Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.

Deep infiltrating endometriosis(DIE)is defined as endometriotic lesions infiltrating≥5 mm beneath the peritoneum,commonly affecting the uterosacral ligaments,rectovaginal septum,vaginal vault,and rectal wall.Due to nonspecific clinical manifestations and atypical imaging features,DIE is often misdiagnosed.This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)and summarizes the multidisciplinary treatment experience in conjunction with a literature review.A 35-year-old woman was admitted for defecation difficulty.MRI and EUS-FNA confirmed rectal DIE.After multidisciplinary team(MDT)evaluation involving colorectal,gynecologic,and urologic specialists,laparoscopic resection of the rectal lesion,sigmoid-rectal anastomosis,and protective ileostomy were performed.Pathology confirmed rectal DIE with negative margins.The stoma was successfully reversed 4 months later,and no recurrence was observed during 21 months of follow-up.These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness,providing valuable guidance for the individualized management of complex pelvic endometriosis.

Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.

Deep infiltrating endometriosis(DIE)is defined as endometriotic lesions infiltrating≥5 mm beneath the peritoneum,commonly affecting the uterosacral ligaments,rectovaginal septum,vaginal vault,and rectal wall.Due to nonspecific clinical manifestations and atypical imaging features,DIE is often misdiagnosed.This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)and summarizes the multidisciplinary treatment experience in conjunction with a literature review.A 35-year-old woman was admitted for defecation difficulty.MRI and EUS-FNA confirmed rectal DIE.After multidisciplinary team(MDT)evaluation involving colorectal,gynecologic,and urologic specialists,laparoscopic resection of the rectal lesion,sigmoid-rectal anastomosis,and protective ileostomy were performed.Pathology confirmed rectal DIE with negative margins.The stoma was successfully reversed 4 months later,and no recurrence was observed during 21 months of follow-up.These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness,providing valuable guidance for the individualized management of complex pelvic endometriosis.

Bowel sounds can reflect the movement and health status of the gastrointestinal tract.However,the traditional manual auscultation method has subjective deviation and is time-consuming and labor-intensive.In order to better assist doctors in diagnosing bowel sounds and improve the reliability and efficiency of bowel sound detection,this study proposed a deep neural network model that combines a residual neural network(ResNet),a bidirectional long short-term memory network(BiLSTM),and an attention mechanism.Firstly,a large number of labeled clinical data was collected using the self-developed multi-channel bowel sound acquisition system,and the multi-scale wavelet decomposition and reconstruction method was used to preprocess the bowel sounds.Then,log Mel spectrogram features were extracted and sent to the network for training.Finally,the performance and effectiveness of the model were evaluated and verified by 10-fold cross-validation and an ablation experiment.The experimental results showed that the precision,recall,and F1 score of the model reached 83%,76%,and 79%,respectively,and it could effectively detect bowel sound segments and locate their start and end times,performing better than previous algorithms.This algorithm can not only provide auxiliary information for doctors in clinical practice but also offer technical support for further analysis and research of bowel sounds.

Intersphincteric resection (ISR) is an advanced sphincter-preserving surgery for low rectal cancer. Accumulating evidences from clinical studies indicate that ISR can spare some pati-ents with low rectal cancer from the distress of anal amputation while ensuring oncological efficacy. However, due to the necessity of removing part or all of the internal sphincter during rectal resection and the extremely low anastomosis level, a subset of patients may experience low anterior resection syndrome (LARS) after surgery. LARS is characterized by symptoms such as anal incontinence, increased bowel frequency, urgency, incomplete evacuation, and obstructed defecation. Based on relevant literature and team practice, the authors provide an overview of the diagnosis and treat-ment progress of LARS following ISR.

Total mesorectal excision (TME) has become the basic principle of surgical treat-ment for middle and low rectal cancer. Some of patients with ultra-low rectal cancer require under-going intersphincteric resection (ISR). Due to the limitation of the narrow pelvis, TME and ISR put forward higher requirements for the precise separation of the anatomical level and the protection of neurological function during the operation. At present, evaluation of the difficulty of surgery for middle and low rectal cancer is mainly based on the subjective judgment of chief surgeon, and there is no unified and objective scoring system or prediction model that can classify the difficulty of surgery for middle and low rectal cancer before surgery. The authors review relevant literatures and summarize the existing studies related to pelvic measurement for predicting the difficulty of surgery for middle and low rectal cancer, in order to provide significant guidance for the selection of surgical approach for patients with middle and low rectal cancer.

