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Original Articles
Minimally invasive surgery
Propensity score–matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci
Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Hiromi Kanai, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise
Ann Coloproctol. 2025;41(4):310-318.   Published online August 25, 2025
DOI: https://doi.org/10.3393/ac.2025.00136.0019
  • 2,095 View
  • 36 Download
  • 1 Web of Science
  • 1 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
The hinotori Surgical Robot System (hereafter “hinotori”) is a novel platform for robot-assisted surgery, while the da Vinci Surgical System (“da Vinci”) remains the field standard. This study compared short-term surgical outcomes of rectal cancer surgery between these systems using propensity score–matched analysis.
Methods
A retrospective analysis was conducted of 209 consecutive patients who underwent robot-assisted surgery with the da Vinci and 58 patients with the hinotori system. After 2:1 propensity score matching, 108 da Vinci and 54 hinotori cases were included. Surgical outcomes, including operative time, blood loss, postoperative complications, length of hospital stay, and pathological findings, were compared.
Results
After matching, the baseline demographics were well balanced between groups. The hinotori system was associated with significantly longer operative time (266 minutes vs. 227 minutes, P=0.014) and console time (156 minutes vs. 110 minutes, P=0.001). However, estimated blood loss and postoperative complication rate did not differ significantly. Pathological findings, including the number of lymph nodes retrieved and the incidence of positive surgical margins, were comparable between systems.
Conclusion
In rectal surgery, the hinotori system demonstrates comparable short-term safety outcomes to da Vinci. Despite longer operative times and limited integrated instrumentation, hinotori‐assisted procedures may be feasible in selected patients. Further research should address long-term oncological outcomes and strategies to improve procedural efficiency.

Citations

Citations to this article as recorded by  
  • Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci
    Sung Uk Bae
    Annals of Coloproctology.2025; 41(4): 259.     CrossRef
CRC
Impact of iron-deficiency anemia on short-term outcomes after resection of colorectal cancer liver metastasis: a US National (Nationwide) Inpatient Sample (NIS) analysis
Ko-Chao Lee, Yu-Li Su, Kuen-Lin Wu, Kung-Chuan Cheng, Ling-Chiao Song, Chien-En Tang, Hong-Hwa Chen, Kuan-Chih Chung
Ann Coloproctol. 2025;41(2):119-126.   Published online April 24, 2025
DOI: https://doi.org/10.3393/ac.2024.00591.0084
  • 3,271 View
  • 86 Download
AbstractAbstract PDFSupplementary Material
Purpose
Colorectal cancer (CRC) often spreads to the liver, necessitating surgical treatment for CRC liver metastasis (CRLM). Iron-deficiency anemia is common in CRC patients and is associated with fatigue and weakness. This study investigated the effects of iron-deficiency anemia on the outcomes of surgical resection of CRLM.
Methods
This population-based, retrospective study evaluated data from adults ≥20 years old with CRLM who underwent hepatic resection. All patient data were extracted from the 2005–2018 US National (Nationwide) Inpatient Sample (NIS) database. The outcome measures were in-hospital outcomes including 30-day mortality, unfavorable discharge, and prolonged length of hospital stay (LOS), and short-term complications such as bleeding and infection. Associations between iron-deficiency anemia and outcomes were determined using logistic regression analysis.
Results
Data from 7,749 patients (representing 37,923 persons in the United States after weighting) were analyzed. Multivariable analysis revealed that iron-deficiency anemia was significantly associated with an increased risk of prolonged LOS (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.30–3.30), unfavorable discharge (aOR, 2.42; 95% CI, 1.83–3.19), bleeding (aOR, 5.05; 95% CI, 2.92–8.74), sepsis (aOR, 1.60; 95% CI, 1.04–2.46), pneumonia (aOR, 2.54; 95% CI, 1.72–3.74), and acute kidney injury (aOR, 1.71; 95% CI, 1.24–2.35). Subgroup analyses revealed consistent associations between iron-deficiency anemia and prolonged LOS across age, sex, and obesity status categories.
Conclusion
In patients undergoing hepatic resection for CRLM, iron-deficiency anemia is an independent risk factor for prolonged LOS, unfavorable discharge, and several critical postoperative complications. These findings underscore the need for proactive anemia management to optimize surgical outcomes.
Anorectal benign disease
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, Luana Passariello, Pasquale Talento, Giovanna Ioia, Corrado Rispoli, Mariano Fortunato Armellino, Vincenzo Bottino, Adolfo Renzi, Carlo Bartone, Luigi Monaco, Paolino Mauro, Stefano Picardi, Maria Paola Menna, Elisa Palladino, Mario Massimo Mensorio, Vinicio Mosca, Claudio Gambardella, Luigi Brusciano, Ludovico Docimo
Ann Coloproctol. 2024;40(6):602-609.   Published online December 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00570.0081
  • 5,561 View
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  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
Purpose
Postoperative pain is a major concern for patients undergoing ultrasound scalpel-assisted hemorrhoidectomy, potentially exacerbated by delayed wound healing. This study aimed to evaluate the impact of an intimate cleansing gel containing chlorhexidine, hyaluronic acid, and other anti-inflammatory agents (Antroclean Fisioderm) on postoperative pain, itching, and wound healing in patients who had undergone this procedure.
Methods
This multicenter observational case-control study involved a cohort of consecutive adult patients who underwent hemorrhoidectomy using an ultrasound device. The study compared 2 different postoperative wound management strategies over 1 month after surgery: washing with warm water twice per day (control group) versus a 2-minute topical application of intimate cleansing gel (Antroclean Fisioderm) followed by a warm water wash (intervention group).
Results
The median postoperative pain score was significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). The percentage of patients reporting anal itching was also significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). All patients in the intervention group achieved complete wound healing 4 weeks after surgery, compared to 88 (82%) in the control group (P<0.01). No adverse events were reported.
Conclusion
The topical application of intimate cleansing gel (Antroclean Fisioderm) twice daily for 1 month following ultrasound scalpel-assisted hemorrhoidectomy appears to be associated with faster healing, reduced pain, decreased itching, and improved quality of life, without any adverse effects. Further larger and prospective randomized trials are recommended to confirm these findings.

Citations

Citations to this article as recorded by  
  • Enhancing Proctological Outcomes: The Role of Hyaluronic Acid in Hemorrhoid Care – An Innovative Adjunct to Surgery
    Riddhi Upadhyay, Akshat Vadaliya, Haryax V. Pathak, Soham Upadhyay
    Journal of Coloproctology.2025; 45(03): 001.     CrossRef
ERAS
Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer
Victoria Weets, Hélène Meillat, Jacques Emmanuel Saadoun, Marie Dazza, Cécile de Chaisemartin, Bernard Lelong
Ann Coloproctol. 2024;40(5):440-450.   Published online September 20, 2024
DOI: https://doi.org/10.3393/ac.2023.00850.0121
  • 9,486 View
  • 220 Download
  • 2 Web of Science
  • 3 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
Purpose
Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts.
Methods
This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016.
Results
Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01).
Conclusion
The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.

Citations

Citations to this article as recorded by  
  • Less is more: simplifying patient-centered cancer care
    In Ja Park
    Annals of Coloproctology.2025; 41(3): 173.     CrossRef
  • Research Progress on the Application of ERAS Concept in the Perioperative Period of Colorectal Cancer Patients
    梦云 孙
    Advances in Clinical Medicine.2025; 15(08): 1208.     CrossRef
  • Optimizing postoperative pain management in minimally invasive colorectal surgery
    Soo Young Lee
    Annals of Coloproctology.2024; 40(6): 525.     CrossRef
Anorectal benign disease
Immediate sphincter repair following fistulotomy for anal fistula: does it impact the healing rate and septic complications?
Maher A. Abbas, Anna T. Tsay, Mohammad Abbass
Ann Coloproctol. 2024;40(3):217-224.   Published online June 28, 2024
DOI: https://doi.org/10.3393/ac.2022.01144.0163
  • 10,046 View
  • 277 Download
  • 2 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair.
Methods
This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications.
Results
In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42).
Conclusion
Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

Citations

Citations to this article as recorded by  
  • Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients
    Pankaj Garg, Gabriele Naldini, Vincent De Parades, Petr Tsarkov, Vipul Yagnik, Kaushik Bhattacharya, Baljit Kaur, G Mahak
    Clinical and Experimental Gastroenterology.2025; Volume 18: 121.     CrossRef
  • Clinical outcome of fistulectomy with partial sphincter preservation in complex fistula-in-ano in a tertiary hospital of Bangladesh
    Jalal Ahmed, M. Meher Ullah, Asif Aman, Satya Ranjan Mondal, Sabrina Akhter Qurashi, Golam Mustafa, Ahsan Habib, Imtiaz Faruk
    International Surgery Journal.2025; 12(7): 1131.     CrossRef
  • Sequential Surgical Management of a Recurrent Complex Transsphincteric Anal Fistula With Sphincter Disruption: A Case Report
    Diego Pérez-Valdez, Alfredo Sinahi Abarca-Magallón, Samuel Hernández-Alvarado, Daniel Castañeda-Rodríguez, Daniel Alejandro Valdivieso-Siguenza
    Cureus.2025;[Epub]     CrossRef
  • Enhanced surgical management of complex anal fistulas via integrated traditional Chinese medicine: A retrospective cohort study
    Ji-Feng Liu, Yu Wang, Xue-Song Peng, Qing-Long Li
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles
    Pankaj Garg, Nicola Clemente, James C. W. Khaw
    Annals of Coloproctology.2024; 40(5): 521.     CrossRef
Technical Note
Technical tips
Introduction of extraperitoneal tunneling method: a way to secure the drain tube in the pelvic cavity after proctectomy
Sung Il Kang, Sohyun Kim, Jae Hwang Kim
Ann Coloproctol. 2024;40(2):182-185.   Published online March 25, 2024
DOI: https://doi.org/10.3393/ac.2023.00073.0010
  • 3,342 View
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  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
The effectiveness of closed drainage tube insertion after low anterior resection has been controversial. We believe that drain tube displacement, which occurs up to 35% in real clinical practice, reduces the effectiveness of the drain tube. We report in this video a simple way to secure the drain tube in the pelvic cavity after low anterior resection and introduce a case that used the drain fixation method and treated anastomotic leakage without interventional procedure.

Citations

Citations to this article as recorded by  
  • Comparison of drain displacement and complications between conventional drain insertion and extraperitoneal tunneling drain insertion following anterior or low anterior resection: a retrospective comparative cohort study
    Sung Il Kang, Sohyun Kim
    Annals of Surgical Treatment and Research.2025; 109(1): 7.     CrossRef
Original Article
Colorectal cancer
Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study
Ahmad Sakr, Seung Yoon Yang, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim
Ann Coloproctol. 2024;40(1):27-35.   Published online February 28, 2024
DOI: https://doi.org/10.3393/ac.2022.01067.0152
  • 4,995 View
  • 205 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
Purpose
Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.
Methods
In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.
Results
Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.
Conclusion
Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

Citations

Citations to this article as recorded by  
  • Funktionelle Folgen von Radiotherapie, Chemotherapie und Operation bei der Behandlung des Rektumkarzinoms
    Philipp Rhode, Matthias Mehdorn, Undine Gabriele Lange, Sebastian Murad Rabe, Johannes Quart, Robert Nowotny, Patrick Sven Plum, Stefan Niebisch, Sigmar Stelzner
    Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2025; 150(04): 353.     CrossRef
  • Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
    Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
    Cancers.2024; 16(24): 4280.     CrossRef
  • Beyond survival: a comprehensive review of quality of life in rectal cancer patients
    Won Beom Jung
    Annals of Coloproctology.2024; 40(6): 527.     CrossRef
Technical Note
Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience
Michael Jones, Brendan Moran, Richard John Heald, John Bunni
Ann Coloproctol. 2024;40(1):82-85.   Published online February 26, 2024
DOI: https://doi.org/10.3393/ac.2023.00038.0005
  • 3,974 View
  • 213 Download
  • 1 Citations
AbstractAbstract PDF
Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Citations

Citations to this article as recorded by  
  • Techniques in coloproctology – controversies in coloproctology resection: rectopexy is an underutilised procedure in the management of both symptomatic high-grade internal and external rectal prolapse
    J. Bunni, E. D. Courtney
    Techniques in Coloproctology.2026;[Epub]     CrossRef
Original Articles
Colorectal cancer
Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea
Hyeon Kyeong Kim, Ho Seung Kim, Gyoung Tae Noh, Jin Hoon Nam, Soon Sup Chung, Kwang Ho Kim, Ryung-Ah Lee
Ann Coloproctol. 2023;39(6):493-501.   Published online December 28, 2023
DOI: https://doi.org/10.3393/ac.2023.00437.0062
  • 4,346 View
  • 109 Download
  • 1 Web of Science
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary Material
Purpose
Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes.
Methods
Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed.
Results
In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142).
Conclusion
During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.
Stoma
Protective loop ileostomy or colostomy? A risk evaluation of all common complications
Yi-Wen Yang, Sheng-Chieh Huang, Hou-Hsuan Cheng, Shih-Ching Chang, Jeng-Kai Jiang, Huann-Sheng Wang, Chun-Chi Lin, Hung-Hsin Lin, Yuan-Tzu Lan
Ann Coloproctol. 2024;40(6):580-587.   Published online January 27, 2023
DOI: https://doi.org/10.3393/ac.2022.00710.0101
  • 9,302 View
  • 283 Download
  • 5 Web of Science
  • 6 Citations
AbstractAbstract PDF
Purpose
Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice.
Methods
Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared.
Results
There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. For stoma retraction, the multivariate analysis revealed that female (odds ratio [OR], 4.00; 95% confidence interval [CI], 2.13–7.69; P<0.001) and long diversion duration (≥4 months; OR, 2.33; 95% CI, 1.22–4.43; P=0.010) were independent risk factors, but ileostomy was an independent favorable factor (OR, 0.40; 95% CI, 0.22–0.72; P=0.003). The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542).
Conclusion
We suggest avoiding colostomy in patients who are female and potential prolonged diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

