Adinaminė graciloplastika išmatų nelaikymui gydyti pacientei po išangės atrezijos chirurginio gydymo vaikystėje: klinikinis atvejis

Background. Here we present a case of female patient suffering from bowel incontinence. Case report. The patient underwent unstimulated graciloplasty. Postoperative period was uneventful. After 4 weeks, a course of low frequency electric external stimulation in the area around the neurovascular bundle in the thigh was performed. Patient was evaluated 3 months postoperatively. On inspection, her anus was closed at rest. She stated moderate improvement in her continence and quality of life, her Wexner score was 10 and FISI score was 32 (prior surgery 19 and 44 accordingly). Conclusion. Adynamic graciloplasty seems to be a reasonable method of choice for faecal incontinence.Įvadas. Straipsnyje aptariamas pacientės, kuri kreipėsi į kliniką dėl išmatų nelaikymo, klinikinis atvejis. Klinikinis atvejis. Pacientei atlikta adinaminė graciloplastika. Pooperacinis periodas buvo sklandus. Praėjus keturioms savaitėms, pacientei taikyta žemų dažnių išorinė elektrinė neurovaskulinio pluošto šlaunyje stimuliacija. Po trijų mėnesių pacientė atvyko į apžiūrą. Apžiūros metu nustatyta užsidariusi išangė. Pacientė teigė, kad išmatų kontrolė pagerėjo (Wexnerio skalė – 10, išmatų nelaikymo rodiklis – 32 (plg. prieš operaciją – atitinkamai 19 ir 44)). Išvada. Adinaminė graciloplastika yra vienas iš patikimų būdų išmatų nelaikymui gydyti

Hand-assisted laparoscopic colorectal surgery for colorectal polyps: single institution experience

Objective To assess outcomes of a hand-assisted laparoscopic approach (HALS) for the management of difficult colorectal polyps. Methods In 2007–2013 at the Institute of Oncology, Vilnius University, 25 HALS colorectal procedures for polyps which could not be treated by endoscopy were performed. Demographic data, histology of the biopsy, type of surgery, length of postoperative stay, complications and final pathology were reviewed prospectively. Results 25 patients with a mean age of 65.88±13.3 years underwent HALS polypectomy. Preoperative morphology was: 20 (80%) patients with adenomas and 5 (20%) – Ca in situ. Laparoscopic mobilization of colonic segment, and colotomy with removal of polyp was performed for 5 (20%) polyps. Laparoscopic segmental bowel resection was performed in 20 (80%): anterior rectal resection with partial total mesorectal excision – 10 (40%), left hemicolectomy – 6 (24%), sigmoid resection – 3 (12%) and resection of transverse colon in 1 (4%). Mean postoperative hospital stay was 6.4±2.5 days. Two patients (8%) had complications – urinary tract infection. Both recovered after conservative treatment. Mean polyp size was 3.8±2.2 cm. Final pathology revealed polyp (n = 1), tubular adenoma (n = 3), tubulovillous adenoma (n = 12), Carcinoma in situ (n = 7) and invasive cancer (n = 2). Both patients underwent laparoscopic left hemicolectomies (HALS) in 14 and 10 days after laparoscopic colotomy and polypectomy. Conclusions For the management of endoscopically unresectable polyps, laparoscopic polypectomy is currently the technique of choice. Key words: colotomy, colorectal polyp, polyp, HALS. Ranka asistuojamoji laparoskopinė chirurgija gydant endoskopiškai nepašalinamus storosios žarnos polipus Tikslas Išnagrinėti ranka asistuojamosios laparoskopinės chirurgijos (HALS) vaidmenį gydant endoskopiškai nepašalinamus storosios žarnos polipus. Metodai 2007–2013 metais Vilniaus universiteto Onkologijos institute buvo atliktos 25 polipų šalinimo HALS operacijos. Prospektyviai buvo išanalizuoti demografiniai rodikliai, histologijos duomenys, atliktų operacijų pobūdis, pooperacinio periodo trukmė, komplikacijos ir galutinė patologijos diagnozė. Rezultatai Operuoti 25 pacientai, kurių amžiaus vidurkis buvo 65,88±13,3 metai. Priešoperacinė diagnozė: 20 (80 %) atvejų adenoma ir 5 (20 %) – Ca in situ. Žarnos segmento mobilizacija su kolotomija ir polipo pašalinimu buvo atlikta 5 (20 %) pacientams. Žarnos segmento rezekcija HALS atlikta – 20 (80 %) atvejų: tiesiosios žarnos rezekcija su visiška mezorektaline ekscizija (TME) – 10 (40 %), kairioji hemikolektomija – 6 (24 %), riestinės žarnos rezekcija – 3 (12 %) ir skersinės žarnos rezekcija – 1 (4 %). Vidutinė pooperacinio periodo trukmė buvo 6.4±2.5 dienos. Dviem pacientams pasireiškė dizurijos reiškiniai (8 %). Abu pacientai pasveiko po taikyto konservatyvaus gydymo. Vidutinis polipo dydis 3,8±2,2 cm. Gauta galutinė patologijos diagnozė: polipas (n = 1), tubulinė adenoma (n = 3), tubuloviliozinė adenoma (n = 12), Carcinoma in situ (n = 7), invazyvus tumoras (n = 2). Abiem pacientams atlikta HALS kairė hemikolektomija praėjus 14 ir 10 dienų po kolotomijos su polipektomija. Išvada HALS galima kaip saugi alternatyva endoskopiškai nepašalinamiems polipams gydyti. Reikšminiai žodžiai: kolotomija, kolorektalinis polipas, polipas, HALS

Hand-assisted laparoscopic colorectal surgery for colorectal polyps: single institution experience

