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Li-Jen Kuo, James Chi-Yong Ngu, Yiu-Shun Tong, Chia-Che Chen
OBJECTIVE: Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. METHODS: Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon...
October 15, 2016: International Journal of Colorectal Disease
C Isbert
The Contour® Transtar™ operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) and/or full thickness rectal prolapse. In contrast to the conventional STARR technique a specially designed single curved stapler is used with which the rectal wall is incised in a circular fashion and anastomosed. This results in a monoblock resection with almost unlimited extent of resection. In multicenter studies the procedure has generally been shown to be effective for treatment of ODS with intussusception and rectocele...
October 14, 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Paul A Lehur, Anne S Didnée, Jean-Luc Faucheron, Guillaume Meurette, Philippe Zerbib, Laurent Siproudhis, Béatrice Vinson-Bonnet, Anne Dubois, Christine Casa, Jean-Benoit Hardouin, Isabelle Durand-Zaleski
OBJECTIVE: To compare Doppler-guided hemorrhoidal artery ligation (DGHAL) with circular stapled hemorrhoidopexy (SH) in the treatment of grade II/III hemorrhoidal disease (HD). BACKGROUND: DGHAL is a treatment option for symptomatic HD; existing studies report limited risk and satisfactory outcomes. DGHAL has never before been compared with SH in a large-scale multi-institutional randomized clinical trial. METHODS: Three hundred ninety-three grade II/III HD patients recruited in 22 centers from 2010 to 2013 were randomized to DGHAL (n = 197) or SH (n = 196)...
November 2016: Annals of Surgery
Marta Penna, Roel Hompes, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B Hanna, Neil J Mortensen, Paris P Tekkis
OBJECTIVE: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology. BACKGROUND: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population...
October 4, 2016: Annals of Surgery
Wen-Tao Zhao, Ning-Ning Li, Dan He, Jin-Yan Feng
BACKGROUND: Transanal tubes (TTs) have been used to prevent and reduce anastomotic leakage after rectal cancer surgery. The aim of this review was to investigate the efficacy and safety of the TT. METHODS: A systematic literature search was performed to identify randomized controlled trials and controlled clinical trials assessing the clinical efficacy and safety of TTs in rectal cancer surgery. RESULTS: Seven trials with 1609 participants were included...
October 12, 2016: World Journal of Surgery
Young Seob Shin, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Tae Won Kim, Heung Moon Chang, Jin-Hong Park, Seung Do Ahn, Sang-Wook Lee, Eun Kyung Choi, Jin Cheon Kim, Jong Hoon Kim
PURPOSE: To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. MATERIALS AND METHODS: Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients' characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months...
September 2016: Radiation Oncology Journal
D A Khubezov, S N Trushin, K V Puchkov, D K Puchkov, A Yu Ogorel'tsev
AIM: to present the results of treatment of rectal foreign bodies. MATERIAL AND METHODS: 15-year outcomes of 112 patients with rectal foreign bodies were analyzed. RESULTS: Outpatient and hospital care were applied in 52 (46%) and 60 (54%) of cases respectively. Transanal removal was made in 97 (87%) patients including 28 (25%) cases of general anaesthesia. 14 (13%) patients underwent surgery. Colostomy was performed in 7 (6%) cases. We presented cases of foreign bodies removal through laparotomy, colotomy and SILS-assisted transanal approach...
2016: Khirurgiia
Kiryu Yap, Sarah Mills, Michelle Thomas, James Moore
BACKGROUND: To establish the incidence of unsuspected malignancy in lesions excised through transanal endoscopic microsurgery (TEM) and examine the justification for full-thickness excision of all lesions thought to be benign pre-operatively. METHODS: Demographic, operative and pathology data of all patients undergoing TEM at a single institution were collected in a prospectively maintained database. Follow-up data were collected with a focus on polyp recurrence rates and outcome in patients found to harbour malignancy...
October 9, 2016: ANZ Journal of Surgery
L Bustamante-Lopez, M Sulbaran, C Sakai, E G de Moura, L Bustamante-Perez, C S Nahas, S C Nahas, I Cecconello, P Sakai
INTRODUCTION AND AIMS: Rectal prolapse is common in the elderly, having an incidence of 1% in patients over 65years of age. The aim of this study was to evaluate the safety and feasibility of a new endoluminal procedure for attaching the previously mobilized rectum to the anterior abdominal wall using an endoscopic fixation device. MATERIALS AND METHODS: The study is a single-arm phasei experimental trial. Under general anesthesia, total rectal prolapse was surgically reproduced in five pigs...
October 4, 2016: Revista de Gastroenterología de México
M Buechter, J M Theysohn, A Kahraman, P Manka, G Gerken, A Canbay, A Dechêne
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is considered the gold standard for treatment of gastrointestinal variceal bleeding refractory to endoscopic therapy in patients with portal hypertension. Clinically relevant hemorrhage from rectal varices is less frequent than from other sources, and the therapeutic role of TIPS is still ambiguous. Case report: A 57-year-old female patient was referred to us in December 2015 with severe signs of decompensated alcohol-induced liver cirrhosis. During hospitalization, she presented with recurrent hematochezia from rectal varices following electrosurgical snare removal of a rectal adenoma...
October 5, 2016: Zeitschrift Für Gastroenterologie
F Borie, T Coste, J M Bigourdan, F Guillon
BACKGROUND: Prosthetic-related infection and erosion occurring after a laparoscopic ventral rectopexy (LVR) are rare complications, and their importance is often underestimated. The aim of this study was to compare the incidence rate and surgical management of these complications in LVR patients with polyester (PE) or polypropylene (PP) prostheses. METHODS: From January 2004 to June 2012, 149 patients underwent LVR with PE and 176 underwent LVR with PP. Surgical management and rate of infectious and erosive prosthesis-related complications, depending on the type of prosthesis, were described and compared...
