Annals of Coloproctology

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Original Article

Anorectal benign disease

New anatomical insight into the muscular structure of the anal canal: revealing Treitz muscle as a directional shift of the internal anal sphincter: Satoru Muro, Kumiko Yamaguchi, Naoko Inoshita, Yasuo Nakajima, Danyo Jennifer Edinam, Akimoto Nimura, Keiichi Akita; Ann Coloproctol. 2025;41(6):501-509. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00647.0092

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Abstract PDF: Purpose
Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function.
Methods
In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated.
Results
Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal.
Conclusion
In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

Reviews

Anorectal benign disease

Pharmacotherapy for fecal incontinence: potential treatment with a traditional Japanese medicine Kampo: Kotaro Maeda, Toshinobu Sasaki, Tomohisa Hattori; Ann Coloproctol. 2025;41(5):369-378. Published online October 23, 2025; DOI: https://doi.org/10.3393/ac.2025.00283.0040

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Abstract PDF: Fecal incontinence (FI) significantly impairs patient quality of life and creates substantial distress not only for affected individuals but also for nurses and caregivers. The prevalence of FI among older adults is estimated at up to 20%, although the sensitive nature of the condition often prevents active reporting by patients. This article reviews risk factors and pharmacotherapies for FI, emphasizing the therapeutic potential of Daikenchuto (DKT). The etiology of FI is multifactorial and lacks a singular definition. Currently, no prescription drugs specifically approved for FI are available, leaving treatment options limited. Nonetheless, major clinical guidelines have identified several viable pharmacological approaches. Strongly recommended treatments include the antidiarrheal agent loperamide and stool bulking or solidifying agents, such as dietary fiber and polycarbophil. Other therapeutic options include ramosetron, a 5-HT3 receptor antagonist; amitriptyline, a tricyclic antidepressant; and sodium valproate and diazepam, which are GABAergic neuromodulators. Recently, research has explored the efficacy and mechanism of action of DKT, a traditional Japanese medicine Kampo. Historically used for abdominal symptoms like bloating and known for promoting intestinal motility, emerging evidence suggests DKT may also effectively manage FI.

Benign proctology

A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence: Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son; Ann Coloproctol. 2022;38(3):183-196. Published online June 9, 2022; DOI: https://doi.org/10.3393/ac.2022.00276.0039

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Abstract PDF

The complexity in the molecular mechanism of the internal anal sphincter (IAS) limits preclinical or clinical outcomes of fecal incontinence (FI) treatment. So far, there are no systematic reviews of IAS translation and experimental studies that have been reported. This systematic review aims to provide a comprehensive understanding of IAS critical role in FI. Previous studies revealed the key pathway for basal tone and relaxation of IAS in different properties as follows; calcium, Rho-associated, coiled-coil containing serine/threonine kinase, aging-associated IAS dysfunction, oxidative stress, renin-angiotensin-aldosterone, cyclooxygenase, and inhibitory neurotransmitters. Previous studies have reported improved functional outcomes of cellular treatment for regeneration of dysfunctional IAS, using various stem cells, but did not demonstrate the interrelationship between those results and basal tone or relaxation-related molecular pathway of IAS. Furthermore, these results have lower specificity for IAS-incontinence due to the included external anal sphincter or nerve injury regardless of the cell type. An acellular approach using bioengineered IAS showed a physiologic response of basal tone and relaxation response similar to human IAS. However, in both cellular and acellular approaches, the lack of human IAS data still hampers clinical application. Therefore, the IAS regeneration presents more challenges and warrants more advances.

Citations

Citations to this article as recorded by

A single-center retrospective analysis of endorectal advancement flaps used for the treatment of simple rectovaginal fistulas
Xuexiao Li, Wanjin Shao, Guidong Sun
Scandinavian Journal of Gastroenterology.2025; 60(4): 307. CrossRef
Anal sphincter reconstruction for fecal incontinence: Techniques, outcomes, and future directions
Hai-Liang Li, Hao-Ran Zhang, Yuan Wu, Kai-Qiang He, Tian-Jie Chen, Jing Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
3D spheroids versus 2D-cultured human adipose stem cells to generate smooth muscle cells in an internal anal sphincter-targeting cryoinjured mouse model
Iltae Son, Minsung Kim, Ji-Seon Lee, Dogeon Yoon, You-Rin Kim, Ji Hye Park, Bo-Young Oh, Wook Chun, Sung-Bum Kang
Stem Cell Research & Therapy.2024;[Epub] CrossRef
Differentiation of Adipose-Derived Stem Cells into Smooth Muscle Cells in an Internal Anal Sphincter-Targeting Anal Incontinence Rat Model
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, You-Rin Kim, Wook Chun, Jong Wan Kim, Il Tae Son
Journal of Clinical Medicine.2023; 12(4): 1632. CrossRef
Improving Efficiency and Accuracy in English Translation Learning: Investigating a Semantic Analysis Correction Algorithm
Lingmei Cao, Junru Fu
Applied Artificial Intelligence.2023;[Epub] CrossRef

