Annals of Coloproctology

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Original Articles

Benign GI diease,Benign diesease & IBD,Surgical technique

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature: Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon; Ann Coloproctol. 2022;38(2):160-165. Published online January 18, 2022; DOI: https://doi.org/10.3393/ac.2021.00598.0085

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Purpose
This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure.
Methods
Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups.
Results
LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012).
Conclusion
Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

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Techniques for Mesoappendix Division and Appendiceal Stump Closure: A Comparative Review
Lovisa Ekestubbe, Maximilian P. Forssten, Sebastian P. Forssten, Gary A. Bass, Yousef AlHussaini, Shahin Mohseni
The American Surgeon™.2026; 92(8): 2038. CrossRef
Polymeric clips versus staplers for appendiceal stump closure in laparoscopic appendectomy: a retrospective observational study
Şebnem Çimen, Kemal Berkay Tekin, Ahmet Kamburoğlu, Burak Uçaner
World Journal of Emergency Surgery.2026;[Epub] CrossRef
Fistula formation between urinary bladder and abdominal wall caused by bladder injury from surgical clips following laparoscopic appendectomy
Wei Zhou, Yong Suo, Tian-Yan Luo, Long-Gang Wang
Asian Journal of Surgery.2025; 48(6): 3926. CrossRef
Comparison of Polymer Clips Versus Endoloop Ligatures for Appendiceal Stump Closure in Laparoscopic Appendectomy
Madan Haravu Srikantegowda, Shilpashree Channasandra Shekar, Vinod Nayak S
Cureus.2025;[Epub] CrossRef
Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis
Aashish Kumar, Muhammad Saqlain Mustafa, Muhammad Ashir Shafique, Abdul Haseeb, Hussain Sohail Rangwala, Haimath Kumar, Burhanuddin Sohail Rangwala, Adarsh Raja, Sandesh Raja, Syed Muhammad Sinaan Ali
Surgery.2024; 176(5): 1329. CrossRef
Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study
Kil-yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh
World Journal of Emergency Surgery.2023;[Epub] CrossRef

A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids: Dong Wan Kang, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim, Gyong Suk Kang; Ann Coloproctol. 2023;39(1):41-49. Published online December 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00717.0102

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4 Web of Science
8 Citations

Graphical Abstract Abstract PDF

Purpose
Rubber band ligation (RBL) for grade 1 to 3 internal hemorrhoids is a well-established modality of choice. But RBL is also a kind of surgical treatment; it is not free from complications (e.g., delayed bleeding [DB], rectal stenosis). This study aimed to investigate the results of the comparative treatment of RBL and BANANA-Clip (BC; Endovision).
Methods
Study participants were 632 consecutive patients with grade 1 to 3 internal hemorrhoids attended to Department of Colorectal Surgery at Wellness Hospital between January 2010 and May 2019. We retrospectively reviewed the incidence rate of complications, including DB between RBL and BC.
Results
There were 304 male and 328 female patients, whose ages ranged from 15 to 84 years, with a mean age of 45.7 years. The common symptom and cause of treatment was prolapse (70.1%). The number of ligated sites was 1.49±0.57 in the RBL group and 1.99±0.77 in the BC group. RBL showed a significantly higher incidence of DB (3.5%) compared to BC (0%) (P=0.001). The 1-year success rate was 95.9% in the RBL group and 99.7% in the BC group (P=0.005).
Conclusion
In our study, BC was more reliable in treating grade 1 to 3 internal hemorrhoids with higher success rates and less post-ligation complications, especially DB, compared to RBL.

