Combined endo-laparoscopic surgery for difficult benign colorectal polyps.

Prevention of colorectal cancer (CRC) depends largely on the detection and removal of colorectal polyps. Despite the advances in endoscopic techniques, there are still a subgroup of polyps that cannot be treated purely by endoscopic approach, which comprise of about 10-15% of all the polyps. These so-called "difficult colorectal polyps" are polyps with large size, morphology, at difficult location, scarring or due to recurrence, which have historically been managed by surgical segmental resection.

Advances in laparoscopic colorectal surgery: a review on NOTES and transanal extraction of specimen.

Laparoscopic colorectal surgery has rapidly developed since the 1980s. Relative to open surgery, it offers the benefits of less invasiveness and earlier recovery. However, when a mini-laparotomy wound is needed to retrieve the specimen, the benefits of minimally invasive surgery may be compromised as a result of pain- and wound-related complications.

Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors.

Background: We conducted a randomized study of a laparoscopic technique for removing left-sided colon tumors that can reduce postoperative pain and other wound-related complications compared to the conventional technique. It is a novel technique of hybrid natural orifice translumenal endoscopic surgery (NOTES) colectomy (HNC) whereby laparoscopic colonic mobilization, transection, and anastomosis are performed intracorporeally. The specimen is then delivered through the anus using the transanal endoscopic operation (TEO) device, precluding the need for mini-laparotomy.

Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial.

Introduction: We previously conducted a randomized trial comparing the endo-laparoscopic approach (i.e. placing self-expanding metallic stents followed by laparoscopic resection) and conventional open surgery in the treatment of obstructing left-sided colon cancer.

Medical expulsive therapy using alfuzosin for patient presenting with ureteral stone less than 10mm: a prospective randomized controlled trial.

Objectives: To assess the spontaneous passage rate for patients being treated with alfuzosin 10mg daily after presenting with an acute ureteral stone compared with a control group, and to assess the respective pain control status.

Methods: This was a prospective randomized controlled trial. Patients presenting with an acute ureteral stone (size 5-10mm) were enrolled and randomized into a medical expulsive therapy (MET) group or control group.

Unplanned admission after day-case haemorrhoidectomy: a retrospective study.

Objective: To identify the risk factors associated with unplanned admission after day-case haemorrhoidectomy.

Methods: This was a retrospective review of the outcomes of patients who underwent elective, intended day-case haemorrhoidectomy in a surgical institution between January 2005 and December 2009. Data were generated from a computerized database.

Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer.

This study aimed to assess the feasibility and long-term outcome of laparoscopic total mesorectal excision for middle and lower rectal cancer. Retrospective assessment was performed on 612 patients with middle and low rectal cancer in the surgery department of our hospital. Three-hundred and three patients underwent laparoscopic total mesorectal excision (LTME), and 309 patients underwent open TME (OTME).

Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial.

Objective: To compare self-expanding metal stents with emergency open surgery in the treatment of obstructing left-sided colon cancer.

Design: A randomized controlled trial.

Setting: An acute care hospital.

Laparoscopic distal gastrectomy for gastric cancer: initial experience on hand-assisted technique and totally laparoscopic technique.

Objective: To review the initial experience and compare the results of hand-assisted laparoscopic distal gastrectomy (HALDG), totally laparoscopic distal gastrectomy (TLDG), and open distal gastrectomy (ODG) in the treatment of gastric cancer in a regional hospital.

Methods: Consecutive patients who received distal gastrectomy for stage 1 or 2 gastric cancer were reviewed retrospectively. Lymphatic dissection and intracorporeal anastomosis were initially performed using the HALDG approach, and subsequently the TLDG approach.

Endo-laparoscopic reduction and resection of gastroduodenal intussuception of gastrointestinal stromal tumor (GIST): a synchronous endoscopic and laparoscopic treatment.

Gastrointestinal stromal tumor (GIST) commonly occurs in the stomach. We would like to report an uncommon presentation of gastric GIST with gastroduodenal intussuception. A patient with known history of gastric GIST at fundus for 10 years presented to the casualty department with recurrent epigastric pain, deranged liver function, and hyperamylasemia.

Laparoscopic resection for rectal cancers: lessons learned from 579 cases.

Objective: The aim of this study is to evaluate the short-term outcomes and long-term survival of laparoscopic rectal cancer resection at a single institution with 579 cases over a 15-year period.

Summary Background Data: The use of laparoscopic resection for colon cancer has been shown to be safe with comparable oncological outcomes. However, the role of laparoscopic resection for rectal cancer is still controversial with few studies looking into long-term outcomes.

Laparoscopic treatment for small bowel obstruction: report of a case.

An unusual case of small bowel obstruction in a patient with "virgin abdomen" was successfully diagnosed and the localized pathology was elucidated by a computed tomography scan, and the case was successfully treated by laparoscopy.

Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in chinese patients.

Objective: The aim of this study was to evaluate the incidence of postoperative deep vein thrombosis (DVT) in Chinese patients who underwent laparoscopic resection of rectal or sigmoid cancer in the absence of thromboprophylaxis.

Methods: Patients with adenocarcinoma of the sigmoid colon or rectum scheduled for laparoscopic resection were recruited. Neither chemoprophylaxis nor mechanical methods against DVT were employed.

Unusual cause of acute abdomen --- ruptured retroperitoneal paraganglioma.

Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

Hand-assisted laparoscopic versus open right colectomy: a randomized controlled trial.

Objective: Laparoscopic colectomy has been proved to be both technically and oncologically feasible. However, the approach has been criticized for its procedural complexity and long operative time as a result of the loss of tactile feedback and absence of depth perception. The advent of hand-access devices offered a potential solution to these problems.

Laparoscopic versus open appendectomy for complicated appendicitis.

Background: Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing postoperative pain, analgesic requirement, and incidence of wound infection. The role of laparoscopy in management of complicated appendicitis, ie, gangrenous, perforated appendicitis and appendiceal abscess, remains undefined. Currently, the choice of operative approach is mostly at the surgeons' discretion.

Acute symptomatic abdominal aortic aneurysm secondary to endovascular stent graft associated type II endoleak.

Endovascular abdominal aneurysm repair (EVAR) is popular because of its low invasiveness and feasibility for high-risk patients. Endoleak is common after EVAR and is characterized by blood flow within the aneurysm sac but outside the stent graft. Type II or collateral endoleak commonly results from retrograde filling of the aneurysm from collateral visceral vessels, lumbar, inferior mesenteric, accessory renal or sacral arteries.

Laparoscopic cholecystectomy for acute cholecystitis: the evolving trend in an institution.

Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic cholecystolithiasis. Technical maturation and advances in instrumentation have enabled the application of this procedure for acute cholecystitis (AC). We review the evolving role of LC for AC in our institution.

Abdominal tuberculosis mimicking metastasis in a patient with carcinoma of the oesophagus.

Oesophageal carcinoma typically manifests as ulcerative growth. Cases of oesophageal tuberculosis mimicking carcinoma of the oesophagus have been reported and create considerable diagnostic difficulty. Abdominal tuberculosis, however, is an uncommon extrapulmonary manifestation of tuberculosis.

Laparoscopy-assisted surgical management of obscure gastrointestinal bleeding secondary to Meckel's diverticulum in a pediatric patient: case report and review of literature.

Despite advances in endoscopy and imaging, acute gastrointestinal (GI) bleeding of obscure origin in children presents a challenge to pediatric gastroenterologist. Bleeding Meckel's diverticulum (MD) commonly presents with acute episode of lower GI bleeding. A conventional diagnostic algorithm includes endoscopy, technetium 99m pertechnetate scintigraphy, angiography, and exploratory laparotomy.

Laparoscopic approach compared with conventional open approach for bezoar-induced small-bowel obstruction.

Background: Bezoar-induced small-bowel obstruction (SBO) is an uncommon surgical emergency. Accurate preoperative diagnosis is notoriously difficult, and conventional management often necessitates laparotomy. Recent articles demonstrate the feasibility of laparoscopy in the management of SBO.

Acute abdomen: an unusual case of ruptured tuberculous mesenteric abscess.

Background: Abdominal tuberculosis is an uncommon extra-pulmonary manifestation of tuberculosis.

Methods: Case report and literature review.

Results: Herein, we report an unusual case of ruptured tuberculous mesenteric cold abscess, which was managed by laparotomy for diagnosis and drainage, and post-operative chemotherapy.

Diaphragmatic hernia: an uncommon cause of dyspepsia.

Adult onset diaphragmatic hernia is a rare condition with variable clinical manifestations. The majority of adult-onset diaphragmatic hernia is associated with trauma. Blunt thoracic and abdominal trauma associated with a 5% to 7% incidence of diaphragmatic injury, and in 3% to 15% for those with penetrating injury.