Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model.

The purpose of this study was to demonstrate that a standardized approach to laparoscopic proctosigmoidectomy in a cadaver model with (1) initial proximal ligation of the inferior mesenteric (IM) vascular pedicle, (2) complete mobilization of the splenic flexure, and (3) intraperitoneal stapled colorectal anastomosis can be accomplished in complete accordance with oncologic surgical principles. Using nine cadavers in the fresh state, six abdominal wall cannulas were placed so as to allow good access to the left colon and rectum. After identifying the left ureter and gonadal vessel, the IM pedicle was divided close to the aorta and the left mesocolon was separated from the retroperitoneal structures. The sigmoid colon was transected at the proximal resection line with an endoscopic stapler; then the splenic flexure and descending colon were completely mobilized. The rectum was freed circumferentially, dissected first posteriorly, laterally, and anteriorly, and then transected in its middle portion with an endoscopic stapler. The specimen was removed through a widened left-lower-quadrant trocar incision and the anvil of a circular endoscopic stapler was placed into the proximal colon extraperitoneally. An intraperitoneal laparoscopic colorectal anastomosis was performed using a double-stapled technique. The median length of specimen was 53 cm (range 45-80 cm) and the median number of removed lymph nodes was 15 (range 11-20). A careful abdominal autopsy was carried out in all cadavers. Length of remaining inferior mesenteric artery was smaller than 1.5 cm in all cases and only one remaining lymph node (3 mm in diameter) was found adjacent to the IMA in one subject. No damage to either ureter occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic oncologic abdominoperineal resection.

PURPOSE: Although the use of laparoscopic techniques in colorectal surgery has recently become a focus of major interest in intestinal surgery, there is no proof that an oncologic abdominoperineal resection can be accomplished using laparoscopic techniques. The hypothesis of this study is that a standardized technique for laparoscopic oncologic abdominoperineal resection according to accepted oncologic surgical principles can be developed in a cadaver model. The end points of this study were intraoperative complications, success in performance of proximal vascular ligation of the inferior mesenteric artery, complete removal of the mesorectum including all lymph nodes adjacent to the named rectal arteries, and wide clearance of pelvic side walls. METHODS: Laparoscopic abdominoperineal resection was performed in 11 fresh cadavers (1 female and 10 males). After surgery, all cadavers underwent autopsy. The number of removed and remaining mesenteric lymph nodes, length of remaining inferior mesenteric artery, and mesorectal and the pelvic side wall soft tissue were evaluated. RESULTS: No major intraoperative complications were recorded. The median number of removed lymph nodes in the mesorectum was 12 (range, 6-22) and no remaining lymph nodes were found at the base of the inferior mesenteric artery. The median length of remaining inferior mesenteric artery was 5 (range, 1-15) mm. Wide lateral clearance of pelvic side walls was noted in all patients. CONCLUSION: A laparoscopic technique of abdominoperineal resection can be performed according to oncologic principles with proximal vascular ligation of inferior mesenteric artery, wide clearance of pelvic side walls, and complete removal of mesorectum using our described technique.

[Biofeedback and surgery in the treatment of fecal incontinence and lesion of the external anal sphincter: long-term follow-up]. / Retroalimentación biológica y cirugía en el tratamiento de la incontinencia fecal con lesión del esfínter anal externo. Seguimiento a largo plazo.

INTRODUCTION: In children, damage in the anal area which affects both the external anal sphincter and the internal anal sphincter is serious problem. Biofeedback is not effective if the external anal sphincter is severely damaged, and surgery by itself cannot effect a cure for incontinence in these cases. CLINICAL CASE: a girl aged 6 yrs 8 months who from the age of two suffered from massive recurrent tricolephalosis, causing rectal prolapse, anal abscesses and fistulas, fistulectomy, and finally severe damage in the anal area with total incontinence. The treatment began with recto-anal manometry, and rectal sensitivity studies. Biofeedback was used before and after gracilis muscle transfer and colostomy. After 12 months, total continence was achieved, and has continued through 7 years of follow-up examinations. CONCLUSIONS: To treat fecal incontinence combined with severe damage in the external anal sphincter, the following procedure should be followed: manometry and sensitivity studies, reconstruction of the external anal sphincter with gracilis muscle transfer, and biofeedback.

