Surgical treatment to aid patients with colorectal perforation.

BACKGROUND: When a patient with colorectal perforation is treated, there is no adequate information about what the best procedure for emergent operation is. In the present study, we examined the clinical features in hemodialysis (HD) and non-HD patients with colorectal perforations. PATIENTS AND METHODS: Forty-four patients (8 HD and 36 non-HD patients) who underwent surgery for colorectal perforation at the Fukuoka Red Cross Hospital were reviewed and analyzed. RESULTS: Poor prognostic factors for patients with colorectal perforation were high age, HD, idiopathic perforation, postoperative complication and Hartmann's operation procedure. Good prognostic factors were diverticulum perforation and operation with anastomosis. In the analysis between HD and non-HD patients, clinical characteristics in HD patients with colorectal perforation were advanced age and rectal perforation. CONCLUSION: High mortality rate of HD patients with colorectal perforation may be due to high age and rectal perforation in which cases it is technically difficult to perform operation. In case of emergent operation of colorectal perforation, the Hartmann's procedure may not be recommended.

Single-incision laparoscopic cholecystectomy with needle graspers.

BACKGROUND/AIMS: Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure. METHODOLOGY: In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N. RESULTS: SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge. CONCLUSIONS: Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.

Merits and faults of transanal ileus tube for obstructing colorectal cancer.

BACKGROUND: We report eight cases of obstructing colorectal cancer successfully managed by preoperative lavage using transanal ileus tube. METHODS: Decompression tube was transanally inserted into the colon proximal to the tumour under the guidance of the guide wire. Intestinal lavage with 1,500-2,000 mL of warm water was done every day until surgery. RESULTS: There were six men and two women; the mean age was 67 years (range, 50-82 years). Three cancers were in the sigmoid colon and five were in the rectum. Seven patients were treated with a one-stage operation with adequate lymph node dissection. In one patient, only sigmoidostomy was carried out for unresectable huge tumour. In all cases, no dilatation was observed at the proximal colon and no anastomotic failure developed. Four patients suffered from fever of unknown cause after the insertion of the tube. In one patient, the resected specimen showed ulcer by tube compression. In the other patient, the tube penetrated the intestinal wall, which was covered by mesentery. CONCLUSION: The transanal ileus tube is effective for the treatment of obstructing colorectal cancer. However, close observation is necessary because of possible perforation.