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"ABSTRACTPurposeTo compare the time-course change in the postoperative anorectal function between laparoscopic intersphincteric resection (ISR) and low anterior resection (LAR).MethodsThis is a single-institution observational study. We evaluated the time-course change in the anorectal function using functional questionnaires before and at 6, 12, and 24 months after laparoscopic ISR or LAR.ResultsSixty-two patients answered the functional questionnaires (28 in the ISR group and 34 in the LAR group). In the ISR group, the Wexner scores at 6, 12, and 24 months postoperatively were significantly higher than preoperatively. Importantly, the Wexner score at 24 months postoperatively was significantly lower than that at 6 months postoperatively. The low GIFO scores at 6 and 12 months postoperatively tended to be recovered to some extent at 24 months postoperatively. In the LAR group, Wexner score at 6 months postoperatively was significantly higher than that preoperatively. Notably, the Wexner score at 12 months postoperatively was recovered to almost the same as that preoperatively. The GIFO scores at 12 months postoperatively were mostly recovered to the same levels as those preoperatively.ConclusionsLaparoscopic ISR exhibits different time-course changes in the anorectal function from laparoscopic LAR."

"Tujuan penelitian ini adalah membandingkan hasil pengobatan adenomiosis dengan reseksi dan pemberian inhibitor aromatase. Kasus adenomiosis dengan infertilitas dikumpulkan selama 3 tahuti (Januari 1999 sampai December 2001) yang ilikonfirmasi dengan USG transvaginal. Kasus dibagi 2 kelompuk, masing-masing kelompok I (dengan reseksi per laparotomi) dan kelompok 2 (mendapat inhibitor aromatase anastrozole). Keduanya dinilai tentang gejala klinik, angka kehamilan. dan angka perkainbuhan pascaoperasi. Selama 3 tahun telah ditangani 1619 kasus infertilitas, di antaranya 66 (4.07%) adenomiosis sebanyak 55 kasus dianalisis, terdiri alas 32 kasus kelompok I dan 23 kasus kelompok 2. Dan 32 kasus yang menjalani reseksi, hasil histopatologik menunjukkan 30 (93.75%) adenomiosis dan 2 (6.25%) mioma uteri. Dalatn kelompok 1, 3 kasus hamil, 2 melahirkan bay! hiditp, I kasus teraklnr dengan abortus pada kehamilan 6 minggu. Sebanyak 25 kasus (78.1%) tidak hamil,4 kasus (12.5%) mengalami perkainbuhan, dan pada 24 kasus (75.35%) gejala-gejala klinis hilang. Sementara itu, 23 kasus kelompok 2, sebanyak 2 (8.6%) hamil, masing-masing 1 lahir hidup dan I abortus. Sebanyak 14 kasus (59.1%) gejala klinik hilang. Selama pengobatan 3 bulan dengan inhibitor aromatase terjadi penunuum ukuran lesi antara 7.31 mm' dan 25.90 mm dengan Cl 95% (p < 0.001). Disimpulkan bahwa pengobatan dengan inhibitor aromatase tidak menyembuhkan lesi, hanya mengurangi ukuran lest adenomiosis. Sebaliknya reseksi dapat menghilangkan lesi walauptin perkainbuhan dapat terjadi (12.5%) sesudah I tahun pascaoperasi. (MedJ Indones 2006; 15:18-23).

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The objective of this study was to observe the results of adenomyosis management with resection and administration of aromatase inhibitor. Cases ofademyosis in infertile women were collected for rhree years (January 1999 to December 2001) and the diagnoses were confirmed using transvaginal USG. Cases were grouped into two groups, i.e. group 1 (undergoing laparotomic resection) and group 2 (receiving treatment with aromatase inhibitor of anastrozole). Both groups were evaluated for changes in clinical symptoms, rate of successful pregnancy, and postoperative recurrency rate. During three years as many as 1619 infertility cases were managed, and among which 66 (4.07%) cases of adenomyosis were diagnosed with transvaginal USG. As many as 55 cases were analyzed, i.e., 32 cases underwent resection and 23 cases received aromatase inhibitor. Of 32 cases of surgical resection, the histopathologica! results showed 30 (93.75%) cases of adenomyosis and 2 (6.25%) cases of uterus myoma. In the group undergoing resection three cases (9.4%) were successfully pregnant, i.e., two cases had live birth, one case ended up with 6-week abortion. Moreover. 25 (78.1%) cases were not pregnant and 4 (12.5%) cases had recurrency, while 24 (75.35%) cases experienced disappearance of symptoms yet not pregnant. On the other hand, of 23 canes in the group receiving aromatase inhibitor 2 (8,6%) cases were able to be pregnant, one case had live birth and another case ended up with abortion, while 14 (59.1%) cases had disappearance of symptoms yet not pregnant. During three months of treatment with aromatase inhibitor, a reduction in the lesion size between 7.3! mm and 25.90 mm' were observed with Cl 95% (p < 0.001). In conclusion, treatment with aromatase inihibitor did not heal lesions, but only reduced the size of adenomyosis lesions. On the other hand, resection could heat lesions, yet recurrency of disease may occur (12.5%) after one postoperative year. (Med J Indones 2006; 15:18-23)."