Citations

Citations to this article as recorded by  
  • Gut microbiome and plasma metabolome alterations in ileostomy and after closure of ileostomy
    Liang Xu, Xiaolong Li, Lang Chen, Haitao Ma, Ying Wang, Wenwen Liu, Anyan Liao, Liang Tan, Xiao Gao, Weidong Xiao, Hua Yang, Guangyan Ji, Yuan Qiu, Wei-Hua Chen, Qin Liu, Song Liu, Yang Yang
    Microbiology Spectrum.2025;[Epub]     CrossRef
  • Effect of one-stitch method of temporary ileostomy on the surgical outcomes and complications after laparoscopic low anterior resection in rectal cancer patients: a propensity score matching analysis
    Xin-Peng Shu, Jia-Liang Wang, Zi-Wei Li, Fei Liu, Xu-Rui Liu, Lian-Shuo Li, Yue Tong, Xiao-Yu Liu, Chun-Yi Wang, Yong Cheng, Dong Peng
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • The Differences in Postoperative Nursing Between Temporary Ileostomy and Temporary Colostomy: A Retrospective Cohort Study
    Mei Wang, Lihong Dai, Xia Fang, Yan Zheng, Yuanhao Shen, Yang Yu
    Nursing Open.2025;[Epub]     CrossRef
  • Uso de ileostomía derivativa en cáncer de ovario. Revisión de la literatura
    Franco Rafael Ruiz-Echeverría, Pedro Hernando Calderón-Quiroz, Juliana Rendón-Hernández
    Revista Colombiana de Cirugía.2024;[Epub]     CrossRef
  • Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer
    Shilai Yang, Gang Tang, Yudi Zhang, Zhengqiang Wei, Donglin Du
    International Journal of Colorectal Disease.2024;[Epub]     CrossRef
  • The Role of Colon in Isolated Intestinal Transplantation: Description of 4 Cases
    Pierpaolo Di Cocco, Giulia Bencini, Alessandro Martinino, Egor Petrochenkov, Stepan Akshelyan, Kentaro Yoshikawa, Mario Spaggiari, Jorge Almario-Alvarez, Ivo Tzvetanov, Enrico Benedetti, Gaetano Gallo
    International Journal of Surgical Oncology.2024;[Epub]     CrossRef
Anorectal benign disease
The importance of compression time in stapled hemorrhoidopexy: is patience a virtue?
Byung Eun Yoo, Wook Ho Kang, Yong Teak Ko, Young Chan Lee, Cheong Ho Lim
Ann Coloproctol. 2024;40(2):176-181.   Published online December 20, 2022
DOI: https://doi.org/10.3393/ac.2022.00556.0079
  • 3,854 View
  • 148 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
Purpose
The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.
Methods
This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grades III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.
Results
A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).
Conclusion
Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by  
  • Latest Research Trends on the Management of Hemorrhoids
    Sung Il Kang
    Journal of the Anus, Rectum and Colon.2025; 9(2): 179.     CrossRef
Stoma
Benefits and risks of diverting stoma creation during rectal cancer surgery
Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki
Ann Coloproctol. 2024;40(5):467-473.   Published online December 5, 2022
DOI: https://doi.org/10.3393/ac.2022.00353.0050
  • 5,593 View
  • 121 Download
  • 8 Web of Science
  • 8 Citations
AbstractAbstract PDF
Purpose
A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared.
Results
The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group.
Conclusion
Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

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    Hirotaka Momose, Makoto Takahashi, Masaya Kawai, Kiichi Sugimoto, Hiromitsu Takahashi, Shunsuke Motegi, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shun Ishiyama, Yuichi Tomiki, Kazuhiro Sakamoto
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  • Prevalence and pooled risk factors of stoma outlet obstruction after colorectal surgery with diverting ileostomy: a systematic review and meta-analysis
    Jian-xin Gan, Hai-peng Liu, Kang Chen
    International Journal of Colorectal Disease.2025;[Epub]     CrossRef
  • A multicentre prospective study of anal function after laparoscopic ultra‐low rectal cancer surgery using a mixed‐effects model
    Makoto Takahashi, Kazuhiro Sakamoto, Yuichiro Tsukada, Shingo Kawano, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshi
    Colorectal Disease.2025;[Epub]     CrossRef
  • The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
    Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
    Journal of Personalized Medicine.2024; 14(1): 121.     CrossRef
  • Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multicentre retrospective study
    Scott MacDonald, Li‐Siang Wong, Hwei Jene Ng, Claire Hastings, Immogen Ross, Tara Quasim, Susan Moug
    Colorectal Disease.2024; 26(5): 994.     CrossRef
  • Nomogram for predicting the probability of rectal anastomotic re-leakage after stoma closure: a retrospective study
    Yuegang Li, Gang Hu, Jinzhu Zhang, Wenlong Qiu, Shiwen Mei, Xishan Wang, Jianqiang Tang
    BMC Cancer.2024;[Epub]     CrossRef
  • Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
    Gyung Mo Son
    Annals of Coloproctology.2024; 40(5): 415.     CrossRef
  • Effect of intraoperative anastomotic reinforcement suture on the prevention of anastomotic leakage of double-stapling anastomosis for laparoscopic rectal cancer: a systematic review and meta-analysis
    Chaoyang Wang, Xiaolong Li, Hao Lin, Jiahua Ju, Haibao Zhang, Yongjiang Yu
    Langenbeck's Archives of Surgery.2023;[Epub]     CrossRef
Review
Benign diesease & IBD,Rare disease & stoma
Prolapse of intestinal stoma
Kotaro Maeda
Ann Coloproctol. 2022;38(5):335-342.   Published online October 28, 2022
DOI: https://doi.org/10.3393/ac.2022.00465.0066
  • 10,787 View
  • 307 Download
  • 8 Web of Science
  • 11 Citations
AbstractAbstract PDF
Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