Original Articles

Benign proctology,Surgical technique

Transperineal rectocele repair is ideal for patients presenting with fecal incontinence: Marie Shella De Robles, Christopher J. Young; Ann Coloproctol. 2022;38(5):376-379. Published online October 19, 2021; DOI: https://doi.org/10.3393/ac.2021.00157.0022

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3 Citations

Abstract PDF

Purpose
Rectocele can be associated with both obstructed defecation and fecal incontinence. There exists a great variety of operative techniques to treat patients with rectocele. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele when presenting with fecal incontinence as the predominant symptom.
Methods
Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon.
Results
All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range, 21–90 years). None were fully continent preoperatively. However, continence improved to just rare mucus soiling or loss of flatus in all patients 6 months after their surgery. There was no operative mortality. Postoperative complications including urinary retention and wound dehiscence occurred in 3 patients.
Conclusion
Fecal incontinence associated with rectocele is multifactorial and may be caused by preexisting anal sphincteric damage and attenuation. Our experience suggests that transperineal repair provides excellent anatomic and physiologic results with minimal morbidity in selected patients presenting with combined rectocele and anal sphincter defect.

Citations

Citations to this article as recorded by

Fecal Incontinence Outcomes Following Transvaginal Posterior Vaginal Wall Repair
Jersey B. Burns, Amr El Haraki, Jesseca Crawford, Candace Y. Parker-Autry
International Urogynecology Journal.2025; 36(5): 1061. CrossRef
IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles
Suneetha Rachaneni, Hans Peter Dietz, Pallavi Latthe, Annie Sirany, Anna Spivak, Anupreet Dua
International Urogynecology Journal.2025;[Epub] CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation
Karim Alavi, Amy J. Thorsen, Sandy H. Fang, Pamela L. Burgess, Gino Trevisani, Amy L. Lightner, Daniel L. Feingold, Ian M. Paquette
Diseases of the Colon & Rectum.2024; 67(10): 1244. CrossRef

Malignant disease, Rectal cancer, Functional outcomes

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma: Osama Eldamshety, Sherif Kotb, Ashraf Khater, Sameh Roshdy, Mohamed Elashry, Mohamed S. Zahi, Hend M. Hamdey Rashed Elkalla, Waleed Elnahas, Omar Farouk, Adel Fathi, Ahmed Senbel, Emad-Eldeen Hamed, Khaled Abdelwahab, Islam Abdou Elzahby, Ahmed abdallah, Mahmoud Abdelaziz, Emanuele Lezoche; Ann Coloproctol. 2020;36(3):148-154. Published online April 20, 2020; DOI: https://doi.org/10.3393/ac.2018.07.19

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15 Web of Science
15 Citations

Abstract PDF

Background
The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma.
Methods
In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year.
Results
Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%).
Conclusion
Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function

Citations

Citations to this article as recorded by

Transanal Minimally Invasive TME (TaTME) Versus Non-Endoscopic Transanal Intersphincteric Resection of Post-Neoadjuvant Ultralow Rectal Adenocarcinoma: A Multicentric, Matched Case–Control Study
Osama Eldamshety, Mohamed Abdekhalek, Amir M. Zaid, Essam Attia, Mohamed Zuhdy, Emanuel Lezoche, Giovanni Lezoche, Enjy Mosaad, Marwa Abogabal, Islam Elzahby
Indian Journal of Surgery.2025; 87(5): 912. CrossRef
Pathologic Implications of Magnetic Resonance Imaging-detected Extramural Venous Invasion of Rectal Cancer
Hyun Gu Lee, Chan Wook Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Clinical Colorectal Cancer.2023; 22(1): 129. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis
Athina A. Samara, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, Alexandros Diamantis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(7): 1385. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Simplification or Accuracy: In Assessing Functional Outcomes After Intersphincteric Resection for Low Rectal Cancer
Kyung Jong Kim
Annals of Coloproctology.2020; 36(3): 129. CrossRef

Benign proctology

Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation: Süleyman Büyükaşık, Mehmet Abdussamet Bozkurt, Selin Kapan, Halil Alis; Ann Coloproctol. 2020;36(5):330-334. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.15

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Abstract PDF

Purpose
Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.
Methods
Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.
Results
The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).
Conclusion
We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.

