Laparoscopic surgery for an intussusception caused by a lipoma in the ascending colon.

A colonic intussusception caused by an intraluminal lipoma is a rare disease in adults, in whom it usually has a definite organic cause. In fact, it is either caused by a benign or a malignant condition, both of which occur at similar rates. However, little literature is available on laparoscopic procedures for use in cases of adult colonic intussusceptions. Recently, a 52-year-old woman was admitted to our hospital with abdominal pain of one-month duration. Abdominal computed tomography showed an intussusception with a fat-containing mass in the right hepatic area. Colonoscopy showed a colon lumen occupied by the mass. A right hemicolectomy was performed laparoscopically, and the cause of the intussusception was found to be a lipoma. Before obtaining histological confirmation, we carefully perform a laparoscopic procedure, which required consideration of the relations between the involved colonic segment and other conditions such as the location of main vessels, the anatomical exposure with respect to colonic mobilization and the location of specimen retrieval.

Relationship between diversion colitis and quality of life in rectal cancer.

AIM: To investigated the incidence of diversion colitis (DC) and impact of DC symptoms on quality of life (QoL) after ileostomy reversal in rectal cancer. METHODS: We performed a prospective study with 30 patients who underwent low anterior resection and the creation of a temporary ileostomy for the rectal cancer between January 2008 and July 2009 at the Department of Surgery, Korea University Anam Hospital. The participants totally underwent two rounds of the examinations. At first examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom were performed 3-4 mo after the ileostomy creations. At second examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom and QoL were performed 5-6 mo after the ileostomy reversals. Clinicopathological data were based on the histopathological reports and clinical records of the patients. RESULTS: At the first examination, all of the patients presented with inflammation, which was mild in 15 (50%) patients, moderate in 11 (36.7%) and severe in 4 (13.3%) by endoscopy and mild in 14 (46.7%) and moderate in 16 (53.3%) by histology. At the second examination, only 11 (36.7%) and 17 (56.7%) patients had mild inflammation by endoscopy and histology, respectively. There was no significant difference in DC grade between the endoscopic and the histological findings at first or second examination. The symptoms detected on the first and second questionnaires were mucous discharge in 12 (40%) and 5 (17%) patients, bloody discharge in 5 (17%) and 3 (10%) patients, abdominal pain in 4 (13%) and 2 (7%) patients and tenesmus in 9 (30%) and 5 (17%) patients, respectively. We found no correlation between the endoscopic or histological findings and the symptoms such as mucous discharge, bleeding, abdominal pain and tenesmus in both time points. Diarrhea was detected in 9 patients at the second examination; this number correlated with the severity of DC (0%, 0%, 66.7%, 33.3% vs 0%, 71.4%, 23.8%, 4.8%, P = 0.001) and the symptom-related QoL (r = -0.791, P < 0.001). CONCLUSION: The severity of DC is related to diarrhea after an ileostomy reversal and may adversely affect QoL.

The role of laparoscopic approach for anastomotic leakage after minimally invasive surgery for colorectal cancer.

OBJECTIVES: The objectives of this study were to evaluate the feasibility and safety of a re-laparoscopic approach to manage anastomotic leakage after minimally invasive colorectal resection and to compare its clinical outcomes with those obtained using an open approach. METHODS: We retrospectively reviewed clinical data from 1714 patients who underwent colorectal cancer resection from September 2006 to August 2009 at the Korea University Medical Center. Clinical data from a total of 57 surgery patients who developed anastomotic leakage were analyzed. RESULTS: Twenty-six leakage cases were managed laparoscopically, whereas the remaining 31 leakage cases were managed using an open approach. There were no significant differences in age, sex, or other clinical features between patients in the two groups. The total operation time was shorter in the laparoscopic group (107.3 ± 68.1 minutes) than in the open group (126.5 ± 50.1 minutes), but this difference was not statistically significant (P = .230). Six cases in each group required additional procedures such as reoperation or percutaneous intervention (P = .126). There was one case of postoperative mortality in the open group. Median (quartiles 25%-75%) number of days required to resume a soft diet tended to be shorter in the laparoscopic group than the open group (5 [3-7] versus 6 [5-10] days; P = .057). Patients in both groups showed similar postoperative complications including intraabdominal abscess; however, the incidence of wound infection was significantly lower in the laparoscopic group than the open group (3.8% versus 25.8%; P = .031). CONCLUSIONS: Compared with conventional open treatment of anastomotic leakage, the laparoscopic approach resulted in fewer wound complications and tendency of early recovery of bowel movement without an increase in adverse outcomes. Using a laparoscopic approach, all the advantages of minimally invasive surgery can be realized in patients who develop anastomotic leakage after minimally invasive surgery.

Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study.

PURPOSE: Few data are available to compare robotic and laparoscopic techniques for rectal cancer resection. This study aimed to compare short-term outcomes with these procedures performed by a single surgeon. METHODS: Using data from a prospective database of all operations performed in our department, we retrospectively analyzed data from 117 robotic and 102 laparoscopic rectal cancer resections performed by one surgeon between July 2007 and October 2009. Robotic resection was offered as a treatment option to all patients, and laparoscopic resection was performed for those who refused. This analysis was a case-control study in which patients in the 2 groups were matched according to tumor location, staging, age, and gender. RESULTS: A total of 118 patients (59 matched pairs) were included in the study. No differences were found between robotic and laparoscopic resection regarding number of lymph nodes harvested (median, 20; interquartile range, 12-27 vs 21; 14-28; P = .702) or distal resection margin (median, 2.2 cm; interquartile range, 1.5-3.0 cm vs 2.0; 1.2-3.5 cm; P = .865). The circumferential margin was positive (≤ 2 mm) in 1 patient in the robotic group but in none of the laparoscopic group (P > .999). Operating time was longer in the robotic group than in the laparoscopic group (P < .0001). No conversions were necessary in the robotic group, but 2 cases (3.4%) were converted to open surgery in the laparoscopic group (P = .496). No differences were observed between groups regarding postoperative complications. Operative mortality was zero in both groups. During a median follow-up of 15.0 months, 2 cases of distant metastases and 1 case of local recurrence were observed in each group. CONCLUSIONS: Robotic rectal cancer resection can be safely performed by experienced laparoscopic surgeons, with acceptable short-term outcomes comparable to those for laparoscopic resection.

Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer.

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.