"ABSTRACT As most often advocated, treatment of intestinal bleeding caused by typhoid fever is by conservative means. Although it requires meticulous and intensive care, treatment by surgery is rarity Four cases which are treated by surgery was reported and was decided upon after failure of conservative treatment. The fourth cases had resections of the distal ileum extended to a right hemicolectomy. The histopathologic examination of the all cases, revealed alcerative plaques of Peyer's patches in the distal ileum and caeceum, confirming the diagnosis of typhoid fever. "

"Dalam kurun waktu Juni 2003 sampai dengan Juni 2004, pasien-pasien yang menderita adenomiosis berdasarkan ultrasonografi transvaginal dan memiliki keluhan menorhagia, dismenore, mcmpun nyeri pelvis diikulsertakan dalam penelitian. Randomisasi dilakukan untuk mengalokasikan subjek ke dalam kelompok reseksi dan kelompok miolisis. Semua pasien dan kedua kelompok mendapal GnRH analog 3 siklus pasca-laparnskopi operatif. Penilaian dilakukan dalam jangka waktu 6 bulan, baik secara subjektif melalui kuesioner maupun secara objektif melalui evaluasi volume adenomiosis per ultrasonografi transvaginal di akhir semester. Terdapat 20 pasien yang menjalani pembedahan, 10 dalam kelompok reseksi dan JO dalam kelompok miolisis. Komplikasi bermakna tidak ditemukan pada kedua kelompok. Evaluasi subyektif dapat dilakukun pada semua pasien sedangkan evaluasi objektif hanya dapal dilakukan pada 17pasien. Tidak didapatkan perbedaan bermakna antar-kelompok dalam penentuan skor keluhan menorhagia (p = 0.399) dan dismenorea (p=0.213). Tidak ditemukan perbedaan bermakna dalam median penambahan volume adenomiosis (p = 0.630) antara kelompok reseksi (medicui= +15,35% (-100 - 159)) dengan kelompok miolisis (median=+48,43% (-100 - 553)). Lima pasien hamil, 3 dari kelompok reseksi, 2 dari kelompok miolisis, dengan satu kasus ruptur uteri pada usia kehamilan 8 bulan pada kelompok miolisis. Efektifitas reseksi adenomiosis per laparoskopi tidak berbeda bermakna dengan miolisis adenomiosis per laparoskopi dalam penataksanaan adenomiosis bergejala. Miolisis tidak disarankan bagi wanitayang masih ingin hamil. (Med J Indones 2006; 15:9-17).

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Effective therapy preserving reproductive function in adenomyosis is warranted. From June 2003 to June 2004, patients diagnosed as having adenomyosis by transvuginal ultrasound and had symptoms of menorrhagta, dysmenorrhea, and pelvic pain were randomly allocated to either receive laparoscopic resection or myolysis. GnRH analog was given for 3 cycles after surgery. Within 6 months, symptoms were evaluated using questionnaires and at the end of follow up, adenomyosis volume was assessed by transvaginal ultrasound. There were 20 patients included, 10 patients had resection and the rest underwent myolysis. Both procedures did not yield significant complications. Subjective evaluation by questionnaires was done in all patients. Three patients could not be evaluated objectively by transvaginal ultrasound, 2 patients resigned and I was pregnant. There was no significant difference in menorrhagia and dysmenorrhea reduction score between the 2 groups (p=0.399 and 0.213, respectively). In both groups, dysmenorrhea was reduced significantly after treatment. No significant statistical difference was found in median adenomyosis volume increment (p=0.630) between the resection (median= + !5.35% (-100-159)) and myolysis groups (median=+48.43% (-100-553)). Five patients were pregnant, 3 from the resection group and 2 from the myolysis group. Uterine rupture was found in I patient (from the myolysis group) at the age of 8 months of pregnancy. The effectiveness of laparoscopic adenomyosis resection was not significantly different compared with la-parascopic myolysis as an alternative conservative surgery in treating symptomatic adenomyosis. Myolysis was not recommended for women who wish to be pregnant. (MedJ Indones 2006; 15:9-17)"

