Procedure for Prolapse and Hemorrhoid (PPH)

Abstract

Colorectal cancer is a major health problem worldwide. Conventional open laparotomy was the gold standard. With the advancement of technology, there are many varieties of minimally invasive approach in managing this condition. Comparative studies showed that endoscopic submucosal dissection (ESD) is an option in managing early colorectal cancers, providing that expertise is available. On the other hand, meta-anaylsis showed that transanal endoscopic microsurgery (TEM) is a recognized option in the treatment of T1 rectal cancer. However, for more advanced tumor, TEM alone is not recommended. Combination of TEM with adjuvant or neoadjuvant therapy may be considered in selected patients and on research basis. Laparoscopic approach for colonic cancer has a better short term outcome while comparable long term oncological survivals to its open counterpart on multiple large-scale RCTs and meta-analyses. Similarly, the short term benefit for laparoscopic approach over open approach for rectal cancer has also been proven by multiple RCTs and meta-analyses, and the long term oncological outcomes are comparable in the latest meta-analysis, although the quality of evidence is moderate. Hand-assisted laparoscopic colectomy (HALS) and single incision laparoscopic colectomy (SILS) have comparable short term outcomes with laparoscopic approach, however, long term oncological data is lacking. Natural orifice transluminal endoscopic surgery (NOTES) and hybrid NOTES are still at the experimental stage and should only be reasearch based. Finally, the benefits of robotic colectomy when compared with laparoscopic colectomy were not obvious on the literature, large scale well designed RCT should be the future direction.