The first symposium on the final day of ESCP’s Virtually Vilnius focused on the importance of education for trainees and students. Dieter Hahnloser (Germany), Chair of ESCP’s Education Committee, welcomed five speakers who shared dynamic presentations on current hot topics in the field of coloproctology.

Kicking off the session, Tomas Poskus (Lithuania) presented ‘Protective ileostomy only in selected cases.’ Tomas outlined technical approaches to improving anastomotic leaks and shared interesting national audits (from the Netherlands and Germany) which provided valuable insights into the risk factors associated with stoma complications and anastomotic leakage in rectal cancer surgery.

He highlighted that ileostomy should be used in high risk cases, and alternatives should be employed to reduce the risk of anastomotic leakage and its consequences.

Next up, Bruno Roche (France), gave a recap of anal fistulas throughout history and outlined the key things surgeons need to be mindful of when treating patients. He discussed the importance of knowing the etiology of the fistula as the majority (90%) tend to be from a cryptoglandular origin. "We know where the fistula finishes at the secondary orifice however we must also know where the fistula begins at the primary orifice. The problem is the persistence of glands’ secretion which keeps the fistula open. The day we find the way to destroy the gland in association with an endoluminal closure is the day we will be able to get better results," he said.

Bruno discussed the closure of fistulas, treatments for distal fistulas and sphincter preservation for high fistulas, noting the flap technique as his favoured form of treatment.

General conclusions: Closure of fistulas, treatments for distal fistulas and sphincter preservation for high fistulas

Monica Millan (Spain) then presented ‘Haemorrhoidectomy: the traditional way’ and discussed advanced haemorrhoids (typically external hemmorids - grade 3 or 4) and the associated treatments.

Monica shared a detailed step by step video of a closed haemorrhoidectomy procedure (using the Ferguson technique), discussed both open and closed haemorrhoidectomies and highlighted postoperative pain control as one of the most important elements to get right as local anaesthetic infiltration and non-steroidal anti-inflammatory drugs must be balanced effectively.

Karoline Horisberger (Switzerland) discussed the development of a rectal prolapse - talking viewers through the symptoms and epidemiology.

She discussed the careful steps of diagnosis to consider including analysing patient history, a physical examination (inspection of the anus and perianum) and a radiographic evaluation (defecography - MRI/X-ray) ahead of surgical procedures - both perienal and abdominal.

David Zimmerman (Netherlands) then shared his top tips and tricks for those interested in the EBSQ Examination in Coloproctology. "The examination is an excellent opportunity for younger surgeons who are starting their career in colorectal surgery and looking to sharpen their professional profile," he said. David highlighted invaluable resources to tap into when preparing to sit the exam which included ESCP’s very own extensive Resource Library which includes a detailed summary of what the exam entails.

Stéphanie Breukink (Netherlands) and Tatiana Garmanova (Russia) then hosted an engaging Q&A session with the panel of experts, giving the audience a chance to ask plenty of questions about their topics!

James Glasbey (UK) then presented a paper on behalf of the celebrated COVID-surg collaborative titled ‘Elective cancer surgery in COVID-19 free surgical pathways during the SARS-CoV-2 pandemic: an international, multi-centre, comparative cohort study.’

The study specifically looked at whether COVID-19 free surgical pathways were associated with lower postoperative pulmonary complication rates in comparison to those hospitals with no defined pathway e.g. mitigations in place to ensure segregation of operating theatres, critical care and inpatient wards which do not admit COVID-19 patients.

James discussed the findings (a consistent benefit found for COVID-19 free surgical pathways in both high and low SARS-CoV-2 incidence areas) and how a major service redesign is justified based on local resources as countries gear up for a second wave.

Dieter Hahnloser and Miguel Leon Arellano screenshot

‘Septin 9 as a follow-up biomarker in colorectal cancer’ was then presented by Miguel Leon Arellano (Spain).

Miguel started his session by expressing that approximately 25-40% of colorectal cancer patients will develop recurrence within five years and highlighted the search for a non-invasive biomarker to detect colorectal cancer recurrence.

He discussed how the Septin 9 test analyses the hypermethylation in colorectal cancer patients as well as DNA, obtained from a peripheral blood sample, being a useful, non-invasive, and effective method for screening for colorectal cancer.

Haemorrhoids are a complex disease, with both genetic and non-genetic contributors and Waheed-Ul-Rahman Ahmed (UK) was up next with a fascinating presentation detailing a genome-wide association analysis of 401,583 individuals which identified novel therapeutic targets for haemorrhoids – the very first study of its kind!

The final abstract presentation of the session ‘CRP daily variation - a valuable tool for excluding anastomotic leakage’ was presented by Ricardo Rocha (Portugal).

The study (conducted between 2012 and 2018) found that patients who do not develop anastomotic leak have a decrease of CRP value between POD2 and POD3. Ricardo discussed the outcomes in detail as well as the study variables (patient and surgical parameters).

The highly engaging and educational session concluded following a wrap-up discussion which saw host Dieter Hahnloser share topical questions from the audience with the panel of speakers.

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