"ABSTRAK Latar Belakang : Angka kejadian reseksi anastomosis pada kasus intususepsi masih sangat tinggi. Hal ini dikarenakan masih seringnya pasien datang terlambatsetelah 72 jam, kurangnya SDM untuk melakukan reduksi non operatif, dankurangnya penunjang seperti USG untuk menegakkan diagnosa. Penting untukmemperhatikan presisi, tehnik dan mempertimbangkan usus yang tersisa dalammelakukan reseksi anastomosis. Hingga saat ini belum ada standar operasi khususyang dapat menjadi panduan bagi para dokter bedah dalam melakukan reseksiakibat intususepsi. Karena itu, peneliti tertarik untuk mencari batas reseksi yangdiperlukan untuk menghasilkan suatu anastomosis end-to-end yang optimal danrendah tingkat kebocorannya. Penelitian akan dilakukan kepada tikus sebagai pilotstudy sebelum dilakukan penelitian lebih lanjut. Tujuan : Mengetahui batas reseksi usus yang optimal dinilai dari kebocorananastomosis berdasarkan grading kolagen pada batas reseksi tersebut. Metode : Penelitian ini merupakan penelitian eksperimental dengan hewan cobatikus putih Sprague Dawley. Tikus putih dilakukan intususepsi denganmenggunakan stylet, dari proksimal ke distal. Setelah 45 menit, intususepsi direduksi.Tikus putih dikelompokkan dalam tiga kelompok sesuai batas reseksianastomosis, yang kemudian batas reseksi ini dilakukan pemeriksaan gradingkolagen. Setelah 5 hari, dilakukan laparotomi untuk menilai kebocorananastomosis. Hasil : Pada perbandingan grading kolagen dengan reseksi usus didapatkangrading terbanyak pada batas 1 adalah grading 2 (57,1 %), pada batas 2 grading 2(71,4 %) ,batas 3 grading 3 (71,4%).Perforasi terbanyak ditemukan pada grading 2 sebanyak 5 sampel. Pada perbandingan batas reseksi dengan perforasi didapatkan perforasi terbanyak pada batas 1 (85,7 %)Simpulan : Terdapat perbedaaan grading kolagen pada batas reseksi usus dimana batas kelompok batas 3 memiliki grading kolagen yang lebih baik ( grade 3 dan 4)sehingga kelompok batas 3 lebih direkomendasikan secara histopatologis.Grading kolagen dapat dinilai untuk melihat kemungkinan perforasi hasilanastomosis. Terdapat faktor-faktor lain yang dapat mempengaruhi kejadian perforasi selain grading kolagen. ;Background ABSTRACT There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. "

"Latar Belakang: Kebocoran anastomosis adalah komplikasi yang dapat terjadi pasca dilakukannya reduksi manual, reseksi dan anastomosis end-to-end pada kasus intususepsi. Faktor-faktor yang mempengaruhi kebocoran anastomosis antara lain teknik operator, kondisi lokal usus, kondisi umum pasien dan grading kolagen yang terbentuk pada proses penyembuhan luka. Tujuan: Mengetahui pengaruh perubahan grading kolagen usus pasca reseksi anastomosis terhadap kebocoran pada kasus intususepsi. Metode: Dua puluh satu tikus Sprague-dawley dilakukan laparatomi untuk dibuat model intususepsi (IN). Setelah 45 menit dilakukan destrangulasi selama 10 menit, dinilai adanya nekrosis dan dilanjutkan reseksi anastomosis. Tikus dibagi menjadi 3 kelompok, kelompok A : reseksi anastomosis pada batas usus yang nekrosis, kelompok B : reseksi anastomosis pada batas usus yang mengalami trombosis pembuluh darah mesenteriumnya, dan kelompok C : reseksi anastomosis pada batas usus yang sehat. Sampel usus yang direseksi diperiksa secara Histopatologi untuk menilai grading kolagen. Setelah 5 hari dilakukan laparatomi ulang, dinilai secara subjektif ada tidaknya kebocoran anastomosis, lalu diambil sampel segmen anastomosis usus untuk dinilai kembali grading kolagennya. Diharapkan jika terjadi kenaikan grading kolagen, anastomosis akan paten, sebaliknya jika terjadi penurunan akan terjadi perforasi. Hasil: Kelompok A: grading kolagen menurun dengan perforasi 6 (85,7%), grading kolagen tetap tanpa perforasi 1 (14,2%). Kelompok B: grading kolagen menurun dengan perforasi 2 (28,6%), tetap dengan perforasi 1 (14,3%), meningkat tanpa perforasi 4 (42,9%). Kelompok C: grading kolagen meningkat tanpa perforasi 5 (71,4%), menetap tanpa perforasi 2 (28,6%). Kesimpulan: Terdapat perubahan grading kolagen pasca reseksi anastomosis usus yang mempengaruhi tingkat kebocoran anastomosis pada kasus intususepsi.

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Background: Anastomosis leakage is a common complication following manual reduction, resection and end-to-end anastomosis in treating intussusceptions. Factors influencing the anastomosis leakage such as surgeon?s technique, local bowel condition, systemic condition of patients and the concentration of collagen in the bowel tissue during the anastomosis healing.

Aim: To study the effect of collagen concentration changes after resection and anastomosis procedure, in relation to the anastomosis leakages in intussusceptions case.

Methods: 21 Sprague-dawley rats were performed laparotomy to create the intussusception model (IN). The IN models were applied for 45 minute, after the bowel considered necrotic, destrangulation were performed for 10 minutes continued with resection and anastomosis on 3 group of resection margin: A on necrotic margin of bowel, B: on the thrombotic mesenterium vessel margin, C: on normal bowel margin. Resected bowels were sent for histopathology examination of collagen concentrations. After 5 days, another laparotomy was performed and the anastomosis leakages were subjectively assessed. The anastomosed segments were sampled for collagen concentration and grade.

Results: In study group A the collagen grading were found to be decreased with 6 leakages occurred (85.7%) and 1 subject (14.2%) with stable collagen grading and no leakages. From group B, subjects with decreased collagen and leakages were 2 (28.6%), and 1 subjects (14.3%) were stable in grading with leakages, and 4 subjects (42.9%) with increased collagen without leakages. In Group C, 5 rats (71.4%) had increased collagens without leakages, and 2 rats were at stable collagen grade without leakages.

Conclusion: There were collagen grade changes in bowel anastomosis that affect the extent of leakages in intussusceptions case."

"ABSTRAKTuberkulosis (TB) merupakan penyebab salah satu utama kematian di dunia. Pada tahun 2014, diperkirakan terdapat 9.6 juta kasus TB baru dan terdapat 1.5 juta kematian yang disebabkan oleh TB dari seluruh dunia. Tuberculosis destroyed lung merupakan komplikasi dari TB paru berat dan dapat menyebabkan berbagai gangguan dan difungsi pernapasan. Destroyed lung dapat mempengaruhi angka harapan hidup sehingga perlu dilakukan pembedahan. Pembedahan dapat membantu mencapai terapi yang efektif dengan membuang jaringan TB aktif.Tujuan untuk menentukan peluang kelangsungan hidup pasien dengan tuberculosis-destroyed lung yang menjalani oprasi.hasil studi oleh Byun CS dkk menunjukan angka mortalitas operatif sebesar 6.8%, SE 2.9%, 9% CI (3.9% TO 9.7%). Mortalitas dalam 5 tahun sebesar 11.1%, SE 3.7%, 95% CI(7.4% TO 14.8%) dan 23.8%, SE 5%, 95% CI (18.8% to 28.8%) dalam 10 tahun. Rifaat A. dkk menunjukan mortalitas post-operasi sebesar 7.1%, SE 6.8%, 95% CI (0% to 20.3%). Bai L. dkk memperllihatkan mortalitas post-operasi sebesar 5.8%, SSE 1.8%, 95% CI (4% to 7.6%).Simpulan tindakan pembedahan pada pasien dengan Tuberculosis destroyed lung dapat dilakukan dengan angka mortalitas yang rendah (operatif dan post-operatif)."

