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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1202-1210页

作者： Shiki Fujino Masayoshi Yasui Masayuki Ohue Norikatsu Miyoshi Innovative Oncology Research and Regenerative Medicine Osaka International Cancer InstituteOsaka 541-8567Japan Department of Surgery Osaka International Cancer InstituteOsaka 541-8567Japan

BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and *** transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects are *** To reveal the effect of TDT in patients with symptomatic AL after rectal cancer *** A systematic literature search was performed using the PubMed,Embase,and Cochrane Library *** included randomized controlled trials(RCTs)and prospective cohort studies(PCSs)in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was *** results of the studies were synthesized using the Mantel-Haenszel randomeffects model,and a two-tailed P value>0.05 was considered statistically *** Three RCTs and two PCSs were included in this *** AL was examined in all 1417 patients(712 with TDT),and TDTs did not reduce the symptomatic AL *** a subgroup analysis of 955 patients without a diverting stoma,TDT reduced the symptomatic AL rate(odds ratio=0.50,95%confidence interval:0.29–0.86,P=0.012).CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer ***,patients without a diverting stoma may benefit from TDT placement.

关键词： Meta-analysis Drainage transanal Anastomotic leakage Surgical stomas Rectal cancer

A NEW MODIFICATION OF transanal SOAVE PULL-THROUGH PROCEDURE FOR HIRSCHSPRUNG’S DISEASE

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Chinese Medical Journal 2006年第1期119卷 37-42页

作者： LI Ai-wu ZHANG Wen-tong LI Fu-hai CUI Xin-hai DUAN Xiang-sheng Department of Paediatric Surgery Qilu Hospital Shandong University Ji＇nan 250012 China

Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in grou

关键词： transanal pull-through Hirschsprung's disease Soave modified procedure

transanal Evisceration of Small Bowel about One Case at the University Hospital Yalgado Ouédraogo of Ouagadougou

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Surgical Science 2016年第7期7卷 291-294页

作者： Adama Sanou Moussa Bazongo Edgar Ouangré Maurice Zida Gilbert Patindé Bonkoungou Rodrique Namékinsba Doamba Sylvain Wendmi Karfo Elie Yamba Sawadogo Nayi Zongo Si Simon Traoré Division of General and Digestive Surgery University Hospital Blaise Compaoré Ouagadougou Burkina Faso Division of General and Digestive Surgery University Hospital Yalgado Ouédraogo Ouagadougou Burkina Faso

Introduction: transanal evisceration of small bowel is an extremely rare condition that can occur spontaneously or after trauma. Objective: To report a case of transanal evisceration of small bowel to describe the circumstances of occurrence and our therapeutic attitude. Observation: An 80-year-old female patient was received at the visceral Emergency of University Hospital Yalgado Ouédraogo for the outcome of the small intestine by the anus with the waning of a defecation effort. The physical examination of the patient accustomed to evacuation purgation noted, eviscerated the small bowel through the anus, edematous but viable. The preoperative laboratory tests were normal. In emergency, under general anesthesia, a laparotomy was possible to objectify the incarceration of intestinal loops through linear perforation of 5 cenimeter from the anterior surface of the rectosigmoid hinge. We conducted an ileo-ileal resection anastomosis, a suture rectosigmoid breach and anal extraction of small bowel incarcerated measuring 200 centimeter. The evolution was simple. Conclusion: The weakening of the rectal mucosa by repeated purges has certainly been the contributory factor. The surgical treatment must be precocious to avoid extensive intestinal resection.