Citations

Citations to this article as recorded by

A possible physiological mechanism of rectocele formation in women
Ge Sun, Robbert J. de Haas, Monika Trzpis, Paul M. A. Broens
Abdominal Radiology.2023; 48(4): 1203. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Case Report

Benign proctology

Complex Obstetric Perineal Injury Reconstruction Using Antropyloric Valve Transposition: Saket Kumar, Noushif Medappil, Sunil Kumar Singh, Abhijit Chandra; Ann Coloproctol. 2020;36(1):58-61. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2018.08.21

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1 Web of Science
1 Citations

Abstract PDF

Despite significant advancements in the field of medicine, management of complex obstetric perineal injuries remains a challenge. Although several surgical techniques have been described, no techniques have provided satisfactory long-term results. Recently, a perineal transposed antropyloric valve has been used for anorectal reconstruction in patients with damaged or excised anal sphincters. We describe this technique in the case of complex obstetric perineal trauma with extensive tissue loss, presenting with end stage fecal incontinence. The functional outcome after this procedure was evaluated. The patient tolerated the surgery well, and there were no procedure-related upper gastrointestinal disturbances. Short-term functional outcomes were encouraging. At the 36-month follow-up, the patient’s neoanal resting and squeeze pressures were 50 and 70 mmHg, respectively. The postoperative St. Mark’s incontinence score was 7. Perineal antropyloric valve transposition is feasible and can be successfully applied in the management of end-stage fecal incontinence associated with complex obstetric perineal injury.

Citations

Citations to this article as recorded by

Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Original Article

Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction: Abhijit Chandra, Ashok Kumar, M Noushif, Nitish Gupta, Vijay Kumar, Navneet Kumar Chauhan, Vishal Gupta; Ann Coloproctol. 2013;29(1):7-11. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.7

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4 Citations

Abstract PDF

Purpose

Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers.

Methods

The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis.

Results

The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied.

Conclusion

An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.

Citations

Citations to this article as recorded by

Current surgical strategies to treat fecal incontinence
Steven D Wexner, Joshua Bleier
Expert Review of Gastroenterology & Hepatology.2015; 9(12): 1577. CrossRef
Dynamic Article
Abhijit Chandra, Brijesh Mishra, Saket Kumar, Vishal Gupta, M. Noushif, U. C. Ghoshal, Asha Misra, P. K. Srivastava
Diseases of the Colon & Rectum.2015; 58(5): 508. CrossRef
Neuromodulation of perineally transposed antropylorus with pudendal nerve anastomosis following total anorectal reconstruction in humans
Abhijit Chandra, Hardeep S. Malhotra, Noushif M, Vishal Gupta, Sunil K. Singh, Neeraj Kumar, Rakesh S. Lalla, Ayush Chandra, Ravindra K. Garg
Neurogastroenterology & Motility.2014; 26(9): 1342. CrossRef
Neurovascular antropylorus perineal transposition using inferior rectal nerve anastomosis for total anorectal reconstruction: preliminary report in humans
A. Chandra, A. Kumar, M. Noushif, V. Gupta, V. Kumar, P. K. Srivastav, H. S. Malhotra, M. Kumar, U. C. Ghoshal
Techniques in Coloproctology.2014; 18(6): 535. CrossRef

Review

Muscle Regeneration: Research for the Treatment of Fecal Incontinence.: Kang, Sung Bum , Lee, Taek Gu; J Korean Soc Coloproctol. 2010;26(1):1-7.; DOI: https://doi.org/10.3393/jksc.2010.26.1.1

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3 Citations

Abstract PDF

Fecal incontinence remains a socially isolating condition, which can have a profound impact on all aspects of quality of life. It affects 2% to 17% of people living in the community and is an iatrogenic disease that develops after a restorative proctectomy for rectal cancer. Conservative management, such as biofeedback and medication, or surgical therapy may be ineffective, the symptomatic benefit being disappointing. In a few recent reports, autologous myoblasts injected into the urinary or anal sphincter were used successfully for the treatment of incontinence, and these cells improved the muscle function. These autologous cell therapies can avoid adverse events, such as tumor formation, compared to the use of embryonic stem cells. However, the limited regenerative capacity of cell therapy has prompted the development of replacing dysfunctional muscle tissue. Regenerative medicine for functioning muscles may be a therapeutic tool for fecal incontinence in the future. Now, many challenges remain to be overcome prior to reaching the ultimate goal of a fully functional 3-D vascularized engineered muscle: These include development of highly organized 3-D scaffolds, development of scaffolds that specifically direct cellular differentiation, development of co-culture systems of multiple cell types on smart surfaces, development of vascularized constructs, reduction of serum dependence, and innervation into constructed muscle. The successful generation of functional muscle tissues requires an in-depth knowledge of both muscle tissue physiology and advanced engineering practices. The recent advances in tissue engineering technique and cell biology suggest that artificially-derived muscle constructs may be used in clinical settings in the near future.

