Surgical outcome after laparoscopic proctectomy in rectal cancer Our experience in 300 cases

IntroductionMinimally invasive surgery is being increasingly performed to treat colorectal cancer. This study aimed to evaluate surgical outcome after laparoscopic proctectomy in rectal cancer.MethodsThis cross sectional study was conducted on 300 patients who underwent laparoscopic proctectomy with Transanal (175 cases, 58.3%) or transabdominal rectal resection (72, 24.0%) and abdominoperineal resection (53 cases, 17.7%) after preop radiochemothrapy from 2010 to 2017. Surgical complications and mortality were evaluated.ResultsThe most common complication (i.e., pre-sacral collection) was observed in 12 (14.0%) patients, and 10 (3.3%) patients had postoperative obstructions. Moreover, peritonitis and abdominal sepsis were observed in 5 (1.7%) cases, and bleeding was reported in 4 (1.3%) patients. In addition, urologic complication and rectovaginal fistula were observed in 2 (0.7%) and 2 (0.7%) patients, respectively. In total, 2 (0.7%) patients suffered from iatrogenic intestinal injury, and 29 (9.7%) cases required reoperation (14 [48.3%] and 15 [51.7%] patients underwent laparotomy and relaparoscopy, respectively). Regarding mortality rate, 2 (0.7%) cases of postoperative mortalities were detected in this study.ConclusionLaparoscopic proctectomy is safe and good procedure in patient with rectal cancer.

Stented Lich-Gregoir Ureteroneocystostomy in renal transplantation: an experience at Bangabandhu Sheikh Mujib Medical University in Bangladesh

Ureteral reimplantation is one of the important components of reconstruction of urinary tract in renal transplantation. There are various techniques of ureteral reimplantation, of which Extravesical Lich-Gregoir is the ideal technique for renal transplantation. Extravesical ureteroneocystostomy to reestablish urinary tract continuity in renal transplantation has been examined through a study of 140 kidney transplants leading to the finding that stented anastomosis was associated with a lower urologic complication rate. We now report the urologic complication rate in our case series in which stented Lich–Gregoir anastomosis was routinely utilized. Methods. The records of 140 consecutive renal transplants were reviewed. Minimum follow-up time was 3 months. The standard anastomosis was a Lich–Gregoir with a 5-6 Fr cm D-J stent. Monitored urologic complications included postoperative vesicoureteral leak or ureteral necrosis, obstruction or stricture, or clinically significant hematuria. Results. One urologic complication were noted—one leak and no other complication. There were no stentrelated complications requiring reoperation. There were no cases in which the urologic complication led to graft loss or patient death. Conclusions. The urologic complication rate in this case series is less to the five previously published randomized trials, as well as our previous study. These results support the routine use of a ureteral stent Bangladesh Journal of Urology, Vol. 14, No. 2, July 2011 p.48-50

Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients.Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013.Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p<0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p= ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%,p<0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p= ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p= ns).Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis.