Modified LigaSure hemorrhoidectomy for the treatment of hemorrhoidal crisis.

PURPOSE: This study aimed at reporting a modified LigaSure technique for the treatment of acute hemorrhoidal crisis. METHODS: Consecutive patients with an acute hemorrhoidal crisis received a modified LigaSure hemorrhoidectomy. After removing the hemorrhoidal tissues above the welding line, scissors were used to undermine the anoderm to excise residual thrombosed hemorrhoidal tissue. The wound was approximated with a continuous 4-0 vicryl suture. RESULTS: Forty patients (mean age, 47.5 years; range 22.0-76.0 years) were included. The mean duration of the crisis, length of the operation, and follow-up were 2.0 days (range 1.0-5.0 days), 35.6 min (range 15.0-60.0 min), and 13.2 months (range 6-24 months), respectively. At the final follow-up, all patients were continent and there were no cases with anal stenosis, recurrent bleeding, prolapse, or thrombus. The mean pain score before surgery was 8.3, and was 4.4 and 3.2 on postoperative days 1 and 7, respectively. Complications within 30 days of surgery included two cases of urine retention, two cases bleeding, one wound infection and one case of fecal impaction, which all resolved with conservative treatment. The only late complication was one case of residual skin tags. CONCLUSIONS: The modified LigaSure hemorrhoidectomy offers rapid pain relief, early recovery, and low morbidity for patients with an acute hemorrhoidal crisis.

Invasive adenocarcinoma arising from a mixed hyperplastic/adenomatous polyp and synchronous transverse colon cancer.

An admixture of hyperplastic and adenomatous components within the same polyp is unusual. Adenocarcinoma arising from a mixed hyperplastic/adenomatous polyp (MHAP) occurs even more rarely. We report the first case of a 59-year-old male who presented with invasive adenocarcinoma originating from a MHAP at a sigmoid colon and synchronous transverse colon cancer.

Single-incision laparoscopic surgery using a homemade transumbilical port for synchronous colon and hepatic lesions: a case report.

Single-incision laparoscopic surgery (SILS) is an emerging technique and has been utilized in various abdominal surgeries. Herein, we reported a case of synchronous colon and hepatic lesions that underwent right hemicolectomy and wedge resection of the liver by SILS. To the best of our knowledge, this is the first case report of synchronous colon and liver resection with SILS using homemade transumbilical port.

Results of 666 consecutive patients treated with LigaSure hemorrhoidectomy for symptomatic prolapsed hemorrhoids with a minimum follow-up of 2 years.

BACKGROUND: Our aim is to report the outcomes of hemorrhoidectomy performed via LigaSure™ with a minimum follow-up of 2 years. METHODS: A total of 666 patients underwent hemorrhoidectomy for symptomatic prolapsed hemorrhoids (grade III and IV) via LigaSure between June 2006 and June 2008. Patient demographic and operative data were collected and analyzed. RESULTS: The mean patient age was 45.4 ± 11.1 years (x ± SD; range, 22-77), and approximately 72% had grade III hemorrhoids. All procedures were performed without complications. The operative time was 18.7 ± 4.1 minutes (range, 9-43), and hospital stay was 1.5 ± 0.6 days (range, 1-4). There was no immediate postoperative bleeding or other procedure-related complications. Twelve (1.8%) patients required urinary catheterization for a maximum of 1 day, and 21 (3.2%) patients had delayed postoperative bleeding. Most cases of bleeding resolved spontaneously; 3 patients (0.4%) required reoperation. A total of 645 patients (96.6%) responded to a follow-up telephone interview at a mean of 36 months (range, 24-49) after hemorrhoidectomy. After 1 year postoperatively, 2 patients received additional excisions for residual skin tags, 1 was treated for an anal stricture, 1 was treated for an anal fistula, and 3 were treated for anal fissures. Minor incontinence (flatus) was present in 11 (1.7%) patients, and 13 (2.0%) experienced mild bleeding caused by residual hemorrhoids; 1 patient underwent rubber-band ligation, and the others were successfully treated medically. No recurrent prolapse or persistent anal pain occurred during the follow-up period. The overall recurrence rate at 2-years follow-up was 3.1%. CONCLUSION: The long-term recurrence rate after hemorrhoidectomy with LigaSure is low and comparable with conventional hemorrhoidectomy.

