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surgery, patients underwent a regular follow up (range 12-26 months) for assessing recur-rence. Results: Two patients were lost during the follow up. RNA transcripts for MMP-7were detected in 31/57 samples (54%). Recurrence was diagnosed in 6 out of 55 patients(11%); 4 patients eventually died because of metastases or peritoneal dissemination. All the6 patients who had relapsed were positive for MMP-7. Sensitivity and specificity of the testwere 100% and 49% respectively. Conclusions: Positivity of MMP-7 in peritoneal cavitysamples could be a novel biomarker for predicting disease recurrence in patients with CRC.

Su1609

High-Dose Circumferential Chemodenervation (HDCC) of the Internal AnalSphincter: A New Treatment Modality for Uncomplicated Chronic AnalFissurePorter H. Glover, James Z. Whatley, Shou Jiang Tang, Eric D. Davis, Kellen T. Jex,Ruonan Wu, Christopher J. Lahr

Background: Botulinum toxin injection into the internal anal sphincter (IAS) is gainingpopularity as a second line therapy for chronic anal fissures after patients fail medical therapy.Although lateral internal sphincterotomy (LIS) can achieve a healing rate of 91-95%, it isassociated with fecal incontinence of 11%. The dosage of Botulinum toxin reported in theliterature ranged from 20-50 IU with no more than 3 injection sites and results in a healingrate of 65%-73% and recurrence rate of 35%. We propose a new injection method of high-dose circumferential chemodenervation (HDCC) of 100 IU in treating chronic anal fissure.Aim: We evaluate the fissure healing, complication, and recurrence rates with this newmethod during 6 months study period after each injection. Methods: Between 2008-2012,75 consecutive patients (32 Blacks, 42 Whites, 1 Native American) (50 Women, 25 Men)with complete follow-up data were included in this study. These patients presented withuncomplicated chronic anal fissure and underwent HDCC-IAS by a single colorectal surgeon.HDCC is an anoscopy assisted percutaneous injection involving greater than 8 injectionsites in a circumferential technique under anesthesia. Follow up data were obtained by chartreview and office follow up. Results: Of the 75 patients, the 1st injection success rate was90.6% at 3 months follow-up (Table 1). A few patients developed transient flatus or fecalincontinence, but shortly resolved. There was no major complication following HDCC-IAS including hematoma, infection, flatus, fecal, and urinary incontinence after 1 month.Conclusion: HDCC-IAS is a safe and effective method for uncomplicated chronic anal fissure.It's efficacy rivals reported LIS healing rate without the associated fecal incontinence. Inaddition, HDCC-IAS demonstrated far superior healing rates compared to standard injectionmethod without increased complication rate. Key Words: Botulinum toxin, anal fissure,injection, high-dose circumferential chemodenvervation (HDCC), internal anal sphincter,lateral internal sphincterotomy (LIS)Table 1. Treatment of uncomplicated chronic anal fissures with high-dose circumferentialchemodenervation (HDCC) of the internal anal sphincter

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Medication Use and the Risk of Diverticular Complications: A SystematicReviewCharlotte Kvasnovsky, Savvas Papagrigoriadis, Ingvar T. Bjarnason

