Total mesorectal excision (TME) has emerged as a gold standard for more than two decades for the ... more Total mesorectal excision (TME) has emerged as a gold standard for more than two decades for the treatment of rectal cancer. This concept was popularized by Heald after propagating the concept that rectum and its mesentry are derivates of hindgut embryologically, and in order to save patients from recurrence, it is wise to dissect rectum and its mesentry together and go along the avascular plane to perform a surgeon-friendly avascular dissection and a patient-friendly oncological dissection to decrease the recurrence rate. In this chapter, we will be dealing with all the embryological, anatomical, and technical aspects of TME and its complications.
Advances in the management of rectal cancer have led to significantly improved outcomes in terms ... more Advances in the management of rectal cancer have led to significantly improved outcomes in terms of better overall survival, disease-free survival, and local recurrence rates. However, all this is possible with some sort of compromise on the patient’s quality of life. In order to offer better quality of life to such patients, the concept of natural orifice transluminal endoscopic surgery (NOTES) has evolved. However, this modality of treatment is suitable for a selected group of patients. There are various types of NOTES procedures that can be used for the treatment of early rectal cancers and other benign rectal lesions. In this chapter, we discuss the principles and technical details of these procedures.
Colorectal surgery in the last 2 decades has seen a great deal of growth owing to technical advan... more Colorectal surgery in the last 2 decades has seen a great deal of growth owing to technical advances like introduction of staplers, energy sources, laparoscopic and robotic surgery. The new technology has made more technically demanding procedures more acceptable and hence more colorectal centers all over the world are now performing more volume of technically demanding surgeries and increasing their expertise with each passing year.
International Journal of Surgery Case Reports, 2022
Introduction The isolated absence of the external oblique musculo-aponeurotic complex in adults i... more Introduction The isolated absence of the external oblique musculo-aponeurotic complex in adults is an extremely rare anomaly. This complex is an important contributor to the strength of the inguinal canal. The present case report describes the unilateral absence of the external oblique muscle in a patient. Case presentation A 40-year-old male patient presented with a history of intermittent lower abdominal pain for 5 years which had increased over the past 6 months. Abdominal examination revealed unilateral reducible, incomplete, left sided direct inguinal hernia. Clinical discussion Elective unilateral Lichtenstein's mesh hernioplasty was planned for the patient. Intraoperatively, there was no evidence of the external oblique aponeurosis and the spermatic cord was noted deep to the thickened membranous fascial layer. The inguinal ligament was thin and atrophic and was attached to the pubic tubercle medially and anterior superior iliac spine laterally. There was no evidence of any superior aponeurotic connection to the inguinal ligament. A postoperative ultrasound examination of the abdomen confirmed the unilateral absence of the external oblique musculo-aponeurotic complex. Conclusion The possibility of such an anomaly should be considered in patients without other risk factors for hernia.
Sphincter saving surgeries performed for mid- and low rectal cancer many a time result in complet... more Sphincter saving surgeries performed for mid- and low rectal cancer many a time result in complete loss of natural reservoir “rectum” which may result in frequency, night soiling, feeling of incomplete evacuation; often referred to as low anterior resection syndrome (LARS). This entity many a time may compromise the quality of life of such patients and keep on reporting to their operating surgeon quite frequently. In order to get rid of this frustrating symptomatology, many conservative or surgical means may be tried to overcome LARS. In this chapter, we will discuss in detail about LARS and all possible modalities of its management.
Total mesorectal excision (TME) has emerged as a gold standard for more than two decades for the ... more Total mesorectal excision (TME) has emerged as a gold standard for more than two decades for the treatment of rectal cancer. This concept was popularized by Heald after propagating the concept that rectum and its mesentry are derivates of hindgut embryologically, and in order to save patients from recurrence, it is wise to dissect rectum and its mesentry together and go along the avascular plane to perform a surgeon-friendly avascular dissection and a patient-friendly oncological dissection to decrease the recurrence rate. In this chapter, we will be dealing with all the embryological, anatomical, and technical aspects of TME and its complications.
Advances in the management of rectal cancer have led to significantly improved outcomes in terms ... more Advances in the management of rectal cancer have led to significantly improved outcomes in terms of better overall survival, disease-free survival, and local recurrence rates. However, all this is possible with some sort of compromise on the patient’s quality of life. In order to offer better quality of life to such patients, the concept of natural orifice transluminal endoscopic surgery (NOTES) has evolved. However, this modality of treatment is suitable for a selected group of patients. There are various types of NOTES procedures that can be used for the treatment of early rectal cancers and other benign rectal lesions. In this chapter, we discuss the principles and technical details of these procedures.
Colorectal surgery in the last 2 decades has seen a great deal of growth owing to technical advan... more Colorectal surgery in the last 2 decades has seen a great deal of growth owing to technical advances like introduction of staplers, energy sources, laparoscopic and robotic surgery. The new technology has made more technically demanding procedures more acceptable and hence more colorectal centers all over the world are now performing more volume of technically demanding surgeries and increasing their expertise with each passing year.
International Journal of Surgery Case Reports, 2022
Introduction The isolated absence of the external oblique musculo-aponeurotic complex in adults i... more Introduction The isolated absence of the external oblique musculo-aponeurotic complex in adults is an extremely rare anomaly. This complex is an important contributor to the strength of the inguinal canal. The present case report describes the unilateral absence of the external oblique muscle in a patient. Case presentation A 40-year-old male patient presented with a history of intermittent lower abdominal pain for 5 years which had increased over the past 6 months. Abdominal examination revealed unilateral reducible, incomplete, left sided direct inguinal hernia. Clinical discussion Elective unilateral Lichtenstein's mesh hernioplasty was planned for the patient. Intraoperatively, there was no evidence of the external oblique aponeurosis and the spermatic cord was noted deep to the thickened membranous fascial layer. The inguinal ligament was thin and atrophic and was attached to the pubic tubercle medially and anterior superior iliac spine laterally. There was no evidence of any superior aponeurotic connection to the inguinal ligament. A postoperative ultrasound examination of the abdomen confirmed the unilateral absence of the external oblique musculo-aponeurotic complex. Conclusion The possibility of such an anomaly should be considered in patients without other risk factors for hernia.
Sphincter saving surgeries performed for mid- and low rectal cancer many a time result in complet... more Sphincter saving surgeries performed for mid- and low rectal cancer many a time result in complete loss of natural reservoir “rectum” which may result in frequency, night soiling, feeling of incomplete evacuation; often referred to as low anterior resection syndrome (LARS). This entity many a time may compromise the quality of life of such patients and keep on reporting to their operating surgeon quite frequently. In order to get rid of this frustrating symptomatology, many conservative or surgical means may be tried to overcome LARS. In this chapter, we will discuss in detail about LARS and all possible modalities of its management.
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