ObjectiveTo assess outcomes of a hand-assisted laparoscopic approach (HALS) for the management of difficult colorectal polyps.MethodsIn 2007–2013 at the Institute of Oncology, Vilnius University, 25 HALS colorectal procedures for polyps which could not be treated by endoscopy were performed. Demographic data, histology of the biopsy, type of surgery, length of postoperative stay, complications and final pathology were reviewed prospectively.Results25 patients with a mean age of 65.88±13.3 years underwent HALS polypectomy. Preoperative morphology was: 20 (80%) patients with adenomas and 5 (20%) – Ca in situ. Laparoscopic mobilization of colonic segment, and colotomy with removal of polyp was performed for 5 (20%) polyps. Laparoscopic segmental bowel resection was performed in 20 (80%): anterior rectal resection with partial total mesorectal excision – 10 (40%), left hemicolectomy – 6 (24%), sigmoid resection – 3 (12%) and resection of transverse colon in 1 (4%).Mean postoperative hospital stay was 6.4±2.5 days. Two patients (8%) had complications – urinary tract infection. Both recovered after conservative treatment. Mean polyp size was 3.8±2.2 cm. Final pathology revealed polyp (n = 1), tubular adenoma (n = 3), tubulovillous adenoma (n = 12), Carcinoma in situ (n = 7) and invasive cancer (n = 2). Both patients underwent laparoscopic left hemicolectomies (HALS) in 14 and 10 days after laparoscopic colotomy and polypectomy.ConclusionsFor the management of endoscopically unresectable polyps, laparoscopic polypectomy is currently the technique of choice.Key words: colotomy, colorectal polyp, polyp, HALS.Ranka asistuojamoji laparoskopinė chirurgija gydant endoskopiškai nepašalinamus storosios žarnos polipus TikslasIšnagrinėti ranka asistuojamosios laparoskopinės chirurgijos (HALS) vaidmenį gydant endoskopiškai nepašalinamus storosios žarnos polipus.Metodai2007–2013 metais Vilniaus universiteto Onkologijos institute buvo atliktos 25 polipų šalinimo HALS operacijos. Prospektyviai buvo išanalizuoti demografiniai rodikliai, histologijos duomenys, atliktų operacijų pobūdis, pooperacinio periodo trukmė,komplikacijos ir galutinė patologijos diagnozė.RezultataiOperuoti 25 pacientai, kurių amžiaus vidurkis buvo 65,88±13,3 metai. Priešoperacinė diagnozė: 20 (80 %) atvejų adenoma ir 5 (20 %) – Ca in situ. Žarnos segmento mobilizacija su kolotomija ir polipo pašalinimu buvo atlikta 5 (20 %) pacientams. Žarnossegmento rezekcija HALS atlikta – 20 (80 %) atvejų: tiesiosios žarnos rezekcija su visiška mezorektaline ekscizija (TME) – 10 (40 %), kairioji hemikolektomija – 6 (24 %), riestinės žarnos rezekcija – 3 (12 %) ir skersinės žarnos rezekcija – 1 (4 %). Vidutinė pooperacinio periodo trukmė buvo 6.4±2.5 dienos. Dviem pacientams pasireiškė dizurijos reiškiniai (8 %). Abu pacientai pasveiko po taikyto konservatyvaus gydymo. Vidutinis polipo dydis 3,8±2,2 cm. Gauta galutinė patologijos diagnozė: polipas (n = 1), tubulinė adenoma (n = 3), tubuloviliozinė adenoma (n = 12), Carcinoma in situ (n = 7), invazyvus tumoras (n = 2). Abiem pacientams atlikta HALS kairė hemikolektomija praėjus 14 ir 10 dienų po kolotomijos su polipektomija.IšvadaHALS galima kaip saugi alternatyva endoskopiškai nepašalinamiems polipams gydyti.Reikšminiai žodžiai: kolotomija, kolorektalinis polipas, polipas, HALS

Hand Assisted Laparoscopic Surgery for Colorectal Cancer: Surgical and Oncological Outcomes from a Single Tertiary Referral Centre

The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26–91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1–30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival

Transanal endoscopic microsurgery for rectal adenomas: single center experience

Introduction: Transanal endoscopic microsurgery (TEM) is a method of choice for the local treatment of rectal adenomas. Though generally considered as a safe method, some authors have expressed skepticism about the anorectal function following TEM. Aim: To review our experience in using TEM for removal of rectal adenomas. We focused on morbidity, local recurrence rates, and anorectal function following the operation. Material and methods : The study included 72 patients who underwent TEM for rectal adenomas from December 2009 to November 2014 at the Department of Surgical Oncology, National Cancer Institute. Of the 72 patients, 31 (43.1%) were lost in the follow-up. We recorded the demographics, operative details, final pathology, post-operative length of stay, post-operative complications, recurrences and functional outcome for each of the 41 (56.9%) remaining participants. Results : Of the 41 eligible patients, 19 (46.3%) were male and 22 (53.7%) were female. The mean age of our patients was 66.8 years. There were no intraoperative complications. In 4 (9.8%) cases, postoperative complications were observed – urinary retention (2 cases, 4.9%) and postoperative hemorrhage (2 cases, 4.9%). All complications were treated conservatively. There was a single case (2.4%) of adenoma recurrence during the follow-up period. The mean score of the FISI questionnaire was 7.6 ±9.2 (ranging from 0 to 36), and the mean Wexner score was 2.3 ±3.4 (ranging from 0 to 17). Conclusions : Transanal endoscopic microsurgery in our experience demonstrated low complication and recurrence rates, and good functional results. We conclude that TEM is an effective and safe method for the treatment of rectal adenomas

Hand assisted laparoscopic surgery for colorectal cancer: surgical and oncological outcomes from a single tertiary referral centre

The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26–91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1–30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorec-tal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival