Trans-anal reinforcing sutures after double stapling for lower rectal cancer: Report of two cases

Abstract

Abstract. To safely avoid the construction of a covering stoma in patients with advanced lower rectal cancer undergoing laparoscopy assisted colorectal surgery (LACS), we added circumferential manual reinforcing sutures via the transanal approach at the site of mechanical anastomosis. In June 2008, LACS was performed for a tumor of 6 cm in longer diameter in the Rb region of the lower rectum ~5 cm from the anal verge. After intraperitoneal coloproctal anastomosis was performed in the pelvis by the double stapling technique (DST), reinforcement was provided by manual trans-anal suturing (trans-anal reinforcing sutures: TARS). A covering stoma was constructed because this was a high-risk case. Complications such as mild wound infection and stoma trouble occurred, and the patient was discharged after conservative therapy. In June 2008, LACS was performed for a tumor of 5 cm in longer diameter in the Ra region of the lower rectum ~7 cm from the anal verge. After intraperitoneal colorectal anastomosis was performed in the pelvis by DST, TARS were added to avoid a covering stoma. Minor leakage occurred postoperatively, but this was controlled conservatively and the patient was discharged. In patients having surgical treatment of advanced lower rectal cancer, good results were obtained by adding circumferential reinforcing sutures via the trans-anal approach at the site of ultra-low anastomosis after DST.

Hybrid 2-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by distal sigmoid colon cancer: A case report

“…Hybrid 2-port HALS differs from pure LACS in various respects. Procedures such as ligation and ablation of vessels like the main colic artery/vein with lymph node dissection, anastomosis, and closure of the mesocolon/mesorectum after colorectal resection can be performed relatively easily under direct vision like standard laparotomy, and it can be performed safely in patients with ileus such as the present case or patients with tumors invading other organs (5,12,13).…”

“…The usual indications for hybrid 2-port HALS include i) patients who can tolerate general anesthesia for ~2 hours, ii) patients with no major concomitant diseases such as cardiac or pulmonary conditions, and iii) if possible, a P.S. of 0-1, an age ≤75 years, and no evidence of lateral lymph node metastasis in patients with advanced rectal cancer (5,13). In patients with advanced lower rectal cancer, a transverse incision of 45-55 mm is usually made at the upper margin of the pubic bone, but open lateral lymph node dissection in patients with nodal metastases can be achieved by making a small incision for hand access such as a lower abdominal incision or lower abdominal pararectal incision in the vicinity of the metastatic lymph nodes.…”

“…Problems with the comparatively long operating time have also been pointed out (5). To solve these problems, we considered the use of hybrid 2-port HALS, in which HALS is combined with open surgery via a small incision (45-55 mm) as the hand access site (5,12,13). Since hybrid 2-port HALS is conducted with a small incision and only two ports, this represents a major difference from pure LACS using 5 to 6 ports.…”

“…Since hybrid 2-port HALS is conducted with a small incision and only two ports, this represents a major difference from pure LACS using 5 to 6 ports. The features of hybrid 2-port HALS are as follows: i) palpation and tactile sensation ensure safe and reliable surgery; ii) protective and smooth procedures can be carried out by manual manipulation, particularly in patients with large and heavy tumors; iii) the procedure can be performed by only two surgeons; iv) it is an extension of standard operation, so the operating time is shorter; and v) there is only a shallow learning curve for the procedure (5,13).…”

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

“…In patients who were not indicated for surgery, anticancer agents other than those mentioned above were administered as second-line treatment. Radiotherapy was added in the case of rectal cancer for the local recurrence involving the pelvic floor (12)(13)(14). As a general rule, outpatient follow-up included measurement of tumor markers 3-4 times per year and ultrasonography/computed tomography (US/CT) 3-4 times a year, with recurrence/metastasis being confirmed by both US and CT (10,13).…”