PURPOSE: Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. METHODS: Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). RESULTS: Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. CONCLUSION: W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.
Appendectomy* ; Appendicitis ; Bupivacaine* ; Humans ; Laparoscopy* ; Methods ; Pain, Postoperative* ; Wounds and Injuries*

PURPOSE: To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) <1 cm without radiotherapy in T3, mid- or low-rectal cancer. METHODS: This retrospective study enrolled 327 patients who underwent a sphincter-saving resection for proven T3 rectal cancer located <10 cm from the anal verge and without radiotherapy between January 1995 and December 2011. The oncologic outcomes included the 5-year cancer-specific survival, the local recurrence, and the systemic recurrence rates. RESULTS: In groups A (DRM < or =1 cm) and B (DRM >1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively. CONCLUSION: This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed.
Humans ; Quality of Life ; Radiotherapy* ; Rectal Neoplasms ; Recurrence* ; Retrospective Studies ; Survival Rate

PURPOSE: The laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative time. Hand-assisted laparoscopic surgery (HALS) is an alternative technique that addresses these problems while preserving the short-term benefits of a laparoscopic colectomy. Our study was aimed to describe the characteristics of patients admitted due to left-sided colon and rectal cancer for HALS. METHODS: A prospectively maintained database was used to identify patients who underwent HALS at the Institute of Oncology, Vilnius University, from July 1, 2009, to October 1, 2012. RESULTS: One hundred-three HALS colorectal resections were performed. The patients' mean age was 64 +/- 13.4 years. There were 46 male and 57 female patients. The body mass index was 27.3 +/- 5.8 kg/m2. Forty-three patients (41.8%) had experienced prior abdominal surgery. The mean HALS time was 105 minutes (range, 55-85 minutes). The conversion rate was 2.7% (3/103). The median of return of gastrointestinal function was 2.5 days (range, 2.2-4.5 days). The median length of hospital stay was 9 days. The postoperative complication and mortality rates were 10.7% and 0.97%, respectively. Four incisional hernias (3.9%) were seen at a mean follow-up of 7.0 +/- 3.4 months. None of the patients had a trocar or a hand-port site recurrence. CONCLUSION: A HALS colorectal resection is a safe and effective technique, and it provides all the benefits of minimally invasive surgery.
Body Mass Index ; Colectomy ; Colon* ; Female ; Follow-Up Studies ; Hand-Assisted Laparoscopy ; Hernia ; Humans ; Laparoscopy* ; Learning Curve ; Length of Stay ; Male ; Mortality ; Operative Time ; Postoperative Complications ; Prospective Studies ; Rectal Neoplasms* ; Recurrence ; Surgical Instruments

No abstract available.

No abstract available.
Colonoscopy*

No abstract available.
Analgesia* ; Laparoscopy*

No abstract available.
Humans ; Radiotherapy* ; Rectal Neoplasms*

No abstract available.
Hand-Assisted Laparoscopy*

Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.
Aged ; Anal Canal* ; Debridement ; Equipment and Supplies ; Humans ; Hypotension ; Ischemia ; Necrosis* ; Precipitating Factors ; Rectum

No abstract available.