Humans ; Osteogenesis ; Mesentery/surgery* ; Ossification, Heterotopic/surgery*

China ; epidemiology ; Humans ; Mesentery ; surgery ; Rectal Neoplasms ; epidemiology ; surgery

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.
Humans ; Mesentery/surgery* ; Digestive System Surgical Procedures ; Fascia/anatomy & histology*

The application of extralevator abdomino-perineal excision (ELAPE) and total mesorectal excision has improved the prognosis of rectal cancer. However, compared with anterior resection for rectal cancer, the circumferential resection margin (CRM) positive rate and intraoperative perforation (IOP) rate are still high. The ELAPE can reduce the CRM positive rate and IOP rate, therefore reduce postoperative local recurrence rate and increase the survival rate of patients. The disadvantage of its trauma, longer operative time, and higher perineum complication in ELAPE is controversial. This review mainly discusses the key points of operative procedure, advantages and disadvantages, research status and development prospects of ELAPE.
Digestive System Surgical Procedures ; methods ; Humans ; Mesentery ; surgery ; Perineum ; surgery ; Prognosis ; Rectal Neoplasms ; surgery ; Rectum ; surgery

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 evaluate the efficacy of laparoscopic total mesorectal excision (laparoscopic TME) versus open total mesorectal excision (open TME) in the treatment of middle and low rectal cancer using meta-analysis.

METHODFrom 1991 to 2012, the Chinese and English articles of randomized controlled trails (RTCs) about laparoscopic TME versus open TME in the treatment of middle and low rectal cancer were collected, and a meta-analysis was performed with RevMan 5.1 software.

RESULTSEight RCTs including 863 patients with middle and low rectal cancer (428 cases in laparoscopic TME group, 435 cases in open TME group) were enrolled in the meta-analysis. Laparoscopic TME was associated with significantly less intraoperative blood loss (P<0.01), earlier to pass first flatus (P<0.01), shorter hospital stay (P<0.05), less postoperative incision infections (P<0.01) and postoperative bleeding (P<0.05) compared to open TME. There were no significant differences between laparoscopic TME and open TME groups in operative time, number of resected lymph nodes, anastomotic leak, ileus and pelvic abscess (all P>0.05).

CONCLUSIONSAs compared to open TME, laparoscopic TME has similar efficacy in terms of lymph nodes harvest, and it can promote postoperative recovery, and reduce incision infection and postoperative bleeding.

Humans ; Laparoscopy ; methods ; Mesentery ; surgery ; Randomized Controlled Trials as Topic ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Treatment Outcome

The mesentery is a continuous unity and the operation of digestive carcinoma is the process of mesenteric resection. This paper attempts to simplify the formation process of all kinds of fusion fascia in the process of digestive tract embryogenesis, and to illuminate the continuity of fusion fascia with a holistic concept. This is helpful for beginners to reversely dissect the fusion fascia and maintain the correct surgical plane during operation, and to achieve the purpose of complete mesenteric resection.
Colonic Neoplasms/surgery* ; Gastrointestinal Neoplasms/surgery* ; Humans ; Laparoscopy ; Mesentery/surgery* ; Mesocolon

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.
Humans ; Mesentery/surgery* ; Colonic Neoplasms/surgery* ; Colorectal Surgery ; Digestive System Surgical Procedures ; Peritoneum/surgery* ; Rectal Neoplasms/surgery* ; Laparoscopy

OBJECTIVETo systemically assess the feasibility and safety of complete mesocolic excision (CME) for colon cancer.

METHODSA computer-based online research of prospective, randomized or nonrandomized, controlled studies addressing CME versus traditional surgery published in the last five years was performed in electronic databases (Wanfang Database, China National Knowledge Infrastructure, Chinese Medical Current Contents, VIP, PubMed, Medline, Ovid, Elsevier, ISI Web of Knowledge, Cochrane Database of Systematic Reviews). With strictly screening according to the standard, the quality of studies was evaluated. Selective trials were analyzed by the Review Manager 5.1 software.

RESULTSA total of eight nonrandomized clinical trials, involving a total of 1209 patients (615 patients in CME group and 594 patients in control group), were identified. Meta-analysis showed that the intraoperative blood loss in CME group was less than that in control group [WMD=-13.05, 95%CI:-25.03 to -1.07, P=0.03]. No significant difference in the operation time was found [WMD=0.46, 95%CI:-26.50 to 27.41, P=0.97], and significant differences in the number of lymph node retrieved from postoperative pathologic specimens, the average length of large bowel resected, the area of mesentery resected, and the high vascular ligation were revealed between two groups. Besides there were no significant differences in the time to first flatus and the hospital stay between two groups (P=0.87, P=0.05). The postoperative complication morbidity did not increase in CME group as compared to control group (P=0.74).

CONCLUSIONCME is safe and effective in accordance with the concept of embryonic anatomy, oncological surgery and delicate surgery, and is expected to become a standardization operation method for colon cancer.

Clinical Trials as Topic ; Colonic Neoplasms ; surgery ; Feasibility Studies ; Humans ; Mesentery ; surgery

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery