maeda kotaro

Purpose: We identified appropriate colon cancer dissection area for muscularis propria (MP) invasion.<BR>Subjects and methods: Clinical outcomes were studied retrospectively in 84 MP cancer subjects based on tumor site. These were clinicopathologically compared to 180 subjects with subserosa invasion (SS cancer).<BR>Results: No difference was seen in left or right–side sites for curative surgery frequency, lymph node metastasis, or main or intermediate lymph node metastasis. Lymph node metastases were fewer at 23.8% in MP cancer with curative surgery than in SS cancer at 33.5% (p=0.08). No significant difference was seen in main or intermediate lymph node metastasis rates, recurrence in those with main or intermediate lymph node metastasis, or prognosis between MP and SS cancer.<BR>Conclusions: Main and intermediate lymph node dissection is recommended for MP cancer just as for SS cancer.

Vascular injuries, bowel injuries and organ injuries are often encountered in laparoscopic colectomy as accidental complications. Such injuries still sometimes occur even at present. We have performed 446 laparoscopic colectomy so far, among whom 14 cases of vascular injuries, 9 cases of bowel injuries and 1 case of organ injury have occurred. Though 12 cases of laparoscopic colectomy had to be converted to open surgery, conversion was not required in any of the vascular injury cases. In order to avoid these accidental situations, there are some significant steps that have to be followed in laparoscopic colectomy. Surgeons need to follow standard operative procedure, learn about the principle and characteristic of surgical devices, and acquire the skill of using those devices. Furthermore, the operator, his/her assistant and endoscopist should have sound anatomical knowledge concerning the membrane structure and proper dissection layer. The collaboration between clinicians can also lead to obtain a better surgical field of view. The surgeon, the assistant and endoscopist become the triunity. A coordinated operation should be carried out, and the visual field is ensured after the anatomical membrane structure and stratum disjunction are understood. However, we should not hesitate to convert to open laparotomy in those cases where the laparoscopic field of view is limited, or bleeding is poorly controlled.

Anorectal manometory is the principal technique used to evaluate anorectal function. We describe our experience with 2 patients in whom rectal perforation was caused by anorectal manometory. Informed consent for this report was obtained from the patients and their families. Case 1 was a man in his 40's who underwent super low anterior resection with a transverse colostomy. In the third month after surgery, anorectal manometory was performed before colostomy closure. During the sensory test, abdominal pain developed. Emergency surgery was performed for a diagnosis of perforated peritonitis. Case 2 was a woman in her 70's who underwent transanal resection to treat a prolapse (using an automatic suture device). In the sixth month after surgery, anorectal manometory (included a sensory test) was performed. The patient had melena after the examination and was given conservative therapy for about 3 weeks for a diagnosis of rectal perforation. Sensory test with an Obatametoro balloon catheter is a useful diagnostic procedure that is very simple to perform, with no individual difference in instrumentation. However, post operative examinations should be carefully performed because excessive pressure can be applied to anastomotic sites.

This article aims to idenfify the characteristics of surgical treatment for fecal incontinence as a standardized modality. While randomized controlled trials are rare, various quantitative measures are used to evaluate the outcomes and the criteria for successful results are often arbitrarily defined, various surgical modalities have recently been developed, improved and established, especially in the western world. Therefore, there is an urgent need to create a guideline for surgical treatment for fecal incontinence in Japan. As of today, overlapping sphincteroplasty is the most commonly accepted technique. Sacral nerve stimulation is a novel, less invasive and promising modality for patients with fecal incontinence, who do not respond to conservative therapies. Although colostomy is often regarded as a failure of treatment, it might be an effective technique to improve quality of life in society. A better understanding among Japanese colorectal surgeons of the surgical algorithm and modalities as well as their pros and cons for fecal incontinence is needed.<br>

This article aims to idenfify the characteristics of surgical treatment for fecal incontinence as a standardized modality. While randomized controlled trials are rare, various quantitative measures are used to evaluate the outcomes and the criteria for successful results are often arbitrarily defined, various surgical modalities have recently been developed, improved and established, especially in the western world. Therefore, there is an urgent need to create a guideline for surgical treatment for fecal incontinence in Japan. As of today, overlapping sphincteroplasty is the most commonly accepted technique. Sacral nerve stimulation is a novel, less invasive and promising modality for patients with fecal incontinence, who do not respond to conservative therapies. Although colostomy is often regarded as a failure of treatment, it might be an effective technique to improve quality of life in society. A better understanding among Japanese colorectal surgeons of the surgical algorithm and modalities as well as their pros and cons for fecal incontinence is needed.<br>

We aimed to evaluate the rapid pull-through technique and the rectal stimulation test in anorectal manometry. Seventy-one patients underwent the examination from September 2007 to August 2008. The examination was carried out in the left lateral decubitus position with water perfusion catheter according to the pull-through technique to measure the high-pressure zone (HPZ) and maximum resting pressure (MRP) 3 times each. An Obatametro balloon catheter of 7mm in diameter was used for the rectal stimulation test. As a result of evaluating the correlates most closely with age, gender and Wexner&#039;s incontinence score, the first sensation (FS) and maximum tolerable volume (MTV) did not reveal a correlation with those factors in the rectal stimulation test, while the tolerable volume (TV) defined in the manuscript as MTV-FS was related to them. In conclusion, TV could be a valuable indicator for fecal incontinence in the near future.&lt;br&gt;