Laparoscopic low anterior resection for early rectal cancer.

INTRODUCTION: Early rectal cancer (ERC) is adenocarcinoma that has invaded into, but not extended beyond, the submucosa. Endoscopic or minimal access surgical procedures, such as laparoscopic resection, have emerged as a useful tool in the surgical treatment of such diseases. The aim of this study is to present and analyze the feasibility, the short- and long-term results of laparoscopic colorectal surgery (LCS) in patients with ERC. PATIENTS AND METHODS: Between 2002 and 4/2011, a total of 164 patients with colorectal cancer underwent laparoscopic surgery (LS). Of these, 7 patients (4.2%) had ERC and underwent laparoscopic anterior resection (LAR). The median follow-up was 41 months. RESULTS: The mean operative time was 2.5 h. None of the laparoscopic procedures was converted to open surgery. Liquids and solid food were started on median postoperative days 1 and 3, respectively. The median length of postoperative stay was 5 days. Postoperative complications occurred in 2 patients (28.5%), including wound infection in one patient (14.2%) and atelectasis in one patient (14.2%). None of the patients required an urgent re-operation. There was no mortality related to LS. CONCLUSIONS: LS for ERC can be used as a strategy sited between endoscopic mucosal resection and open anterior resection with beneficial long- and short-term results. It appears as a technically and oncologically safe procedure when performed by surgeons with sufficient experience in laparoscopic techniques.

Cecal volvulus after twin gestation: laparoscopic approach.

INTRODUCTION: Intestinal obstruction in pregnancy is not common. Colonic volvulus occurs in 24% of such cases. Due to the rare incidence and lack of imaging during pregnancy, correct diagnosis is often delayed. CASE PRESENTATION: We present a case of a 33-year-old female with a twin pregnancy gestation, who presented with acute abdominal pain. Physical examination revealed a gravid uterus and tenderness in the lower abdominal quadrants. Due to intense uterine contractions, the patient was urgently submitted to cesarean delivery, giving birth to two healthy infants. Twelve hours after the cesarean section, right lower quadrant abdominal pain was persistently severe. Nausea, vomiting, diarrhea, and abdominal dilatation were also present. Abdominal X-ray and CT scan showed bowel obstruction, possibly secondary to cecal volvulus. The patient was subjected to explorative laparoscopy, cecal volvulus detorsion, and laparoscopic appendectomy. RESULTS: The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. CONCLUSIONS: Cecal volvulus in pregnancy is a rare, difficult to diagnose, clinical entity. It is associated with high morbidity and mortality, both of mother and fetus, because of delayed diagnosis. A high index of clinical suspicion is required in pregnant or puerperant women with signs and symptoms of bowel obstruction and persistent pain at the right low abdominal quadrant. As long as diagnosis is timely set, laparoscopy is a safe and successful means of surgical treatment.

The stapled hemorrhoidopexy syndrome: a new clinical entity?

PURPOSE: Haemorrhoidal disease is a rather common disease of unknown cause. A new technique for treating prolapsing haemorrhoids known as the stapled hemorrhoidopexy (SH) or the "Longo procedure" is widely used. Serious adverse events were reported in 2000 and some discussion over the syndrome but nothing since. METHODS: Two hundred and five patients underwent SH by our surgical team at the Interbalkan European Medical Center. Modified SH was performed. RESULTS: Despite the low incidence of postoperative complications (11/205), 36.58% of patients developed syndrome comprised of urgency to defecate, sensation of anal foreign body and incomplete defecation and mild cramp like anal discomfort, immediately after surgery or in the following 48 h. There is not statistically significant relationship between the presence of the syndrome and the gender, the presence of muscle fibres in the resected "ring" the degree of haemorrhoidal disease, age and ring length. CONCLUSION: Observations led us to conclude that the stapled hemorrhoidopexy syndrome (SHS) is probably caused by the irritating presence of the titanium staples in the rectal mucosa and by the resection itself.

Breast cancer metastatic to the rectum: a case report.

INTRODUCTION: Patients with breast cancer may present with systemic recurrence in any organ, primarily the bones, lungs, lymph nodes, liver, pleura, and adrenal glands. We report a case of rectal tumor, metastatic from breast cancer, which represents an unusual location of metastasis. CASE PRESENTATION: A 74-year-old woman, operated for lobular breast cancer 5 years ago, but not compliant with the annual follow-up, presented with severe constipation and pseudodiarrhea. Digital examination and anoscopy revealed a mass at the lower rectum, 2 cm distant from the anal verge. CT and MRI scan of the abdomen confirmed this finding and did not reveal metastatic lesions elsewhere. The patient underwent abdominoperineal resection. RESULTS: The postoperative period was uneventful, and the patient was discharged on the 7th postoperative day. The histopathological findings revealed rectal cancer, metastatic from the known invasive lobular breast cancer. CONCLUSIONS: Rectal metastasis from breast cancer is very rare. The presented case emphasizes the need to keep in mind this possibility and at all times associate the emergency condition with the related history of breast cancer.

Plasma levels of active extracellular matrix metalloproteinases 2 and 9 in patients with essential hypertension before and after antihypertensive treatment.

This study was designed to test the hypothesis that plasma concentrations of matrix metallo-proteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9), two enzymes that share similar substrate specificity (collagen type IV and V), possibly related to vascular remodelling, are altered in essential hypertension. The second aim of the study was to assess whether chronic antihypertensive treatment with the calcium channel blocker amlodipine would normalize these alterations. To test this hypothesis, we measured plasma concentrations of active MMP-2 and MMP-9 in 42 patients with never-treated essential hypertension and in 25 normotensive control subjects. Measurements were repeated after 6 months of treatment with the calcium channel blocker amlodipine. Baseline values of MMP-2 and MMP-9 were decreased (P=0.01 and 0.002, respectively) in hypertensive patients compared with normotensives. Hypertensive patients with systemic vascular resistances <1440 dyn s/cm(5) exhibited higher values of MMP-2 (P=0.005) and MMP-9 (P=0.001) than hypertensive patients with systemic vascular resistances >1440 dyn s/cm(5). Treated patients attained a nonsignificant increase in MMP-2 plasma concentrations, but a significant increase in MMP-9 plasma concentrations (P=0.01) compared to respective values before treatment. In conclusion, these findings suggest that plasma concentrations of active MMP-2 and MMP-9, mainly related to vascular extracellular matrix metabolism, are depressed in patients with essential hypertension. A 6 month treatment with amlodipine can normalize MMP-9 but not MMP-2 plasma concentrations. The hypothesis that antihypertensive treatment may modulate collagen metabolism remains to be determined by further studies.