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ABSTRACT: OBJECTIVE:: To compare long-term oncologic outcomes between laparoscopic and open surgery for rectal cancer and to identify independent predictors of survival. BACKGROUND:: Few randomized trials comparing laparoscopic and open surgery for rectal cancer have reported long-term survival data. METHODS:: Data from the 3 randomized controlled trials comparing curative laparoscopic (n = 136) and open surgery (n = 142) for upper, mid, and low rectal cancer conducted at the Prince of Wales Hospital, Hong Kong, between September 1993 and August 2007 were pooled together for this analysis. Survival and disease status were updated to February 2012. Survival was calculated using the Kaplan-Meier method, and independent predictors of survival were determined using the Cox regression analysis. RESULTS:: The demographic data of the 2 groups were comparable. The median follow-up time of living patients was 124.5 months in the laparoscopic group and 136.6 months in the open group. At 10 years, there were no significant differences in locoregional recurrence (5.5% vs. 9.3%; P = 0.296), cancer-specific survival (82.5% vs. 77.6%; P = 0.443), and overall survival (63.0% vs. 61.1%; P = 0.505) between the laparoscopic and open groups. There was a trend toward lower recurrence rate at 10 years in the laparoscopic group than in the open group among patients with stage III cancer (P = 0.078). The Cox regression analysis showed that stage III cancer, lymphovascular permeation, and blood transfusion, but not the operative approach, were independent predictors of poorer cancer-specific survival. CONCLUSIONS:: This pooled analysis with a follow-up of more than 10 years confirms the long-term oncologic safety of laparoscopic surgery for rectal cancer.
Annals of surgery 04/2013; · 7.90 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to evaluate a structured training programme for laparoscopic colorectal surgery in a university colorectal unit over a 6-year period. METHODS: Data on patients who underwent laparoscopic colectomy between November 2004 and October 2010 were analyzed. Operations were performed either by the consultant colorectal surgeons or colorectal fellows. The effectiveness and safety of our structured training programme were evaluated. RESULTS: During the study period, 813 patients (478 men) with a median age 69 years (range 22-93) underwent laparoscopic colectomy. A total of 370 cases (45.5 %) were performed by four colorectal fellows. Overall, 674 patients (82.9 %) were classified as ASA I or II. The conversion rate was 3.7 %. The conversion rate, intra-operative blood loss, number of lymph nodes retrieved and post-operative recovery were similar between the two groups. When comparing with consultant group, the patients operated by fellows were: (1) significantly older; (2) more were operated on as emergency cases; (3) had pathologically less advanced tumours; (4) less patients with low rectal cancers. There were two surgical mortalities in this series. The morbidities between the two groups were similar. At the end of 3 years of training, the fellows had performed more than 85 cases of laparoscopic colectomies. The level of supervision decreased with increased experience. Finally, experienced fellows were able to supervise more junior colleagues on laparoscopic colectomies. CONCLUSIONS: Our results confirmed a structured training programme for laparoscopic colectomy is safe and effective. Reasonable results were achieved even though a high volume of cases were performed by surgical fellows.
International Journal of Colorectal Disease 12/2012; · 2.38 Impact Factor
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ABSTRACT: BackgroundLaparoscopic resection of colonic cancer has been shown to improve postoperative recovery without jeopardizing tumor clearance
and survival, but information on low rectal cancer is scarce. The aim of this randomized trial was to compare postoperative
recovery between laparoscopic-assisted versus open abdominoperineal resection (APR) in patients with low rectal cancer. Recurrence
and survival data were also recorded and compared between the two groups.
MethodsBetween September 1994 and February 2005, 99 patients with low rectal cancer were randomized to receive either laparoscopic-assisted
(51 patients) or conventional open (48 patients) APR. The median follow-up time of living patients was about 90months for
both groups. The primary and secondary endpoints of the study were postoperative recovery and survival, respectively. Data
were analyzed by intention-to-treat principle.
