Prolapsed hemorrhoids is a common clinical disease, and severe symptoms can significantly affect work and life. The transanal stapler has the advantages of simple operation and less trauma in treating prolapsed hemorrhoids. Its clinical efficacy is closely related to the selection of indications, the standardization of surgical operations, and the prevention and treatment of complications. In current clinical practice, there is no consensus on the treatment of prolapsed hemorrhoids with transanal stapler. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the indications, contraindications, operating specifications and perioperative management of prolapsed hemorrhoids. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Anal Canal/surgery* ; China ; Consensus ; Hemorrhoidectomy/methods* ; Hemorrhoids/surgery* ; Humans ; Surgical Stapling/methods* ; Treatment Outcome

OBJECTIVETo investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS).

METHODSThirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016).

RESULTSAverage age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05).

CONCLUSIONModified STARR combined with POPFBFT is safe and effective for ODS patients.

Aged ; Anal Canal ; surgery ; Biofeedback, Psychology ; physiology ; Constipation ; rehabilitation ; surgery ; Defecation ; Defecography ; Digestive System Surgical Procedures ; methods ; rehabilitation ; Female ; Humans ; Length of Stay ; Middle Aged ; Operative Time ; Pain, Postoperative ; etiology ; Pelvic Floor ; physiology ; Postoperative Complications ; Quality of Life ; Rectocele ; Surgical Stapling ; Suture Techniques ; Treatment Outcome ; Urinary Retention ; etiology

OBJECTIVETo evaluate the efficacy of partial stapled transanal rectal resection (part-STARR) combined with Bresler procedure in the treatment of obstructed defecation syndrome (ODS) associated with rectocele and internal rectal intussusception(IRI), and compare with STARR.

METHODSA randomized controlled study from January 2013 to December 2014 was undertaken. Sixty female patients with ODS caused by rectocele and IRI were prospectively enrolled and randomly divided into trial group (29 cases) receiving part-STARR combined with Bresler procedure, and control group (31 cases) undergoing STARR only. For patients in trial group, two thirds of posterior rectal wall were stapled with STARR methods and one third of anterior with Bresler procedure, while for those in control group, only STARR was performed. Intra-operational status, postoperative complications, Wexner constipation score and patient satisfaction 3 months and 6 months after operation, and rectocele defecography 6 months after operation were compared between the two groups.

RESULTSThe average operation time of trial group was longer than that of control group [(31.2±5.4) minutes vs. (28.7±4.0) minutes, t=2.127, P=0.038]. There were no significant differences in intra-operative blood loss, postoperative hospital stay and complications(pain, postoperative bleeding, rectovaginal fistula, feeling of tenesmus and swelling) between the two methods(all P>0.05). There were no significant differences in the Wexner score of constipation between the two groups before operation and 3 months after operation (6.72±1.19 vs. 7.32±1.25, t=-1.896, P=0.063), while the Wexner score of trial group was significantly lower 6 months after operation (6.90±1.42 vs. 7.74±1.26, t=-2.463, P=0.018). Patient satisfaction between two groups was not significantly different 3 months after operation(χ(2)=5.743, P=0.125), while trial group had better satisfaction 6 months after operation[93.1%(27/29) vs. 67.7%(21/31), χ(2)=8.247, P=0.041]. There was no difference in depth of rectocele on defecography between the two groups before operation, while rectocele was significantly improved 6 months after operation [(0.7±0.2) cm vs. (0.9±0.2) cm, t=2.527, P=0.014].

CONCLUSIONPartial STARR combined with Bresler procedure in the treatment of ODS associated with rectocele and IRI has better efficacy than STARR only.

Blood Loss, Surgical ; Constipation ; Defecography ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Intestinal Obstruction ; surgery ; Intussusception ; surgery ; Length of Stay ; Operative Time ; Postoperative Complications ; Rectocele ; surgery ; Rectovaginal Fistula ; Surgical Stapling

OBJECTIVETo explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.

METHODSClinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.

RESULTSAll the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).

CONCLUSIONThe gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.

