Background This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer. Methods Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed. Results Thirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2. Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. Conclusion Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

BackgroundNatural orifice transluminal endoscopic surgery (NOTES) has theoretical advantages over other approaches.MethodsThis was a prospective cohort study of colorectal cancers operated on by NOTES (transanally for rectal tumours, transvaginally for sigmoid tumours) between December 2013 and December 2015, with a minimum follow‐up of 1 year. Eligibility criteria included ASA fitness grade I–III, BMI below 25 kg/m2 and TNM stage T3 N0 M0. Exclusion criteria included pregnancy or distant metastasis. The anastomosis was either handsewn or performed mechanically.ResultsSixteen patients were operated on by a transanal and four by a transvaginal approach. There were ten men and ten women, with a mean(s.d.) age of 55·6(12·1) years. Mean BMI was 22·4(2·6) kg/m2. Four anterior, 11 low anterior and five intersphincteric resections were performed for 16 rectal and four low sigmoid tumours. The mean duration of surgery was 258(11) min. No conversion to laparotomy was needed, and there were no deaths. Five patients required additional ports, for intraoperative bleeding (1), suture of an intraoperative urethral injury with covering ileostomy (1) and difficulty in dissection (3). One patient had an anastomotic leak requiring transanal closure and ileostomy on day 7. Both ileostomies were closed after 2 months. The mean hospital stay was 6·4(1·8) days. All resections were R0.ConclusionIn carefully selected patients NOTES for colorectal cancer resection was feasible and effective.

Background: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst in children. The aim of this study is to determine the feasible and safe of the laparoscopic excision with Roux-en-Y hepaticojejunostomy, and evaluate the short-term outcomes after treatment for children with choledochal cyst.Methods: A prospectively of 51 consecutive pediatric patients undergoing laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon cysts at Hue Central Hospital from June 2012 to December 2017 was studied.Results: The mean operative time was 214.7±67.95 minutes (range, 100~360 minutes), including the time for intraoperative cholangiography. There were two children requiring blood transfusion. Time to first flatus was 40.35±28.55 hours in average. The mean time to drain removal was 2.89±1.02 days. Mean postoperative hospital stay was 9.31±3.43 days. 6 out of 51 cases having early complications, including 2 cases of pancreatitis and 4 cases of bile leakage. Most of cases (90.5%) were classified as good after 10 days to 3 months of follow-up.Conclusions: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was feasible and safe in children. The short-term outcomes were good in most cases.

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Objectives: evaluation of feasibility, safety, and outcomes of single port laparoscopic surgery (SPLS) for right hemicolectomy. Method and material: Prospective study of 84 patients suffering from right colon cancer who underwent SPLS between Decem-ber 2010 and December 2016 and were followed up until December 2017 in Hue Central Hospital. Results: Mean age of patients was 56.3 ±16.2 (25-87) years, fifty-five (64,28%) were males. Mean BMI was 24.2±5.3kg/m2. mean ASA score for all patients was 2.7 (1-3). Ten cases (11.9%) required additional ports in which 6 were finally converted to open surgery. There were no deaths as well as intraoperative complications. Mean tumor size was 4.4±3.6 (3-8 cm). For successful operated group with SPLS, mean operation time was 135.5±23.2 minutes. Blood loss was 54±22 ml. Mean incisional length (including extension for extraction) was 4.6±3.5cm. Mean lymph nodes harvest was 14.2±0.8. Stage I: 13.5%; stage II: 35.1%; stage III: 51.4%; Postoperative pain was 4 points at day 0. The surgical site infection rate was 2.7%. Mean hospital stay was 6.3±3.4 days. There was one anastomotic leakage in open conversion group. Mean follow-up period was 41.5 months (12-84 months). There were 7 local recurrences, 4 patients developed liver metastasis and 1 lung metastasis. The overall survival time of all stages was 96.2% (24 months); 92.8% (36 months) and 75.7% (60 months). Conclusion: SPLS for right hemicolectomy is feasible and safe. The cosmetic value is better (short incision confounded by um-bilicus). Other outcomes were equivalent to conventional laparoscopy.