ResultsThe demographic data of the two groups were comparable. Postoperative recovery was better after laparoscopic surgery, with
earlier return of bowel function (P<.001) and mobilization (P=.005), and less analgesic requirement (P=.007). This was at the expense of longer operative time and higher direct cost. There were no differences in morbidity
and operative mortality rates between the two groups. After curative resection, the probabilities of survival at 5years of
the laparoscopic-assisted and open groups were 75.2% and 76.5% respectively (P=.20). The respective probabilities of being disease-free were 78.1% and 73.6% (P=.55).
ConclusionsLaparoscopic-assisted APR improves postoperative recovery and seemingly does not jeopardize survival when compared with open
surgery for low rectal cancer. A larger sample size is needed to fully assess oncological outcomes.
Annals of Surgical Oncology 04/2012; 15(9):2418-2425. · 4.17 Impact Factor
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ABSTRACT: This study aimed to evaluate the learning curve for laparoscopic colorectal resection of a university colorectal unit, the operative outcome in its developing and established period of laparoscopic colorectal resection is compared.
We analyzed 1,031 consecutive patients who underwent laparoscopic colorectal resections for colorectal carcinoma performed in a colorectal unit between April 1992 and December 2008. Multi-dimensional analyses of the learning curves of the institution and seven individual surgeons were performed.
The operative outcomes of period 2 (2002-2008) was generally better than period 1 (1992-2001), in terms of operative time, number of lymph nodes retrieved, intra-operative blood loss and transfusion. The conversion rate of period 1 was higher than period 2 (19.7% vs. 5.1%, p < 0.001). There were no difference in the rates of intra-operative complications (2% vs. 3.3%, p = 0.32) and major post-operative complications (6% vs. 4.5%, p = 0.28). Analysis of the operative time using moving average method showed that the operative time of period 2 was generally shorter than that of period 1. The operative time transiently increased when there were new trainee surgeons joining the program. The CUSUM analysis of institutional conversion rate showed a steady state being reached at 310 cases. For the rates of intra-operative and major post-operative complications, steady states were both achieved at around 50 cases, and these rates were maintained during the whole study period.
Operative outcome of laparoscopic colorectal resection improved with experience. Continuous training of new trainee would not affect the operative outcomes of an established specialized unit.
International Journal of Colorectal Disease 11/2011; 27(4):527-33. · 2.38 Impact Factor
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ABSTRACT: 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.
Between July 1996 and October 2005, 145 patients were randomized to receive LARH (n = 71) or ORH (n = 74).
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.
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 )).
International Journal of Colorectal Disease 08/2011; 27(1):95-102. · 2.38 Impact Factor
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ABSTRACT: 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.
Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2011; 21(8):701-4. · 1.40 Impact Factor
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ABSTRACT: En bloc bladder resection is often required for treating colorectal cancer with suspected urinary bladder invasion. Our aim was to review our institutional experience in en bloc resection of locally advanced colorectal cancer involving the urinary bladder over a period of 17 years.
The hospital records of 72 patients with locally advanced colorectal cancer who underwent en bloc urinary bladder resection at our institution between July 1987 and December 2004 were retrospectively reviewed. Clinical and oncologic outcomes were evaluated.
The mean duration of follow-up was 64.3 months. Genuine tumor invasion into the urinary bladder was confirmed in 34 patients (47%) by histopathology. Forty patients (56%) underwent primary closure of the urinary bladder, while 32 patients (44%) required various kinds of urologic reconstructive procedures. Operative mortality occurred in four patients (6%). The overall postoperative morbidity rate was significantly higher in patients undergoing urologic reconstruction (81% vs. 45%, p = 0.002) when compared to that in patients undergoing primary closure. This was mostly attributable to significantly higher rates of urinary anastomotic leak (21.9% vs. 0%, p = 0.002) and urinary tract infection (50% vs. 18%, p = 0.003) in the urologic reconstruction group. For the 57 patients (79%) who underwent curative resection, the 5-year overall survival rate was 59%, and the local recurrence at 5 years was 15%. Both parameters were not significantly affected by the presence of pathologic bladder invasion or the extent of surgical procedures.
