30-Second Takeaway
- Funnel-shaped intra-abdominal mesh at colostomy creation substantially lowers 3-year parastomal hernia without added complications.
- Modern 5- and 10-year surgical recurrence after primary ileocolic resection for Crohn ileitis is lower than historically reported.
- LCI plus computer-aided detection meaningfully reduces proximal adenoma and polyp miss rates compared with white-light colonoscopy.
- Contrast-enhanced rectal MRI with the Avocado sign markedly improves mesorectal nodal staging accuracy over T2 morphology alone.
- Emergency CT in IBD infrequently detects penetrating complications or alternative diagnoses, supporting more selective imaging use.
Week ending April 25, 2026
Colorectal surgery updates: parastomal hernia prevention, rectal nodal staging, Crohn’s outcomes, and evolving colorectal cancer epidemiology
Funnel-shaped mesh at permanent colostomy cuts 3-year parastomal hernia risk
In this multicenter randomized Chimney Trial, funnel-shaped intra-abdominal mesh was placed at permanent colostomy during laparoscopic or robotic APR or Hartmann procedures. At 3 years, CT-confirmed parastomal hernia occurred in 57% with mesh versus 82% without mesh, with significantly smaller hernia volumes in the mesh group. Clinically detected parastomal hernia was 10% with mesh versus 39% without, indicating a marked reduction in symptomatic hernias. Importantly, there were no significant differences in other complications or adverse outcomes between groups over 3 years. These data support routine funnel-shaped mesh placement for permanent colostomies after rectal adenocarcinoma resection, barring specific contraindications.
Modern surgical recurrence risk after primary ileocolic resection for Crohn ileitis is relatively low
This systematic review and meta-analysis included 55 studies, with over 28,000 patients undergoing primary ileocolic resection for Crohn disease. In the biologics era, pooled surgical recurrence was 5.7% at 5 years and 13.0% at 10 years for neoterminal ileum reoperations. Meta-regression showed recurrence rates declined threefold over decades, then plateaued after 2000. Traditional factors, including smoking, sex, perianal disease, and disease behavior, were not significantly predictive of surgical recurrence. These findings allow more reassuring long-term counseling after primary ileocolic resection but limit risk stratification based on common clinical variables.
LCI plus CADe halves right-colon adenoma miss rate versus white-light colonoscopy
In a single-center randomized tandem trial of FIT-positive and surveillance patients, right-colon LCI with CADe was compared to white-light imaging. Among 209 analyzed patients, adenoma miss rate was 39% with white light versus 20% with LCI/CADe in the right colon. Polyp and diminutive adenoma miss rates were also significantly lower with LCI/CADe than white light. Reductions in miss rates were most pronounced among expert endoscopists, suggesting benefit even in high-performing hands. These results support adoption of LCI with CADe to improve proximal neoplasia detection, particularly for screening and surveillance colonoscopy.
3D-TRUS–based nomogram predicts early biologic failure in perianal fistulizing Crohn disease
This double-center retrospective study included 102 patients with perianal fistulizing Crohn disease starting biologic therapy, all undergoing baseline and 12-week 3D-TRUS and MRI. Early biologic failure was defined as stable or aggravated disease on MRI at about 12 weeks. Main fistula length ≥2 cm, inflammatory mass size >2 cm, and greater internal orifice–anal margin distance independently predicted early failure. A nomogram using these 3D-TRUS variables had an AUC of 0.955 in the training cohort and 0.875 in external validation. This tool may help identify patients needing earlier escalation, switch of biologic, or stronger integration of surgical management.
References
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Additional Reads
Optional additional studies from this edition.