Two-stage treatment (Mukai's method) with hybrid 2-port HALS (Mukai's operation) for complete bowel obstruction by left colon cancer or rectal cancer.
During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome.
Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan. mukai.masaya@hachioji-hosp.tokai.ac.jp
Masaya
M
Mukai
Yasutomo
Y
Sekido
Tatsuhiko
T
Hoshikawa
Naoki
N
Yazawa
Hiroshi
H
Fukumitsu
Kazutake
K
Okada
Takayuki
T
Tajima
Masato
M
Nakamura
Kyouji
K
Ogoshi
D002277:Carcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008954:Models, Biological; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors