Clinical and Functional Comparison Between Stapled Colonic J-Pouch Low Rectal Anastomosis and Hand-Sewn Colonic J-Pouch Anal Anastomosis for Very Low Rectal Cancer

Purpose. We investigated intersphincteric resection with hand-sewn coloanal anastomosis, which may be an alternative to standard low anterior resection for very low rectal cancer when stapled anastomosis is technically impossible. Methods. The present study compared the clinical and functional results of 16 patients who underwent stapled colonic J-pouch low rectal anastomosis (CJLRA) with those of 15 patients who underwent intersphincteric excision and hand-sewn colonic J-pouch anal anastomosis (CJAA). Results. After a median follow-up period of 59 months, local recurrence was found in four patients from the CJAA group, three of whom subsequently underwent curative abdominoperineal resection. Defecatory function 6 and 12 months after surgery did not differ between the groups, although pads were used significantly more frequently in the CJAA group. Anorectal physiologic study before and 12 months after surgery revealed that the internal anal sphincter function was impaired to a larger extent after CJAA than after CJLRA, probably due to the partial or subtotal resection of the internal sphincter, and the anal dilatation during resection and anastomosis. Conclusion. Although the prevention of intraoperative tumor implantation and the early detection of local recurrence is of utmost importance, CJAA may be an acceptable sphincter-preserving procedure for selected patients in whom stapled anastomosis is impossible. Received: February 26, 2001 / Accepted: September 11, 2001     

Long-Term Functional Outcome of Colonic J-pouch Reconstruction After Low Anterior Resection for Rectal Cancer

Purpose To evaluate the long-term functional outcome of colonic J-pouch reconstruction after low anterior resection (LAR) for rectal cancer in a prospective study. Methods We compared the functional outcome of 46 patients who underwent J-pouch reconstruction (J-group) and 49 patients who underwent straight anastomosis (S-group) after LAR for rectal cancer. We evaluated clinical function using a 17-item questionnaire about different aspects of bowel function. Physiologic reservoir function was evaluated by manovolumetry. Results Among the patients with an ultralow anastomosis (≤4 cm from the anal verge), those in the J-group had fewer bowel movements during the day and at night, and less urgency, soiling, protective pad use, incontinence, and dissatisfaction with bowel function than those in the S-group. Among the patients with a low anastomosis (5–8 cm from the verge), those in the J-group had fewer bowel movements at night, and less urgency and soiling than those in the S-group. Moreover, reservoir function (reflected by the maximum tolerable volume, threshold volume, and compliance) was better in the J-group than in the S-group in both the ultralow and low anastomosis groups. Conclusion J-pouch reconstruction after low anterior resection creates a better stool reservoir than straight anastomosis, especially when the anastomosis is less than 4 cm from the anal verge, resulting in a better quality of life 3 years after rectal cancer resection.     

Poor Neorectal Evacuation as a Cause of Impaired Defecatory Function After Low Anterior Resection: A Study Using Scintigraphic Assessment

Purpose. Patients who have undergone low anterior resection (LAR) of the rectum occasionally complain of symptoms related to impaired neorectal evacuation. Using scintigraphy, we assessed neorectal evacuation in 22 patients who underwent LAR and straight anastomosis, and correlated the results with clinical defecatory function, clinical factors, and anorectal manovolumetric parameters. Methods. After the introduction of an artificial stool containing ^99mTc-DTPA into the neorectum, sequential lateral gamma images were obtained. From the time–activity curve of radioactivity in the whole pelvis, the time taken to eva-cuate half of the introduced artificial stool (T _1/2) and the percentage of artificial stool evacuated in 1 min (Evac₁) were calculated. Results. The Evac₁ was significantly lower in the patients who had undergone LAR than in reference normal volunteers. A long T _1/2 was significantly associated with worse defecatory function. The Evac₁ was also significantly lower in patients with a low anastomosis. The rectal sensory threshold was significantly greater in patients with a shorter T _1/2. The maximum tolerable volume of the neorectum was significantly greater in patients with a shorter T _1/2 and a higher Evac₁. Conclusion. Poor neorectal evacuation is associated with impaired defecatory function after LAR. Therefore, it is suggested that optimizing both reservoir function and evacuation of the neorectum would improve defecatory function after LAR. Received: January 19, 2001 / Accepted: July 17, 2001     

