American Society of Colon and Rectal Surgeons

Welcome to Gut Check, the official podcast of the American Society of Colon and Rectal Surgeons.

Gut Check is a space for open conversation across the specialty.

The discussions in each episode do not necessarily represent official ASCRS positions or recommendations.

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We also invite you to learn more about the American Society of Colon and Rectal Surgeons by visiting our website at www.fascrs.org.

Gut Check is a space for open conversation across the specialty.

The discussions in each episode do not necessarily represent official ASCRS positions or recommendations.

A reasonably proven surgeon would do under similar circumstances, given that clinical situation.

As a matter of fact, if you look at many of the guidelines, including the ones from the American Society of Colorectal Surgeons, There is a disclaimer.

It is not meant to be a legal disclaimer, but it is in there saying that they're not proscriptive.

The guidelines provide information upon which decisions can be made.

So the goal of this deep dive today is to serve as a high-yield synthesis for your clinical practice.

We are applying a magnifying glass to the 2022 American Society of Colon and Rectal Surgeons, the ASCRS Clinical Practice Guidelines for the Management of Colon Cancer.

The big one.

The big one, exactly.

And I always say, you know, if there's 10 ways to do something in surgery, it probably means that none of them are the best, right? Like there's not one that has come out that is dominantly in studies across the board has proven to be best, which is why surgeons across the nation are still doing whatever anastomosis they feel most comfortable with.

ASCRS actually just sent out a link to do a survey for ileocolic anastomosis kind of configuration.

So it will be interesting to see kind of what the national trends are with that and see if there's been any difference in it.

But you know, when the KONOS, you know, the data on the KONOS first came out a few years ago, it was pretty encouraging, but I think the follow-up data has sort of put it in line with the rest of the anastomosis.

the grades of recommendation, assessment, development, and evaluation.

We have to understand the structural logic behind why the ASCRS committee made such radical shifts between the 2016 guidelines and these 2022 updates.

So they really did shift.

Massively.

So if the physical exam is deceiving us and Goodsall's rule is basically failing us in the posterior half of the perineum, Our natural instinct as modern surgeons is to just order a scan, right? We want to see the plumbing before we start tearing up the floorboards.

Which brings us to the imaging guidelines.

The ASCRS gave this a 1B recommendation, a strong recommendation based on moderate quality evidence.

And what did they say? They explicitly stated that routine use of diagnostic imaging is not necessary.

And the reason there's so many surgeries been described because none work.

So we really, as a society, as a pelvic floor society and pelvic floor consortium, part of American Society of Colorectal Surgeons, we're really gaining a momentum and learning to understand what works better.

There is some new research that's on the forefront for fecal incontinence that involves cell therapies.

That's very exciting.

It's a daily occurrence.

Right? So today we are taking a rigorous academic deep dive into the 2020-2023 American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

These were authored by Davids and colleagues.

And these guidelines, I mean, they are the benchmark.