Amaniel Kefleyesus

Introduction: Crohn’s disease (CD) remains associated with long-term morbidity despite biologic therapies. Surgery, historically considered a last-resort option, is increasingly integrated into disease management earlier. This review examines the evolving role of surgery in the biologic era. Methods: A focused narrative review of randomized controlled trials, meta-analyses, observational studies, and international guidelines addressing contemporary surgical strategies in CD was performed. Results: The LIR!C trial demonstrated that early ileocecal resection provides durable remission and improves long-term outcomes compared with biologic therapy in selected patients. The PISA II trial supported an early combined surgical and medical approach for perianal fistulizing disease. Preoperative optimization, including nutritional support and adjustment of immunosuppressive therapy, has become a cornerstone of perioperative management. Laparoscopic surgery remains the preferred approach whenever feasible, while robotic surgery is emerging as a promising platform that is expected to play an increasingly important role in the surgical management of CD. Postoperative recurrence remains a major challenge, prompting the development of innovative surgical strategies. Although the Kono-S anastomosis initially showed promising reductions in recurrence, recent prospective studies failed to confirm superiority over conventional techniques. Similarly, extended mesenteric excision did not demonstrate improved outcomes despite increasing evidence implicating the mesentery in CD pathogenesis. Strictureplasty remains an effective option for selected fibrotic small-bowel strictures. Conclusions: Surgery remains central to multidisciplinary CD management and offers the potential to modify disease when performed early in selected patients. The impact of innovative surgical strategies on postoperative recurrence remains uncertain, and ongoing trials are expected to further help with surgical decision-making.

Background: Small bowel obstruction (SBO) is a common surgical emergency. In transplant recipients, atypical etiologies may delay diagnosis and lead to suboptimal management. Methods: We report a case of phytobezoar-induced SBO in a liver transplant recipient and conducted a focused narrative literature review (PubMed/MEDLINE, Embase, Cochrane Library, Google Scholar, OpenEvidence, Litmaps) of adult transplant patients with mechanical SBO reported up to January 2026. Results: A 60-year-old man with two prior liver transplantations (2012, 2022) presented with acute abdominal pain and vomiting after ingestion of wild mushrooms. Initial contrast-enhanced CT suggested adhesional SBO. After failure of conservative management, exploratory laparoscopy identified an intraluminal mass in the distal jejunum. Mini-laparotomy with enterotomy allowed extraction of a phytobezoar composed of Craterellus cornucopioides . Despite marked bowel congestion and equivocal conventional viability criteria, intraoperative indocyanine green (ICG) fluorescence confirmed adequate perfusion and avoided resection. Postoperative course was complicated by paralytic ileus, successfully reversed with neostigmine. The patient was discharged on postoperative day 14. The literature review retrieved one retrospective study and seven adult case reports; bezoars accounted for 5/7 cases, predominantly located at Roux-en-Y enteric anastomoses. ICG fluorescence had not been used in any previously reported case. Conclusion: Bezoars are a rare but clinically relevant cause of SBO in transplant recipients. Early surgical exploration is warranted when conservative management fails or imaging is ambiguous. Intraoperative ICG fluorescence is a useful adjunct to assess bowel viability and may avoid unnecessary resection. Individualized dietary counseling adapted to regional habits should be considered in long-term transplant follow-up. Larger contemporary series are needed to refine the etiologic spectrum and preventive strategies in this population.

Objectives: Malignant bowel obstruction (MBO) caused by advanced peritoneal metastases (PM) carries a poor prognosis. Surgical intervention may be the only therapeutic option in selected cases, but operative risks must be carefully balanced against potential benefits. This study aimed to evaluate the outcomes of patients undergoing surgery for MBO secondary to PM. Methods: Single-centre retrospective analysis of consecutive patients operated for MBO of various origins between 2016 and 2021. The primary outcome was overall survival (OS). Secondary outcomes included postoperative morbidity, resumption of systemic chemotherapy, and incidence of re-obstruction. Results: A total of 27 patients (median age 64 years, 67 % female) were included. Median peritoneal cancer index (PCI) was 32, and ascites was present in 16 patients (59 %). Surgical resolution of obstruction was achieved in 24 patients (88 %) via bowel resection (n=10), internal bypass (n=7), stoma formation (n=5), or adhesiolysis (n=2). Severe morbidity occurred in 26 %, with no postoperative mortality. Five patients (19 %) required reoperation, and three (11 %) developed enterocutaneous fistulae. Median OS was 4.0 months (IQR 9.4). Survival rates at 3, 6, and 12 months were 56 , 37, and 26 %, respectively. Postoperative systemic chemotherapy was resumed in 19 patients (70 %), significantly more often among those surviving >6 months (p=0.02). Re-obstruction occurred in 14 patients (52 %). Conclusions: Surgery is a feasible and valid therapeutic option for selected patients with MBO due to advanced PM. Despite considerable morbidity, most patients are able to resume systemic chemotherapy, which may contribute to improved survival outcomes.

In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5–42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8–16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1–9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.