Laparoscopic-assisted versus open resection of right-sided colonic cancer--a prospective randomized controlled trial.

PURPOSES: This study aims to compare the perioperative outcomes and survival between laparoscopic-assisted right hemicolectomy (LARH) and open right hemicolectomy (ORH) for right-sided colon cancer. METHODS: Between July 1996 and October 2005, 145 patients were randomized to receive LARH (n = 71) or ORH (n = 74). RESULTS: The median follow-up of living patients was 99.7 months. The demographic data of the two groups were similar. The time to resume diet (4 vs. 5 days, p = 0.045) and the hospital stay (7.8 vs. 10 days, p = 0.033) were significantly shorter in LARH group, but these benefits were at the expense of longer operating time (198 vs. 129 min, p = 0.002) and higher direct cost (USD8745 vs. USD6293, p < 0.001). The morbidity and mortality were comparable between the two groups. After curative resection, the probabilities of survival at 5 years of the LARH and ORH groups were 74.2% (SE 7.4%) and 75% (SE 7.1%), respectively. The probabilities of being disease free at 5 years were 82.3% (SE 6.9%) and 84.1% (SE 6.2%), respectively. CONCLUSIONS: Laparoscopic-assisted resection of right-sided colonic cancer has the advantage over open surgery in allowing earlier recovery. However this is at the expense of a longer operating time and higher direct cost (registration number: NCT00485316 ( http://www.clinicaltrials.gov )).

Emergency laparoscopic-assisted right hemicolectomy: can we achieve outcomes similar to elective operation?

The aim of this study was to compare short-term clinical outcomes of elective and emergency laparoscopic-assisted right hemicolectomy. Between January 2005 and December 2009, 181 patients had laparoscopic-assisted right hemicolectomy performed at our institute (148 elective and 33 emergency cases). The demographic data, operative details, and short-term outcomes were collected. There were 104 men and 77 women. The median age was 69 years (range, 22-88 years). The demographic data of the 2 groups were similar except the patients were younger in the emergency surgery group (60 vs. 69 years; P=.02). The operating time of the emergency group was significantly longer then the elective group (165 vs. 150 minutes; P<.001) but the intraoperative blood loss was similar. The postoperative complication and recovery were similar between the 2 groups. In selected clinical settings, emergency laparoscopic-assisted right hemicolectomy can be safely performed without worsening the clinical outcomes.

Chinese validation of Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to investigate the reliability and validity of the Chinese version of Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). METHODS: Women who presented for pelvic floor disorders completed the Chinese version of PFDI and PFIQ, SF-36, a 3-day urinary and fecal diary. POP-Q assessment, urodynamic study, anal manometry, and ultrasound were performed where appropriate. RESULTS: Five hundred and ninety-seven women completed the study. The Cronbach's alpha and test-retest reliability of PFDI and PFIQ was 0.92 and 0.98, and 0.77 and 0.79, respectively. Convergent validity was demonstrated with negative correlation of PFDI and PFIQ with SF-36; positive correlation of staging of prolapse, urinary or fecal incontinent episodes with the respective subscales of PFDI and PFIQ. CONCLUSIONS: The Chinese version of PFDI and PFIQ are reliable and valid condition-specific health-related quality of life questionnaires for women with pelvic floor disorders.

Giant Meckel's diverticulitis: a rare condition complicating pregnancy.

A 33-year-old pregnant woman presented with peritonitis at the right iliac fossa. Preoperative ultrasonography identified an 8-cm tubular structure at the tender point that was mistaken as appendicitis. Emergency operation finally confirmed a 12-cm giant Meckel's diverticulum with genuine inflammation and imminent perforation. The patient made an uneventful recovery after Meckel's diverticulectomy.

Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer: report of the first case in Hong Kong and China with an updated literature review.