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  • Comprehensive nursing management for an older patient with diarrhoea and risk of dehydration
    Tiago Horta Reis da Silva
    Gastrointestinal Nursing.2025; 23(2): 89.     CrossRef
  • Incarcerated trans-stomal herniation resembling a stomal prolapse – a case report
    N Shaikh, RV Blanco, M Vente, R Ebrahim
    South African Journal of Surgery.2025; 63(1): 31.     CrossRef
  • Non-Operative Considerations in Relation to Parastomal Hernia
    Z. Malaibari, M. W. Christoffersen, M. Krogsgaard, N. A. Henriksen, K. Andresen, F. Helgstrand, R. Aldemyati, J. Rosenberg
    Journal of Abdominal Wall Surgery.2025;[Epub]     CrossRef
  • Stoma Complications
    Aaron J. Dawes, John V. Gahagan
    Clinics in Colon and Rectal Surgery.2024; 37(06): 387.     CrossRef
  • Management of the Difficult Stoma
    Clay Merritt, Paola Maldonado
    Surgical Clinics of North America.2024; 104(3): 579.     CrossRef
  • Ileostomy: Early and Late Complications
    Francisco Duarte Cerqueira Gomes Girão Santos, Laura Elisabete Ribeiro Barbosa, João Paulo Meireles de Araújo Teixeira
    Journal of Coloproctology.2024; 44(01): e80.     CrossRef
  • Risk factors for stoma prolapse after laparoscopic loop colostomy
    Yusuke Takashima, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka, Chikara Maeda, Shunsuke Kasai, Yusuke Tanaka
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  • Linear stapler refashioning technique for irreducible stomal prolapse—A video vignette
    Rajesh S. Shinde, Deep Mashru, Murali V
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  • Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study
    Takuya Yano, Masanori Yoshimitsu, Chiyomi Ishibashi, Atsuko Nishibara, Kanyu Nakano, Hitoshi Idani, Masazumi Okajima
    Journal of the Anus, Rectum and Colon.2023; 7(4): 258.     CrossRef
  • Intestinal Stomas—Current Practice and Challenges: An Institutional Review
    Isam Mazin Juma, Tabarak Qassim, Mirza Faraz Saeed, Aya Qassim, Sana Al-Rawi, Sabrina Al-Salmi, Mustafa Thaer Salman, Ibrahim Al-Saadi, Abdulaziz Almutawea, Eman Aljahmi, Mohamed Khalid Fadhul
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Original Articles
Surgical management of retrorectal tumors: a single-center 12 years’ experience
Amirhosein Naseri, Behnam Behboudi, Ali Faryabi, Seyed Mohsen Ahmadi Tafti, Amirsina Sharifi, Mohammad Reza Keramati, Mohammad Sadegh Fazeli, Amir Keshvari, Mehdi Zeinalizadeh, Reza Akbari Asbagh, Niloufar Hoorshad, Alireza Kazemeini
Received April 26, 2022  Accepted June 23, 2022  Published online October 11, 2022  
DOI: https://doi.org/10.3393/ac.2022.00297.0042    [Epub ahead of print]
  • 6,153 View
  • 127 Download
  • 2 Citations
AbstractAbstract PDF
Purpose
Retrorectal tumors (RTs) are rare tumors that arise in the space between the mesorectum and the pelvic wall and often originate in embryonic tissues. The primary treatment for these tumors is complete excision surgery, and choosing the best surgical approach is very important.
Methods
In this study, we retrospectively collected the data of 15 patients with RTs who underwent surgery in Imam Khomeini Hospital (Tehran, Iran) for 12 years to share our experiences of patients’ treatment and compare different surgical approaches.
Results
A total of 5 tumors were malignant, 10 were benign, and most of the tumors were congenital. Malignant tumors were seen in older patients. Three surgical procedures were performed on patients. Three patients underwent abdominal approach surgery, and 8 patients underwent posterior surgery. A combined surgical approach was performed on 4 patients. Two patients underwent laparoscopic surgery. The abdominal approach had the least long-term complication, and the combined approach had the most complications; laparoscopic surgery reduced the length of hospital stay and complications after surgery.
Conclusion
A multidisciplinary team collaboration using magnetic resonance imaging details is necessary to determine a surgical treatment approach. It could reduce the need for a preoperative biopsy. However, every approach has its advantages and disadvantages, and individualized treatment is the key.

Citations

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  • Tailgut Cyst—Gynecologist’s Pitfall: Literature Review and Case Report
    Andrei Mihai Malutan, Viorela-Elena Suciu, Florin Laurentiu Ignat, Doru Diculescu, Razvan Ciortea, Emil-Claudiu Boțan, Carmen Elena Bucuri, Maria Patricia Roman, Ionel Nati, Cristina Ormindean, Dan Mihu
    Diagnostics.2025; 15(1): 108.     CrossRef
  • Presacral Neuroendocrine Tumor Treated With a Combined Robotic Dissection and Kraske Procedure: A Case Report
    Cesar A Barros de Sousa, Steven J Capece, Mikhail I Rakhmanine, John S Park
    Cureus.2025;[Epub]     CrossRef
Malignant disease,Colorectal cancer,Complication,Biomarker & risk factor
Presepsin (soluble CD14 subtype) as a risk factor for the development of infectious and inflammatory complications in operated colorectal cancer patients
Kayrat Shakeyev, Yermek Turgunov, Alina Ogizbayeva, Olga Avdiyenko, Miras Mugazov, Sofiko Grigolashvili, Ilya Azizov
Ann Coloproctol. 2022;38(6):442-448.   Published online April 4, 2022
DOI: https://doi.org/10.3393/ac.2022.00115.0016
  • 5,182 View
  • 139 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF
Purpose
In this pilot study the dynamic of presepsin (soluble CD14 subtype, sCD14-ST) in blood serum was assessed as a possible risk factor for the development of systemic inflammatory response syndrome (SIRS) and infectious and inflammatory complications in operated colorectal cancer patients.
Methods
To determine sCD14-ST by enzyme-linked immunosorbent assay method venous blood was taken 1 hour before surgery and 72 hours after it (3rd day). The presence of SIRS and organ dysfunctions (ODs) according to the Sequential Organ Failure Assessment scale were assessed.
Results
Thiry-six patients with colorectal cancer were enrolled in the study. sCD14-ST level before surgery was 269.8±103.1 pg/mL (interquartile range [IQR], 196.7–327.1 pg/mL). Despite the presepsin level on the 3rd day being higher (291.1±136.5 pg/mL; IQR, 181.2–395.5 pg/mL), there was no statistical significance in its dynamics (P=0.437). sCD14-ST value both before surgery and on the 3rd day after it was significantly higher in patients with bowel obstruction (P=0.038 and P=0.007). sCD14-ST level before surgery above 330 pg/mL showed an increase in the probability of complications, SIRS, and OD (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.1–28.2; OR, 7.0; 95% CI, 1.3–36.7; and OR, 13.0; 95% CI, 1.1–147.8; respectively). Patients with OD had higher levels on the 3rd day after surgery (P=0.049).
Conclusion
sCD14-ST level in operated colorectal cancer patients was much higher if they were admitted with complication like bowel obstruction. Higher preoperative levels of sCD14-ST increase the probability of postoperative complications, SIRS, and OD. Therefore, further studies with large sample size are needed.

