city of São Paulo and compare these data between services provided by the Public and Supplementary Health System. Methodology Retrospective analysis of data from electronic medical records of patients over 14 years old who underwent appendectomy for acute appendicitis at Hospital Santa Marcelina, both in the Public and Supplementary Health Systems from January 2015 to December 2017. Results A total of 536 patients were analyzed, 354 (66%) of whom were male with a general mean age of 29.85 years (14-81 years). The mean time from symptoms to seeking medical care was 53.84 hours. Regarding the phases of acute appendicitis, a greater number of cases of complicated disease was observed in patients operated on in the Public Health System (p < 0.0001), as well as the time course of symptoms (p = 0.0005) and Conclusion There was a predominance of male patients undergoing appendectomy for acute appendicitis, with longer time course of symptoms in those operated on in the Public Health System and a predominance of appendicitis in advanced stages (3 and 4) in this group. However, in this group there was no significant increase in the rate of postoperative infection, and the length of stay was shorter than that of patients operated on in the Supplementary Health System.