Anastomosis, Surgical ; adverse effects ; methods ; Anastomotic Leak ; epidemiology ; prevention & control ; Comparative Effectiveness Research ; Constriction, Pathologic ; epidemiology ; prevention & control ; Esophageal Neoplasms ; complications ; surgery ; Esophagectomy ; adverse effects ; methods ; Esophagoplasty ; adverse effects ; methods ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Neck ; surgery ; Omentum ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Surgical Stapling ; adverse effects ; methods

OBJECTIVE: The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus, pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients with widespread pelvic involvement. METHODS: The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacent pelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic disease within this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying the bladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vessels are divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon is divided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesentery is ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed and dissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to the left of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in a retrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosis was completed using stapling device. RESULTS: En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvic disease leaving no gross residual disease was possible using en bloc pelvic resection. CONCLUSION: En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic disease in advanced primary ovarian cancer patients with extensive pelvic organ involvement.
Anastomosis, Surgical ; Colon, Sigmoid/pathology/surgery ; Disease Progression ; Female ; Humans ; Hysterectomy/*methods ; Neoplasm Invasiveness ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial/*pathology/*surgery ; Ovarian Neoplasms/*pathology/*surgery ; Ovary/pathology/surgery ; Pelvic Exenteration/*methods ; Pelvis/pathology/surgery ; Rectum/pathology/surgery ; Salpingectomy ; Surgical Stapling

OBJECTIVETo compare the efficacy and complication of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in the treatment of severe hemorrhoids.

METHODSClinical data of 542 cases of severe hemorrhoids undergoing TST (258 cases) or PPH (284 cases) in The First Affiliated Hospital of Fujian Medical University from November 2010 to January 2012 were analyzed retrospectively. Operative parameters, efficacy and complication 3 months after operation were assessed and compared.

RESULTSNo significant difference in cure rate between TST and PPH (96.5% vs. 95.4%) was found, while the operation time and hospital stay after operation in TST group were significantly shorter urgency [(20.6±4.7) vs. (26.4±6.3) min, (2.9±0.5) vs. (3.5±0.7) d, both P<0.05]. Incidences of postoperative pain, bleeding, anal urgency and urinary retention in TST group were significantly lower than those in PPH group (all P<0.01). No anal stenosis was observed in TST group, and 5 cases developed anal stenosis in PPH group (P<0.05). Hemorrhoid recurrence did not differ significantly between the two groups.

CONCLUSIONSThe efficacy of TST and PPH is comparable for severe hemorrhoids patients, while TST is associated with faster postoperative recovery and less complications.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Surgical Stapling ; methods ; Treatment Outcome ; Young Adult

OBJECTIVEto present the preliminary results of minimally invasive Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil technique.

METHODSsix patients with esophageal cancer received minimally invasive Ivor Lewis oesophagectomy from April 2010 to June 2010. There were 5 males and 1 female with mean age of 55 years (ranging 38 to 69 years). The lesion located in cardiac in 1 case, in lower third of the esophagus in 4 cases and in middle third in 1 case. The abdominal portion was operated laparoscopically. The thoracic portion was done using thoracoscopic techniques. The esophago-gastric anastomosis was created using a 25 mm anvil passed trans-orally and connected to a 90 cm long polyvinyl chloride delivery tube through an opening in the esophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler) inserted into the gastric conduit.

RESULTSsix patients with esophageal squamous cell cancer (n = 5) and small-cell cancer (n = 1) underwent an Ivor Lewis esophagectomy. All the operation was successfully performed without intra-operative technical failures of the anastomosis. There was no severe postoperative complications. The mean operation time was 380 min. The mean blood loss was 300 ml. pTNM staging: T2N0M0 in 3 cases, T2N1M0 in 1 case and T3N0M0 in 2 cases.

CONCLUSIONSthe circular-stapled anastomosis with the trans-oral anvil is an efficient and safe technique for esophago-gastric anastomosis.

Adult ; Aged ; Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Esophagus ; surgery ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Stomach ; surgery ; Surgical Stapling ; methods ; Thoracoscopy

OBJECTIVETo compare the long-term results of procedure for prolapse and hemorrhoids(PPH) and Milligan-Morgan(MM) hemorrhoidectomy in the treatment of third- and fourth-degree hemorrhoids.