关键词： Evisceration transanal Small Bowel Rectum Sigmoid

transanal Endoscopic Microsurgery (TEM) for Rectal Neoplasms

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Surgical Science 2012年第6期3卷 283-289页

作者： Manuel Ferrer-Márquez ángel Reina-Duarte Francisco Rubio-Gil Ricardo Belda-Lozano Antonio álvarez-García Departments of Colorectal Surgery General Surgery Torrecárdenas Hospital Almería Spain

Introduction: The abdominal approach for the treatment of rectal tumors is associated with a considerable rate of morbidity. transanal Endoscopic Microsurgery (TEM) is an alternative technique that is less invasive than radical surgery, and therefore has a lower associated morbidity. Moreover, with proper patient selection, TEM presents oncological outcomes comparable to radical surgery. The aim of this study is to review our results obtained with TEM and discuss its role in the treatment of malignant rectal lesions. Patients and Methods: A prospective descriptive study from June 2008 until February 2011. The indications for TEM were: early rectal neoplastic lesions (T1N0M0) with good prognostic factors;neoplastic lesions in more advanced stages in selected patients (high surgical risk, refusal of radical surgery or stoma, and palliative intention). Results: Resection by TEM was performed on 19 patients. The average hospital stay was 5.7 days with an associated morbidity of 16.7%. R0 resection was 88.8%. During the follow-up of 15 (3 - 31) months, no recurrence has been shown. Conclusions: TEM is a safe and effective procedure for the treatment of selected early malignant rectal lesions and is associated with low morbidity. It is a therapeutic strategy based on a multidisciplinary team, careful patient selection, an audited surgical technique and a strict follow-up protocol.

关键词： transanal Endoscopic Microsurgey TEM Rectal Neoplasms

transanal polypectomy using single incision laparoscopic instruments

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World Journal of Gastrointestinal Surgery 2011年第4期3卷 56-58页

作者： Dimitrios Dardamanis Dimitrios Theodorou George Theodoropoulos Andreas Larentzakis Maria Natoudi Georgia Doulami Christina Zoumpouli Haridimos Markogiannakis Stylianos Katsaragakis George C Zografos Department of Propaedeutic Surgery Athens Medical SchoolUniversity of AthensHippocration Hospital Department of Pathology Hippocration Hospital

transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.

关键词： Polypectomy SILS transanal endoscopic microsurgery Laparoscopy Endoscopy

transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions:a single centre experience

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World Journal of Gastrointestinal Endoscopy 2016年第17期8卷 623-627页

作者： Monica Ortenzi Roberto Ghiselli Maria Michela Cappelletti Trombettoni Luca Cardinali Mario Guerrieri Department of General Surgery Università Politecnica delle Marche

AIM To analyze the outcomes of transanal endoscopic microsurgery(TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were *** Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males(57.7%) and 22 females(42.3%). Mean age was 55 years(median = 60, range = 24-78). This series included 14(26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors(40.4%), 1 ganglioneuroma(1.9%), 2 solitary ulcers in the rectum(3.8%), 6 cases of rectal endometriosis(11.5%), 6 cases of rectal condylomatosis(11.5%) and 2 rectal melanomas(3.8%). Mean lesion diameter was 2.7 cm(median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm(median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences(3.8%) with an overall survival equal to 97.6%(95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98%(95%CI: 96%-99%).CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions.

关键词： transanal endoscopic microsurgery Rare rectal conditions Full-thickness excision minimally invasive surgery Retrospective study

Efficacy and Safety of transanal Tube Drainage for Prevention of Anastomotic Leakage Following Laparoscopic Low Anterior Resection for Rectal Cancers

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Journal of Cancer Therapy 2018年第7期9卷 538-544页

作者： Yasutake Uchima Naoki Aomatsu Hironari Miyamoto Takuma Okada Shigeaki Kurihara Toshiki Hirakawa Takehiko Iwauchi Junya Morimoto Shigehito Yamagata Kazunori Nakazawa Kazuhiro Takeuchi Department of Surgery Fuchu Hospital Izumi city Osaka Japan

