Disposable single-port surgery devices have been used for transanal minimally invasive surgery (TAMIS). Their advantage, compared to transanal endoscopic microsurgery, is that they do not require special equipment or training. The aim of this study was to assess our initial experience using the single-site laparoscopic (SSL™) access system (Ethicon Endo-Surgery, Cincinnati, OH, USA) for TAMIS. Five patients eligible for local excision of rectal tumors, four males and one female, mean age 58 years (range 50-78), underwent surgery using the SSL™ device. The average distance from anal verge was 4 cm (range 1-6). Four patients had an initial diagnosis of adenoma, and one had a previous endoscopic excision of a T1 adenocarcinoma with positive margins. In one patient, due to the lack of exposure, the procedure was converted to a low anterior resection. In the remaining four patients, average setup time was 7 minutes (range 4-15) and average operative time was 52 minutes (range 38-72). All resection margins were tumor free. There were no postoperative complications. Two of the presumed adenomas were intramucosal adenocarcinomas, while one patient had a T2 tumor and underwent radical surgery. Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique with great potential. Because of its simplicity and similarity with conventional laparoscopic surgery, it can be learned easily by surgeons not trained in transanal endoscopic microsurgery.

An association between gastric cancer and obesity has been suggested in large epidemiologic series. We present a 61-year-old lady with BMI 48.7 kg/m2, who underwent preoperative work-up for Roux-en-Y gastric bypass. Her endoscopy showed a depressed lesion at the incisura angularis, suggesting early gastric cancer. The biopsy confirmed well/moderately-differentiated adenocarcinoma. The surgical approach was subtotal gastrectomy leaving only part of the fundus, and was performed on an oncological basis, with lymphatic D2 dissection. The gastro-enterostomy was 1.5 cm wide, and was constructed closer to the greater curvature over a 12-Fr Fouchet tube. The reconstruction was in a Roux-en-Y fashion, but the alimentary limb was 150 cm long. Despite the short follow-up, the way the surgery was conducted presumably maintained both oncologic and bariatric determinations.

Purpose: Steatorrhea is one of the most common complications in reconstruction after total gastrectomy. Many reconstruction techniques after total gastrectomy have been developed in order to avoid these undesirable effects, but each one of them has some inconvenience. In this experiment, a modified Rosanov technique that keeps duodenal transit, evaluation of fat absorption after gastrectomy was tested. Methods: Three groups of rats with the same characteristics were used. Total gastrectomy was performed in two groups: one was operated on and transit was reestablished by the Roux-en-Y technique (group Y), while the other was submitted to the modified Rosanov technique (group R). Following surgery, a handmade hyper fatty diet (11% of fat) was offered. A third group (control -group C) was not operated but was submitted to the same conditions of the other groups, and used for reference steatocrit values. The animals underwent laparotomy 14 days after surgery and had their feces collected from cecum to determine their steatocrit by analysis of their values. Results: Steatocrit values for groups R and C (mean 5.16% and 4.15% respectively) were similar (p > 0.1), while group Y had significantly higher values (mean = 28.18%, p = 0.0001 -p < 0,05). This was attributed to the fact that group R animals had their duodenal transit patent, decreasing the complications expected in the Roux-en-Y reconstruction. Conclusions: Steatorrhea in the modified Rosanov technique was similar to the control group, while Roux-en-Y reconstruction presented higher steatorrhea and fat malabsorption. Key words: Gastrectomy. Postgastrectomy Syndromes. Anastomosis, Roux-en-Y. Steatorrhea. Diarrhea. RESUMOObjetivo: Uma das principais complicações tardias da gastrectomia total com reconstrução de trânsito excluindo duodeno é a esteatorréia. Várias técnicas de reconstrução após gastrectomia total foram descritas para que se pudesse evitar esses efeitos indesejáveis, mas cada uma apresentou seus inconvenientes. Nesse estudo foi avaliada a técnica descrita por Rosanov com uma pequena modificação, que mantém o trânsito através do duodeno, para avaliar a absorção de gorduras. Métodos: Foram utilizados três grupos de ratos Wistar machos, com peso e características semelhante. Dois grupos foram submetidos à gastrectomia total: o primeiro teve sua reconstrução com técnica de Y de Roux (grupo Y), e o segundo com Rosanov modificado (grupo R). Após a cirurgia, foi introduzida dieta com teor de gorduras conhecido (11%). Um terceiro grupo (grupo C) esteve sob mesmas condições dos outros animais, sem ter sido submetido à cirurgia, e foi utilizado como grupo controle para o esteatócrito. Após 14 dias, antes de serem sacrificados, foram submetidos a laparotomia para coleta de fezes do ceco e dosagem de esteatócrito. Os valores de esteatócrito foram analisados estatisticamente pelo método de Kruskal-Wallis. Resultados: O esteatócrito dos grupos R (média = 5,16%) e C (média = 4,15%) foram semelhantes (p > 0,1), enquanto o grupo Y teve valores significativame...

Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is by far the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between March 2003 and July 2016. After exclusion criteria were applied, one hundred twenty two patients were analyzed. Global recurrence was found in 22% of them, while 13.1% have had local recurrence. Disease-free survival was 23.9 months, in average, and medium follow-up was 34.13 months, varying from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years, and shows a 5-years survival rate of only 5%. Around 50% of cases, recurrence is local, confined to pelvis. This data followed literature in most aspects evaluated, although finding a high rate of local recurrence remains a challenge in the seek for better surgical outcomes.