Regular Finger Dilation for Preventing Anastomotic Stenosis After Low Anterior Resection

Purpose. This study evaluated the usefulness of performing regular finger dilation (RFD) of the anastomosis to prevent stenosis after low anterior resection (LAR). Methods. Defecatory function was assessed in 22 patients who had undergone LAR more than 6 months earlier. The patients were divided into an RFD group, comprising 15 patients who had undergone regular RFD, and a non-RFD group, comprising 7 patients who had dropped out of our follow-up with RFD. The physiological and clinical findings in relation to defecatory function were compared. Results. The type and size of the stapler and anal manometric parameters were similar. The RFD group had significantly better defecatory function in terms of bowel movement and sensation of incomplete evacuation (P < 0.01, respectively) with a significantly wider anastomotic diameter and higher evacuation rate (P < 0.01, respectively). Conclusion. These findings demonstrate that RFD is useful for preventing anastomotic stenosis and achieving favorable defecatory function after LAR. Therefore, a prospective randomized study should be scheduled. Received: February 13, 2001 / Accepted: September 11, 2001     

Comparison of Functional and Surgical Outcomes of Laparoscopic-Assisted Colonic J-Pouch Versus Straight Reconstruction After Total Mesorectal Excision for Lower Rectal Cancer

Background To compare the functional and surgical outcomes of colonic J-pouch and straight anastomosis in the context that both reconstruction procedures were performed laparoscopically. Methods The present study was a randomized prospective clinical trial. Patients with lower rectal cancer requiring laparoscopic total mesorectal excision were equally randomized to either laparoscopic-assisted colonic J-pouch reconstruction or laparoscopic straight end-to-end anastomosis. The techniques of the laparoscopic-assisted colonic J-pouch reconstruction are shown in the attached video. The primary end point was the comparison of functional results in both reconstruction methods. The secondary end points included the safety (surgical morbidity and mortality), surgical efficiency, and postoperative recovery. Results A total of 48 patients were recruited within 2-year periods, in consideration of statistical power of 90% for comparison. There was no marked difference between patient groups undergoing colonic J-pouch surgery (n = 24) and straight anastomosis (n = 24) in various demographic and clinicopathogic parameters. The anorectal function of patients by colonic J-pouch were better than those by straight anastomosis in 3 months after operation, as evaluated by stool frequency (mean ± standard deviation: 4.0 ± 2.0 vs. 7.0 ± 2.4 times/day, P < .001); use of antidiarrheal agents (29.2% [n = 7] vs. 75.0% [n = 18], P = .004); and perineal irritation (45.8% [n = 11] vs. 79.2% [n = 19], P = .037). Because of the relatively better bowel function in immediate postoperative period, patients by colonic J-pouch reconstruction were less disabled after surgery and had quicker return to partial activity (P = .039), full activity (P < .001), and work (P < .001). Both reconstruction methods were performed with similar amounts of blood loss, complication rates, and postoperative recovery. However, the operation time was significantly longer in the colonic J-pouch group (274.4 ± 34.0 vs. 202.0 ± 28.0 minutes, P < .001). Conclusions Because laparoscopic-assisted creation of a colonic J-pouch achieved better short-term functional results of the anorectum and did not increase surgical morbidity, as compared with laparoscopic straight anastomosis, this reconstruction procedure could be recommended to patients with lower rectal cancer requiring laparoscopic total mesorectal excision. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

A New Anastomotic Leakage Model in Circular Double Stapled Colorectal Anastomosis After Low Anterior Rectum Resection in Pigs