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Suture Reinforcement of Rubber Band Ligation for Internal Hemorrhoids: A Technical Modification to Reduce Delayed Massive Bleeding
Haibin Wu, Wenxin Shen, Zecheng Zhang, Yi Zhang
The American Surgeon™.2026;[Epub] CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Management of Internal Hemorrhoidal Disease by Elastic Ligation in Ouagadougou, Burkina Faso
Aboubacar Coulibaly, Zitgnimian Souleymane Sanne, Brunel Fernandez Keubou Zebaze, Sougrinoma Issouf Abel Sawadogo, Yamba Elie Sawadogo, Léonce Zoungrana, Kounpièlimè Sosthène Somda, Arsène Roger Sombie
Open Journal of Gastroenterology.2025; 15(07): 367. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
The BANANA-Clip: an innovative solution for hemorrhoidal pile ligation?
Kyung Uk Jung
Annals of Coloproctology.2023; 39(1): 1. CrossRef
Banana Clip: Advancing Hemorrhoid Ligation Beyond Rubber Bands
Navneet Arora, Ranjeet Kumar
Journal of Coloproctology.2023; 43(04): e324. CrossRef
Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy
Sen Lin, Meichun Zang, Zhaoqi Dong
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation—a retrospective study
Jiazi Yu, Jie Zhong, Tao Peng, Liangbin Jin, Leibin Shen, Mian Yang
BMC Surgery.2022;[Epub] CrossRef

Case Reports

Benign bowel disease

A case report of a colouterine fistula treatment: when the patient chooses the steeplechase: Stefano Pontone, Pier Giorgio Nardis, Chiara Eberspacher, Domenico Mascagni; Ann Coloproctol. 2023;39(4):366-370. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00318.0045

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Abstract PDF: Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.

A Case of Successful Colonoscopic Treatment of Acute Appendiceal Bleeding by Endoclips: Il Hyung Chung, Kwang Hyun Kim; J Korean Soc Coloproctol. 2011;27(6):329-332. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.329

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13 Citations

Abstract PDF

Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasm, inflammatory bowel disease, hemorrhoid, and ischemic colitis. However, bleeding from the appendix has been reported very rarely in patients with lower gastrointestinal tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, a laparoscopic or surgical appendectomy would be recommended. We report a case of successful colonoscopic treatment of appendiceal bleeding without complications by endoclips. This report suggests that colonoscopic clipping is a safe and effective means to treat bleeding from appendiceal lesions. Further study is needed to evaluate procedure-related complications and to confirm the procedure's safety and efficacy.

Citations

Citations to this article as recorded by

Appendiceal bleeding caused by angiodysplasia: A case report and review of literature
Jiang-Wei Zhou, Cheng-Feng Jin, Wei-Shang Lei, Meng-Lu Zhu, Xi-Ping Yu, Wei-Hua Yu
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef
Endoscopic observation of acute appendiceal hemorrhage: A case report
Chenyang Jiao, Cuixia Liu, Zhen Yang, Haihua Zhou, Yiwei Fu
Endoscopy.2025; 57(S 01): E77. CrossRef
An Elusive Case of Arterial Appendiceal Bleeding: Diagnostic and Therapeutic Insights
Seema Belani, Janki Luther, Surachai Amornsawadwattana, Judy Trieu
ACG Case Reports Journal.2025; 12(7): e01778. CrossRef
Appendiceal bleeding caused by vascular malformation: A case report
Qin Ma, Jin-Jie Du
World Journal of Clinical Cases.2024; 12(14): 2457. CrossRef
WITHDRAWN: Appendiceal bleeding caused by vascular malformation: A case report and literature review
Qin Ma, Jinjie Du
International Journal of Surgery Case Reports.2023; : 108903. CrossRef
Acute lower gastrointestinal bleeding due to low-grade mucinous neoplasm of appendix
Murat Karatas, Cenk Simsek, Süleyman Gunay, Baha Zengel, Gokalp Okut, Ali Murat Yıldırım, Enver Vardar, Adam Uslu
Acta Chirurgica Belgica.2022; 122(5): 357. CrossRef
Appendiceal bleeding: A case report
Sheng-Yue Zhou, Mao-Dong Guo, Xiao-Hua Ye
World Journal of Clinical Cases.2022; 10(18): 6314. CrossRef
Appendiceal bleeding in an elderly male: a case report and a review of the literature
Yuto Maeda, Seiya Saito, Mayuko Ohuchi, Yuka Tamaoki, Jiro Nasu, Hideo Baba
Surgical Case Reports.2021;[Epub] CrossRef
A case of endovascular management to gain control of a lower gastrointestinal haemorrhage caused by appendiceal artery bleeding
Eleanor J Smith, Charles Coventry, Jeremy Taylor, Henry De’ath, Ali Haque
Journal of Surgical Case Reports.2021;[Epub] CrossRef
A complete hemostasis of an appendiceal bleeding in a dialysis patient by an endoscopic traction method using endoscopic clips
Koichi Soga
International Journal of Gastrointestinal Intervention.2021; 10(3): 146. CrossRef
Acute Eosinophilic Appendicitis: A Rare Cause of Lower Gastrointestinal Hemorrhage
So Ra Ahn, Joo Hyun Lee
The Korean Journal of Gastroenterology.2021; 78(2): 134. CrossRef
Acute Suppurative Appendicitis Diagnosed by Acute Lower Gastrointestinal Hemorrhage
Dae-ha Kim, Ju Han Lee, Dongwoo Kim, Suhyun Hwang, Kyuho Kang, Ja Seol Koo
The Korean Journal of Gastroenterology.2019; 73(1): 45. CrossRef
A Case Report of Emergency Surgery for Bleeding from Multiple Diverticula in the Appendix
Hirotsugu Morioka, Akihiro Miki, Shinichiro Yoshitani
Nippon Daicho Komonbyo Gakkai Zasshi.2015; 68(4): 232. CrossRef

