Para-sacral approach for large gastrointestinal stromal tumor of the lower rectum.

Rectal gastrointestinal stromal tumor (GIST) is comparatively rare and usually already large when detected. As resection is the main therapy for patients with primary resectable GIST, the surgical procedure must be tailored to the tumor status. For GISTs of the lower rectum, laparoscopic low anterior resection or abdominoperineal resection is one of the procedures of choice. However, rectal tumor, including rectal GIST, can also be surgically treated using a variety of posterior approaches. Of these, para-sacral approach is both simple and less invasive, even for large rectal GISTs, and provides a good view of the operative field. Here, we describe our procedure for the surgical treatment of large GISTs of the lower rectum.

Applying contact-mode argon plasma coagulation for retroflex colonoscopic treatment of ultra-lower rectal polyps / 中国内镜杂志

Objective To explore the clinical values of applying contact-mode argon plasma coagulation (APC) for retroflex colonoscopic treatment of ultra-lower rectal polyps. Methods 46 wide outsole and applanate polyps smaller than 1.0 cm located at ultra-lower rectum in 17 cases of patients were treated by contact-mode APC under U-type retroflex colonoscopy after failure in regular colonoscopic treatment. Then observe the contacting rate of APC probe with polyps, success rate of curing polyps, rate of probe being adhered and blocked by the solidification structures, incidence of submucosal emphysemas, and incidence of colonoscope ambustion. Results Under U-type retroflex colonoscopy, the probe could contact with polyps in 17 patients. The polyps in every patient were cured by APC in the first time of colonoscopic treatment, whereas all 46 polyps were cured by 97 times of APC spurt. Mild adhesions occurred between the probe and solidification structures at 5 times (5.15 %) among 97 times of APC spurt, without injuries to the coagulation surface from which when the probe separated. The solidification structures blocked the probe only twice (2.06 %). When the solidification structures were cleared, efficiency of the probe restored. No sub-mucosal emphysemas and colonoscope ambustion happened. Conclusion Applying contact-mode APC for retroflex colonoscopic treatment of ultra-lower rectal polyps is safe and effective, it can prevent the damage of colonoscope from the argon knife.

The combined abdominal and perineal approach for dissection of the lower rectum. The development of new indications.

AIMS: Dissection of the lower rectum in some low rectal and pararectal pathologies can be technically difficult that it ends up in abandoning the procedure or raising a permanent stoma. The recently described combined abdomino-perineal approach allows completion of rectal dissection from the perineal route and preservation of the anal sphincters. Patients requiring the combined approach are not seen frequently and reports on this new technique are scarce. The purpose of this study is to analyze our results of using the combined abdomino-perineal approach in different benign and malignant low rectal pathologies, and to describe two new indications for the technique. PATIENTS AND METHODS: This is a retrospective analysis of prospectively collected data of 10 patients (8 males, age range 22-75 years), including 7 cancer patients who required the combined abdomino-perineal approach for completion of their procedures. Previously unreported indications for the technique included iatrogenic rectovaginal fistula and presacral tumor. The study was conducted in a tertiary referral colorectal unit in a university hospital. RESULTS: The procedure was completed and the sphincters preserved in all patients. All cancer patients had adequate resection with good quality mesorectum. Continence was preserved in 4 patients. Three patients are living with permanent stoma. Anastomotic perineal fistula requiring dismantling the anastomosis and raising a permanent stoma occurred in one patient. CONCLUSIONS: The combined abdomino-perineal approach is useful to complete rectal resection in a highly selected group of patients with technically difficult low rectal pathologies. The technique is probably safe in cancer patients and new indications are evolving. Expectations for preservation of continence are disappointing.

Strategies of surgical approaches of local resection for mid-lower rectal tumors and pelvic floor neoplasia / 国际外科学杂志

Objective To investigate the strategies of surgical approaches,indications and surgical techniques of local resection for mid-lower rectal tumors and pelvic floor neoplasia.Methods Clinical data of 122 patients underwent local resection for mid-lower rectal tumors pelvic floor neoplasia between July 2004 and July 2008 were analyzed retrospectively.Results Transanal,transsacral,transsphincteric local resection was respectively performed in 45,and 32,and 45 patients.Pathological examination proved that benign tumors were account for 81 cases,pelvic floor neoplasia 16 cases,malignant tumors 25 cases.The masses were 5.6 cm(0 to 12 cm) apart from the anal border,and the mean tumors' diameter was 4.2 cm (0.5 to 11 cm).No case was diagnosed with positive margins upon final pathology of resected specimens.The rate of postoperative complications of transanal,transsacral,transsphincteric approaches was 8.9％ (4/45),18.8％ (6/32),20.0％ (9/45),respectively.The recurrence of transanal,transsacral,transsphincteric approaches was 6.7％ (3/45),9.4％ (3/32),4.4％ (2/45),respectively.Conclusions The three approaches for patients suffering from mid-lower rectal tumors and pelvic floor neoplasia have respectively advantages.Transsphincteric approach is the most useful methods,but with more postoperative complications,so it need more surgical techniques.

Clinical application of curve-type stapler in lower rectal cancer reserving anus / 临床外科杂志

Objective To evaluate the effect of Curve-t ype Stapler applied in lower rectal cancer reserving anus. Method The experiences were summarized and analyzed in 31 patients underwent re serving anus from January 2000 to April 2001.In 31 patients were performed end- to-side anastomosis for lower rectum cancer through abdomen.Result There were no complications including hemorrhage, stenosis and postope rative fistula in 31 cases lower rectum cancer end-to-side anastomosis.Conclutions The way of anastomosis is an effective, reliable, co nvenient method which lasts a short time.