ABSTRACT

Background: A high incidence of anastomotic leakage (37.5%) is reported after low anterior rectal resection (LAR) and circular double-stapled anastomosis without protective ileostoma. Since the pathomechanism of anastomosis leakage is still unclear, a suitable animal model would be most desirable. Methods: The objective was to assess the incidence of clinically apparent and inapparent leakage after LAR in pigs (n = 20). Endpoints were radiological, clinical, macroscopic, and histologic proof of anastomotic leakage on the 9th postoperative day. Integrity of anastomosis was assessed by double-contrast barium examination on 9th postoperative day. Animals were sacrificed and anastomoses were resected for histopathological investigation. In case of earlier clinical apparent anastomotic leakage, radiologic double-contrast barium was performed immediately. Results: LAR with a circular double-stapled anastomosis without protective ileostoma was performed in 20 pigs (m:f = 8:12). Length of resection was 10–20 cm, anastomosis was performed 7 cm ab ano. Five animals (25%) developed clinical apparent anastomotic leakage (no appetite, fever, inactivity, tachypnea, discomfort, pain) between the 6th (n = 1) and 9th (n = 4) postoperative day, proven by double-contrast barium radiographs. Additionally in 1 animal clinical inapparent anastomotic insufficiency was observed radiologically. Total rate of leakage was 30% (n = 6). These results were confirmed by leucocytosis, low potassium levels, in two cases high ALT and AST and local peritonitis in all cases. Conclusion: Including one additional case of clinical inapparent leakage, total rate of anastomotic leakage was 30% (6/20). Thus we managed to establish a new experimental model of anastomotic leakage after low rectal resection comparable to the human situation.     

Modified Double-Stapling Technique in Low Anterior Resection for Lower Rectal Carcinoma

Purpose The original double-stapling technique (DST) using a standard linear stapler horizontally can be difficult in patients with a narrow pelvis or an ultralow anastomosis. We review our experience of performing a modified DST (IO-DST) with vertical division of the rectum achieved using an endostapler. Methods We retrospectively studied the clinical outcomes of 90 patients who underwent low anterior resection (LAR) for lower rectal carcinoma. Low anterior resection was performed with IO-DST in 34 patients (IO-DST group), with the single-stapling technique (SST) in 47 (SST group), and with per anal anastomosis (PAA) in 9 (PAA group). Results The distances from the anal verge to the tumor and to the anastomosis were significantly shorter in the IO-DST group than in the SST group (5.8 cm, 4.0 cm vs 7.0 cm, 5.0 cm, respectively), whereas it was equivalent in the IO-DST and PAA groups (5.0 cm, 4.0 cm). Blood loss was less in the IO-DST group than in the SST and PAA groups (400 ml vs 578 ml and 950 ml, respectively). The operative time was shorter in the IO-DST group than in the PAA group (281 min vs 327 min, respectively). There were no significant differences in the length of the distal surgical margin among the three groups. The IO-DST group patients suffered less bowel frequency than the SST group patients 1 month after surgery (2.5 times/day vs 4.0 times/day, respectively) and less than the PAA group patients more than 1 year after surgery (2.0 times/day vs 3.5 times/day, respectively). There were no significant differences in the incidence of complications or local recurrence among the three groups. Conclusions IO-DST is a feasible and safe procedure for performing low anastomosis, which results in less bowel frequency after LAR for lower rectal carcinoma.     

Uncontrollable Intra-Abdominal Bleeding Necessitating Low Anterior Resection of the Rectum After Stapled Hemorrhoidopexy: Report of a Case

Stapled hemorrhoidopexy (SH) has become a widely accepted surgical procedure for hemorrhoids; however, one of the most serious complications of this technique is severe bleeding. We report a case of extensive hemoperitoneum after SH for third-degree hemorrhoids. On postoperative day (POD) 1, the patient complained of severe abdominal pain and clinical signs of peritonitis soon became evident. Computed tomography (CT) showed blood in the abdomen. We performed an emergency exploratory laparotomy, which revealed extensive hemoperitoneum, and a devitalized, edematous rectum with a tense hematoma, approximately 1 cm above the staple line and extending up to the level of the peritoneal reflection. We also found a small seromuscular laceration in the anterior aspect of the rectum just above the peritoneal reflection. This small laceration was bleeding actively. Thus, we performed a low anterior resection and the patient was discharged from hospital 10 days later. We report this case to raise awareness of the possibility of life-threatening intra-abdominal complications without evidence of typical rectal bleeding.     

