Single incision laparoscopic right hemicolectomy: different approaches.

BACKGROUND: Single incision laparoscopic colectomy has been performed in recent years, and has been shown to be feasible and safe. This study was to assess the feasibility of single incision laparoscopic right hemicolectomy and to compare the differences in different approaches. METHODS: This retrospective study included eighteen patients with carcinoma of caecum and ascending colon, undergoing single incision laparoscopic right hemicolectomy. This study also compared single incision laparoscopic right hemicolectomy using different approaches: (1) single incision multiport, (2) single access port and (3) glove port. RESULTS: There was no statistical difference in surgical outcomes. Concerning the surgeon's satisfaction toward three methods, overcrowding and durability were similar but the single incision multiport was associated with the highest gas-leak and the "glove" port was associated with poor durability. However, the method of single incision multiport has the lowest average cost of the special trocar or port in each operation. The operative time and blood loss of the operations in this study were comparable to previous publications. CONCLUSION: There was no significant difference between different approaches of single incision laparoscopic right hemicolectomy for colonic cancer in right side colon.

Is it safe to perform operation for colorectal malignancy in Chinese patients without DVT prophylaxis? An 8-year experience from a regional hospital in Hong Kong / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Colorectal surgery was regarded as one of the high risk surgery for post-operative deep vein thrombosis (DVT) and pulmonary embolism. This study aimed at investigating the incidence of venous thromboembolism (VTE) after colorectal surgery for malignancy.</p><p><b>METHODS</b>Data were collected from the prospective database of colorectal malignancy from 2000 to 2008. A total of 1421 colorectal (open and laparoscopic) operations were performed for the colorectal malignancy without DVT prophylaxis.</p><p><b>RESULTS</b>Only seven patients (0.5%) developed symptomatic DVT and one of them had complication of pulmonary embolism without mortality. Open operation for colorectal malignancy was identified as possible risk factor of DVT, however, risk factors like operative time, low anterior resection, sex, age etc. were not identified.</p><p><b>CONCLUSION</b>Risk of venous thromboembolism after colorectal operation is low in Chinese of our locality and it might be safe to perform colorectal operation for malignancy without DVT prophylaxis.</p>

Hepatectomy for hepatocellular carcinoma in a community hospital: the importance of surgeon procedural volume in operative outcomes.

BACKGROUND/AIMS: Hospital procedural volume is shown to be important in affecting the postoperative mortality after major cancer surgery. Recent analysis demonstrates that hospital and surgeon volume effects on postoperative outcomes after major operations are actually interdependent and surgeon volume may be more important. The effects of hospital and surgeon volume on postoperative outcomes after hepatectomy for hepatocellular carcinoma are uncertain. METHODOLOGY: A retrospective study was conducted of 65 patients who had undergone hepatectomy for hepatocellular carcinoma in a 6-year period. A specialized hepatobiliary team was set up in 2002 in the Kwong Wah Hospital. The postoperative outcomes of patients operated between 1999 and 2001 (Group 1) were compared to that of those treated between 2002 and 2004 (Group 2). RESULTS: The hospital mortality was 8.3% in Group 1 and 3.4% in Group 2 (p = 0.393). The postoperative morbidity was 50% in Group 1 but decreased to 27.6% in Group 2, though the difference was not statistically significant (p = 0.056). The median hospital stay of patients in Group 2 was significantly shorter than that of those in Group 1 (17 days vs. 11 days, p = 0.005). CONCLUSIONS: Despite the unchanged hospital volume, concentration of patients into a single team increases surgeon volume and improves postoperative outcomes after hepatectomy for hepatocellular carcinoma.

Delayed colonic perforation after percutaneous radiofrequency ablation of hepatocellular carcinoma.

Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma. Colonic perforation secondary to RFA of the liver is an uncommon complication that has been reported to have an incidence between 0.1% and 0.3%. Lesions adjacent (within 1 cm) to the colonic wall and those in patients with history of upper abdominal surgery or chronic cholecystitis are particularly at risk. More importantly, thermal injury leading to colonic perforation has proved to have a fatal outcome. We present a case of percutaneous RFA in a patient with hepatocellular carcinoma that was abutting the colonic hepatic flexure. Colonic perforation was diagnosed on the eighth day postablation when the patient was readmitted with peritonitis.

Efficacy and safety of on demand tadalafil in the treatment of East and Southeast Asian men with erectile dysfunction: a randomized double-blind, parallel, placebo-controlled clinical study.

AIM: To assess the efficacy and safety of tadalafil in comparison to a placebo, when taken on demand for 12 weeks by East/Southeast Asian men with erectile dysfunction (ED). METHODS: This multicenter, randomized, double-blind, parallel group, placebo-controlled study was conducted at 17 centers across East and Southeast Asia between August 2002 and February 2003. Men more than 18 years of age with mild to severe ED of various etiologies were randomized to receive a placebo or 20 mg of tadalafil taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function, the Sexual Encounter Profile diary and Global Assessment Questions. RESULTS: Tadalafil significantly improved erectile function as compared to the placebo (P < 0.001). At the endpoint, the patients receiving 20 mg of tadalafil reported a greater mean per patient percentage of successful intercourse attempts (Sexual Encounter Profile question 3: 70.9% compared to 33.5% in the placebo) and a greater proportion of improved erections (Global Assessment Question: 86.2% compared to 30.1%). Most (= or < 3%) treatment emergent adverse events were mild or moderate. The most common treatment emergent adverse events were headache, back pain, dizziness and dyspepsia. CONCLUSION: Tadalafil was an effective and well-tolerated treatment for ED in East and Southeast Asian men.