Citations

Citations to this article as recorded by  
  • Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
    Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
    Cancers.2023; 15(20): 5098.     CrossRef
Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Ann Coloproctol. 2023;39(1):50-58.   Published online November 18, 2021
DOI: https://doi.org/10.3393/ac.2021.00773.0110
  • 6,813 View
  • 171 Download
  • 3 Web of Science
  • 4 Citations
AbstractAbstract PDFSupplementary Material
Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

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  • Association between preoperative neutrophil-to-lymphocyte ratio and length of stay in pediatric patients undergoing laparoscopic appendectomy: a retrospective cohort study
    Ming Liu, Yunpeng Gou, Ping Yang
    BMC Pediatrics.2025;[Epub]     CrossRef
  • Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
    Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Umar Umar
    DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 18.     CrossRef
  • Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
    Ming Liu, Ping Yang, Yunpeng Gou
    Frontiers in Pediatrics.2024;[Epub]     CrossRef
  • Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
    Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
    Frontiers in Pediatrics.2024;[Epub]     CrossRef
Benign proctology,Complication,Biomarker & risk factor
Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study
Sarah Taieb, Patrick Atienza, Jean-David Zeitoun, Milad Taouk, Josée Bourguignon, Christian Thomas, Nabila Rabahi, Saliha Dahlouk, Anne-Carole Lesage, David Lobo, Isabelle Etienney
Ann Coloproctol. 2022;38(5):370-375.   Published online July 27, 2021
DOI: https://doi.org/10.3393/ac.2021.00122.0017
  • 6,326 View
  • 167 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract PDF
Purpose
The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment.
Methods
All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery.
Results
Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding.
Conclusion
Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

Citations

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  • Efficacy of Endoscopic Evaluation and Hemostatic Intervention for Post-hemorrhoidectomy Bleeding
    Katsuhisa Ohashi, Katsuhide Ohashi, Akinori Sasaki, Kazuyoshi Ota, Kazutomo Kitagawa
    Journal of the Anus, Rectum and Colon.2025; 9(1): 162.     CrossRef
  • Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
    Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
    Journal of Clinical Medicine.2023; 12(15): 5119.     CrossRef
  • Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study
    Francesco Pata, Luigi M. Bracchitta, Bruno Nardo, Gaetano Gallo, Giancarlo D’Ambrosio, Salvatore Bracchitta
    Frontiers in Surgery.2023;[Epub]     CrossRef
  • Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects
    Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysz
    Polish Journal of Surgery.2023; 95(5): 14.     CrossRef
Benign proctology,Postoperative outcome & ERAS
Is There a Relationship Between Stool Consistency and Pain at First Defecation After Limited Half Hemorrhoidectomy? A Pilot Study
Takaaki Yano
Ann Coloproctol. 2021;37(5):306-310.   Published online September 18, 2020
DOI: https://doi.org/10.3393/ac.2020.08.10
  • 7,273 View
  • 91 Download
  • 2 Web of Science
  • 2 Citations
AbstractAbstract PDF
Purpose
While the first defecation pain is a problem following hemorrhoidectomy, it is unknown whether the stool consistency has an influence on pain. This pilot study aimed to investigate whether the intensity of defecation pain varied according to stool consistency.
Methods
This prospective cohort study evaluated patients who underwent hemorrhoidectomy in combination with injection sclerotherapy for grade III or IV hemorrhoids. The pain intensity and stool form during the first postoperative defecation were self-recorded by the patients using a visual analogue scale (score of 0–10) and Bristol Stool Form Scale, respectively. The patients were classified into 3 groups according to stool consistency, and the intensity of defecation pain was compared among the groups using analysis of variance.
Results
A total of 61 patients were eligible for this study and were classified into the hard stool (n=15), normal stool (n=21), and soft stool groups (n=25). No significant intergroup differences were identified in the intensity of pain at defecation (P=0.29).
Conclusion
This pilot study demonstrated that there were no clear differences in pain intensity during the first defecation after surgery among the 3 groups with different levels of stool consistency.

Citations

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  • Pain at the First Post-hemorrhoidectomy Defecation Is Associated with Stool Form
    Takaaki Yano, Daijiro Kabata, Seiichi Kimura
    Journal of the Anus, Rectum and Colon.2022; 6(3): 168.     CrossRef
  • Treatment of Hemorrhoid in Unusual Condition-Pregnancy
    Hyo Seon Ryu
    The Ewha Medical Journal.2022;[Epub]     CrossRef
Review
Malignant disease
How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review
Mohamed Ali Chaouch, Tarek Kellil, Camillia Jeddi, Ahmed Saidani, Faouzi Chebbi, Khadija Zouari
Ann Coloproctol. 2020;36(4):213-222.   Published online August 31, 2020
DOI: https://doi.org/10.3393/ac.2020.05.14.2
  • 11,440 View
  • 371 Download
  • 25 Web of Science
  • 31 Citations
AbstractAbstract PDF
Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

