Management of early rectal cancer: Current practice and future.

Early rectal cancer management includes tumour stages TiS, T1 and some selected T2 lesions that undergo appropriate clinical pre-operatie evaluation. Local excision of these lesions with acceptable recurrence rate can be achieved through various transanal endoscopic techniques like transanal endoscopic microsurgery (TEM) and transanal minimal invasive surgery (TAMIS) that are superior to simple transanal excision (TAE). The current literature review was planned to present the oncological evaluation of local excision in the context of available evidence. An overview of perioperative adjuvant therapies employed along with local excision is presented, with an update on the latest trials.

Repair of massive inguinal hernia with loss of abdominal domain using laparoscopic component separation technique.

Giant inguinoscrotal hernias present a challenging surgical problem and are associated with high morbidity and mortality. The main difficulty is that of returning herniated viscera to an abdominal cavity accustomed to being empty, also known as loss of domain. In our case, we present laparoscopic component separation as a technique to increase capacity of the abdominal cavity to facilitate closure and reduce postoperative complications in those patients.

Assessment of cosmetic outcome after laparoscopic cholecystectomy among women 4 years after laparoscopic cholecystectomy: is there a problem?

BACKGROUND: Advocates of single-port laparoscopic cholecystectomy (SPLC) claim that improved cosmetic outcome is one of its main benefits over conventional laparoscopic cholecystectomy (CLC). However, the published data quantifying the cosmetic outcome after CLC is sparse. This study aimed to determine the cosmetic outcome after CLC using a validated scar assessment tool. METHODS: The patient scar assessment questionnaire was sent to all women ages 20-50 years who had undergone CLC at the Norfolk and Norwich University Hospital (Norwich), the Homerton Hospital (London), and the Musgrove Park Hospital (Taunton) in 2005 (n = 380). In all cases, the operation had been performed using a four-port technique. The patients were asked to give scores related to the appearance and symptoms associated with the scars at the time the questionnaire was completed. RESULTS: Of the 380 patients, 195 responded to the questionnaire, giving a response rate of 51%. The median age of the responders was 39 years, and 63 (32%) of them had undergone previous surgery. The mean score for each section was low, indicating a favorable cosmetic outcome. This correlated with the global question answered with "excellent" for 4 of 5 categories and "good" for the remaining category. Nine patients highlighted dissatisfaction with the umbilical incision. CONCLUSIONS: Patients perceive the cosmetic results after CLC as excellent. Therefore, SPLC seems to have a limited role in terms of improving cosmesis for patients undergoing cholecystectomy. Anecdotal evidence from the questionnaire suggests that the umbilical port may be the site of problems for some patients. Further investigation is needed to determine whether this is significant, especially because it may be exaggerated after SPLC.