Comparison of laparoscopic subtotal colectomy with posterior vaginal suspension and laparoscopic subtotal colectomy with transvaginal repair for patients with slow-transit constipation complicated with rectocele: a non-randomized comparative study in a single center.

BACKGROUND: Slow-transit constipation complicated with rectocele is a mixed constipation difficult to treat by surgery. Different hospitals and surgeons may employ different surgical procedures. The present study aims to compare the efficacy of laparoscopic subtotal colectomy (LSC) with posterior vaginal suspension and LSC with transvaginal repair for patients having refractory slow-transit constipation complicated with rectocele. METHODS: This paper is a retrospective study of 64 patients having refractory slow-transit constipation complicated with rectocele. Admitted from January 2002 to December 2012, the 64 patients were non-randomly divided into two groups: patients who underwent LSC with posterior vaginal suspension (Group A, 36 patients) and patients who underwent LSC with transvaginal repair (Group B, 28 patients). RESULTS: There was no statistically significant difference (P > 0.05) in preoperative general characteristics and Wexner constipation score between Group A and Group B. There was no statistically significant difference (P > 0.05) in operative time and intraoperative blood loss between the two groups. One month after the surgery, there was no statistically significant difference (P > 0.05) in early postoperative complications, constipation recurrence rate, degree of improvement in constipation symptoms, and Wexner constipation score between the two groups. But 1-year follow-up results show that there was statistically significant difference (P < 0.05) in constipation recurrence rate, gastrointestinal quality of life index, the degree of improvement in constipation symptoms, and Wexner constipation score between the two groups. CONCLUSION: Compared with the LSC with transvaginal repair, the LSC with posterior vaginal suspension demonstrated better efficacy in treating refractory slow-transit constipation complicated with rectocele.

[Causes of anastomotic leakage after colorectal cancer laparoscopic-assisted surgery].

OBJECTIVE: To explore the causes of postoperative anastomotic leakage of colorectal cancer. METHODS: A total of 1462 cases with colorectal cancer undergoing laparoscopic operation and intestinal anastomosis at our department over the last decade were analyzed retrospectively. Data analysis was performed with SPSS 13.0. The risk factors were analyzed by binary Logistic regression while the annual incidence of anastomotic leakage by trend χ(2) test. RESULTS: Thirty anastomotic leakage occurred in 1462 cases with an incidence rate of 2.1%. There were significant correlations of anastomotic leakage with body built, tumor location, tumor size, operation time (χ(2) = 6.117, 50.167, 36.693, 4.481, P = 0.013, 0.000, 0.000, 0.034). However, there was no correction with gender, age or histological type (P = 0.871, 0.775, 1.000). Then the significance check of binary Logistic regression equation was performed. Tumor location was an independent risk factor of postoperative anastomotic leakage for colorectal cancer. The relative risk was 2.056. The annual incidence of anastomotic leakage was statistically insignificant (χ(2) = 1.827, P = 0.176). And the difference was. CONCLUSIONS: The occurrence of anastomotic leakage after colorectal cancer surgery is significantly correlated with body built, tumor location, tumor size and operation time. And tumor location below peritoneal reversal is an independent risk factor of anastomotic leakage.

[Efficacy evaluation of laparoscopic complete mesocolic excision for transverse colon cancer].

OBJECTIVE: To investigate the safety, feasibility and long-term outcomes of laparoscopic complete mesocolic excision for the transverse colon cancer. METHODS: Clinical data of 61 patients who underwent laparoscopic complete mesocolic excision for transverse colon cancer (transverse group) in our department from January 2011 to January 2014 were retrospectively analyzed, which were compared with those of 155 patients undergoing laparoscopic complete mesocolic excision for ascending colon cancer (ascending group) and 230 patients undergoing laparoscopic complete mesocolic excision for sigmoid colon cancer (sigmoid group). Differences in operative details, postoperative recovery, postoperative complications and long-term survival among 3 groups were evaluated. RESULTS: No significant differences in the baseline information were found among 3 groups(all P>0.05). The average operative time was significantly longer in transverse group as compared to ascending group and sigmoid group [(192.1±58.7) min vs. (172.2±54.7) min and (169.1±53.6) min]( P<0.05), while the blood loss [(89.7±63.6) ml, (86.3±66.3) ml, (82.6±61.5) ml], conversion rate [3.3%(2/61), 2.6%(4/155), 2.2%(5/230)], number of harvested lymph node (13.0±4.7, 14.4±6.5, 13.4±5.6), time to flatus [(2.7±1.1) d, (2.6±1.1) d, (2.5±1.0) d], time to liquid diet [(3.0±1.7) d, (2.8±1.5) d, (2.7±1.4) d], incidence of postoperative complication(6.6%, 9.0%, 11.7%), and hospital stay [(11.6±5.8) d, (10.7±5.8) d, (10.6±5.7) d] among 3 groups were not significantly different (all P>0.05). A total of 436 patients received postoperative follow-up of median 36 (5 to 67) months. The overall 5-year survival rate was 73.1%, 73.7% and 74.8%, and the 5-year disease-free survival rate was 71.5%, 71.1% and 72.7% in transverse, ascending and sigmoid colon cancer groups respectively, whose differences were not significant among 3 groups (all P>0.05). CONCLUSION: Laparoscopic complete mesocolic excision for transverse colon cancer is safe and feasible with slightly longer operation time, and has quite good long-term oncologic efficacy.

[Comparative study of colostomy in the laparoscopic-assisted abdominoperineal resection].

OBJECTIVE: To compare two different procedures of colostomy in the laparoscopic- assisted abdominoperineal resection(LAPR), and to reduce the related complications of colostomy. METHODS: Sixty- three cases with anorectal cancer undergone LAPR from June 2001 to December 2005 were registered and followed up. Circular stapler anastomosis with sigmoid colon and abdominal skin were applied on 61 cases of the colostomy, and 2 cases were hand sutured. All patients were assigned to group A and B. Thirty- seven cases received the procedure of colostomy through the rectus abdominis peritoneally in group A,other 26 cases through extraperitoneal tunnel and the rectus abdominis in group B. RESULTS: Descending colon, sigmoid colon and rectum were dissected using laparoscopic instruments in 63 cases. No conversion to open procedure and no operative death occurred in two groups of patients. There was no significant difference between two groups in mean operation time, but significant differences were found in the time of return of bowl function[A group (2.4 +/- 1.1)d vs B group (1.9 +/- 0.8)d,P < 0.05], duration of postoperative hospital stay [A group (19.9 +/- 7.8)d vs B group (14.5 +/- 3.9)d,P < 0.01] and stoma related complications(A group 29.4% vs B group 4.0%,P < 0.05). Postoperative hospital stay were shorter, and less colostomy related complications were found in group B. CONCLUSION: Colostomy through extraperitoneal tunnel and the rectus abdominis is a better procedure in LAPR, which can reduce the related complications of colostomy and shorten postoperative hospital stay.