Background and Purpose: Serious complications of colonic diverticula, namely bleeding andperforation, are a source of morbidity and mortality. A variety of drugs have been implicatedin these complications. We present a systemic review of the literature to assess the importanceof this relationship. Data Sources: A systematic review of articles using PubMed and CochraneReviews was undertaken in August 2012. Search terms included ‘diverticulitis, diverticulum,diverticulosis, diverticular perforation, diverticular bleed, OR ‘lower GI bleed' AND ‘acetamin-ophen, anti-thrombotic, cyclooxygenase-2 inhibitors, cox-2, aspirin, amino salicylic acid,ASA, nonsteroidal anti-inflammatory drugs, NSAID, steroid, corticosteroid, OR calciumchannel'. Study selection and Data Extraction: An initial search yielded 853 results that wereassessed for study design and topicality. A total off 23 articles were included in the review,including 74 subgroup analyses, where drug usage and specific complications were clearlydocumented. Data were extracted on these topics, as well as effect measures found. DataSynthesis: We performed a qualitative data synthesis with a forest plot when five or morestudies compared a single medication and similar patient complications. Results: There wereincreased odds of bleeding with the use of NSAIDs (range 2.01-12.6), acetaminophen (0-3.75), aspirin (1.14-3.70), and steroids (0.57-5.40). There were increased odds of perforationand abscess formation with NSAIDs (1.46-10.3), aspirin (0.66-2.40), steroids (2.17-31.9),and opioids (1.80-4.51). Limitations: Most studies did not describe duration or dosage ofmedications used, nor did they systematically describe the severity of diverticular complica-tions. Conclusions: A variety of common medications are implicated in colonic diverticularcomplications, rare, but occasionally devastating outcome in themany patients with diverticu-lar disease.

S-1072SSAT Abstracts

Su1611

Postoperative Bleeding After Colon and Rectal Surgery by PreoperativeDiagnosis: A Nationwide AnalysisNitin Kumar, Ashok Kumar, Christopher C. Thompson

Background: Colorectal surgery is performed for a wide array of gastrointestinal disease,in patients with varied preoperative fitness and comorbidity rates. Postoperative outcomes,including bleeding rates, are shaped by preoperative diagnosis in addition to operativefactors. Aims: To determine incidence of postoperative bleeding after colorectal surgery andanalyze outcomes in patients with postoperative bleeding by preoperative diagnosis. Meth-ods: This is a retrospective cohort study using the 2010 Nationwide Inpatient Sample (NIS),a nationally representative inpatient database. Adult patients were included if they had ICD-9 code for gastrointestinal malignancy, ulcerative colitis (UC), Crohn's disease (CD), ischemiccolitis (IC), diverticulitis, diverticulosis, or diverticular bleeding. Inclusion was limited topatients with ICD-9 procedure code for colectomy, proctectomy, or colostomy. Inclusionalso required ICD-9 code for intraoperative bleeding, intraoperative hematoma, or lowergastrointestinal bleeding during the postoperative period, as well as postoperative packedred blood cell transfusion. Charlson Comorbidity Index was calculated for each patient.Outcomes included rate of reoperation, incidence of shock, mortality, length of stay (LOS),and inpatient charge. Statistical significance was established if p,0.05. Results: 214,933patients met inclusion criteria. Of these, 1528 (0.7%) had postoperative bleeding requiringblood transfusion. Charlson score for patients with postoperative bleeding was 2.4 ±0.2 vs2.3 ±0.1 in patients without bleeding. Rate of postoperative bleeding, which was highest inpatients with IC, is shown by diagnosis in Table 1. Clinical outcomes are shown in Table2. Reoperation was significantly more frequent after bleeding in each diagnosis exceptdiverticulosis. Shock was more frequent after bleeding in patients who had surgery formalignancy and IC, but less frequent in patients with diverticular bleeding. Mortality wassignificantly more frequent after postoperative bleeding in patients with malignancy, CD,diverticulitis, and diverticular bleeding. Hospital outcomes are shown in Table 2. Length ofstay was significantly longer after postoperative bleeding in patients with malignancy anddiverticulitis; charge was significantly higher in patients with malignancy, CD, IC, anddiverticulitis. Conclusion: Preoperative diagnosis is associated with significant differencesin outcome in patients with postoperative bleeding after colorectal surgery. Rates of shockand mortality are significantly increased in patients with gastrointestinal malignancy andIC. Mortality is substantially increased in patients with CD, UC, diverticulitis, and diverticularbleeding. Further study is needed to better understand the reasons for this disparity and todevelop better management strategies.Table 1: Rate of postoperative bleeding by diagnosis

* denotes statistical significanceTable 2: Clinical outcomes

* denotes statistical significance