J型贮袋直肠吻合术对肛门功能影响的回顾性研究

目的评价低位直肠癌前切除保肛术后J型贮袋对改善排便功能的疗效。方法 60例患者行低位直肠癌前切除术以及结直肠或结肛吻合,其中22例应用J型贮袋（贮袋组）、38例应用结直肠或结肛直接吻合（无袋组）。记录并比较两组患者的术后并发症的发生情况及排便情况,对术后6个月和12个月的排便功能进行评估。结果两组间术后并发症发生率无明显差异。6个月后贮袋组患者在夜间溢便、漏稀便、区别排气排便和集团性排便方面明显优于无袋组。在术后6个月、12个月贮袋组的延缓排便均优于无袋组（P〈0.05）;两组在便不尽、需抗腹泻药和使用缓泻剂方面无显著性差异。结论结肠J型贮袋可改善低位直肠癌前切除患者术后早期的控变能力。     

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital stay     

低位/超低位直肠癌结肛吻合术中运用单吻合器及双吻合器技术的疗效比较

目的比较在低位/超低位直肠癌结肛吻合术中运用单吻合器技术（SST）和双吻合器技术（DST）进行吻合重建的效果。方法回顾性分析2009年1月至2010年12月期间四川大学华西医院胃肠外科中心结直肠外科专业组收治的351例低位/超低位直肠癌患者的临床资料,比较采用SST（n=49）和DST（n=302）进行结肛吻合患者的术中和术后情况。结果与DST组比较,SST组患者的肿瘤下缘距齿状线距离较短（P〈0.05）,远端切缘长度较短〔（1.83±0.59）cm比（2.07±0.56）cm,P〈0.05〕,手术时间较长〔（112.86±39.29）min比（100.10±36.75）min,P〈0.05〕,住院费用较低〔（24 350.48±7 812.73）元比（29 455.32±7 869.33）元,P〈0.05〕。而2组患者的术中出血量,首次下床活动时间,首次排气、排便时间,拔除胃管、尿管及引流管时间,术后住院时间、总住院时间及术后并发症发生率比较差异均无统计学意义（P〉0.05）。术后所有患者的肛门控便功能均恢复良好。术后全部获访,随访时间6～24个月,平均16个月。随访期间,局部复发1例（SST组）;远处转移3例（均为DST组）;死亡15例（4.27%）,其中DST组13例（4.30%）,SST组2例（4.08%）。结论低位/超低位直肠癌结肛吻合术中SST的远端切缘长度较DST短,适用于肿瘤位置较低的患者,并且其住院费用也较DST低。     

Health-Related Quality of Life after Colonic Resection for Diverticular Disease: Long-term Results

Background and Aims  While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only. Patients and Methods  Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3–102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used. Results  The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only. Conclusions  Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD. Presented as a poster at the Digestive Disease Week, San Diego CA, USA May 19-24, 2008.     