"ABSTRAKKanker rektum merupakan salah satu masalah keganasan yang lebih banyak terjadi pada masyarakat perkotaan. Penatalaksanaan kanker rektum salah satunya yang dapat dilakukan dengan pembedahan abdominoperineal resection. Penelitian menyatakan bahwa pasien yang akan menjalani pembedahan memiliki risiko tinggi mengalami kecemasan. Alternatif tindakan yang dapat dilakukan pada pasien yang mengalami kecemasan saat pre operasi adalah teknik relaksasi, yaitu terapi musik. Penulisan ini bertujuan untuk menganalisis asuhan keperawatan terapi musik pada pasien kanker rektum yang mengalami kecemasan dalam menjalani pembedahan abdominiperineal resection. Penulisan ini menggunakan pendekatan studi kasus klinik. Intervensi yang dilakukan selama 3 hari pada pasien menunjukkan bahwa terapi musik efektif dalam menurunkan kecemasan pasien. Hal tersebut terlihat dari respons pasien menjadi lebih tenang dan rileks. Rekomendasi dari studi kasus ini dalam meningkatkan keefektifan terapi musik untuk menurunkan kecemasan pasien pre operasi abdominoperineal resection adalah dengan pemberian edukasi dari tenaga kesehatan dan support sistem.

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ABSTRACTRectal cancer is one of the most common malignant problems in urban community. One of the surgery choices is abdominoperineal resection. Recent research stated that, patients who will to be surgery have high risk of anxiety preoperative. One of the alternative interventions is techniques relaxation, namely music therapy. The aim of this paper was analyze the nursing care of applying music therapy in rectal cancer patients who have an anxiety before preoperative abdominoperineal resection. This paper used a clinical study approach. The result of this study showed that music therapy during 3 days intervention were tranquility and relax patient. This study recommended that to imrpove music therapy in reducing patient rsquo;s anxiety are education from health care professional and support system from family."

"ABSTRACTLow anterior resection syndrome (LARS) commonly develops after an anal sphincter-preserving operation (SPO). The etiology of LARS is not well understood, as the anatomical components and physiological function of normal defecation, which may be damaged during the SPO, are not well established. SPOs may damage components of the anal canal (such as the internal anal sphincter, longitudinal conjoint muscle, or hiatal ligament), either mechanically or via injury to the nerves that supply these organs. The function of the rectum is substantially impaired by resection of the rectum, division of the rectococcygeus muscle, and/or injury of the nervous supply. When the remnant rectum is small and does not function properly, an important functional role may be played by the neorectum, which is usually constructed from the left side of the colon. Hypermotility of the remnant colon may affect the manifestation of urge fecal incontinence. To develop an SPO that minimizes the risk of LARS, the anatomy and physiology of the structures involved in normal defecation need to be understood better. LARS is managed similarly to fecal incontinence. In particular, management should focus on reducing colonic motility when urge fecal incontinence is the dominant symptom."

"ABSTRACTPurpose Adenosquamous carcinoma (ASC) of the pancreas is a rare malignancy, associated with a poor prognosis after surgical resection, with reported median survival times (MSTs) ranging from 4.4 to 13.1 months. We conducted this study to investigate the long-term outcomes of patients after the resection for ASC.MethodsBetween 2002 and 2016, a total of 456 patients underwent resection for ASC or adenocarcinoma (AC) of the pancreas. ASC was confirmed in 17 (3.7%) of these patients. We analyzed the clinicopathological characteristics and survival of these 17 patients in comparison with those of patients with AC of the pancreas.ResultsThe operative procedures performed were pancreaticoduodenectomy (n = 6) and distal pancreatectomy (n = 11). Seven (41.2%) of the 17 patients underwent combined organ resection. R0 resection was achieved in 16 (94.1%) patients. The 5-year overall survival (OS) rate and MST were 40.3% and 20.9 months, respectively. A squamous component of ≥ 60% (P = 0.001) and R1 resection (P < 0.001) were significantly associated with poor OS for patients with ASCConclusionThis study revealed longer survival and a higher R0 resection rate after aggressive combined resection in our ASC patients than those in previous studies. Although this was only a small series, our findings suggest that local control with aggressive resection may be an effective treatment protocol for ASC patients."