Objective: This study aimed to assess the short-term outcomes of right-sided colon cancer surgeries with intracorporeal anastomosis, comparing them to the conventional extracorporeal anastomosis.

Methods: 181 cases of laparoscopic right-sided colon resections performed between April 2018 and December 2021 for cStage I-III colorectal cancer were included. Propensity Score Matching (PSM) was conducted, considering age, gender, BMI, ASA-PS, preoperative predicted depth of tumor invasion, tumor size, and surgical procedure as covariates. The short-term outcomes of the intracorporeal anastomosis (IA) group were compared with the extracorporeal anastomosis (EA) group.

Results: After PSM, both groups comprised 52 cases each. The IA group had a significantly shorter incision length, less blood loss, and shorter postoperative hospital stay than the EA group. The frequency of Clavien-Dindo classification II or higher complications did not show a significant difference.

Conclusion: The short-term outcomes of intracorporeal anastomosis for laparoscopic right-sided colon cancer surgery were comparable and deemed acceptable compared to the conventional extracorporeal anastomosis.

Objective: To examine whether surgical control of peritoneal dissemination improves patient prognosis in patients with peritoneal dissemination of colorectal cancer with hematogenous metastasis.

Methods: We retrospectively reviewed the outcomes of 55 patients with simultaneous peritoneal dissemination of colorectal cancer who underwent surgical resection (primary site and disseminated site) at Nippon Medical School Hospital, and extracted factors associated with poor prognosis.

Results: Survival tended to be better in patients who underwent surgery without peritoneal dissemination (median survival: 29, 8 months vs. 17, 2 months, P = 0, 09). Patients who could receive postoperative chemotherapy had significantly better survival rate than those who could not (median survival: 30, 5 months vs. 8, 2 months, P < 0.01). Multivariate analysis identified no postoperative chemotherapy as an independent poor prognostic factor (hazard ratio: 0.28, P < 0.01).

Conclusion: Our results suggest that surgical control of peritoneal dissemination may lead to long-term survival in patients who can receive postoperative chemotherapy, even if liver and lung metastases co-exist.

Objective: Stoma site obstruction (SSO) is one of the stoma-related complications. Diverting stoma is often constructed with anus-preserving surgery for the purpose of reducing the risk of anastomotic failure. We examined the risk factors of SSO with anus-preserving surgery.

Methods: We studied 99 patients who underwent anus-preserving surgery and elective diverting stoma. We evaluated the incidence of SSO and looked for any relationship between perioperative factors and SSO.

Results: SSO was detected 9 cases (9%). SSO occurred 5 days after surgery in most cases. Patients were divided into two cohorts according to the occurrence of SSO. The thickness of rectus muscles of the abdomen was thicker in the SSO group (12.3mm vs. 9.1mm; p=0.001).

Conclusion: The thickness of rectus muscles of the abdomen was an independent risk for SSO.

Laparoscopic appendicectomy was performed on 15,983 patients in 2021 in Japan, of whom only 2,598 (16.2%) underwent a single-site appendicectomy. In our center, the basic strategy for patients with appendicitis is to start with a single-site laparoscopic approach. Additional ports or ileocecal resection can be utilized depending on the intraoperative abdominal condition. In this study, we reviewed retrospectively the outcomes of the 85 consecutive patients, who underwent a single-site laparoscopic approach for appendicitis between April 2020 and March 2022 in our center.

The single-site approach was completed in 94% of patients. The final surgical procedures included appendicectomy in 68 cases (80%), partial cecal resection in 7 cases (8.2%), and ileocecal resection in 10 cases (11.8%). The median operative time was 79 minutes, and the median blood loss was 0 ml. Pathological inflammation status was gangrenous appendicitis in 37 cases, phlegmonous appendicitis in 34 cases, chronic appendicitis in 6 cases, and appendiceal diverticulitis in 3 cases. Postoperative complications were observed in 13 cases without Grade IIIb or higher complications (Clavien-Dindo classification). The median post-operative hospital stay was 5 days. The single-site approach is safe and feasible to allow intraoperative modification of the extended procedure according to the inflammation condition.