Synchronous adenocarcinomas of the colon presenting as synchronous colocolic intussusceptions in an adult.

Intussusception is uncommon in adults. To our knowledge, synchronous colocolic intussusceptions have never been reported in the literature. Here we described the case of a 59-year-old female of synchronous colocolic intussusceptions presenting as acute abdomen that was diagnosed by CT preoperatively. Laparotomy with radical right hemicolectomy and sigmoidectomy was undertaken without reduction of the invagination due to a significant risk of associated malignancy. The final diagnosis was synchronous adenocarcinoma of proximal transverse colon and sigmoid colon without lymph nodes or distant metastasis. The patient had an uneventful recovery. The case also emphasizes the importance of thorough exploration during surgery for bowel invagination since synchronous events may occur.

Effect of preoperative concurrent chemoradiotherapy in locally advanced low rectal cancer after radical resection surgery.

To evaluate the outcome of patients with locally advanced low rectal adenocarcinoma who required preoperative concurrent chemoradiotherapy (CCRT), a total of 22 patients underwent preoperative CCRT and radical resection for locally advanced low rectal adenocarcinoma. Patients received concurrent chemotherapy with high-dose 5-fluorouracil (5-FU) in continuous infusion and leucovorin and preoperative radiation with a mean dose of 50.4 Gy (range, 45-50.4 Gy). Radical resection surgery was performed 6 weeks after treatment. Fifty-five percent of patients achieved tumor downstaging, and 14% patients. showed pathological complete remission. No severe hematological and gastrointestinal toxicity of preoperative CCRT was noted. Sphincter-saving rate was 82%, and there were no deaths related to preoperative CCRT and surgery. Overall, 3-year survival rate was 69%, and a rate of locoregional recurrence was 13.6%. This study shows that many patients with locally advanced rectal cancer can be operated on with sphincter-saving radical resection surgery under good local control after preoperative concurrent chemoradiotherapy, which induces tumor downstaging.

Prospective randomized comparison of oral sodium phosphate and polyethylene glycol lavage for colonoscopy preparation.

AIM: To compare the effectiveness, patient acceptability, and physical tolerability of two oral lavage solutions prior to colonoscopy in a Taiwanese population. METHODS: Eighty consecutive patients were randomized to receive either standard 4 L of polyethylene glycol (PEG) or 90 mL of sodium phosphate (NaP) in a split regimen of two 45 mL doses separated by 12 h, prior to colonoscopic evaluation. The primary endpoint was the percent of subjects who had completed the preparation. Secondary endpoints included colonic cleansing evaluated with an overall assessment and segmental evaluation, the tolerance and acceptability assessed by a self-administered structured questionnaire, and a safety profile such as any unexpected adverse events, electrolyte tests, physical exams, vital signs, and body weights. RESULTS: A significantly higher completion rate was found in the NaP group compared to the PEG group (84.2% vs 27.5%, P<0.001). The amount of fluid suctioned was significantly less in patients taking NaP vs PEG (50.13+/-54.8 cc vs 121.13+/-115.4 cc, P<0.001), even after controlling for completion of the oral solution (P = 0.031). The two groups showed a comparable overall assessment of bowel preparation with a rate of "good" or "excellent" in 78.9% of patients in the NaP group and 82.5% in PEG group (P = 0.778). Patients taking NaP tended to have significantly better colonic segmental cleansing relative to stool amount observed in the descending (94.7% vs 70%, P = 0.007) and transverse (94.6% vs 74.4%, P = 0.025) colon. Slightly more patients graded the taste of NaP as "good" or "very good" compared to the PEG patients (32.5% vs 12.5%; P = 0.059). Patients' willingness to take the same preparation in the future was 68.4% in the NaP compared to 75% in the PEG group (P = 0.617). There was a significant increase in serum sodium and a significant decrease in phosphate and chloride levels in NaP group on the day following the colonoscopy without any clinical sequelae. Prolonged (>24 h) hemodynamic changes were also observed in 20-35% subjects of either group. CONCLUSION: Both bowel cleansing agents proved to be similar in safety and effectiveness, while NaP appeared to be more cost-effective. After identifying and excluding patients with potential risk factors, sodium phosphate should become an alternative preparation for patients undergoing elective colonoscopy in the Taiwanese population.