Citations

Citations to this article as recorded by

Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction
Abhijit Chandra, Ashok Kumar, M Noushif, Nitish Gupta, Vijay Kumar, Navneet Kumar Chauhan, Vishal Gupta
Annals of Coloproctology.2013; 29(1): 7. CrossRef
Functional New Sphincter Ani Reconstruction by Using Neurovascualr Antropylorus Transposition After an Anorectal Excision
Bong Hwa Lee, Min Jung Kim, Hyoung Chul Park
Annals of Coloproctology.2013; 29(1): 5. CrossRef
Injection of porous polycaprolactone beads containing autologous myoblasts in a dog model of fecal incontinence
Sung-Bum Kang, Hye Seung Lee, Jae-Young Lim, Se Heang Oh, Sang Joon Kim, Sa-Min Hong, Je-Ho Jang, Jeong-Eun Cho, Sung-Min Lee, Jin Ho Lee
Journal of the Korean Surgical Society.2013; 84(4): 216. CrossRef

Original Articles

Clinical Significance of the Pecten Band in Hemorrhoids.: Lee, Je Seung , Ahn, Byeong Yul , Lee, Han Il; J Korean Soc Coloproctol. 2006;22(1):8-14.

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Abstract PDF: PURPOSE
The pecten band can be defined as a fibrous tissue on the lowermost part of internal anal sphincter and may cause anal outlet obstruction, but its role is debatable. We evaluated the functional roles of the pecten band in hemorrhoids patients.
METHODS
Three hundred sixteen hemorrhoids patients who underwent operations from January 1998 to April 2003 were analyzed for anal function according to presence or absence of a pecten band by using anorectal manometry and the constipation score.
RESULTS
The numbers of males and females were 167 and 149. The overall pecten band positive was 63.6% (201/316), and pecten band positive was 84.6% (33/39) in patients who had previous anal surgery while it was 60.6% (168/277) in patients who had no history of surgery (P= 0.002). Pure hemorrhoids patients showed an 18.3% positive rate while patients with hemorrhoids and other conditions, such as anal fissure, fistula, or stricture, showed a 95.7% positive rate (P=0.00). Maximal resting anal pressures (mmHg, Mean+/-SD) and constipation score were 78.9+/-24.7 and 7.88+/-3.8 in the positive group and 67.1+/-22.2 and 4.55+/-2.8 in the negative group (P=0.00, 0.00). Postoperatively, the constipation score decreased significantly from 7.25 to 2.82 (P=0.003).
CONCLUSIONS
The pecten band seems to be associated with anal outlet obstruction, and a pecten band releasing operation may be considered according to its presence or absence.

Anal Endosonographic Findings of Internal Anal Sphincter in Normal Adult Korean.: Kim, Kyung Jong , Kim, Cheong Yong , Jang, Jeong Hwan , Kim, Kweon Cheon , Min, Young Don; J Korean Soc Coloproctol. 1998;14(2):217-224.

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Abstract PDF: PURPOSE
To describe the appearance and average thickness of the internal anal sphincter with anal endosonography in healthy Korean adults. MATERIAL AND METHODS: 184 subjects(male: 96, female: 88) with no history of anorectal disease or surgery were studied with anal endosonography. The average thickness of internal sphincter was meas ured at the mid-anal canal. For the internal sphincter, which is often asymmetric, the thickness of each 4 part(12, 3, 6 and 9 o'clock direction) were measured in left lateral decubitus position.
RESULTS
The anal wall was well visualized in 5 layers(mucosa, submucosa, internal anal sphincter, intersphincteric plane, external anal sphincter) with anal endosonography. The anal endosonogram showed the internal anal sphincter as a homogenous, well-defined, hypoechoic, circular band, and slightly asymmetric. The average thickness of the internal anal sphincter in the area of mid-anal portion was 2.0 0.3 mm(range: 1~3 mm). There was no sexual difference; however, a significant positive correlation with age was found in average thickness of the internal anal sphincter. The correlation with lean body mass was not found.
CONCLUSION
The internal anal sphincter is well-visualized, best defined structure by anal endosonography. Average thickeness of the sphincter in Korean appeared to be the same as in the Western.

