ABSTRACT
Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.
ABSTRACT
PURPOSE: The results of anal fistula treatments have improved with the development of the anal fistula operative technique. However, there are still complications, such as recurrence and anal incontinence. To this end, the authors classified anal fistulas by using Sumikoshi's classification and performed an anal-sphincter-preserving procedure. METHODS: We experienced 98 anal fistula cases involving 86 patients who underwent anal fistula operations at The Catholic University of Korea, St. Vincent's Hospital from January 2001 to December 2006. This study was done retrospectively by chart review and telephone questioning. The follow-up period was from 2 to 72 months (mean 29.5, SD: 19.1). RESULTS: The study showed 0 cases of Type I (0.0%), 49 cases of Type II (50.0%), 46 cases of Type III (46.9%), and 3 cases of Type IV (3.1%) fistulas. Among the 98 fistula-in-ano operations were 27 (27.6%) of fistulotomies and 71 (72.4%) sphincter-preserving procedures (2 cases of coring-out+muscle filling+rectal mucosal advancement flap, 31 cases of coring-out+ muscle closure+rectal mucosal advancement flap, 28 cases of coring-out+cutting seton, and 10 cases of loose seton). After the sphincter-preserving operation, there were 4 cases (4/71, 5.6%) of recurrence. There were no major disorders of the anal sphincter. However, minor disorders of the anal sphincter (6/71, 8.5%, soiling) were found. CONCLUSIONS: The anal-sphincter-preserving procedure is very effective in preventing recurrence and anal incontinence, but these results are from a retrospective study with a small number of patients and the follow-up period was short. If further cases are collected and continuous follow-up is done, better results can be expected.
Subject(s)
Humans , Anal Canal , Classification , Fistula , Follow-Up Studies , Korea , Rectal Fistula , Recurrence , Retrospective Studies , TelephoneABSTRACT
Objective To discuss causes and prevention of complications and recurrence following sphincter preserving procedure(SPP) for rectal cancer.Methods A retrospective study on clinical and follow-up data of 375 cases of rectal cancer treated by SPP from January 2000 to January 2006 was carried out.Factors relating complications and recurrence after the operation were analyzed with the Logistic regression.Results A follow-up was conducted for 1～60 months(mean,37 months).The 5-year survival rate was 75.77%,and 79 cases of those followed died.Postoperative complications included anastomotic leakage in 14 cases(3.73%),anastomotic stenosis in 37 cases(9.87%),and anastomotic bleeding in 13 cases(3.47%).Anastomotic tumor recurrence was seen in 25 cases.Logistic regression analysis showed that the distance between the tumor and the dentate line was the most important factor for postoperative complications(P=0.017),and the distance and patient's age were the most important factors for recurrence(P=0.040,P=0.041). Conclusions The distance of tumor and patient's age are the most important factors for complications and recurrence following sphincter preserving procedure for rectal cancer.Strict selection of patients for surgery,normative procedure performance,and proper peri-operative management are essential for the prevention of complications and recurrence.