Anorectal physiology testing is useful in the evaluation of patients with fecal incontinence. Without the information obtained from physiologic testing, 11 percent of patients who may have benefited from surgery would not have been given this option, and 7 percent of patients could have potentially undergone unnecessary surgery. Transanal ultrasound is the study most likely to change a patient's management plan.
Background: Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes.Methods: All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes.
Results:The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career.
Conclusion:Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.Contexte : La chirurgie du côlon par laparoscopie, qui réduit les traumatismes, est une solution de rechange à la chirurgie ouverte. De plus, il a été démontré que l'excision mésocolique complète (EMC) optimise le curage ganglionnaire et offre la perspective de meilleurs résultats oncologiques.
Méthodes :On a examiné rétrospectivement la durée de l'opération et les résultats périopératoires de toutes les résections du côlon droit réalisées par laparoscopie avec EMC pratiquées par un seul chirurgien depuis le début de sa carrière.Résultats : L'étude a été menée auprès de 81 patients. La durée moyenne de l'intervention chirurgicale était de 220 minutes (intervalle de 206 à 233 minutes). Au début, l'intervention durait environ 250 minutes; avec le temps, sa durée a progressivement diminué de sorte qu'à la fin, elle était de moins de 200 minutes, d'après une relation linéaire négative (y = -0,58x × 248). Le taux de complications graves s'est établi à 3,6 % ± 4,2 % et le nombre moyen de noeuds lymphatiques excisés a été de 31,3 ± 4,1. En utilisant la méthode d'analyse des sommes cumulées, on a observé un taux de complications et des résultats oncologiques acceptables depuis le début de la carrière du chirurgien en laparoscopie.
Conclusion :En perfectionnant sa technique laparoscopique, un chirurgien formé principalement en chirurgie colorectale ouverte peut produire des résultats acceptables dans les cas d'hé...
The consensus process has provided guidance for the management of patients with PRC-bTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.
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