We report a single-incision laparoscopic assisted ileocecal resection on a case of low-grade appendiceal mucinous neoplasm (LAMN). The patient was a 65-year-old man with positive fecal occult blood test. Colonoscopic examination showed a submucosal tumor-like lesion measuring 40 mm in the cecum.

Abdominal enhanced CT scan showed a cystic mass in the cecum, but physical examination revealed no abdominal pain and laboratory tests showed no elevated inflammatory response. We considered an appendiceal mucinous tumor at first; carcinoid, appendiceal cancer, and malignant lymphoma were listed as differential diagnoses. We performed single-incision laparoscopic assisted ileocecal resection with D3 lymph node dissection for the purpose of diagnosis and treatment, in view of minimally invasive and esthetic aspects, by devising surgical techniques and the surgical field. The final pathologic diagnosis was LAMN. Surgery is the principal of treatment for LAMN, but there is no clear standard opinion regarding the diagnostic method, surgical procedure, postoperative follow-up period, etc. More cases need to be accumulated and further investigation conducted in the future.

A 76-year-old man visited our hospital complaining of pain during defecation. Rectal examination revealed an anal fissure at the 6 o'clock position. Sharp induration was suggested. The anus was highly tense owing to pain, and anoscopy confirmed the anal fissure at the 6 o'clock position. He was conservatively treated with anal ointment and analgesics and was followed up 1 week later, during which time the pain did not improve. Therefore, rectal endoscopy was performed because it was suggested that there was a fish bone stuck in the anus, resulting in the formation of a localized abscess near the anal crypt. There was a press-through pack (PTP) measuring approximately 2 cm in diameter above the anal canal, and a deep fissure had formed. The PTP was extracted using a recovery net. There was no mediastinal emphysema or free air on computed tomography, and the symptoms improved with conservative treatment.

PTP is a form of drug packaging with aluminum foil and vinyl chloride, and gastrointestinal damage due to accidental ingestion is often reported, but it rarely reaches the rectum intact. We encountered a PTP-induced rectal foreign body and succeeded in endoscopically removing it. We report this case with a review of the literature.

Most mesotheliomas have a pleural primary; peritoneal primary is less frequent. Among them, peritoneal mesothelioma is considered to be the diffuse malignant form, while multicystic peritoneal mesothelioma (BMMP) is a very rare benign tumor and a relatively new concept, first reported in Japan in 1988 as a retroperitoneal mass. We report our experience with a case of BMMP occurring in the paracolon. The patient was aware of left lower abdominal pain, and surgery was performed for the intraperitoneal mass with bowel compression. Intraoperative findings revealed jelly-like cysts up to 7 cm in size in the paracolon, and descending colon resection was performed for complete resection. The pathological diagnosis was BMMP. As of 16 months after the surgery, the patient is under observation with no recurrence. As far as we could find, there were 31 cases reported in Japan since 2000. Since there are cases of recurrence and malignant transformation of BMMPs, it is considered that thought that the treatment plan should be determined with a view toward complete resection.

We report two cases in which dyssynergic defecation with rectocele was considered to be the cause of defecation disorder. Case 1 was a 51-year-old woman with the main complaints of dyschezia and a feeling of incomplete evacuation. Rectocele of about 4cm was detected in defecography and radical operation for rectocele was performed. The patient complained dyschezia even after the operation, so defecography was performed again. The defecography showed dyssynergic defecation was the cause of outlet obstruction and the complaint improved by biofeedback therapy. Case 2 was a 74-year-old woman with the main complaint of dyschezia. Rectocele of about 2.5cm was detected and dyssynergic defecation was found by defecography. The complaint improved by biofeedback treatment. A rectocele can be diagnosed by digital examination, but the cause of outlet obstruction should be considered and treated not only due to rectocele but also due to dyssynergic defecation.