Journal of the Anus, Rectum and Colon
Online ISSN : 2432-3853
ISSN-L : 2432-3853
Volume 2, Issue 3
Displaying 1-7 of 7 articles from this issue
REVIEW ARTICLE
  • Shlomo Yellinek, Dimitri Krizzuk, Juan J. Nogueras, Steven D. Wexner
    2018 Volume 2 Issue 3 Pages 71-76
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Iatrogenic ureteral injury (IUI) is a dreaded complication of abdominopelvic surgery. Although rare, it is associated with severe consequences. This complication most commonly occurs during gynecological procedures but may also occur during colorectal surgeries. We present two cases of IUI in patients in whom the ureteric stents were electively placed. The first case was a 71-year-old male with no significant medical history. The patient underwent an elective laparoscopic sigmoidectomy for complicated diverticulitis. During the procedure, a proximal IUI occurred, and was recognized and repaired. The second case occurred in a 68-year-old male with a history of multiple complicated abdominal surgeries. The patient underwent a second redo low anterior resection for a long preanastomotic stricture. The IUI occurred in the right fibrosed presacral plane, approximately 3 cm proximal to the bladder. The ureter was reimplanted to the bladder during the same procedure. We will also present a literature review of IUI, including the risk factors, intraoperative prevention, and repair options.

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  • Masahiro Hada, Kengo Hayashi, Koichiro Sawada, Masahiro Oshima, Yosuke ...
    2018 Volume 2 Issue 3 Pages 77-82
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Objective: The use of laparoscopic surgery for rectal disease is expected to provide good cosmetic benefits for patients postoperatively. However, this expectation is significantly reduced when a diverting ileostomy is created. We present a new technique that reduces the size of the skin wound by constructing a diverting ileostomy in the umbilicus. This procedure, diverting umbilical ileostomy (umbistoma) does not require special tools for its construction and closure. Methods: Twenty-nine patients underwent treatment with umbilical diverting stoma, including five women and 24 men, with a mean age of 70 years (range: 40-88 years). At the time of ostomy closure, a new umbilicus was formed by subcutaneously suturing the wound to the fascia. In addition, we did not close the new umbilical upper and lower spaces, so as to allow open drainage of the healing wound. Results: All procedures were completed successfully without any perioperative complications. Conclusions: Our findings suggest that the umbilical diverting stoma could provide improved safety and cosmetic advantages in laparoscopic rectal resection.

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  • Yujiro Fujie, Hirofumi Ota, Masakazu Ikenaga, Junichi Hasegawa, Kohei ...
    2018 Volume 2 Issue 3 Pages 83-89
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Objectives: The aim of this study was to evaluate the feasibility of a protocol for enhanced recovery after surgery (ERAS) for colon cancer in older patients. Methods: One hundred and fifty-nine patients enrolled in the ERAS group of our previous clinical study were divided according to age into an older group (n = 31; ≥80 years old) and a younger group (n = 128; <80 years old). We compared the two groups for clinical outcomes, including surgical complications, re-admission rates, and the time to discharge, based on criteria for hospital discharge. Compliance with each ERAS element was compared between groups. Results: Concomitant diseases were present in all older patients (100%), but only in 57.8% of the younger group (P < 0.0001). The preoperative risk grade according to the American Society of Anesthesiologists classification was significantly higher in the older group than in the younger group. The postoperative surgical complications and re-admission rates were not significantly different between groups. Discharge criteria were met three days after the operation. The median length of hospital stay was slightly longer in the older group (9 days, range 5-15) than in the younger group (8 days, range 4-41; P = 0.061). Compliance above 80% was observed for 13 ERAS items in the older group and 14 ERAS items in the younger group; thus, compliance with the ERAS protocol was equally feasible in both groups. Conclusions: For older patients undergoing colon cancer surgery, an ERAS protocol might be feasible with a high implementation rate of the elements in the protocol.

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  • Takeshi Suto, Toshihiko Sato, Hazime Iizawa
    2018 Volume 2 Issue 3 Pages 90-96
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Objectives: The therapeutic value of lateral lymph node dissection in low rectal cancer (RC) patients remains a matter of debate. The present study evaluated the dissection value of each lateral lymph node, based on its histopathological characteristics. Methods: This study enrolled 381 consecutive RC patients with bilateral lateral lymph node dissection, from 1995 to 2014. We investigated their clinicopathological characteristics, and the therapeutic value of each lymph node dissection. The therapeutic values of the distal internal iliac and obturator lymph nodes were further investigated on the basis of histopathological classifications, as follows: minimum metastasis (Type A), massive metastasis (Type B) without capsular invasion, and invasive metastasis (Type C) with capsular invasion and were evaluated by the local or distant recurrence and 5 year overall survival. Results: Among the lateral lymph nodes, the therapeutic values of distal internal iliac (6.1) and obturator (7.4) lymph node dissection were higher than those of common (0.4) and proximal iliac (1.2) lymph node dissection. However, our further investigation revealed that the 5 year overall survival rates of Type C (obturator/distal iliac) were 12.5%/22.9%, whereas those of Type A and Type B were 100%/91.6% and 77.8%/50.0%, respectively. Conclusions: Metastasis and prognosis of RC patients depend on the histopathological characteristics of the distal internal iliac and obturator lymph nodes. The present study provides new insights for choices of appropriate treatments for RC patients.