En bloc bladder resection for locally advanced colorectal cancer involving the urinary bladder can produce reasonable long-term local control and patient survival.
International Journal of Colorectal Disease 04/2011; 26(9):1169-76. · 2.38 Impact Factor
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ABSTRACT: Laparoscopic colon resection is technically challenging, and conversion to open surgery is sometimes unavoidable. The impact of conversion may vary among different types of colorectal resection and pathology. Our present study aims at evaluating the risk factors and clinical outcomes of conversion in laparoscopic resection for right colon cancer.
Between the periods April 1992 to July 2007, 183 consecutive patients undergoing laparoscopic-assisted right colon resection for carcinoma of colon were identified from our database. Data pertaining demographic information, operative details, postoperative course, complications, length of stay, 30-day mortality, and follow-up status were analyzed.
The overall conversion rate was 12% (22 patients). Stage IV disease, tumor length >5 cm, and surgery performed in an earlier time period (before year 2002) were independent risk factors for conversion. Although the median operative time was comparable (195 vs 180 min, p = 0.074), more blood loss was recorded among the conversion group (350 vs 20 ml, p < 0.001). Conversion was also associated with higher wound infection rate (27.3% vs 5%, p = 0.002) and 30-day mortality (9.1% vs 0.62%, p = 0.039). After potential curative resection, the 5-year overall survival rate of the conversion and no conversion group was 53.8% and 72.6%, respectively (p = 0.039).
Our results showed that conversion increased the intraoperative blood loss, wound related morbidities, and the 30-day mortality. Moreover, it had negative impact on overall survival.
International Journal of Colorectal Disease 08/2010; 25(8):983-8. · 2.38 Impact Factor
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ABSTRACT: Endorectal ultrasound (ERUS) is an emerging technique for preoperative rectal cancer staging. It is an operator-dependent examination with accuracy closely related to endosonographer experience. In this study, we prospectively analyzed our results of ERUS staging for rectal cancer, aiming to determine its accuracy and to define the learning curve of the procedure.
Between July 2007 and August 2009, consecutive patients with rectal cancer were recruited for preoperative ERUS staging performed by a single colorectal surgeon. We compared results of ERUS tumor (uT) and nodal (uN) staging with pathological staging of surgical specimens in patients who had surgery without neoadjuvant chemoradiation. To evaluate the learning-curve effect on ERUS, patients were divided into two equal halves for analysis (early group and late group).
In the 26-month study period, 50 patients (36 males) with median age of 67 years (range 47-89 years) underwent ERUS staging. The overall accuracy rates of uT and uN staging were 86 and 66%. For uT staging, 10% of tumors were overstaged and 4% were understaged. For uN staging, 22% of patients were overstaged and 12% were understaged. With experience accumulation from early group to late group, accuracy improvement was observed in uN staging (52 vs. 80%, P = 0.037), while the accuracy rate remained consistently high in uT staging (84 vs. 88%, P = 1.0).
ERUS was accurate in preoperative staging of rectal cancer. It was an easy-to-learn procedure for accurate tumor staging, but considerable experience was required to attain accuracy for nodal staging.
Surgical Endoscopy 05/2010; 24(12):3054-9. · 4.01 Impact Factor
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ABSTRACT: In ictal scalp electroencephalogram (EEG) the presence of artefacts and the wide ranging patterns of discharges are hurdles to good diagnostic accuracy. Quantitative EEG aids the lateralization and/or localization process of epileptiform activity.
Twelve patients achieving Engel Class I/IIa outcome following temporal lobe surgery (1 year) were selected with approximately 1-3 ictal EEGs analyzed/patient. The EEG signals were denoised with discrete wavelet transform (DWT), followed by computing the normalized absolute slopes and spatial interpolation of scalp topography associated to detection of local maxima. For localization, the region with the highest normalized absolute slopes at the time when epileptiform activities were registered (>2.5 times standard deviation) was designated as the region of onset. For lateralization, the cerebral hemisphere registering the first appearance of normalized absolute slopes >2.5 times the standard deviation was designated as the side of onset. As comparison, all the EEG episodes were reviewed by two neurologists blinded to clinical information to determine the localization and lateralization of seizure onset by visual analysis.
16/25 seizures (64%) were correctly localized by the visual method and 21/25 seizures (84%) by the quantitative EEG method. 12/25 seizures (48%) were correctly lateralized by the visual method and 23/25 seizures (92%) by the quantitative EEG method. The McNemar test showed p=0.15 for localization and p=0.0026 for lateralization when comparing the two methods.
The quantitative EEG method yielded significantly more seizure episodes that were correctly lateralized and there was a trend towards more correctly localized seizures.
Coupling DWT with the absolute slope method helps clinicians achieve a better EEG diagnostic accuracy.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 06/2009; 120(7):1273-81. · 3.12 Impact Factor
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ABSTRACT: Emergency open colectomy is generally agreed, by most surgeons, to be the treatment of choice for complicated cecal diverticulitis. However, the literature on the use of laparoscopy in treating this surgical emergency is scanty. This study aimed to evaluate the feasibility and safety of emergency laparoscopic-assisted right hemicolectomy for complicated cecal diverticulitis and to compare its operative and short-term clinical outcomes with the open approach.
Between September 2001 and June 2006, 18 consecutive patients with an intraoperative diagnosis of complicated cecal diverticulitis underwent emergency right hemicolectomy at our institution, 6 with the laparoscopic-assisted approach and 12 with the open approach. Clinical data were retrospectively collected and compared between the two groups.
The demographic data of the two groups were comparable. The operative time was similar between the two groups, but the laparoscopic-assisted group had significantly less blood loss (35 vs. 100 mL; P = 0.041). Although the time to first bowel motion was significantly shorter in the laparoscopic-assisted group (3.5 vs. 5 days; P = 0.041), the time to full ambulation and the duration of hospital stay were not different between the two groups. More patients in the open group developed postoperative complications (50 vs. 33.3%), but the difference was not statistically significant.
With the availability of experienced laparoscopic surgeons, emergency laparoscopic-assisted right hemicolectomy can be safely performed in patients with complicated cecal diverticulitis. Compared with the open approach, the laparoscopic-assisted approach is associated with less blood loss and earlier return of bowel function.
Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2009; 19(4):479-83. · 1.40 Impact Factor
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ABSTRACT: We have previously reported the five-year results of a randomized trial comparing laparoscopic and open resection for cancer of the upper rectum and rectosigmoid junction. The aim of this follow-up study is to report on the long-term morbidity and ten-year oncologic outcomes among the subgroup of patients with upper rectal cancer.
From September 1993 to October 2002, 153 patients with upper rectal cancer were randomly assigned to receive either laparoscopic-assisted (n = 76) or open (n = 77) anterior resection. Patients were last followed up in December 2007. Long-term morbidity, survival, and disease-free interval were prospectively recorded. Data were analyzed by intention-to-treat principle.
The demographic data of the two groups were comparable. More patients in the open group developed adhesion-related bowel obstruction requiring hospitalization (P = 0.001) and intervention. The overall long-term morbidity rate was also significantly higher in the open group (P = 0.012). After curative resection, the probabilities of cancer-specific survival at ten years of the laparoscopic-assisted and open groups were 83.5 percent and 78.0 percent, respectively (P = 0.595), and their probabilities of being disease-free at ten years were 82.9 percent and 80.4 percent, respectively (P = 0.698).
Laparoscopic-assisted anterior resection for upper rectal cancer is associated with fewer long-term complications and similar ten-year oncologic outcomes when compared with open surgery.
Diseases of the Colon & Rectum 05/2009; 52(4):558-66. · 3.13 Impact Factor
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ABSTRACT: The aim of the present study was to compare the clinical outcomes of emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma.
Between July 2003 and July 2006, 43 consecutive patients with obstructing right-sided colonic carcinoma underwent emergency right hemicolectomy at our institution, 14 with the laparoscopic-assisted approach and 29 with the open approach. Clinical data were retrospectively recorded and compared between the two groups.
