Raymond Ying‐Chang Yiu

Laparoscopic-assisted resection of colorectal carcinoma: five-year audit.

INTRODUCTION: The place of laparoscopic-assisted colectomy for colorectal carcinoma is controversial. This study reviewed a consecutive series of patients who underwent laparoscopic-assisted resection of colorectal carcinoma in the past five years. METHODS: Two hundred seventeen laparoscopic-assisted resections of colorectal carcinoma were attempted starting in April 1992. Initially, we only selected patients with metastatic disease or patients who were older than 65 years. Subsequently, both palliative and curative resections were attempted in patients with a suitable tumor, with no age limitation. Thus, all suitable patients were randomly assigned to received either laparoscopic-assisted or conventional open surgery. RESULTS: Data collection was completed in 201 patients. In 22 patients open surgery was performed after a diagnostic laparoscopy. In the remaining 179 patients (90 males) in whom laparoscopic dissection was actually performed, the mean follow-up was 19.8 months, and the mean age was 66.3 years. The procedures performed included right hemicolectomy or extended right hemicolectomy (30 patients), transverse colectomy (2 patients), left hemicolectomy (3 patients), sigmoidectomy (48 patients), anterior resection (59 patients), and abdominoperineal resection (37 patients). Thirty-two (17.7 percent) procedures were converted to open surgery. The mean operation time was 203 minutes. The median blood loss was negligible, and the median requirement of transfusion was zero. The median number of postoperative parenteral analgesic injections was three. The median time to resume diet and hospital discharge were four and six days, respectively. The operative mortality was 1.7 percent. The survival rates at four years were 100, 88.3, and 64.5 percent for patients with Dukes A, B, and C disease, respectively. There was only one (0.65 percent) port-site recurrence. CONCLUSION: Laparoscopic-assisted resection of colorectal carcinoma was technically feasible and safe. It allowed early postoperative recovery with satisfactory long-term survival. This is at the expense of a long operation. Its benefits over the conventional open technique await the results of the randomized trials.

Laparoscopic total colectomy for colorectal cancers: a comparative study.

BackgroundNo previous report could be found in the literature comparing laparoscopic and open total colectomy for colorectal cancers, especially synchronous colorectal cancers. This study aimed to compare the short-term clinical outcomes and oncologic results of laparoscopic and open total colectomy or proctocolectomy for colorectal cancers.MethodsBetween July 1997 and January 2005, six patients with colorectal cancers underwent elective laparoscopic total colectomy or proctocolectomy at the authors’ institution. Clinical data for 12 patients who underwent elective open total colectomy or proctocolectomy for colorectal cancers during the same period were prospectively collected and compared.ResultsThe median follow-up periods were 43.9 months for the laparoscopic group and 48.2 months for the open group. Conversion to open procedure was required for one patient (16.7%) in the laparoscopic group because of bleeding. The median operative time was significantly longer in the laparoscopic group (427.5 min; range, 280–480 min vs 172.5 min; range, 90–260 min; p = 0.001). The patients in the laparoscopic group required a significantly shorter duration of parenteral analgesia (3 vs 5 days; p = 0.01), but there were no differences in time to first bowel motion, time to resumption of diet, time to full ambulation, and duration of hospital stay between the two groups. Perioperative morbidity rates were comparable between the two groups, and there was no operative mortality. The oncologic results, including number of lymph nodes removed, recurrence rates, and survival rates, were similar in the two groups.ConclusionsLaparoscopic total colectomy has short-term clinical outcomes (postoperative recovery and perioperative morbidity and mortality rates) and oncologic results similar to those of open surgery for treating patients with colorectal cancers. Our study has shown that the only advantage of laparoscopic over open surgery is a shorter duration of analgesic requirement, but at the expense of a longer operative time.

The use of liposucker for spleen retrieval after laparoscopic splenectomy.

The retrieval of spleen after laparoscopic splenectomy has long been a problem. Frequently, it is necessary to extend the wound for retrieving the spleen intact and to prevent potential spillage of splenic tissue into the peritoneal cavity. We describe the application of the liposuction unit to remove the spleen piecemeal after laparoscopic splenectomy. We have found this technique easy to apply and safe, without the necessity of excessive wound extension, while preserving splenic tissue for histologic examination.

Pre‐emptive analgesia and metronidazole on post‐haemorrhoidectomy pain control

Background:  Post‐haemorrhoidectomy wound pain is often the focus of concern for patients as well as their clinicians. Despite the recent enthusiasm brought about by stapled haemorrhoidectomy, conventional haemorrhoidectomy still remains the mainstay of surgical treatment for symptomatic third and fourth degree haemorrhoids in places where healthcare funding cannot afford these expensive devices. The present study aims at evaluating the effectiveness of pre‐emptive analgesia and oral metronidazole in reducing wound pain and complications after open haemorrhoidectomy.

Adult colonic intussusception

Objective:  To study the clinical characteristics, investigations, management and pathology in adult colonic intussusception.

Short‐term and long‐term outcomes of patients with malignant large bowel obstruction

Objective:  The aim of the present study was to review our experience in the surgical management of patients with obstructing colorectal cancers over an 11‐year period, 1987–1997.

Formalin dab for refractory radiation proctitis: Preliminary Hong Kong experience

Objective:  This prospective study aimed to evaluate the efficacy and safety of 4% formalin dab in managing patients with refractory radiation proctitis.