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  • Takashi Inoue, Fumikazu Koyama, Hiroyuki Kuge, Takeshi Ueda, Shinsaku ...
    2018 Volume 2 Issue 3 Pages 97-102
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Objectives: With endoscopic submucosal dissection and laparoscopic surgery, treatment for colorectal neoplasms has become minimally invasive. However, few studies have compared endoscopic submucosal dissection with laparoscopic surgery for colorectal neoplasms, excluding deeply invasive cancer on preoperative diagnosis. Methods: We retrospectively reviewed the files of patients who had undergone endoscopic submucosal dissection or laparoscopic surgery for colorectal neoplasms between November 2005 and December 2015. We limited patients who were not suspected preoperatively to have aggressive submucosal invasion >1,000 μm. Results: Ninety-five patients underwent endoscopic submucosal dissection and 37 underwent laparoscopic surgery. Cases of endoscopic submucosal dissection tended to involve rectal neoplasms more often than colonic neoplasms, shorter operative times, and shorter lengths of hospital stay compared with laparoscopic surgery. The perforation rate during colonic endoscopic submucosal dissection in the early period (November 2005 to December 2010) and late period (January 2011 to December 2015) was 14.8% and 2.9%, respectively. In all cases of perforation during colonic endoscopic submucosal dissection, the ability to maneuver the endoscope was compromised. Though tumors were larger in patients who underwent rectal endoscopic submucosal dissection compared with colonic endoscopic submucosal dissection, the perforation and postoperative bleeding rates with rectal endoscopic submucosal dissection were both 3.2%. The most common indication for laparoscopic surgery was difficulty performing endoscopic submucosal dissection. Serious complications were rare. Conclusions: For colonic neoplasms, laparoscopic surgery should be considered when endoscopic submucosal dissection is technically difficult in the early period. For rectal neoplasms, endoscopic submucosal dissection is desirable even for those of large size.

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PRACTICE GUIDELINES
  • Tetsuo Yamana
    2018 Volume 2 Issue 3 Pages 103-109
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Anal fistulas usually result from an anal gland infection in the intersphincteric space, which is caused by bacteria entering through the anal crypt (cryoptglandular infection). Reports of anal fistulas have been as high as 21 people in 100,000. Anal fistulas are 2-6 times more prevalent in males than females, with the condition occurring most frequently in patients in their 30s and 40s. Anal abscess symptoms include sudden onset of anal pain, swelling, redness, and fever. Purulent discharge or intermittent perianal swelling and pain are most often consistent with anal fistula symptoms. Methods for diagnosing anal fistulas include visual inspection, palpation, digital examination, anoscopic examination, barium enema, fistulography, as well as imaging, such as ultrasound, CT, and MRI. Parks classification is widely adapted in the West; however, Japan usually employs Sumikoshi classification. Antibiotics should be administered in cases of perianal abscess with surrounding cellulitis, or concomitant systemic disease, or those not alleviated by incision and drainage. The site and size of incision and drainage depend upon the abscess type and location. Incisions should be performed taking care not to damage the sphincter muscles and with possible future fistula surgery in mind. As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas. Several approaches are utilized for anal fistulas. A specific procedure may be chosen depending upon curability and anal function. Postsurgical outcomes vary from study to study. Fecal incontinence may occur after fistula surgery, but reports vary.

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CASE REPORT
  • Daichi Kitaguchi, Yuji Nishizawa, Takeshi Sasaki, Yuichiro Tsukada, Ak ...
    2018 Volume 2 Issue 3 Pages 110-114
    Published: July 25, 2018
    Released on J-STAGE: July 30, 2018
    JOURNAL OPEN ACCESS

    Total mesorectal excision or mesorectal excision with lateral lymph node dissection (LLND) is a standard treatment for locally advanced lower rectal cancer in Japan. Although laparoscopic LLND for rectal cancer is technically complex and challenging, previous studies have demonstrated its feasibility, and the procedure is gradually becoming more common. With this increased use, the incidence of new complications specific to laparoscopic LLND is likely to increase, and a greater awareness of these complications is required. Here we report two cases of internal hernia of the small bowel through an orifice of the vesicohypogastric fascia below the superior vesical artery after laparoscopic LLND. There are six previous reports of internal hernia underneath the pelvic blood vessel after pelvic lymph node dissection for urological or gynecological malignancies, but our cases are the first two that occurred after LLND for rectal cancer. Almost all cases, including our two cases, occurred after laparoscopic surgery and required resection of an incarcerated small bowel. Therefore, the incidence of this complication is likely to increase as the number of cases treated with laparoscopic LLND increases. Our cases show that it is important to perform an emergency operation promptly instead of conservative treatment.

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