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    Journal of Gastrointestinal Cancer.2025;[Epub]     CrossRef
  • Robotic versus laparoscopic right colectomy with complete mesocolon excision for right-sided colon cancer: a systematic review and meta-analysis
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    Pin-Yang Huang, Meng-Che Tsai, Kee-Thai Kiu, Min-Hsuan Yen, Tung-Cheng Chang
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    Simon Stoerzer, Markus Winny, Oliver Beetz, Severin Jacobi, Juergen Klempnauer, Daniel Poehnert
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    A. S. Gorbunova, D. V. Kuzmichev, Z. Z. Mamedli, A. A. Aniskin, A. V. Polinovsky, D. V. Aleksantsev, A. V. Korshak
    Pelvic Surgery and Oncology.2023; 13(2): 54.     CrossRef
  • How to prevent postoperative ileus in colorectal surgery? a systematic review
    Mohamed Ali Chaouch, Mohamed Aziz Daghmouri, Abdallah Lahdheri, Mohammad Iqbal Hussain, Salsabil Nasri, Amine Gouader, Faouzi Noomen, Hani Oweira
    Annals of Medicine & Surgery.2023; 85(9): 4501.     CrossRef
  • Possible role of features of the intestinal microbiome in patients with colorectal cancer as a cause of anastomotic leak
    P. V. Kosareva, R. A. Konev, A. P. Godovalov, L. V. Sivakova, E. I. Samodelkin
    Bulletin of Siberian Medicine.2023; 22(3): 120.     CrossRef
  • Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
    Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
    Annals of Surgical Treatment and Research.2023; 105(5): 252.     CrossRef
  • Pelvic exenteration for gynecologic malignancies: The experience of a tertiary center from Greece
    Dimitrios Haidopoulos, Vasilios Pergialiotis, Kyveli Aggelou, Nikolaos Thomakos, Nikolaos Alexakis, Emmanouil Stamatakis, Alexandros Rodolakis
    Surgical Oncology.2022; 40: 101702.     CrossRef
  • Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review
    Zheng'ao Xu, Rui Zong, Yu Zhang, Jie Chen, Weidong Liu
    International Journal of Surgery.2022; 100: 106592.     CrossRef
  • Immediate results of rectal resections for cancer in depending on the restoration of the integrity of the pelvic peritoneal floor: retrospective study
    M.  S.  Lebedko, S.  S.  Gordeev, S.   G. Gaydarov, Z.   Z. Mamedli, V.  Yu.  Kosyrev, A.  A.  Aniskin, S.  O.  Kochkina
    Pelvic Surgery and Oncology.2022; 11(3-4): 23.     CrossRef
  • Laparoscopic PME with colorectal anstomosis with transanal control – A video vignette
    Francesco Crafa, Serafino Vanella, Adele Noviello, Giuseppe Longo, Francesco Longo
    Colorectal Disease.2022; 24(7): 887.     CrossRef
  • Risk factors for colorectal anastomotic leakage and preventive measures: a retrospective cohort study
    M. S. Lebedko, S. S. Gordeev, E. V. Alieva, M. D. Sivolob, Z. Z. Mamedli, S. G. Gaydarov, V. Yu. Kosyrev
    Pelvic Surgery and Oncology.2022; 12(2): 17.     CrossRef
  • Surgical safety in the COVID-19 era: present and future considerations
    Young Il Kim, In Ja Park
    Annals of Surgical Treatment and Research.2022; 102(6): 295.     CrossRef
  • Colonic splenic flexure resection with an end‐to‐end intracorporeal anastomosis using a circular stapler – A video vignette
    Roberto Secchi del Rio, Jose Ignacio Ortiz de Elguea‐Lizarraga, Paulina Muñoz‐Ledo Ceron, Eli Castillo, Victor Gerardo Pena, Diego Marines Copado
    Colorectal Disease.2022; 24(11): 1447.     CrossRef
  • Как предотвратить несостоятельность кишечных анастомозов «высокого риска»
    Эльчин Агаев, Зульфия Исмайылова, Мушвиг Гасанов
    InterConf.2022; (26(129)): 283.     CrossRef
  • Safe Anastomoses without Ostomies in Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy: Technical Considerations and Modifications
    Pedro Barrios, Isabel Ramos, Oriol Crusellas, Domenico Sabia, Sergio Mompart, Lana Bijelic
    Annals of Surgical Oncology.2021; 28(12): 7784.     CrossRef
  • Early salvage total mesorectal excision (sTME) after organ preservation failure in rectal cancer does not worsen postoperative outcomes compared to primary TME: systematic review and meta-analysis
    Mohamed Ali Chaouch, Jim Khan, Talvinder Singh Gill, Arianeb Mehrabi, Christoph Reissfelder, Nuh Rahberi, Hazem Elhadedy, Hani Oweira
    International Journal of Colorectal Disease.2021; 36(11): 2375.     CrossRef
  • Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review
    Mohamed Aziz Daghmouri, Mohamed Ali Chaouch, Maroua Oueslati, Lotfi Rebai, Hani Oweira
    Annals of Medicine and Surgery.2021; 72: 103124.     CrossRef
Case Report
Benign GI diease,Complication
Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report
Yujin Lee, Byung-Noe Bae
Ann Coloproctol. 2021;37(Suppl 1):S28-S33.   Published online May 15, 2020
DOI: https://doi.org/10.3393/ac.2020.04.19
  • 6,707 View
  • 91 Download
  • 7 Web of Science
  • 8 Citations
AbstractAbstract PDF
Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.

Citations

Citations to this article as recorded by  
  • Clinical Insights and Brief Research Report on Mesh Erosion Into Bowel Following Hernia Repair: A Single-Centre Series of Eight Cases
    Vidit Dholakia, Suvendu Sekhar Jena, Amitabh Yadav, Samiran Nundy
    Journal of Abdominal Wall Surgery.2025;[Epub]     CrossRef
  • An unlikely path: hernia mesh migration
    Ana Rita Ferreira, Bárbara Castro, Catarina Ortigosa, Sílvia Costa, Bela Pereira, Manuel Oliveira
    European Surgery.2024; 56(1-2): 39.     CrossRef
  • Spontaneous Migration of Intraperitoneal Mesh into Rectum following Ventral Hernia Repair
    Aruna R. Patil, Ravishankar Bhat, Madhusudhana Basavarajappa
    Journal of Gastrointestinal and Abdominal Radiology.2023; 06(01): 053.     CrossRef
  • Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair
    Yuan Zhang, Jun Peng, Xingui Wu, Dingjiao Zhu, Yaozhi Chen
    ANZ Journal of Surgery.2023; 93(4): 1042.     CrossRef
  • Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair
    Michael L. Lorentziadis, Moustafa Mahmoud Nafady Hego, Fatma Al Nasser
    International Journal of Abdominal Wall and Hernia Surgery.2023; 6(1): 48.     CrossRef
  • Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis
    Théophile Delorme, Jonathan Cottenet, Fawaz Abo-Alhassan, Alain Bernard, Pablo Ortega-Deballon, Catherine Quantin
    Hernia.2023; 28(2): 419.     CrossRef
  • A Cecal Surprise
    Muhammad B. Hammami, Jean-Pierre Raufman
    Gastroenterology.2022; 162(7): 1847.     CrossRef
  • Mesh on the move: a case report of total transmural surgical mesh migration causing bowel obstruction
    Joseph Ryan Leach, Bryan Manoukian, Lygia Stewart
    Clinical Journal of Gastroenterology.2021; 14(1): 136.     CrossRef
Original Article
Benign proctology,Functional outcome
The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence
Ilia Pinsk, David Czeiger, Daria Lichtman, Avraham Reshef
Ann Coloproctol. 2021;37(2):115-119.   Published online March 16, 2020
DOI: https://doi.org/10.3393/ac.2020.03.16
  • 10,034 View
  • 216 Download
  • 8 Web of Science
  • 10 Citations
AbstractAbstract PDF
Purpose
For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long-term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function.
Methods
The study was approved by the local Institutional Review Board and given a waiver of written consent. A phone call survey was undertaken among a group of consecutive patients who had an anal dilatation by standardized technique for chronic anal fissure for the period between 2000 and 2016. The survey included medical, obstetrical and surgical-related data, Wexner fecal incontinence score, recurrence of the anal fissure, and the need for additional medical intervention. Five hundred 48 patients were identified after limitations of age, concomitant pathology, and procedures that were applied to the hospital computerized database. Eighty-five patients (group A) agreed to participate in the survey and 463 patients did not.
Results
There were no differences between groups in demographic information and medical records data; therefore, group A may well represent a satisfactory sample of the whole group. The interval between the procedure and the survey was 6.8 ± 2.7 years. The Wexner incontinence score was 0 in 94% of patients.
Conclusion
Anal dilatation, performed in a systematic and standardized way, has a successful outcome with no complications and has no clear long-term negative impact on anal sphincter function.