Introduction: Laparoscopic surgery is widely used for the treatment of colorectal cancer. But anastomotic leakage is one of the most serious complications following laparoscopic low anterior resection (LAR) for rectal cancer. The purpose of this study was to investigate whether transanal drainage tube placement can reduce anastomotic leakage and avoid re-operation after laparoscopic LAR. Methods: Retrospective assessment was performed on 143 patients with rectal cancers who underwent laparoscopic LAR between April 2009 and March 2016. A diverting stoma was not created in all 143 patients. A transanal drainage tube was placed after anastomosis using a double stapling technique, in 90 patients (group TT). In group TT, a 24 Fr. Silicon catheter was inserted into the anus and was placed approximately 20 - 25 cm in the descending colon. Another 53 patients were operated on without a transanal drainage tube (group NTT). Clinicopathological and operative variables, the frequencies of anastomotic leakage and re-operation after leakage were investigated. Results: Between the two groups (Group TT and NTT), age, gender, body mass index, tumor size, Dukes’ stage, the number of Liniar stapler firings for rectal transaction, and the rate of left colic artery preservation were comparable. Intra-operative blood loss and operation time decreased group TT from group NTT (p transanal drainage tube (perforation or bleeding of the colon, or deviation of the tube) in Group TT. Conclusions: Tran

关键词： Rectal Cancer Anastomosis Leakage transanal Drainage Tube

Decompression of Malignant Large-bowel Obstruction with a Self-expanding Metallic Stent or transanal Drainage Tube

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Journal of Nutritional Oncology 2018年第4期3卷 170-176页

作者： Jing Jing Wei Ting Ting Lian Ze Hao Zhuang Lu Peng Liu Cheng Dang Wang Jian Tao Zheng Jian Ding Yu Feng Pan Department of Endoscopy The First Affiliated Hospital of Fujian Medical University Fuzhou Fujian 350005 China Department of Surgery The First Affiliated Hospital of Fujian Medical University Fuzhou Fujiang 350005 China

Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.

关键词： Malignant large-bowel obstruction Self-expanding metallic stent transanal drainage tube Karnofsky performance status scoring Enteral nutrition

A comparison of transanal excision and endoscopic resection for early rectal cancer

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World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 56-60页

作者： Soon Hak Lee Seong Woo Jeon Min Kyu Jung Sung Kook Kim Gyu Seog Choi Department of Internal Medicine Kyungpook National University School of Medicine50 Samduk 2GaChung-guDaegu 700-721South Korea Department of Colorectal Surgery Kyungpook National University School of Medicine50 Samduk 2GaChung-guDaegu 700-721South Korea

AIM:To compare the outcomes of endoscopic resection with transanal excision in patients with early rectal ***:Thirty-two patients with early rectal cancer were treated by transanal excision or endoscopic resection between May 1999 and December *** patients were regularly re-examined by means of colonoscopy and abdominal computed tomography after resection of the early rectal ***,length of hospital-stay,disease recurrence and follow up outcomes were ***:Sixteen patients were treated by endoscopic resection and 16 patients were treated by transanal *** significant differences were present in the baseline *** rate of complete resection in the endoscopic resection group was 93.8%,compared to 87.5% in the transanal excision group(P=0.544).The mean length of hospital-stay in the endoscopic resection group was 2.7 ± 1.1 d,compared to 8.9 ± 2.7 d in the transanal excision group(P=0.001).The median follow up was 15.0 mo(range 6-99).During the follow up period,there was no case of recurrent disease in either ***:Endoscopic resection was a safe and effective method for the treatment of early rectal cancers and its outcomes were comparable to those of transanal excision procedures.

关键词： Endoscopic resection Rectal cancer transanal excision

Strangulated transanal Evisceration of Small Bowel Complicating Rectal Prolapse of the Child: An Observation of the University Hospital Center of Parakou, Benin

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Surgical Science 2018年第2期9卷 85-89页

作者： Montcho Adrien Hodonou Bio Tamou-Sambo Isidore Gandoho Djifid Morel Séto Salako Alexandre Allode Department of General Surgery School Hospital of Parakou Faculty of Medicine University of Parakou Parakou Benin

transanal intestinal evisceration is an extremely rare and dramatic digestive surgical emergency. The cases reported in the literature are few and concern much more elderly patients. We report the case of a 3-year-old boy admitted in very general poor condition to the emergency department, late for transanal evisceration complicating rectal prolapse that the parents tried to reduce. The fatal outcome of this case is probably related to strangulation and delay in consultation. We learn from this that parents should avoid inopportune prolapse reduction and early consultation.

关键词： transanal Evisceration Strangulation Rectal Prolapse Child Benin