Evaluating the result of sphincteric-preserving surgery (Parks procedure) for low rectal cancer

Sphincter-preserving surgery for low rectal cancer improved the quality of life while maintaining the oncologic outcomes. A retrospective, descriptive study was conducted with 45 patients who underwent sphincter-preserving surgery for low rectal cancer at the National Cancer Hospital and Hanoi Medical University Hospital between January 2016 and April 2020. The mean age was 55.6 years old. Male: female ratio = 0.7:1. Nearly all patients presented with hematochezia (95.6%). 75.6% of the tumors are located within 4-6 cm from the anal verge. The anastomotic leak rate was 4.4%. All patients had a normal postoperative urinary function. The sexual dysfunction rate was low (15.8%) and reversible. None had erectile or ejaculation dysfunction. 97.8% satisfied with sphincter function after one year. Tumors located > 4 cm and the anastomosis sites located > 2 cm from the anal verge were good prognostic factors for the recovery of sphincter function (p < 0.05). The Parks procedure had optimistic postoperative outcomes with a low complication rate, minimal sexual dysfunction, and good sphincter function in long-term follow-up.

Comparison of side-to-end with end-to-end Anastomosis technique for colorectal anastomosis

Objective: To compared the functional and anatomic outcomes of end-to-end anastpmosis (EEA) technique with side-to-end anastomosis (SEA) technique for colorectal anastomosis. Methods: A randomized clinical trail was conducted in Jinnah Postgraduate Medical Center (JPMC), Karachi. We recruited 60 patients who were planned for colorectal surgery from January 2020 to January 2021. Patients having histology proven adenocarcinoma of rectum of sigmoid colon, with normal sphincter function were included. Patients were randomly attributed into two groups in 1:1 ratio. The primary endpoint was to determine immediate post-operative complications, and assessment of intestinal function (using Lower anterior resection syndrome (LARS) score) at one-month follow-up. Results: There was no statistical difference in anatomic and functional outcomes in SEA and EEA groups, mean operative time was 168±43 minutes in SEA group versus 159±38 minutes in EEA group. Anastomosis leakage was diagnosed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). Redo-procedure was needed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). At one-month follow-up, major LARS was diagnosed in 03 (10.0%) patients in EEA group, while minor LARS was diagnosed in 5 (16.7%) patients in SEA group versus in 4 (13.3%) patients in EEA group (p-value 0.52). Conclusion: Both side to end anastomosis and end to end anastomosis are comparable in-terms of functional and anatomic outcomes. So the operating surgeons can adopt any of these techniques for colorectal anastomosis. Keywords: side-to-end anastomosis, end-to-end anastomosis, lower anterior resection syndrome, colorectal anastomosis.

Reconstruction of a large lower lip defect using a combination of Abbe and staircase flaps: a case report

Lip defects often occur following wide excision as a surgical treatment for squamous cell carcinoma of the oral cavity. Defects larger than one-half of the lip cannot be closed primarily and require flap surgery. Reconstruction of the oral sphincter function can be achieved by means of a local flap using the like tissue, rather than with a free flap utilizing different tissues. A defect of the lower lip requires reconstruction using different techniques, depending on its size and location. Herein, we present the case of a patient exhibiting a lip defect spanning more than two-thirds of the lower lip, after a wide resection due to squamous cell carcinoma. The defect was reconstructed using an Abbe flap and a staircase flap. Revision was performed after 16 days. The patient’s oral competencies were fully restored 3 months postoperatively, and the esthetic results were ideal. Based on our experience, a combination of the Abbe and staircase flaps can produce excellent functional and esthetic outcomes in the reconstruction of a lower lip with a large defect. It can serve as a reliable reconstruction option for defects spanning more than two-thirds of the lower lip, not including the oral commissures.

Topographic and anatomical characteristics of the bladder neck in early fetuses

Aim. To determine macro-and microscopic anatomical characteristics and the dynamics in topographic and anatomical interactions of the bladder neck with adjacent organs and structures at the beginning of the fetal period. Material and methods. The study was carried out on 70 fetal specimens. The age of subjects included in the study was determined according to the tables of B.M. Patten, B.P. Khvatova, Yu.N. Shapovalov based on measurements of the parietal-calcaneal length (PCL), taking into account the Instructions for determining the perinatal period, live birth, and stillbirth criteria, approved by Order of the Ministry of Health of Ukraine No. 179 dated March 29, 2006. To achieve this goal, the following methods of anatomical research were used: anthropometry - to determine the age of the studied subjects; injection of arterial vessels with subsequent dissection under the control of a microscope – to study the peculiarities of the blood supply to the vesicoureteral segment; radiography - to determine the skeletotopy of the vesicoureteral segment; macro-microscopy – to explore the anatomical relationships of the components of the vesicoureteral segment, their structure, shape, position; histological – to study the structure of the wall of the vesicoureteral segment; morphometry – to determine the morphometric parameters of the vesicoureteral segment; 3-D reconstruction method – to study the spatial structure of the vesicoureteral segment; statistical – to analyze and establish the reliability of differences in organometric parameters.Results. Skeletopically, the projection of the vesicoureteral junction of early fetuses is located at the level of the upper third of the pubic symphysis. At the beginning of the perinatal period in female fetuses, the bladder neck (6.9 ± 2.6 mm) is longer than in male fetuses (6.4 ± 2.4 mm). Based on the analysis and generalization of the research results, it is substantiated that at the beginning of the fetal period, the internal urethral sphincter can be formed: a) by two loops of the outer longitudinal layer; b) the ring of the circular layer and the front bundles of the outer longitudinal layer; c) anterior bundles of the outer longitudinal layer and transverse bundles of the inner longitudinal layer within the trigone of urinary bladder; d) a ring of the circular layer, thickened in the anterolateral sections.Conclusions. Considering the topographic and anatomical characteristics of the angio- and myoarchitectonics of the vesicoureteral segment, we believe that its role as a physiological sphincter of the lower urinary tract is provided by the interaction of the vascular and muscle components. The vascular component of the sphincter apparatus of the vesicoureteral segment is provided by veins located in three layers: 1) cavernous-like veins of the submucosa; 2) veins of the muscular membrane; 3) veins of tunica adventitia. The second anatomical component of the sphincter function of the vesicoureteral segment is the muscular one, represented by the internal urethral sphincter.

P.222 Subjective pattern of postoperative neurological recovery in degenerative cervical myelopathy varies by preoperative severity of disease

Background: Degenerative cervical myelopathy is a spinal disorder resulting in progressive spinal cord compression and consequent neurological deficits that can be assessed and tracked using the modified Japanese Orthopedic Association (mJOA) questionnaire. However, it is difficult to predict which patients will recover neurological function after surgery, making it difficult for clinicians to set reliable postoperative patient expectations. Methods: Sixty-eight operative myelopathy patients (50 male, 14 female) consented to complete the mJOA questionnaire both preoperatively and 6-months postoperatively. Fifteen of these patients had mild, twenty-three had moderate, and thirty had severe preoperative disease. Results: We found that in mild myelopathy, sensation and strength recover in similar proportions. In moderate myelopathy, a greater proportion of patients recover in each domain except for sensation. Recovery in severe myelopathy was comparable to moderate disease, but showed more dramatic recovery in sensation and sphincter function. Conclusions: This study shows that the severity of myelopathic disease influences the pattern of postoperative recovery. Though limited in sample size, the recovery patterns identified above are an important first step in recognizing myelopathy as a disease that patients experience heterogeneously both pre- and post-operatively. Our results will aid clinicians in goals-of-surgery discussions and assist with managing postoperative patient expectations.

Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer

BACKGROUND: Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. OBJECTIVE: Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. METHODS: 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. RESULTS: Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. CONCLUSION: The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Clinical and functional features of rectal sphincter in patients with rectovaginal fistulas before and after split vaginal-rectal flap application

Dysfunction of the rectal sphincter is noted in more than 70 % of patients with rectovaginal fistulas (RVF), which require an extremely careful evaluation of the rectal sphincter function both by clinical and instrumental methods. Objective: to study the state of rectal sphincter in patients with rectovaginal fistulas before and after surgical treatment. Materials and methods: in the period from 2012 to 2021 198 patients (age from 20 to 73 years, Me = 35 (30; 45)) were included in the comprehensive study of the rectal sphincter functional state before and after surgical treatment. 106 (53,5 %) cases were recurrent. Traumatic childbirth was the most common cause of RVF (43,9 %). Results: dysfunction of the rectal sphincter is revealed in 154 (77,8 %) patients with rectovaginal fistulas. The etiology of the disease and the recurrent course do not affect the severity of the rectal sphincter functional disorders. Using of a split rectal-vaginal flap do not lead to a worsening of the rectal sphincter function. Conclusion: A significant mismatch between the obtained objective (sphincterometry) and subjective (Wexner scale) data of the rectal sphincter function in patients with rectovaginal fistulas proves the need for sphincterometry in this category of patients. Elimination of rectovaginal fistulas by using a split vaginal-rectal flap is a safe and low-traumatic surgical method.