腹腔镜低位直肠前切除术并发症的影响因素分析

目的探讨腹腔镜直肠癌低位前切除术并发症的影响因素，为降低并发症的发生、提高手术疗效提供依据。方法回顾性研究2004年8月～2007年7月我院132例根治性腹腔镜直肠癌低位前切除术的临床资料，收集所有手术并发症病例，通过单因素和多因素统计分析筛选其危险因素。结果除5例术中采用手助方式外，余127例为腹腔镜辅助下低位直肠前切除术，无中转开腹。手术并发症发生率为20．5％（27／132），其中吻合口漏（8．3％，11／132）的发生率最高。二分类Logistie回归方程筛选得出肿瘤大小（直径≥3cm）、肿瘤部位（距肛缘距离≤6cm）和病理TNM分期为影响并发症发生的独立危险因素，相对危险度分别为1．149、0．552、2．816。结论手术并发症中吻合口漏的发生率最高；肿瘤大小、肿瘤部位和病理分期是影响手术并发症发生的独立危险因素。     

Stapled Versus Hand-Sewn Anastomoses in Emergency Intestinal Surgery: Results of a Prospective Randomized Study

Purpose Sutured and stapled intestinal anastomoses are perceived to be equally safe in elective intestinal surgery. However, our search of the literature failed to find any studies comparing hand-sewn and mechanical anastomoses in emergency intestinal surgery. Thus, we compared the short-term outcomes of patients with sutured as opposed to stapled anastomoses in emergency intestinal surgery.Methods Between 1995 and 2001, 201 patients underwent emergency intestinal operations at the Department of Emergency Surgery of SantOrsola-Malpighi University Hospital. The outcomes of patients with sutured and stapled anastomoses were compared in a prospective analysis. Patients were randomly divided into a stapled group (106 anastomoses) with anastomoses made using linear and circular staplers, and a hand-sewn group (95 anastomoses) with anastomoses made by double-layer suturing.Results There were no significant differences between the groups in operative indications or other parameters. The operation times in the stapled group were significantly shorter than those in the hand-sewn group (P < 0.05), but there were no significant differences in anastomotic leak rates, morbidity, or postoperative mortality between the two groups.Conclusions In emergency intestinal surgery comparable results can be achieved using mechanical and manual anastomoses.     

高龄直肠或肛管癌患者的两种极限保肛术式的术后近期结果的比较研究

目的比较低位／超低位前切除术和外翻切除术治疗高龄直肠或肛管癌的手术效果。方法回顾性分析2009年1月至2011年12月期间我院结直肠外科专业组收治的符合纳入条件的184例行直肠或肛管癌根治手术患者的临床资料,比较行低位／超低位前切除（低位／超低位前切除组,n=99）与外翻切除术（外翻切除术组,n=85）的术中、术后情况及并发症发生情况。结果①2组基线资料如年龄、身体质量指数、性别、肿瘤直径、TNM分期、分化程度、大体类型、组织学类型及内科合并症方面差异均无统计学意义（P〉0．05）。②外翻切除术组的肿瘤距肛距离较低位／超低位前切除术组更近P〈0．05）,且远端切除距离长于低位／超低位前切除术组P〈0．05）。③2组在手术时间、术中出血量、美国麻醉医师协会分级及术后并发症方面差异均无统计学意义（P〉0．05）。④2组在拔除胃管、尿管、引流管时间及首次排气、排便、经口进食、首次下床活动时间以及总费用方面比较差异均无统计学意义（P〉0．05）;但外翻切除术组的术后住院时间和总住院时间均明显长于低位／超低位前切除术组P〈0．05）。⑤术后全部获得随访,平均随访时间13个月。随访期间,外翻切除组有1例局部复发;低位／超低位前切除组和外翻切除组各有1例远处转移;低位／超低位前切除组死亡4例（4．04％）,外翻切除组死亡4例（4．71％）。2组术后复发率、远处转移率及死亡率比较,差异均无统计学意义（P〉0．05）。存活患者的肛门控便功能均恢复良好。结论低位／超低位前切除术和外翻切除术都可以应用在高龄极低位直肠癌和肛管癌患者,外翻切除术的远端切除距离长于低位／超低位前切除术,适用于位置更低的肿瘤。     

Laparoscopic-Assisted Versus Open Abdominoperineal Resection for Low Rectal Cancer: A Prospective Randomized Trial

