Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions

AIM:To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.METHODS:From March 2010 to June 2014, 30 patients(14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection.The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases.In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0.Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut.Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor.For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum.The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum.RESULTS:For the present cohort of 30 cases,the mean operative time was 178 min,with an average of 13 positive lymph nodes detected.One case of postoperative anastomotic leak was observed,requiring temporary colostomy,which was closed and recovered3 mo later.The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases.Twelve months after surgery,94.4%patients achieved anal function Kirwan grade 1,indicating that their analfunction returned to normal.The patients were followed up for 1-36 mo,with an average of 23 mo.There was no local recurrence,and 17 patients survived for>3years(with a survival rate of 100%).CONCLUSION:Laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.

Efficacy of ilaprazole in the treatment of duodenal ulcers:A meta-analysis

AIM: To compare the efficacy and tolerance of ilaprazole compared with other proton pump inhibitors (PPIs) in the treatment of duodenal ulcer.

Diffuse hemolymphangioma of the rectum: A report of a rare case

Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, esophagus and other organs have been reported. We herein report a case of a 37-year-old man with severe rectal bleeding. Digital examination revealed nodular mucosa. No rectal mass was palpated, but bleeding in the ampulla was detected. Colonoscopy revealed an extensive hypervascular submucosal lesion arising from the rectosigmoid junction colon to the distal edge of the anus. Endoscopic ultrasonography demonstrated an extensive anechoic mass with clear edge. Magnetic resonance imaging (MRI) showed a significant thickness of the rectal wall, extending to the distal edge of the anus, with a narrowing lumen. A sphinctersaving rectal surgery was performed. Due to a lack of knowledge of the clinical, endoscopic and radiological features, preoperative recognition of hemolymphangioma is not easy. Computed tomography and MRI are helpful in confirming the diagnosis, and defining the extent and invasion of the lesion. For the low malignant potential tumors, a sphincter-saving rectal surgery is recommended after a full evaluation of the tumor.