There were no significant differences between the two groups with respect to age, gender, co-morbidities, duration of obstructing symptoms, tumor length, and tumor staging. The laparoscopic-assisted group had longer operative time than the open group (187.5 min versus 145 min; p=0.034) but less blood loss (20 ml versus 100 ml; p=0.020). The median time to full ambulation was significantly shorter in the laparoscopic-assisted group (4 days versus 6 days; p=0.016), but the time to return of gastrointestinal function and the duration of hospital stay were similar between the two groups. More patients in the open group developed postoperative complications (55.2% versus 28.6%), but the difference was not statistically significant.
Emergency laparoscopic-assisted right hemicolectomy for obstructing right-sided colonic carcinoma is feasible and safe. In comparison with the open approach, the laparoscopic-assisted procedure is associated with less blood loss, earlier ambulation, and possibly lower morbidity rate.
World Journal of Surgery 04/2008; 32(3):454-8. · 2.36 Impact Factor
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ABSTRACT: Synchronous laparoscopic resections of coexisting abdominal diseases are shown to be feasible without additional postoperative morbidity. We report our experience with synchronous laparoscopic resection of colorectal carcinoma and renal/adrenal neoplasms with an emphasis on surgical and oncologic outcomes. Five patients diagnosed to have synchronous colorectal carcinoma and renal/adrenal neoplasms (renal cell carcinoma in 2 patients, adrenal cortical adenoma in 2 patients, and adrenal metastasis in 1 patient) underwent synchronous laparoscopic resection. The median operative time was 420 minutes and the median operative blood loss was 1000 mL. Three patients developed minor complications, including wound infection in 2 patients and retention of urine in 1 patient. There was no operative mortality. The median duration of hospital stay was 11 days. At a median follow-up of 17.6 months, no patient developed recurrence of disease. Synchronous laparoscopic resection of colorectal and renal/adrenal neoplasms is technically feasible and safe.
Surgical laparoscopy, endoscopy & percutaneous techniques 09/2007; 17(4):283-6. · 1.23 Impact Factor
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ABSTRACT: To assess the usefulness of air-inflated magnetic resonance colonography (MRC) in patients with incomplete conventional colonoscopy (CC).
From September 2001 to December 2004, 51 patients (25 male and 26 female, age range 32 to 85 years) with incomplete colonoscopy were recruited to have MRC performed. Half-fourier single short turbo spin echo (HASTE) axial, coronal, and three dimensional fat suppressed gradient echo sequence (VIBE) coronal images in both the prone and supine positions were performed for each patient. MRC was reviewed by two radiologists for detection of synchronous colonic lesion. The location and size of lesions were recorded and were compared with the findings of CC. Patients were managed according to the clinical situation and intraoperative findings were compared with MRC findings. Follow-up colonoscopy was performed in 29 patients. The follow-up colonoscopy findings were then compared with the MRC findings.
Forty-four patients had incomplete colonoscopy because of an obstructing tumor. The other seven patients had incomplete colonoscopy because of excessive bowel looping. Apart from one patient suffering from chronic obstructive airway disease with resulting nondiagnostic MRC, all other patients had MRC successfully performed. Each colon was divided into six bowel segments for analysis. All 300 segments were of diagnostic quality and were assessed by the MRC. MRC correctly identified all 44 obstructing tumors demonstrated by initial CC. Synchronous tumors in proximal colonic segments were identified in two patients by MRC. In addition, MRC identified two colonic tumors located in bowel segments inaccessible by CC because of excessive looping.
MRC is useful for detection of colonic pathology and assessment of proximal colon in patients with colonic cancer after incomplete colonoscopy.
The American Journal of Gastroenterology 02/2007; 102(1):56-63. · 7.28 Impact Factor
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ABSTRACT: Simultaneous resection of colorectal tumor and liver metastasis has been advocated because of the benefits of avoiding a second operation, reduced morbidity, shorter treatment time, and similar outcomes. We report a case of simultaneous laparoscopic resection. The operative time was 350 minutes and the estimated blood loss was 500 mL. The patient required parenteral analgesia for less than 48 hours. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 5. He was fully mobile on postoperative day 4 and was discharged 3 days later. With the advance of laparoscopic technology and technique, simultaneous resection becomes an attractive option.
Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2006; 16(5):486-8. · 1.40 Impact Factor
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ABSTRACT: 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.
World Journal of Gastroenterology 10/2006; 12(34):5582-6. · 2.47 Impact Factor
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ABSTRACT: Objective: This prospective study aimed to evaluate the efficacy and safety of 4% formalin dab in managing patients with refractory radiation proctitis.Methods: From January 2001 to December 2004, 11 patients with radiation proctitis who did not respond to regular steroid enemas and/or argon plasma coagulation were treated with local application of 4% formalin-soaked gauze (formalin dab). Main outcome measures were control of bleeding, changes in haemoglobin level, hospitalization and blood transfusion requirements, and complications.Results: The mean haemoglobin level before formalin dab was 7.3 ± 2.4 g/dL. Eight patients had required repeated admissions to hospital for blood transfusions (median 4 units; range, 2–27 units). The median number of sessions of formalin dab was two (range, 1–6). The treatment was effective in 10 patients (90.9%): four patients had complete cessation of bleeding and six patients had improvement of symptoms. At a median follow-up of 15.3 months, only three patients required hospital admission once for blood transfusions (range 1–2 units). The mean haemoglobin level after formalin dab was 10.4 ± 2.2 g/dL, which was significantly higher than that before formalin dab (P = 0.007). No patient developed complications after formalin dab.Conclusions: Formalin dab is an effective and safe treatment modality for refractory radiation proctitis.
Surgical Practice 09/2006; 10(4):143 - 147. · 0.15 Impact Factor
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ABSTRACT: We report our preliminary experience in urgent laparoscopically assisted right hemicolectomy for obstructing right-sided colon carcinoma.
From January to April 2005, seven consecutive patients with obstructing right-sided colon carcinoma underwent emergency laparoscopically assisted right or extended right hemicolectomy. Patient demographic data, operative details, and short-term clinical outcomes were prospectively collected and analyzed.
The median duration of obstructing symptoms prior to admission was 3 days (range, 1-6 days). Two patients underwent palliative resection and five patients underwent curative resection. The median operative time was 180 minutes (range, 125-350 minutes). There were no conversions to the open procedure. Median blood loss was 30 mL (range, negligible-300 mL). The median times to resuming diet, first bowel motion, and full ambulation were 4 days (range, 3-10 days), 5 days (range, 3-7 days), and 4 days (range, 4-5 days), respectively. The median duration of hospital stay was 7 days (range, 6-19 days). One patient with ischemic heart disease developed acute coronary syndrome postoperatively and died on postoperative day 19. The remaining patients had no complications. The median tumor length was 3.5 cm (range, 2-5 cm) and the median number of lymph nodes removed was 17 (range, 16-36).
Emergency laparoscopically assisted right hemicolectomy for obstructing right-sided colon carcinoma is feasible and safe, with favorable short-term clinical outcomes and an acceptable number of lymph nodes removed.
Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2006; 16(4):350-4. · 1.40 Impact Factor
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ABSTRACT: Background: Post-haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre-emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy.Method: Patients with symptomatic third or fourth degree haemorrhoids undergoing open haemorrhoidectomy were randomized into four groups. Group 1 received pre-emptive analgesia (0.5% bupivacaine). Group 2 received oral metronidazole (400 mg three times daily for 1 week). Group 3 received both treatments while group 4 was the control group.Results: Number of patients recruited was 105. There was no significant difference among the four groups in terms of pain scores on the first three postoperative days, analgesic requirements, hospital stay and the time to return to normal daily activities. Patients who received oral metronidazole had significantly less pain at the time of the first bowel motion (P = 0.037).Conclusion: Oral metronidazole significantly reduces pain during the first bowel motion after open haemorrhoidectomy. Pre-emptive analgesia with 0.5% bupivacaine does not reduce postoperative pain.
Surgical Practice 07/2006; 10(3):102 - 105. · 0.15 Impact Factor