Background  Laparoscopic 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. Methods  Between 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 90 months 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. Results  The 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 5 years 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). Conclusions  Laparoscopic-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. Part of this paper has been presented as free paper in the Congress of Endoscopic and Laparoscopic Surgeons of Asia 2006, October 18–21, 2006, Seoul, Korea. An erratum to this article can be found at     

Prospective Evaluation of the Defecatory Functional Results in Patients Following Aorto-Aortic Reconstruction Surgery for an Abdominal Aortic Aneurysm

Purpose Anterior rectal resections have been associated with postoperative bowel function abnormalities, a condition defined as anterior resection syndrome. Autonomic denervation could be one of the possible mechanisms underlying this complication. Damage to the preaortic tissue containing autonomic nervous plexus during abdominal aortic reconstruction surgery may affect the anorectal defecation function. Methods The anorectal function was prospectively studied in 22 patients undergoing abdominal aortic reconstruction surgery. The patients were examined preoperatively and 6 months postoperatively by symptom-specific questionnaires. Results Postoperatively, the patients showed no significant impairment of the anorectal functions in both constipation- and fecal incontinence-specific questionnaires. Self-estimation of the defecatory function was slightly lower compared with preoperative scores. Conclusion An injury to the intermesenteric, inferior mesenteric, and superior hypogastric plexuses does not significantly influence the defecatory functions in patients following abdominal reconstruction surgery for an abdominal aortic aneurysm.     

Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer

BACKGROUNDWith advancements in laparoscopic technology and the wide application of linear staplers, sphincter-saving procedures are increasingly performed for low rectal cancer. However, sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome. Colonic pouch anastomosis improves the quality of life of patients with rectal cancer > 7 cm from the anal margin. But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIMTo compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODSWe conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses. Functional evaluations were completed preoperatively and at 1, 6, and 12 mo postoperatively. We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTSThere were no significant differences in mean operating time, blood loss, time to first passage of flatus and excrement, and duration of hospital stay between the colonic pouch and straight anastomosis groups. The incidence of anastomotic leakage following colonic pouch construction was lower (11.4% vs 16.2%) but not significantly different than that of straight anastomosis. Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group, suggesting better bowel function (preoperative: 4.71 vs 3.89, P = 0.43; 1 mo after surgery: 34.2 vs 34.7, P = 0.59; 6 mo after surgery: 22.70 vs 29.0, P < 0.05; 12 mo after surgery: 15.5 vs 19.5, P = 0.01). The overall recurrence and metastasis rates were similar (4.3% and 11.4%, respectively).CONCLUSIONColonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections. Moreover, colonic pouch construction may provide better functional outcomes compared to straight anastomosis.     

腹腔镜低位直肠癌经肛拖出切除吻合术的临床应用

目的 探讨腹腔镜低位直肠癌经肛拖出切除吻合术的临床应用价值.方法 2009年6月～ 2011年9月,对45例低位直肠癌行腹腔镜经肛拖出切除吻合术,均行腹腔镜下全直肠系膜切除,并行预防性回肠造瘘.结果 45例均完成手术,无中转开腹,切割圈均完整,无输尿管损伤.手术时间185 ～ 260 min,平均215 min,术中出血量50 ～250 ml,平均110ml.切除淋巴结15 ～ 20枚,平均16.5枚,术后病理9例有阳性淋巴结.术后回肠造瘘排气时间3～5d,平均3.5d,留置导尿3～4d.术后无切口感染、肠粘连、切口裂开,术后住院时间12～ 17 d,平均15 d.随访15～28个月,平均23个月,未发现局部复发及远处转移.回肠造瘘回纳后,肛门控便、控气功能良好.结论 腹腔镜低位直肠癌经肛拖出切除吻合术安全可行,为瘤体较小、组织学分型好的早、中期的低位直肠癌提供一种较好的术式选择.     

Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial

Background

Controversy exists as to whether early functional outcomes differ after total hip arthroplasty performed using the direct anterior approach (DAA) or the posterolateral approach (PLA).