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Many rectal tumors can be excised transanally using inexpensive equipment. Transanal endoscopic microsurgery allows excision of lesions beyond the reach of conventional technique. Transanal endoscopic microsurgery is performed with specialized expensive instruments. Surgeons working in smaller community hospitals lack the budget to purchase transanal endoscopic microsurgery instruments. I modified the transanal endoscopic microsurgery technique by using a single-incision laparoscopic port that was inserted into the anal canal. Through this port, insufflation with gas maintained exposure of the surgical site, a 30-degree 5-mm camera, a grasper, and electrocautery were used to remove a large villous adenoma. This is the first report of the use of a single-access port to perform transanal endoscopic microsurgery. This modification is inexpensive compared with traditional transanal endoscopic microsurgery and allows more surgeons to perform difficult transanal tumor excisions (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A39).

A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n = 54) or subcutaneous (n = 58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7 +/- 0.2 days) than for the open group (2.3 +/- 0.1 days; P less than 0.001). Although the response rate to a pain questionnaire was less than 50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.

No abstract

Loop ileostomy is an effective means of temporary fecal diversion. This type of stoma is easy to manage and closure does not require formal laparotomy. We describe a laparoscopic technique of loop ileostomy formation. The procedure can be done with ease and with less discomfort and morbidity when compared with open laparotomy.