Retroalimentacion biologica y cirugia en el tratamiento de la incontinencia fecal con lesion del esfinter anal externo: seguimento a largo plazo / Biofeedback and surgery in the treatment of fecal incontinence and lesion of the external anal sphincter: long-term follow-up

INTRODUCCION: En niños, el traumatismo de la región anal que afecta tanto al esfínter anal externo como al esfínter anal interno es un grave problema. La retroalimentación biológica no es efectiva si hay destrucción del esfínter anal externo, y la restitución de la morfologia con cirugía tampoco cura la incontinencia. CASO CLINICO: Niña de 6 años 8 meses de edad, que desde los 2 años sufrió tricocefalosis masiva recurrente; condicionándole prolapso rectal, abscesos y fístulas perianales, fistulectomías, y finalmente destrucción de la región perianal, con incontinencia total. Previa manometría rectoanal, y determinación de receptores rectales, se efectuó retroalimentación biológica antes y después de la transposición del músculo gracilis y colostomía. a los 12 meses se obtuvo continencia total, que aún persiste a 7 años de seguimiento. CONCLUSIONES: En la incontinencia fecal con destrucción del esfínter anal externo, y alteración fisiológica del esfínter anal interno, se debe efectuar: manometria y determinación de receptores rectales, reconstrucción del esfínter anal externo con transposición del músculo gracilis, y retroalimentación biológica

Retroalimentacion biologica y cirugia en el tratamiento de la incontinencia fecal con lesion del esfinter anal externo: seguimento a largo plazo / Biofeedback and surgery in the treatment of fecal incontinence and lesion of the external anal sphincter: long-term follow-up

INTRODUCCION: En niños, el traumatismo de la región anal que afecta tanto al esfínter anal externo como al esfínter anal interno es un grave problema. La retroalimentación biológica no es efectiva si hay destrucción del esfínter anal externo, y la restitución de la morfologia con cirugía tampoco cura la incontinencia. CASO CLINICO: Niña de 6 años 8 meses de edad, que desde los 2 años sufrió tricocefalosis masiva recurrente; condicionándole prolapso rectal, abscesos y fístulas perianales, fistulectomías, y finalmente destrucción de la región perianal, con incontinencia total. Previa manometría rectoanal, y determinación de receptores rectales, se efectuó retroalimentación biológica antes y después de la transposición del músculo gracilis y colostomía. a los 12 meses se obtuvo continencia total, que aún persiste a 7 años de seguimiento. CONCLUSIONES: En la incontinencia fecal con destrucción del esfínter anal externo, y alteración fisiológica del esfínter anal interno, se debe efectuar: manometria y determinación de receptores rectales, reconstrucción del esfínter anal externo con transposición del músculo gracilis, y retroalimentación biológica (AU)

Retroalimentación biológica y cirugía en el tratamiento de la incontinencia fecal con lesión del esfínter anal externo. Seguimiento a largo plazo. / [Biofeedback and surgery in the treatment of fecal incontinence and lesion of the external anal sphincter: long-term follow-up]

INTRODUCTION: In children, damage in the anal area which affects both the external anal sphincter and the internal anal sphincter is serious problem. Biofeedback is not effective if the external anal sphincter is severely damaged, and surgery by itself cannot effect a cure for incontinence in these cases. CLINICAL CASE: a girl aged 6 yrs 8 months who from the age of two suffered from massive recurrent tricolephalosis, causing rectal prolapse, anal abscesses and fistulas, fistulectomy, and finally severe damage in the anal area with total incontinence. The treatment began with recto-anal manometry, and rectal sensitivity studies. Biofeedback was used before and after gracilis muscle transfer and colostomy. After 12 months, total continence was achieved, and has continued through 7 years of follow-up examinations. CONCLUSIONS: To treat fecal incontinence combined with severe damage in the external anal sphincter, the following procedure should be followed: manometry and sensitivity studies, reconstruction of the external anal sphincter with gracilis muscle transfer, and biofeedback.

Gastrin cell populations after highly selective vagotomy in the dog.

Highly selective vagotomy was performed on five dogs. Postoperatively, gastrin cell (G cell) hyperplasia occurred in all dogs. Mean preoperative G cell numbers increased from 350 to 530/cm mucosal length (p less than 0.02). Antral tissue gastrin also increased by 100 per cent (6.7 x 10(6) to 13.7 x 10(6) pg/gm tissue, p less than 0.05). Basal and stimulated serum gastrin were unchanged following highly selective vagotomy. The cause for G cell hyperplasia is not clear, but is probably multifactorial.