October 3, 2016: Techniques in Coloproctology
Shingo Noura, Masayuki Ohue, Norikatsu Miyoshi, Masayoshi Yasui
Transanal excision (TAE) for rectal tumors is increasingly applied and it is generally recommended that the defect following full-thickness excision should be closed. The aim of this study was to compare the complications and anal function following TAE between cases where the defect was closed and those where it was not. A total of 43 consecutive rectal malignant tumor patients eligible for TAE were investigated. Regarding anorectal function, incontinence was assessed using the Wexner score. The defect of the rectum was closed in 21 of the 43 patients...
October 2016: Molecular and Clinical Oncology
W Xu, Z Xu, H Cheng, J Ying, F Cheng, W Xu, J Cao, J Luo
AIM: The objective of this meta-analysis was to evaluate the feasibility, safety, and short-term clinical outcomes of transanal total mesorectal excision (TaTME) comparing with laparoscopy total mesorectal excision (LapTME) for mid and low rectal cancer. METHODS: Relevant studies were searched from the databases of Pubmed, Embase, and the Cochrane Library. The qualities of all of the included studies were evaluated using Newcastle-Ottawa Scale (NOS). The synthesized outcomes were pooled using fixed-effects models or random-effects models, which weighted the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI)...
September 19, 2016: European Journal of Surgical Oncology
M-P Bernardi, A L A Bloemendaal, M Albert, M Whiteford, A R L Stevenson, R Hompes
PURPOSE: Transanal total mesorectal excision (taTME) requires specific technical expertise, as it is often difficult to ascertain the correct dissection plane. Consequently, one can easily enter an incorrect plane, potentially resulting in bleeding (sidewall or presacral vessels), autonomic nerve injury and urethral injury. We aim to demonstrate specific visual features, which may be encountered during surgery and can guide the surgeon to perform the dissection in the correct plane. METHOD: Specific features of dissection in the correct and incorrect planes are demonstrated in the accompanying video...
October 1, 2016: Techniques in Coloproctology
Marta Penna, Nicolas C Buchs, Alexander L Bloemendaal, Roel Hompes
The surgical approach to total mesorectal excision (TME) for rectal cancer has undergone a substantial evolution with the adoption of more minimally invasive procedures. Transanal TME (taTME) is the latest advanced technique pioneered to tackle difficult pelvic dissections. Areas covered: The evolution of TME surgery from open to laparoscopic, robotic and transanal techniques was explored in this review. The outcomes to date on the latest approach, taTME, are reviewed and the future direction of rectal cancer surgery proposed...
October 3, 2016: Expert Review of Anticancer Therapy
Giancarlo D'Ambrosio, Gianfrancesco Intini, Andrea Balla, Silvia Quaresima, Andrea Picchetto, Ardit Seitaj, Salvatore Campo, Francesca De Laurentis, Alessandro M Paganin
AIM: Recto-Urinary Fistula (RUF) is a rare complication of pelvic surgery. Different approaches are reported in literature but a gold standard treatment has not yet been achieved. Transanal Endoscopic Microsurgery (TEM) is a miniinvasive approach with well known advantages as magnification, 3D view and lighting of the operative field. Aim of the present review is to report the current evidence in literature about technique and results of RUF treatment by TEM and to suggest some key points for its correct management...
2016: Annali Italiani di Chirurgia
Jean-Gabriel Previnaire, Jean-Marc Soler, Pierre-Eugène Mortier, Hemanou Bordji, Marie-Claude Fiolet, Marie-Agnès Navaux
OBJECTIVE: Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease. The prevalence of neurogenic bowel dysfunction (NBD) in rehabilitation centers is still largely unknown, their assessment difficult and the use of transanal irrigation non systematic even in presence of severe NBD. OBSERVATIONS: Prospective study by detailed questionnaire, with use of the Neurogenic Bowel Dysfunction Score (0-47) and the Patient Global Impression of Severity (PGI-S), a 1-item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and Bristol Stool Chart for stool consistency...
September 2016: Annals of Physical and Rehabilitation Medicine
Wei-Cheng Liu, Song-Lin Wan, S M Yaseen, Xiang-Hai Ren, Cui-Ping Tian, Zhao Ding, Ken-Yan Zheng, Yun-Hua Wu, Cong-Qing Jiang, Qun Qian
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS...
September 21, 2016: World Journal of Gastroenterology: WJG
Manabu Okawada, Michael W Wilson, Scott D Larsen, Elke Lipka, John Hillfinger, Daniel H Teitelbaum
BACKGROUND: Blockade of the renin-angiotensin system (RAS) has been shown to alleviate inflammatory processes in the gastrointestinal tract. The aim of this study was to determine if blockade of the RAS would be effective in an immunologically relevant colitis model, and to compare outcome with an acute colitis model. METHODS: A losartan analog, CCG-203025 (C23H26ClN3O5S) containing a highly polar sulfonic acid moiety that we expected would allow localized mucosal antagonism with minimal systemic absorption was selected as an angiotensin II type 1a receptor antagonist (AT1aR-A)...
September 26, 2016: Pediatric Surgery International
Monica Ortenzi, Roberto Ghiselli, Maria Michela Cappelletti Trombettoni, Luca Cardinali, Mario Guerrieri
AIM: To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS: We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging...
September 16, 2016: World Journal of Gastrointestinal Endoscopy
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