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. This study is a follow-up of the previous randomized trial and aims to report the long-term outcomes of the two groups. Methods: Forty-eight patients from the randomized trial were followed up in an outpatient clinic with regular monitoring. Patients were compared for clinicopathological variables, disease recurrence and survival rates.Results: Clinicopathological details were comparable between the two groups. During the median follow-up periods of 32 months for the open group and 65 months endo-laparoscopic group, no statistically significant difference was observed between the groups in disease recurrence rate, 5-year overall survival (27% vs 48%, P = 0.076) and 5-year disease-free survival rates (48% vs 52%, P = 0.63). Conclusion: Besides being a safe bridge to subsequent elective laparoscopic surgery, preoperative self-expanding metallic stents insertion does not adversely affect oncological outcomes and patient survival. Based on our data, the endo-laparoscopic approach is the treatment of choice for patients presenting with malignant left-sided colonic obstruction.

HALC is safe and feasible, but it does not show any significant benefits over TLC in terms of operating time and conversion rate. Routine use of the hand-assisted laparoscopic technique in right hemicolectomy is therefore not recommended.

The operation was performed on a 42-year-old woman and lasted 120 minutes; blood loss was 30 mL. The patient had an uneventful recovery and was discharged on postoperative day 5. The median pain score was 2 (range, 2-3). Our preliminary experience shows that hybrid NOTES right hemicolectomy is safe and feasible. The technique eliminates the need for mini-laparotomy in patients undergoing laparoscopic right hemicolectomy, and it offers promise in this era of minimally invasive surgery.

Background: Anal fistula plug was recently introduced as an alternative treatment for anal fistula. However, there is, so far, no published data on the use of the anal fistula plug both locally and in the Chinese population. , consecutive Chinese patients with transphincteric or suprasphincteric anal fistula scheduled for elective surgery were enrolled. Anal fistula plug was used if examination under anaesthesia reviewed an internal opening. Baseline manometry pressure study was carried out for patients with recurrent fistulae. The operative technique was standardized. Measured outcomes included healing and recurrence rates, operating time, length of stay, and time for patients to return to work or normal activity. Results: Eleven patients underwent anal fistula plug placement, with a median follow up of 19 months. Five had completely healed fistulae, including three patients with recurrent fistulae. The success rate was 45 per cent. In the three patients with recurrent fistulae, no significant difference was demonstrated in the resting pressure between preoperative and postoperative values. There is an observable trend that proportionally more recurrent fistulae were healed by anal fistulae plug placement when compared to primary fistulae (100% vs 25%); the difference, however, did not reach statistical significance (P = 0.06, Fisher's exact test). At the conclusion of this study, no recurrence was noted in the five patients with confirmed healing. Conclusions: Our preliminary experience indicates anal fistula plug placement is safe and non-invasive. However, the efficacy appears lower than initially reported. Based on our data the routine use of an anal fistula plug cannot be recommended. In our opinion, anal fistula plug placement can be considered in patients with more complex, high fistulae and in those who have recurrent fistulae despite previous surgery. It provides a non-invasive alternative in these patients, in whom postoperative incontinence is a real concern.

Removal of rectal adenoma poses a challenge to coloproctologists. Conventional approaches include colonoscopic polypectomy, Park's perianal submucosal excision, 1 posterior approach, 2 and endoscopic transanal resection. 3 However, these approaches can be difficult for high-lying rectal lesions and might result in a fragmented specimen if the adenoma is large. Transanal endoscopic microsurgery (TEM) was developed by Buess et al. in 1984; 4 the technique allows en bloc resection of sizable adenomas up to 24 cm from the anal verge. More recently, the technique of transanal endoscopic operation (TEO) was developed based on a similar concept as TEM. Besides allowing precise surgical dissection, haemostasis and suturing similar to TEM, TEO has the added advantage of increased surgeon comfort, as the surgeon operates through a monitor attached to a camera-endoscope system. The device is also system-compatible with most laparoscopic instruments. Herein, we report this technique and our results for rectal adenomas. Operative techniqueThe patient received full bowel preparation before surgery. The operation was carried out under general anaethesia, with the patient in the lithotomy position. This position is suitable for both anteriorly and posteriorly placed rectal lesions. The TEO device (Karl Storz Endoscopy, Tuttlingen, Germany), 4 cm in diameter, was inserted into the rectum, which was then insufflated with CO2. An optical endoscope attached to a camera system was used to visualize the surgical field. The polyp was excised using an ultrasonic dissector; a full thickness excision with a 1-cm circumferential margin was intended. After the specimen was retrieved from the TEO device, the defect was closed with continuous absorbable sutures. Beads were applied on both ends of the sutures to replace tedious knot-tying. ResultsSince 2008, we have utilized this technique in 11 patients (5 males and 6 females), with a median age of 72 years (range 48-96). The median operation time and median hospital stay were 60 min (range 50-160) and 4 days (range 1-7) respectively.The median size of the rectal polyps was 3.5 cm (range 2.4-8.5). Subsequent histological examination showed tubulovillous adenoma in nine patients (two with involved margin), whereas two patients had T1 adenocarcinoma with a clear margin. None of the patients required a second operation. At a median follow up of 9 months (range 2-22), two patients developed recurrent adenoma and were successfully managed with colonoscopic polypectomy. ConclusionOur experience shows that TEO is a safe technique that allows precise removal of sizable rectal adenomas. The technique results in a good quality specimen and reduces the need for radical surgery in selected patients. TEO should be considered in patients with large mid or upper rectal polyps that are difficult to be removed by other transanal approaches. Video imageAdditional video images can be found in the online version of this article.