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Purpose: This study was designed to introduce a new surgical innovation, referred to as the "Longtan modification," for cases with parastomal hernia (PSH) following intraperitoneal sigmoidostomy, and to assess the safety and feasibility of this procedure.Methods: Between January 2013 and June 2016, a total of 26 consecutive cases with PSH successfully underwent this procedure. The patient demographics, surgical outcomes, stoma-related complications, and the stoma function were collected and analyzed.Results: Mean diameter of the hernia ring was 7.6 cm, mean operation time was 94.2 minutes, and mean intraoperative blood loss was 18.0 mL. The mean period of postoperative hospitalization was 4.4 days while the mean hospitalization cost was only $3,750 USD. There were no severe complications such as postoperative hemorrhage, ischemic necrosis, peritoneal infection, or intestinal obstruction, although one case suffered from postoperative infection at the site of incision. None of the cases had a recurrence of PSH during the follow-up period. In addition, the stoma functioned efficiently and appropriately following the Longtan modification.Conclusion: Overall, the Longtan modification appears to be an effective and economical surgical innovation for cases with PSH following intraperitoneal sigmoidostomy. [ABSTRACT FROM AUTHOR]

As a new surgical technique, extralevator abdominoperineal excision (eLAPE) is recommended for the treatment of low rectal cancer. The patient's position is changed to a prone jackknife position before extralevator excision is performed via the perineal approach. Whether the extralevator excision can be completed through a transabdominal route under laparoscopy is controversial. This study was designed to introduce a modified technique of laparoscopic-assisted eLAPE and to evaluate the feasibility and safety of this technique. With no change of position, laparoscopic eLAPE was performed in 12 patients with low rectal cancer through a transabdominal route between February 2012 and August 2013. There was no case with bowel perforation and positive circumferential resection margins among these 12 patients. The mean operative time was 177.1 minutes, and the mean intraoperative blood loss was 92.5 mL. The mean time to passing of first flatus was 2.3 days, and the mean postoperative hospital stay was 7.5 days. There was no case with bladder dysfunction. No patients suffered from sexual dysfunction during the follow-up period. Without the change of the patient's position, eLAPE can be performed through a transabdominal route by the laparoscopic approach. The procedure of the former eLAPE is simplified without compromising oncologic outcome. [ABSTRACT FROM AUTHOR]

Ureteral injury is one of the major complications for rectal surgery. However, few studies focused on ureteral injuries from laparoscopic rectal surgery have been reported. Characteristics of this kind of ureteral injuries and the related reasons are unclear. This study was designed to illustrate the characteristics of ureteral injuries during the procedure of laparoscopic rectal surgery and to analyze the related reasons. Of 1120 patients with rectal cancer who underwent laparoscopic surgery between July 2007 and July 2013, 11 cases had the complication of ureteral injuries. Data of these 11 patients were collected and analyzed retrospectively. In our study, the total incidence of ureteral injuries from laparoscopic rectal surgery was 0.98%, and left ureteral injuries were more common. Five cases of ureteral injuries occurred at the takeoff of the inferior mesenteric artery, 4 cases occurred at the small pelvic inlet, and 2 cases occurred at the location where the infundibulopelvic ligament crosses the pelvic brim. Four reasons accounted for the ureteral injuries: 5 cases resulted from massive ligation or cutting off without recognizing the anatomical structure, 3 cases resulted from unfamiliarity with normal anatomical structure under laparoscopy and unskilled laparoscopic operation, 2 cases resulted from an abnormal anatomical structure due to invasion of the tumor, and 1 case resulted from an unusual anatomical variation of ureter. It was easier to damage the left ureter during the procedure of laparoscopic rectal surgery. In conclusion, ureteral injuries usually occurred at three locations, and massive ligation or cutting off without recognizing the anatomical structure was the most common reason for laparoscopy-related ureteral injuries. [ABSTRACT FROM AUTHOR]