A 64-year-old man with alcoholic cirrhosis was referred to our hospital because of wall thickening in the terminal ileum found by CT scan performed to investigate the cause of right lower abdominal pain and bloody stools. Capsule endoscopy and double-balloon endoscopy showed multiple submucosal tumors (SMTs) in the middle to lower small intestine. Histological examination of the SMTs demonstrated proliferation of atypical cells having round shaped nuclei and eosinophilic cytoplasm, arranged in a nested pattern. Neuroendocrine tumor (NET) in the ileum was diagnosed and surgery was performed. Intraoperative findings revealed multiple tumors located in the ileum 315 cm to 365 cm from the Treitz ligament, and partial resection of the small intestine was performed. In addition, intraoperative endoscopy showed tumors in six other locations, and so wedge resection of the tumors was performed to avoid nutritional disturbance and deterioration of liver function. Pathological findings of the resected specimens revealed that all tumors were NET (G1, G2). We describe here a rare case of multiple NETs involving the small intestine treated by laparoscopic surgery.

Purpose: To evaluate the surgical outcomes of transabdominal rectopexy for rectal prolapse.

Subjects: 94 cases between 2012 and 2019.

Results: 24 patients underwent laparotomy and 70 patients underwent laparoscopy. Mean age was 72.3 years (17-93), with 10 males and 84 females. Mean prolapse length was 4.3 cm (1-10). 55 cases were operated for the first time, and 39 were recurrent cases (8 second recurrence or more). The mean operative time was 148 minutes for open suture fixation, 143 minutes for laparoscopic suture fixation, and 229 minutes for laparoscopic ventral rectopexy. Recurrence was observed in 8 patients (8.5%). In all cases of recurrence with suture rectopexy as the previous treatment, the fixation on the intestinal side had dislocated, suggesting that the intestinal serosal muscle layer at the fixation site had torn due to tissue fragility or a shallow and narrow needle, resulting in recurrence.

Conclusion: In transabdominal rectopexy, it is important to pay close attention to tissue fragility of the intestinal tract, especially during suture fixation, to ensure secure fixation.

We evaluated the significance of the prognostic nutritional index (PNI) and modified Glasgow Prognostic Score (mGPS) for colorectal cancer resection in elderly patients.

Methods: We classified 332 patients undergoing colorectal cancer excision according to PNI (＞40 [n＝251] and ≤40 [n＝81]) and mGPS (0/1 [n＝278], 2 [n＝54]). We examined the incidence of postoperative complications, and survival.

Results: mGPS 2 was associated with all complications, especially in anastomotic leakage. The prognosis was significantly poor in the PNI low group and the mGPS high group. A correlation was observed between PNI and mGPS, and low PNI and high mGPS had the poorest prognosis and were independent predictive prognostic factors.

Purpose: taTME requires a safer anastomotic technique with the use of a distal purse-string suture for the single stapling technique (SST). We herein present a novel technique of quadruple purse-string suture (PSS) for SST and surgical outcomes following taTME for rectal cancer.

Results: We retrospectively evaluated prospectively collected data of 27 consecutive patients (20 men, 7 women; median age, 65 years; median body mass index, 23 kg/m²) with rectal cancer who underwent taTME with SST using quadruple PSS from November 2014 to October 2020. The resection ring for the rectal stump was complete in 85.2%. The rates of postoperative complications and anastomosis-related morbidity were 22.2% and 7.2%, respectively.

Conclusions: The quadruple PSS for SST following taTME is a useful technique for improving the completeness of resection rings and the anastomosis-related morbidity in patients with rectal cancer.

Background: Ligation and excision (LE) is a highly versatile procedure applicable to all forms of internal and external hemorrhoids as well as hemorrhoids with concomitant lesions. Hence, LE is an essential surgical technique that proctologists should learn. However, compared with other surgical techniques, this procedure has several disadvantages, such as complications (e.g., pain, bleeding, and stenosis) and longer learning time.

Objective and methods: Among 558 patients who underwent LE at more than three sites at our hospital between December 2015 and March 2022, 368 who had received anorectal manometry before and after the surgery were included in the study. Postoperative outcomes and complications were evaluated.

Surgical outcomes: Overall, 134 men and 234 women with a median age of 49.5 years were included. The median duration of surgery was 23 min. The maximum anal canal resting pressure decreased by 17.6% and 13.6% after surgery in men and women, respectively. Postoperative complications comprised 4.3% bleeding, 2.2% stenosis, and 1.6% urinary incontinence.

Conclusion: The incidence of postoperative complications here was in line with the results of previous studies. LE is a highly radical surgical technique; however, surgeons should be wary of a decrease in sphincter function.

Chemoradiation therapy (CRT) is becoming the standard treatment for anal canal squamous cell carcinoma (ACSCC). In this study, we examined the treatment results of 7 cases of ACSCC treated at our hospital. TNM classification was 1 case, 1 case, 5 cases and 0 case of Stage I, II, III and IV, respectively. CRT was performed in all cases. Two courses of chemotherapy with 5-FU and mitomycin C (cisplatin for one patient) were performed. Radiation therapy was performed in the pelvis and both inguinal lymph node areas. As a result, CR was obtained in all cases and all cases survived without recurrence. As Grade 3 or higher adverse events, diarrhea, hematologic adverse events and radiation dermatitis occurred. Grade 2 radiation rectalitis and radiation cystitis were observed as late adverse effects. We also searched case reports of ACSCC treated with CRT in Japan and obtained relatively good outcomes. CRT is considered to be a curative treatment method in Japan.

Implantation cysts are late-onset cysts in the intestinal anastomosis. The cysts have been reported as lesions occurring after the low anterior resection procedure for prolapse and hemorrhoids. We report a case of an elevated lesion that was thought to have self-destructed after PPH and underwent endoscopic fenestration. In 2006, PPH was performed by a previous doctor, and in 2019, endoscopy during a regular examination revealed a submucosal tumor-like lesion in the rectum. Upon close examination, it was found to be a submucosal tumor-like lesion with a fistula, located on the oral side of the staples of PPH, and protruding outside the internal anal sphincter. The contents were a stool mass. We performed fenestration safely for the purpose of diagnostic treatment. Implantation cysts such as those reported this time were found in 5 cases of PPH and 23 cases of LAR, and thus are relatively rare. We report this case, with a review of the literature.

The patient was a 47-year-old woman scheduled for surgery in gynecology. She presented with a chief complaint of abdominal pain. An abdominal CT scan showed an enlarged appendix. Colonoscopy showed a mass at the appendix opening, which was diagnosed as normal mucous membrane by biopsy. The preoperative diagnosis was an appendiceal mass and laparoscopic surgery was performed. The histopathological findings were an appendiceal intussusception related to endometriosis. This disease is very rare.