Comparison of three concentrations of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs.

PURPOSE: The aim of the present randomized clinical study was to assess the efficacy of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs, compare analgesia of three different concentrations of lidocaine, and explore use of lower concentrations of lidocaine in local anesthesia for inguinal hernia mesh-repairs. METHODS: A total of 102 consecutive patients undergoing inguinal hernia repairs were randomized to three groups: group A (n = 34) received solution with a lidocaine concentration of 8 mg/mL, group B (n = 34) received a lidocaine concentration of 5 mg/mL, and in group C (n = 34) the lidocaine level was reduced to 3.3 mg/mL. Intraoperative pain and pain at 24 h and 48 h postoperatively were assessed by means of a visual analogue scale. Volume and doses of lidocaine used in local anesthesia were strictly recorded. RESULTS: The efficacy of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs was excellent, no patient required conversion to general anesthesia. The mean pain scores were not significantly different among the three groups. CONCLUSIONS: The local anesthesia technique was good with lidocaine alone in local anesthesia for inguinal hernia mesh-repairs. A concentration of 3.3 mg/mL lidocaine provided similar analgesia as 5 or 8 mg/mL lidocaine.

Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer.

AIMS: We aimed at investigating the patterns of lymph node metastases and micrometastases in regions of lateral pelvic area, examining circumferential margin involvement and clarifying their prognostic significance. METHODS: Large tissue slice and tissue array were adopted in the study of 67 patients with AJCC stages I-III lower rectal cancer who underwent total mesorectal excision with systematic lateral pelvic dissection. The outcomes were followed. RESULTS: Altogether, 726 lateral lymph nodes were examined, with 32 and 38 were involved by tumor metastases and micrometastases, respectively. Fifty-eight (82.9%) of the involved lymph nodes were smaller than 5mm. Status of lateral nodes was related to that of mesorectal ones. Middle rectal root (45.5%), internal iliac (31.8%) and obturator (22.7%) regions were more likely to be involved by metastases. Patients with lateral metastases, similar to the group with micrometastases, suffered more recurrence and poorer survival when compared with the ones without metastases. The occurrence of circumferential margin involvement suggested poor prognosis and was related to lateral node status. CONCLUSIONS: In lateral pelvic area, the majority of lymph nodes harboring tumor were small and could easily be neglected by conventional examination. Incidence of lateral metastases differed among regions, thus more attention should be given to the clearance of the highly occurred areas. More extensive range of dissection and/or adjuvant therapy was recommended for patients with lateral node metastases, micrometastases and circumferential margin involvement, since they predisposed poor prognosis.

Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer.

BACKGROUND: The Laparoscopic approach has been applied to colorectal surgery for many years; however, there are only a few reports on laparoscopic low and ultralow anterior resection with construction of coloanal anastomosis. This study compares open versus laparoscopic low and ultralow anterior resections, assesses the feasibility and efficacy of the laparoscopic approach of total mesorectal excision (TME) with anal sphincter preservation (ASP), and analyzes the short-term results of patients with low rectal cancer. METHODS: We analyzed our experience via a prospective, randomized control trail. From June 2001 to September 2002, 171 patients with low rectal cancer underwent TME with ASP, 82 by the laparoscopic procedure and 89 by the open technique. The lowest margin of tumors was below peritoneal reflection and 1.5-8 cm above the dentate line (1.5-4.9 cm in 104 cases and 5-8 cm in 67 cases). The grouping was randomized. RESULTS: Results of operation, postoperative recovery, and short-term oncological follow-up were compared between 82 laparoscopic procedures and 89 controls who underwent open surgery during the same period. In the laparoscopic group, 30 patients in whom low anterior resection was performed had the anastomosis below peritoneal reflection and more than 2 cm above the dentate line, 27 patients in whom ultralow anterior resection was performed had anastomotic height within 2 cm of the dentate line, and 25 patients in whom coloanal anastomosis was performed had the anastomosis at or below the dentate line. In the open group, the numbers were 35, 27, and 27, respectively. There was no statistical difference in operation time, administration of parenteral analgesics, start of food intake, and mortality rate between the two groups. However, blood loss was less, bowel function recovered earlier, and hospitalization time was shorter in the laparoscopic group. CONCLUSION: Totally laparoscopic TME with ASP is feasible, and it is a minimally invasive technique with the benefits of much less blood loss during operation, earlier return of bowel function, and shorter hospitalization.