Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for malignant disease. PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates. Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = − 16.10, 95% CI [− 36.57 to 4.36], p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI − 0.18 to 1.36, p = 0.13), and recurrence (OR = 0.97, 95% CI 0.30 to 3.15, p = 0.96). HALS is an efficient alternative to OS in right colectomy which combines the advantages of OS with the mini-invasive surgery.

/pdf/a-meta-analysis-comparing-hand-assisted-laparoscopic-right-4kpsa3qzv5.pdf

A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer

Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate.

Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria.

Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies).

Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.

/pdf/diagnosis-and-treatment-of-vulvo-perineal-endometriosis-a-3mnzucb9uj.pdf

Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review.

Introduction: Endometriosis is a benign condition characterized by endometrial tissue deposited outside the uterine cavity. Endometriosis characteristics include a welldefined cyst (endometrioma) with or without internal septations and seeding nodules; however, no case of extensive infiltrating abdominopelvic endometriosis have been

A rare case report of extensive abdominopelvic endometriosis mimicking peritoneal malignancy: an imaging investigation

Hemorrhoids (Piles) are an inflammation of blood vessels around the anal canal. When the anal cushions are displaced during defecation, piles are formed. The purpose of this study is to document traditional knowledge and medicinal plants used in pile therapy in Nigeria. This study is to establish the usage of beneficial medicinal herbs to cure hemorrhoids and provides a foundation for future research to identify effective and economical anti-hemorrhoid medications.

https://gsconlinepress.com/journals/gscarr/sites/default/files/GSCARR-2024-0025.pdf

Anti- hemorrhoids potential of selected medicinal plants used in treatment of Hemorrhoids: A revie

An asymptomatic anterior vaginal wall endometrioma, a rare manifestation of endometriosis: A case report.

“PNR-Bleed” classification and Hemorrhoid Severity Score-a novel attempt at classifying the hemorrhoids

Endometriosis is defined as the presence of endometrial tissue outside the uterus and is common in fertile women. Pelvis is the most frequent location of the endometriosis. Endometriosis is mostly found in peritoneal surfaces but can also involve the vagina, vulva, rectovaginal septum, and perineum usually postobstetric, gynecological, or other surgical trauma. Extrapelvic endometriosis has been reported in any region of the body including bowel, bladder, lung, kidney, extremities, perineum, and umbilicus. We present a case of a patient perineal surgical scar endometriosis. The endometriotic scar nodule was surgically excised. Postoperatively, The patient was treated with gonadotropin-releasing hormone analogs. The surgical outcome was successful, and the patient is on our close follow-up and reports that she is asymptomatic during subsequent menstrual periods unlike before.

Perineal scar endometriosis

Role of ghost ileostomy in low anterior resection for carcinoma rectum.

Background: Neoadjuvant chemoradiotherapy (NACRT) is an established treatment option for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following NACRT have better oncological outcomes and may be subjected to wait and watch policy as well. The aim of this study was to identify predictors of pCR in LARC following NACRT. Materials and Methods: A retrospective analysis of a prospectively maintained colorectal cancer database from January 2018 to December 2019 was undertaken. A total of 129 patients of LARC who were subjected to conventional long course NACRT, followed by surgery were included in the study. Pathological response to NACRT was assessed using Mandard grading system and response was categorized as pCR or not-pCR. Correlation between various clinico pathological parameters and pCR was determined using univariate and multivariate logistic regression analysis. Results: Mean age of patients was 53.79 ± 1.303 years. Complete pathological response (Mandard Gr 1) was achieved in 24/129 (18.6%) patients. Age of patients more than 60 years (P = 0.011; odds ratio [OR] 3.194, 95% confidence interval [CI] 1.274-8.011), interval between last dose of NACRT and surgery >8 weeks (P = 0.004; OR 4.833, 95% CI 1.874-12.467), well-differentiated tumors (P < 0.0001; OR 32.00, 95% CI 10.14–100.97) and node-negative disease (P = 0.003; OR 111.0, 95% CI 2.51–48.03) proved to be strong predictors of pCR. Conclusion: Older age, longer interval between NACRT and surgery, node-negative disease and favorable tumor grade help in achieving better pCR rates. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

Predictors of pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer

Colorectal cancers has shown an appreciable improvement in survival over last two decades because of improved diagnostic modalities, better understanding of molecular genetics, and multidisciplinary management. Minimal access surgery has further improved the quality of life of these patients by decreasing their wound site pain, improving cosmesis, and making them resume their daily routine quite early. Even though literature from trials have shown clear cut advantage of laparoscopy in management of colon cancer but in rectal cancer there are still some controversies. In high-volume centers and expert hands, after overcoming the learning curve, laparoscopy is now being practiced more and more even in the management of rectal cancers. In this chapter, we will also be discussing hand-assisted laparoscopy and single port laparoscopy and their advantages and disadvantages on the basis of evidence for the benefit of our readers.

Laparoscopy in Colorectal Cancer

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