Arijit Mukherjee

Extralevator abdominoperineal excision (Elape): A retrospective cohort study.

Introduction Extralevator abdominoperineal excision (ELAPE) is relatively new surgical technique for low rectal cancers. It is a more radical approach than conventional abdominoperineal excision (APE) with potentially better oncological outcome. The aim of this study was to analyse short term results of ELAPE compared with conventional abdominoperineal excision. Methods Data were collected prospectively for 72 patients who underwent abdominoperineal excision (APE) for low rectal carcinomas from 2010 to 2014. Of these 24 patients underwent ELAPE with biological prosthetic mesh used to close the perineal defect. Results The median age of patients was 68 (37–87). Positive circumferential resection margin (1/24 vs. 8/48) and Intra operative perorations (0/24 vs. 6/48) compared favourably with ELAPE. Conclusions Short term results from this study support that ELAPE has better oncological outcome.

Colonic stent and percutaneous ethanol injection as a treatment for colocutaneous fistula secondary to benign stricture

We report successful treatment of colocutanteous stulae at the site of a benign colonic anastomotic stricture using Self-Expandable Metal Stents (SEMS) and Percutaneous Ethanol Injection (PEI). The stricture and the secondary stulae developed after Hartmann’s procedure for sigmoid diverticular abscess followed by reversal of the Hartmann’s procedure with a de-functioning loop ileostomy. Although there have been previously reported cases of SEMS for closure of malignant colonic stula, there are limited reports of SEMS for closure of benign colonic stulae and none of SEMS combined with PEI for benign colonic fistula. We conclude that this patient’s case exemplies the potential applications of SEMS combined with PEI as a feasible option of therapy for benign colorectal disease.

THD and mucopexy: Efficacy and controversy

Aims Transanal haemorrhoidal dearterialisation and mucopexy has evolved in recent years as a popular minimally invasive non-excisional surgery for symptomatic prolapsing haemorrhoids. The long-term outcome of this procedure however, remains to be established. We aim to analyse the long-term outcome of THD-mucopexy in the management of prolapsing haemorrhoids based on the evidence of a prospective data from a single institution. Methods A prospective data was collected on 100 consecutive cases of grade 3 and 4 symptomatic haemorrhoids between the period 03/2010 and 06/2015 who underwent the procedure as a day case under general anaesthetic. Overall median follow up was for two years with average age of 54.4 ranges from 34 to 79 and gender ratio of 61% Male and 39% Female. Pre-and postoperative symptoms were assessed with a view to evaluate the nature of complications and long-term recurrence rate. Results Preop Post op (6 weeks) Post op (6 months) P value Bleeding 74 (74%) 9 9 P<0.0001 Prolapse 31 (31%) 6 7 P<0.0001 Perianal pain 15 (15%) 3 2 P = 0.006 Discharge 5 (5%) 1 0 P = 0.21 Itching 2 (2%) 0 0 P = 0.47 Anal fissure (Healed) 4 (4%) 0 4 P = 0.71 Postoperative complications Bleeding 7 (7%) Pain 5 (5%) Urgency 1 (1%) Fistula 1 (1%) Discharge 2 (2%) Infection 3 (3%) Recurrence rate– 13 (13%) Conclusion THD mucopexy is a safe and effective minimally invasive modality for prolapsing symptomatic haemorrhoids with acceptable complication rates and a recurrence rate of 13% majority of which could be dealt with a repeat procedure. Long terms follow up and randomised (THD VS Haemorrhoidectomy) multicentre trials are warranted to compare its efficacy with that of conventional excisional surgery.