Telerobotic surgery is the most advanced development in the field of minimally invasive surgery. The da Vinci surgical system, which is currently the most widely used telerobotic device, was approved by the Food and Drug Administration of the United States of America for clinical use in all abdominal operations in July 2000. The first da Vinci surgical system in China was installed in November 2005 at our institution. We herein report the first telerobotic-assisted laparoscopic abdominoperineal resection using the 3-arm da Vinci surgical system for low rectal cancer in Hong Kong and China, which was performed in August 2006. The operative time and blood loss were 240 min and 200 mL, respectively. There was no complication, and the patient was discharged on postoperative day five. An updated review of published literature on telerobotic-assisted colorectal surgery is included in this report, with special emphasis on its advantages and limitations.

Outcome of radical excision of anorectal gastrointestinal stromal tumors in Hong Kong Chinese patients.

Anorectal gastrointestinal stromal tumor (GIST) is a rare disease entity with malignant potential. Medical records of six patients (median age 68 years) with anorectal GIST who underwent surgical treatment at our institution between 1992 and 1999 were retrospectively reviewed. Four patients presented with rectal bleeding. The tumors were located in the mid and lower rectum in 4 patients and in the anal canal in 2 patients. The median tumor diameter was 4.5 cm. One patient who had undergone local excisions in another hospital presented with recurrent GIST. He refused radical excision and underwent wide local excision again. He developed recurrence 2 years later and underwent salvage pelvic exenteration, but finally died of disseminated disease. Five patients underwent initial radical excision. Among them, 3 developed recurrences (one each local, distant and both) at a median duration of 50.3 months. Two patients died of the disease, while one patient who had both local and distant recurrences resected remained alive till the end of the study period (median duration of follow-up of the 5 patients was 84.6 months). At 5 years, of 5 patients who underwent initial radical excision, 3 and 4 patients, respectively, had disease-free and overall survival. Recurrence of anorectal GIST is common despite radical excision. Nevertheless, a reasonable survival rate can be achieved.

Portal venous gas and thrombosis in a Chinese patient with fulminant Crohn's colitis: a case report with literature review.

Ever since its earliest reports, portal venous gas (PVG) has been associated with numerous intraabdominal catastrophes and has served as an indication for urgent surgical exploration. It is traditionally regarded to be an ominous finding of impending death, with highest mortality reported in patients with underlying bowel ischemia. Today, computed tomography has demonstrated a wider range of clinical conditions associated with PVG, some of which are "benign" and do not necessarily require surgery, unless when there are signs of intraabdominal catastrophe or systemic toxicity. One of these "benign" conditions is Crohn's disease. The present report describes a 19-year-old Chinese boy with Crohn's pancolitis who presented with septic shock associated with PVG and portal vein thrombosis, and was successfully managed surgically. To our knowledge, this is the first report of PVG and portal vein thrombosis associated with Crohn's disease in a Chinese patient. In addition, we have also reviewed the reports of another 18 Crohn's patients with PVG previously described in the English literature. Specific predisposing factors for PVG were identified in 8 patients, including barium enema, colonoscopy, blunt abdominal trauma, and enterovenous fistula. The patients who developed PVG following barium enema and blunt trauma were all asymptomatic and no specific treatment was necessary. Eleven patients (58%) who presented with signs of intraabdominal catastrophe or systemic toxicity required either immediate or eventual surgery. The overall mortality rate among the 19 patients was only 11%. The present literature review has shown that the finding of PVG associated with Crohn's disease does not always mandate surgical intervention. It is the clinical features and the related complications that ultimately determine the treatment approaches. The overall outcome of PVG associated with Crohn's disease has been favourable.

Polypoid lesions of the gallbladder.

BACKGROUND: Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinomas of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery, the operative approach, and the method of follow-up of those deemed not needing surgery. DATA SOURCES: This review was done by Medline search of the English literature by the keywords "polypoid lesions of gallbladder," "gallbladder polyps," "carcinoma of gallbladder," and "benign tumors of gallbladder." CONCLUSIONS: Most small polypoid lesions of the gallbladder are benign and remain static for years. Three- to six-monthly ultrasonography examination is warranted in the initial follow-up period but it is probably unnecessary after 1 or 2 years. Age more than 50 years and size of polyp more than 1 cm are the two most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstones, solitary polyp, and symptomatic polyp. Laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high, in which case it is advisable to have open exploration, intraoperative frozen section, and preparation for extended resection.