Purpose: Increasing evidence has shown an association of surgical technique, particularly anastomotic configuration, with postoperative recurrence of CD. This pilot study aimed to evaluate short-term outcomes of isoperistaltic side-to-side anastomosis (ISSA) employed on Crohn disease (CD) patients. Methods: Data were retrieved from a prospectively maintained database. Postoperatively, all patients were followed up with close endoscopic (ileocolonoscopy) surveillance. Results: From January 2017 to May 2021, 30 patients diagnosed with CD who underwent ISSA were compared with 45 CD patients who underwent antiperistaltic side-to-side anastomosis (ASSA). The 2 groups were comparable in baseline demographics and clinical characteristics. No significant differences were observed between groups regarding postoperative safety issues, including anastomotic leak, abdominal/pelvic abscess, length of hospital stay, readmission rate within 30 days, etc. At postoperative 24th month, reduced endoscopic recurrence was observed in the ISSA group compared with that in the ASSA group (18 of 24, 75.0%, vs. 36 of 38, 94.7%; P = 0.024). Regarding surgical recurrence, there was 0% in the ISSA group vs. 4.4% (2 of 45) in the ASSA group (P = 0.510). Conclusion In this study, we aimed to explore the influence of ISSA on postoperative recurrence in CD patients, and the preliminary results show that ISSA was technically safe and feasible, and appears to be effective in reducing postoperative recurrence in CD patients. However, our conclusion was underpowered due to small sample size and inadequate followup. We proposed ISSA be considered as another alternative option in the toolbox of inflammatory bowel disease surgeons when performing anastomosis on CD patients.

Bowel sounds is an important indicator to monitor and reflect intestinal motor function, and traditional manual auscultation requires high professional knowledge and rich clinical experience of doctors. In addition, long-time auscultation is time-consuming and laborious， which may lead to misjudgment caused by subjective error. To solve the problem, firstly, the wavelet transform is used to preprocess the bowel sounds signal for noise reduction and enhancement. Secondly, three typical features of intestinal sound were extracted. According to the combination of these features, a three-stage decision was designed to carry out multi-parameter and multi-feature joint threshold detection. This algorithm realized the detection of bowel sound signal and the location of its start and end points, making it possible that the complete bowel sound signal was extracted effectively. In this study, a large number of clinical data and label of bowel sounds were collected, and a new effective evaluation method was proposed to verify the proposed method. The accuracy rate is 83.51%. Results of this study will provide systematic support and theoretical guarantee for the diagnosis of intestinal diseases and the monitoring of postoperative intestinal function recovery of patients.
Algorithms ; Auscultation ; Humans ; Intestines ; Signal Processing, Computer-Assisted ; Wavelet Analysis

Objective: To investigate the sexual function, urinary function and quality of life in patients of ulcerative colitis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA). Methods: The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed , postoperative sexual function, urinary function, and long-term quality of life were assessed. Results: There were 45 patients with median age of 35 years , median follow-up time of 31 months. 18 were UC, 27 were FAP, 5 did 1-stage surgery, 37 did 2-stage surgery, 3 for 3-stage surgery, 13 underwent open surgery, and 32 underwent laparoscopic surgery. 7 patients suffered sexual dysfunction after IPAA, and there was no statistical difference between male and female (P=0.992), UC and FAP (P=0.153), 1-stage , 2-stage , and 3-stage surgery (P=0.363) , with statistically significant difference between the open group and the laparoscopic group (P=0.025). 6 patients complicated with urinary dysfunction after IPAA , and there was no statistical difference between male and female (P=0.562), UC and FAP (P=0.325), 1-stage, 2-stage, and 3-stage surgery (P=0.286) , with statistically significant difference between the open group and the laparoscopic group (P=0.007). The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696±0.085. There were no statistical difference on CGQL scores in males and females (P=0.635), UC and FAP (P=0.664), 1-stage, 2-stage, and 3-stage (P>0.05), open group and laparoscopic group (P=0.205), postoperative long-term QOL was significantly associated only with age at the time of surgery (P=0.001). Conclusions Compared with open surgery, laparoscopic TPC-IPAA patients had better postoperative sexual function and urination function.