From September 1999 to August 2003, 118 cases of perineal canal or anorectovestibular fistula were treated at the Pediatric Hospital No 1, HCM City using Tsuchida technique, among them, 90 cases without colsotomy and 28 cases with colostomy. The operation was carried as follows: excision of the fistula and an anterior haft of rectal wall below the fistula, the free intact proximal wall of rectum was directly sutured tissue of anus at its anterior circumference. After 3 months: there were 3 recurrence of fistula among no- colostomy cases and one recurrence among the colostomy cases. On case without and 1 with colostomy had been reoperated. Result were satisfied
surgery ; Therapeutics ; child ; Anal Canal ; Fistula

Anal Canal ; surgery ; Humans ; Postoperative Complications ; Rectal Neoplasms ; surgery

Despite the neoadjuvant therapy and adjuvant therapy improve the curative effect of rectal cancer, surgery plays the most important role in rectal cancer therapy. With the appearance of functional surgery, increasing number of low and ultra-low anastomosis sphincter-preserving operations are being performed, and it is urgent to establish surgical standard for the procedure.
Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Humans ; Rectal Neoplasms ; surgery

Anal Canal ; surgery ; Humans ; Lymph Node Excision ; Rectal Neoplasms ; surgery

Anal Canal ; pathology ; surgery ; Humans ; Rectal Neoplasms ; pathology ; surgery

Anal Canal/surgery* ; Humans ; Rectal Fistula/surgery* ; Treatment Outcome

OBJECTIVETo evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer.

METHODSThirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall.

RESULTSThere was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis.

CONCLUSIONRadical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.

Anal Canal ; surgery ; Follow-Up Studies ; Humans ; Mesentery ; surgery ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Treatment Outcome

OBJECTIVETo analyze the factors related to sphincter preserving(SP) operation for lower rectal cancer.

METHODSClinicopathological data of 316 patients with lower rectal cancer 1-5 cm from the anorectal line who underwent surgical resection from Aug. 1994 to Nov. 2005 were analyzed. The whole period was divided into two period based on the introduction of TME in Jan. 1999. The SP rates, leakage between the two period were compared.

RESULTSThe SP rate increased significantly from 44.9 % in period I (Aug. 1994-Dec. 1998) to 76.2 % in period II (Jan. 1999-Nov. 2005)(P=0.000). The factors significantly influencing SP were the distance from the anorectal line, sex, period, circumference of intramural spread, histological differentiation (P< 0.05). Significant differences were detected between the two period in sex, volume of blood transfusion, Dukes' stage (P< 0.05). The rate of leakage were 2.7 % and 1.3 % in the two period (P > 0.05).

CONCLUSIONSOver 12 years, the SP rate of rectal cancers 1-5 cm from the anorectal line was significantly increased and volume of blood transfusion reduced obviously due to the introduction of TME. These surgical techniques, however, have no effect on the operating time and leakage rates.

Anal Canal ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

OBJECTIVETo explore the indications of sphincter preservation operation (SPO) for rectal cancer, and factors influencing selective indications of SPO.

METHODSFrom April 1994 to April 2004, clinical data of 708 cases with rectal cancer were analyzed retrospectively. The patients received either SPO (SPO group, n=481) or abdominoperineal resection (APR group, n=227). Clinical pathologic parameters and survival rate were compared between the two groups.

RESULTSThere were 66 patients with tumor located in sigmoid-rectum borderline, 138 in upper rectum, 195 in middle rectum, 309 in lower rectum. Dixon operation was performed in 449 patients, Bacon operation in 12, and "J" Poch anastomosis in 20 and Hartman operation in 13. There was no differences in sex, ages, liver metastasis, size, depth of invasion and Dukes stages between APR and SPO groups, but there was significant difference in lower bowel obstruction, tumor location, differentiation degree, infiltrated circumference of intestine, lymph node metastasis and radical approaches between the two groups. Radical excision was performed in 660 rectal cancer cases with radical excision rate of 91.5% . SPO was performed in 481 cases with preservation rate of 66.7%, including 135 lower rectal cancer with preservation rate of 43.7%. The operative mortality was 0.4% (3/708), regional recurrence rate was 5.51% (39/708) after operation. The median survival time was (65.0+/- 6.9) months in SPO group and (42.2+/- 5.6) months in APR group (P< 0.01), the 5-year survival rate was 59.3% and 42.3% in SPO and APR group (P< 0.001).

CONCLUSIONSSPO should be considered as primary choice for rectal cancer patients, but it must be ensured that complete radical resection be performed. Indications for SPO in lower rectal cancer depend on tumor location,differentiation degree,and infiltrated circumference of intestine,lymph node metastasis.

Anal Canal ; surgery ; Colorectal Surgery ; trends ; Humans ; Rectal Neoplasms ; surgery ; Retrospective Studies

Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time, and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost. Therefore, the value of colonic pouch in low rectal anastomosis is being questioned, and its application diminishes gradually. For patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after total colectomy, ileal pouch anal anastomosis (IPAA) can reduce fecal frequency and improve patients' quality of life in both short-term and long-term, by increasing the volume of the neo-rectum and altering intestinal motility. For these reasons, IPAA is the first surgical choice for UC and FAP.
Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Humans ; Ileum ; surgery ; Rectum ; surgery