Citations

Citations to this article as recorded by  
  • Early Outcomes of Hirschsprung's Disease after Definitive Surgery: A Ten-year Experience
    Muntadhar Muhammad Isa, Maimun Syukri, Muchlisin Zainal Abidin, Dian Adi Syahputra, Teuku Yusriadi, Yumna Muzakkir, Siti Magfirah, Gunadi Gunadi
    Current Pediatric Reviews.2025; 21(4): 384.     CrossRef
  • Сontrolled circular dilatation and lateral subcutaneous sphincterotomy for chronic anal fissures associated with hemorrhoids III-IV
    Z. Z. Kamaeva, A. Yu. Titov, R. Yu. Khryukin, I. S. Anosov, Yu. A. Shelygin
    Koloproktologia.2024; 23(1): 42.     CrossRef
  • Modern trends and priority in treatment of chronic anal fissure
    S. A. Aliev, E. S. Aliev
    Grekov's Bulletin of Surgery.2024; 183(4): 77.     CrossRef
  • New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
    Aswini Kumar Pujahari
    Indian Journal of Surgery.2023; 85(3): 585.     CrossRef
  • 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
    Annals of Coloproctology.2022; 38(3): 183.     CrossRef
  • The role of dilatation methods and lateral subcutaneous sphincterotomy in the internal anal sphincter spasm treatment (systematic literature review and meta-analysis)
    Z. Z. Kamaeva, A. Yu. Titov, A. A. Ponomarenko, R. Yu. Khrukin, I. S. Anosov, Yu. A. Shelygin
    Hirurg (Surgeon).2022; (4): 19.     CrossRef
  • Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
    Chungyeop Lee, Jong Lyul Lee
    The Ewha Medical Journal.2022;[Epub]     CrossRef
  • The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review
    Konstantinos Perivoliotis, Ioannis Baloyiannis, Dimitrios Ragias, Nikolaos Beis, Despoina Papageorgouli, Emmanouil Xydias, Konstantinos Tepetes
    International Journal of Colorectal Disease.2021; 36(11): 2337.     CrossRef
  • Anorectal emergencies: WSES-AAST guidelines
    Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
    World Journal of Emergency Surgery.2021;[Epub]     CrossRef
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    Fatma Al-thoubaity
    Annals of Medicine and Surgery.2020; 57: 291.     CrossRef
Case Report
Benign GI diease,Benign diesease & IBD
Enterovesical Fistula From Meckel Diverticulum
Seung-Rim Han, Hyung-Jin Kim, Ri Na Yoo, Suk Hyun Shin, Gun Kim, Hyeon Min Cho, Seung-Ju Lee, Hyang-Im Lee
Ann Coloproctol. 2021;37(Suppl 1):S1-S3.   Published online March 16, 2020
DOI: https://doi.org/10.3393/ac.2019.01.18
  • 5,592 View
  • 102 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

Citations

Citations to this article as recorded by  
  • Management of vesicoenteric fistulas arising from perforated Meckel’s diverticulum: a report of a case and review of the literature
    Dimitrios Diamantidis, Nikolaos Papatheodorou, Panagiotis Kostoglou, Georgios Tsakaldimis, Sotirios Botaitis
    Oxford Medical Case Reports.2024;[Epub]     CrossRef
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    Dorota Skrajnowska, Barbara Bobrowska-Korczak
    Nutrients.2024; 16(18): 3141.     CrossRef
  • A case report of a ruptured Meckel's diverticulum with ectopic gastric and pancreatic tissue with negative computed tomography
    Marcos Rosado, Thomas Serena, John Pui, John Parmely
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Original Articles
Malignant disease, Functional outcomes
Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings
Seng-Muk Kang, Jung Rae Cho, Heung-Kwon Oh, Eun-Ju Lee, Min Hyun Kim, Duck-Woo Kim, Sung-Bum Kang
Ann Coloproctol. 2020;36(1):17-21.   Published online February 29, 2020
DOI: https://doi.org/10.3393/ac.2019.04.25
  • 5,317 View
  • 80 Download
  • 1 Web of Science
  • 2 Citations
AbstractAbstract PDF
Purpose
Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy.
Methods
Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed.
Results
Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality.
Conclusion
Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.

Citations

Citations to this article as recorded by  
  • Single port–assisted diverting ileostomy formation for anastomotic leakage after low anterior resection
    Kyong-Min Kang, Heung-Kwon Oh, Hong-min Ahn, Hye-Rim Shin, Min-Hyeong Jo, Mi-Jeong Choi, Duck-Woo Kim, Sung-Bum Kang
    Journal of Minimally Invasive Surgery.2025; 28(1): 47.     CrossRef
  • Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
    Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
    Journal of Minimally Invasive Surgery.2024; 27(1): 14.     CrossRef
Short-term Outcomes After Upfront Chemotherapy Followed by Curative Surgery in Metastatic Colon Cancer: A Comparison With Upfront Surgery Patients
Myung Hyun Han, Youn Young Park, Shiva Pratap, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim
Ann Coloproctol. 2019;35(6):327-334.   Published online December 31, 2019
DOI: https://doi.org/10.3393/ac.2019.03.04.1
  • 4,677 View
  • 71 Download
  • 2 Web of Science
  • 2 Citations
AbstractAbstract PDF
Purpose
Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.
Methods
Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.
Results
There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).
Conclusion
There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.