Original Articles

An Incidental Asymptomatic Dieulafoy's Lesion in the Colon: A Case Report.: Moon, Gyoo , Park, Jong Beom , Chang, Hee Chul , Huh, Chang , Paik, Chang Hee , Kim, Hyun Shig; J Korean Soc Coloproctol. 2008;24(1):58-61.; DOI: https://doi.org/10.3393/jksc.2008.24.1.58

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Abstract PDF: A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.

Delayed Bleeding in a Colonoscopic Polypectomy: An experience with 5,236 polypectomies.: Kim, Hyun Shig , Kim, Kuhn Uk , Park, Weon Kap , Cho, Kyung A , Hwang, Do Yean , Kang, Yong Won , Yoon, Seo Gue , Lee, Kwang Real , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2000;16(6):462-468.

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Abstract PDF: PURPOSE
Delayed hemorrhage rarely happens after a colonoscopic polypectomy, ranging from 0.2 to 1.8% in frequency. Although its occurrence is unpredictable and it may be serious in some cases, scanty data on its causes, characteristics, and effective management exist in Korea. This study was conducted to provide such data, especially data on the characteristics of delayed hemorrhage and its effective management.
METHODS
From 1997 to 1999, one endoscopist at Song-Do Colorectal Hospital performed 5236 polypectomies on 2511 patients. Delayed hemorrhage occurred after 9 of those polypectomies, for a bleeding incidence rate of 0.17% (9/5236). The authors reviewed those 9 incidence of delayed hemorrhage, which involved 9 patients and 9 lesions, with emphasis on the characteristics of the bleeding and the treatment.
RESULTS
The mean age of the 9 patients was 50 years, and the male-to-female ratio was 8: 1. The sigmoid colon was involved in 4 of those patients (44.4%), and the right-sided colon was involved in another 4 of those patients. Lesions smaller than 11 mm were either sessile or flat-elevated and accounted for 6 of the 9 lesions (66.7%). The remaning lesions, which were larger than 10 mm, were either pedunculated or semipedunculated. Three (3) of the 9 patients (33.3%) experienced bleeding on day 1, the most common bleeding day. Another 5 patients (55.6%) experienced bleeding during the next 4 days (days 2 to 5). The last patient experienced bleeding on day 9, the latest bleeding day. A snare polypectomy had been performed on 7 of the 9 patients (77.8%), and a hot biopsy had been performed on the other 2 (22.2%). All delayed bleeding was treated by using hemoclips; additional epinephrine injection was used in 55.6% of the cases and an additional detachable snare in 22.2%. Rebleeding was noticed the day following the initial treatment of bleeding in one case and was managed by using hemoclips.
CONCLUSIONS
The first 5 days after a colonoscopic polypectomy are crucial, and caution is required during the next 5 days. Thorough knowledge about preventing and managing bleeding is essential.

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