A pudendal nerve block with bupivacaine results in fewer postoperative voiding complications and less pain compared with the traditional spinal anesthesia in a hemorrhoidectomy.

The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

Laparoscopic resection of the low rectum is technically difficult. This article describes a technique for laparoscopic-assisted, transvaginal low anterior resection of the rectum, which is technically easier and leads to an excellent cosmetic result.

Purpose: An obstructed colorectal cancer (OB) has a poorer survival than a non-obstructed cancer (NOB). This study examined the prognostic impact of bowel obstruction on colorectal cancer. Methods: From December 1999 to December 2005, patients undergoing single stage operation for OB were examined prospectively. OB (n= 193) was compared with a NOB (n=444) used in a primary tumor resection during the same period. 637 colorectal cancers were examined in this study. Results: The overall operative mortality was 21 (3.3%) and the postoperative mortality was significantly higher in the OB (OB: 16, 8.3%) group than in the NOB (NOB: 5, 1.1%) group. The proportion of OB was higher in the left-colon (52.8%) than in the right colon (16.0%) and rectum (31.1%, P＜0.001). However, OB was associated with an older age (P=0.013). The proportion of advanced tumor stage was higher in OB (II: 35.8%, III: 39.5%, IV: 24.7%) than in NOB (II: 53.2%, III: 35.8%, IV: 11.0%, P＜0.001). The 5-year cancer-related survival for OB was worse than NOB (OB: 77.3%, NOB: 57.8%, P＜0.05). However, in the cases of a colorectal cancer performed curative resection (stage II and III), the survival for OB was not worse than NOB: stage II (OB: 82.8%, NOB: 92.2%, P=0.24), stage III (OB: 65.2%, NOB: 56.9%, P=0.43). Conclusions: OB has older and more advanced disease characteristics. However, if an oncologically curative resection is performed, the survival for OB is similar to that of a NOB.

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