The Effect of Intraoperative Anal Sphincter Injection of Ketorolac Tromethamine for Pain Control after Hemorrhoidectomy.: Park, Jea Kun , Kim, Nam Kyu , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2000;16(5):296-301.

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Abstract PDF: PURPOSE
An adequate pain control is one of important factors for obtaining good outcomes in the ambulatory basis of hemorrhoidectomy. There have been many methods for pain control after hemorrhoidectomy such as narcotics, various kinds of analgesics, etc. The aim of this study is to compare intraoperative internal anal sphincter injection of Ketorolac tromethamine and other two conventional methods for pain control.
METHODS
A total of 56 patients with hemorrhoid grade III or IV underwent surgery between May and October 1999, and prospectively assigned to three groups in the consecutive order. The group was divided in Group 1: [Ketorolac tromethamine (Tarasyn) 60 mg intrasphincteric injection intraoperatively and 30 mg IM/prn?10 mg po/6hrs], Group 2: [No intraoperative injection and maintain pain control with Tarasyn 30 mg IM/prn/10 mg po/6hrs], and Group 3: [No intraoperative injection and maintain pain control with Pethidine (Demerol) 50 mg IM/prn and Ibuprofen 400 mg/Paracetamol 500 mg/Codeine 20 mg (Myprodol) po/8hrs]. The post operative data and pain scoring was performed on the questionnaire with Point box scale (BS-11) and Behavioral rating scale (BRS-6) each 24 hours during 5 days after surgery.
RESULTS
There are 22 patients in the Group 1, 16 in the Group 2 and 18 patients in the Group 3. The median age of the Group 1 is 42.5, Group 2, 44.5 and Group 3, 45 years. The pain score on the first day after surgery in group 1 was significantly lower than group 2 (p<0.05) in the both pain scoring scale but was no differences between group 1 and 3. On the fifth day after surgery group 3 was significantly lower than both group 1 and 2 in the point box scale (p<0.05). The urinary retention rate and the day of first bowel movement after surgery show no differences among three groups (p>0.05).
CONCLUSIONS
Intraoperative internal anal sphincter injection of Ketorolac tromethamine shows a better pain control than conventional methods in early postoperative period. Therefore it might be helpful for patients to go home on the day after surgery, and strong pain killer to control pain after discharge will be needed.

Diagnosis of Anal Sphincter Injuries by Manometric Radial Asymmetry.: Seong, Moo Kyung , Cha, Hyung Hwan , Park, Ung Chae; J Korean Soc Coloproctol. 1999;15(2):131-136.

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Abstract PDF: PURPOSE
This study was undertaken to evaluate how well anorectal manometry diagnose anal sphincter injury, especially with regard to the parameter of radial asymmetry. METHODS: Anorectal manometry were performed in 27 male patients with anal fistula of transsphincteric type. The postoperative values of each manometric parameter including radial asymmetry (RA) were compared with preoperative ones. And also, the association between the sites of functional defect assessed by cross-sectional pressure data under station pull-through (SPT) technique and those of anatomical defect made by fistulotomy operation were determined.
RESULTS
Under rapid pull-through (RPT) technique, maximum resting pressure (MRP); 113.1 21.3 mmHg (preoperative value) vs 68.0 18.5 mmHg (p=.000) (postoperative value), RA of MRP; 16.7 3.7% vs 24.1 7.5% (p=.002), Maximum squeeze pressures (MSP); 199.0 35.2 mmHg, 169.6 48.7 mmHg (p=.006), RA of MSP; 15.5 3.7%, 22.8 3.5% (p=.000). Under SPT technique, MRP; 100.4 39.5 mmHg vs 71.2 34.6 mmHg (p=.000), RA of MRP; 16.3 7.9% vs 24.2 10.8% (p=.026), MSP; 299.1 71.6 mmHg vs 231.4 90.3 mmHg (p=.004), RA of MSP; 13.0 6.1% vs 22.0 8.4% (p=.001). Sites of functional defects interpreted upon SPT data were coincidental with sites of anatomical defects made by fistulotomy in 88.9% (MRP) and 92.6% (MSP) of cases.
CONCLUSIONS
Manometric radial asymmetry could be a useful parameter in diagnosing anal sphincter injury and locating the site of defect.

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