METHODSNinety-one patients in PPH group and 120 patients in MM group, treated in our hospital from May 2001 to May 2005, were followed up. All the patients suffered with third- or fourth-degree hemorrhoids. The data including symptoms relief, complication and recurrence were compared between two groups.

RESULTSPPH and MM both significantly relieved bleeding (95.6% vs 92.7%), pain (93.1% vs 94.3%) and prolapse (93.4% vs 93.1%). There were no significant differences between two groups(P >0.05). PPH significantly relieved constipation compared with MM(60.0% vs 32.1%, P <0.05). No significant differences of complete relief rates between PPH group and MM group according to different degrees, types and prolapses of hemorrhoids were found(P >0.05). There were no significant differences in the overall complication rate(14.3% vs 12.7%), recurrence rates(12.1% vs 8.8%) and satisfactory degree (85.1 vs 88.2) between two groups as well.

CONCLUSIONThe long-term outcomes of PPH in the treatment of third and fourth-degree hemorrhoids are similar to Milligan-Morgan hemorrhoidectomy.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Follow-Up Studies ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Surgical Stapling ; Surgical Stomas ; Young Adult

OBJECTIVETo introduce the experiences of pull-through transection and double stapling anastomosis for early lower rectal cancer.

METHODSFrom May 2001 to March 2008, 25 patients with early stage lower rectal cancer were operated by using pull-through transection and double stapling anastomosis. The average distance between the dentate line and lower margin of the tumor is (3.2 +/- 0.5) cm (2.0 - 4.5 cm). The average tumor diameter is (2.8 +/- 0.8) cm (2.0 - 3.5 cm).

RESULTSThe average distance between the lower margin of the tumor and transection line is (1.5 +/- 0.4) cm (1.1 - 2.2 cm). All the resection margins were negative. Eighteen cases of the anastomosis were above the dentate line, 0.3 - 2.1 cm [(1.7 +/- 0.2) cm] and the other 7 were below, 0.1 - 0.5 cm (average 0.3 cm). Anastomotic leakage occurred in 1 case, and cured with conservative treatment. Local recurrence occurred in 1 case (4.0%), liver metastasis in 3 (12.0%) and lung metastasis in 2(8.0%), respectively. Mild fecal incontinence occurred in 7 cases.

CONCLUSIONCompared with trans-abdominal transection of distal rectum in low anterior resection of rectal cancer, pull-through transection and anastomosis provides more precise control of the cutting line and simpler resection.

Adult ; Anal Canal ; surgery ; Anastomosis, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Retrospective Studies ; Surgical Stapling ; methods

OBJECTIVETo investigate and compare the clinical effects of procedure for prolapse and hemorrhoids (PPH) and Ligasure technique (LT) for the treatment of severe hemorrhoids.

METHODSPatients with prolapsed hemorrhoids were randomly divided into two groups treated with PPH (n=44) and LT (n=42). The outcomes were evaluated postoperatively (i.e., operation time, length of hospital stay, pain intensity scoring, relapse of prolapse, bleeding and cost).

RESULTS(1)The average operating time for patients treated by LT was (12.0+/- 4.1) min, while for those by PPH was(19.0+/- 6.4)min (P < 0.05). (2)The average scores of visual analogue scale (VAS) for PPH and LT patients were 3.1 points (2 approximately 6) and 5.4 points (3~8) respectively(P < 0.05). (3)The average costs for LT group and PPH group were (4838+/- 301) yuan and (7796+/- 492) yuan respectively (P < 0.05). (4)In PPH group, 4 patients were complicated with hemorrhage (over 50 ml) and 1 patients with relapse, while there were no complications occurred in LT group. (5)Six months after operation, the self scores of postoperative pain,defecation and total satisfaction were 95.0%, 100% and 100% in PPH group, and 87.2%, 97.4% and 97.4% in LT group respectively.

CONCLUSIONSCompared with PPH, LT has the advantages of shorter operation time, less hemorrhage and expense, but more postoperative pain. Both LT and PPH are effective procedures for severe hemorrhoids.

Adult ; Aged ; Aged, 80 and over ; Female ; Hemorrhoids ; surgery ; Humans ; Male ; Middle Aged ; Surgical Stapling ; methods ; Suture Techniques ; Treatment Outcome ; Young Adult