Citations

Citations to this article as recorded by  
  • Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases
    Joy Z. Done, Angelos Papanikolaou, Miloslawa Stem, Shannon N. Radomski, Sophia Y. Chen, Chady Atallah, Jonathan E. Efron, Bashar Safar
    Journal of Gastrointestinal Surgery.2023; 27(11): 2380.     CrossRef
  • Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
    Young Jin Kim, Chang Hyun Kim
    Annals of Coloproctology.2021; 37(6): 425.     CrossRef
Malignant disease, Prognosis and adjuvant therapy
Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery
Chang Kyu Oh, Jung Wook Huh, You Jin Lee, Moon Suk Choi, Dae Hee Pyo, Sung Chul Lee, Seong Mun Park, Jung Kyong Shin, Yoon Ah Park, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee
Ann Coloproctol. 2020;36(4):273-280.   Published online November 13, 2019
DOI: https://doi.org/10.3393/ac.2019.10.15
  • 6,813 View
  • 171 Download
  • 23 Web of Science
  • 23 Citations
AbstractAbstract PDF
Purpose
The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.
Methods
From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.
Results
Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).
Conclusion
Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

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  • Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study
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  • Organ/space surgical site infection and long-term outcomes of rectal cancer surgery: retrospective population-based cohort study
    Carlota Matallana, Paula Manchon-Walsh, Eloy Espín, Marta Pascual, Sebastiano Biondo, Marta Jiménez-Toscano, Josep Maria Borràs, Josep M Badia, Enric Limón, Luisa Aliste, Rebeca Font, Miguel Pera
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    Misha A. T. Sier, Anke H. C. Gielen, Thaís T. T. Tweed, Noémi C. van Nie, Tim Lubbers, Jan H. M. B. Stoot
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    Qiang Li, Yingjun Lu
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    Anjana Wajekar, Sohan Lal Solanki, Juan Cata, Vijaya Gottumukkala
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    Jae Eun Lee, Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
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    Jing-jing Li, Zhi-bo Zhang, Shi-yun Xu, Cheng-ren Zhang, Xiong-fei Yang, Yao-xing Duan
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    Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
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  • A propensity score-matched analysis of advanced energy devices and conventional monopolar device for colorectal cancer surgery: comparison of clinical and oncologic outcomes
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Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients
Vincenzo Consalvo, Francesca D’Auria, Vincenzo Salsano
Ann Coloproctol. 2019;35(3):118-122.   Published online May 31, 2019
DOI: https://doi.org/10.3393/ac.2017.09.04
  • 7,267 View
  • 176 Download
  • 5 Web of Science
  • 7 Citations
AbstractAbstract PDF
Purpose
Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids.
Methods
A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences.
Results
Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009).
Conclusion
The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.

Citations

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    Qing Long, Yong Wen, Jun Li
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    Akiharu Kurihara, Yu Yoshino, Yu Sakai, Yasuyuki Miura, Satoru Kagami, Tomoaki Kaneko, Mitsunori Ushigome, Hiroyuki Shiokawa, Hironori Kaneko, Kimihiko Funahashi
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Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study
Mina Alvandipour, Mohammad Sadegh Zamani, Mojtaba Ghorbani, Jamshid Yazdani Charati, Mohammad Yasin Karami
Ann Coloproctol. 2019;35(6):313-318.   Published online May 22, 2019
DOI: https://doi.org/10.3393/ac.2018.09.27
  • 18,551 View
  • 267 Download
  • 15 Web of Science
  • 24 Citations
AbstractAbstract PDF
Purpose
Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.
Methods
A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.
Results
Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.
Conclusion
Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

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Postoperative Outcomes of Stoma Takedown: Results of Long-term Follow-up
Bomina Paik, Chang Woo Kim, Sun Jin Park, Kil Yeon Lee, Suk-Hwan Lee
Ann Coloproctol. 2018;34(5):266-270.   Published online October 10, 2018
DOI: https://doi.org/10.3393/ac.2017.12.13
  • 6,940 View
  • 166 Download
  • 6 Web of Science
  • 8 Citations
AbstractAbstract PDF
Purpose
Stoma takedown is a frequently performed procedure with considerable postoperative morbidities. Various skin closure techniques have been introduced to reduce surgical site infections. The aim of this study was to assess postoperative outcomes after stoma takedown during a long-term follow-up period.
Methods
Between October 2006 and December 2015, 84 consecutive patients underwent a colostomy or ileostomy takedown at our institution. Baseline characteristics and perioperative outcomes were analyzed through retrospective reviews of medical records.
Results
The proportion of male patients was 60.7%, and the mean age of the patients was 59.0 years. The overall complication rate was 28.6%, with the most common complication being prolonged ileus, followed by incisional hernia, anastomotic leakage, surgical site infection, anastomotic stenosis, and entero-cutaneous fistula. The mean follow-up period was 64.3 months. The univariate analysis revealed no risk factors related to overall complications or prolonged ileus.
Conclusion
The postoperative clinical course and long-term outcomes following stoma takedown were acceptable. Stoma takedown is a procedure that can be performed safely.

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Case Report
Rhabdomyolysis Following Colonoscopy: A Case Report
Jin Yong Jeong, Kap Tae Kim, Mi Jin Kim, Yea Jeong Kim
Ann Coloproctol. 2018;34(1):52-55.   Published online February 28, 2018
DOI: https://doi.org/10.3393/ac.2018.34.1.52
  • 6,296 View
  • 83 Download
  • 1 Web of Science
  • 1 Citations
AbstractAbstract PDF

We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.

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  • Rhabdomyolysis following colorectal endoscopic submucosal dissection: A case report
    Ying Chen, Wenxuan Zhang, Junqiang Cai, Min Zhong
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Original Articles
The First Year After Colorectal Surgery in the Elderly
Verena N.N. Kornmann, Jeroen L.A. van Vugt, Anke B. Smits, Bert van Ramshorst, Djamila Boerma
Ann Coloproctol. 2017;33(4):134-138.   Published online August 31, 2017
DOI: https://doi.org/10.3393/ac.2017.33.4.134
  • 5,952 View
  • 59 Download
  • 14 Web of Science
  • 14 Citations
AbstractAbstract PDF
Purpose

Surgery for colorectal malignancy is increasingly being performed in the elderly. Little is known about the impact of complications on late mortality. This study aimed to analyze whether a complicated postoperative course affects the 1-year survival in elderly patients.

Methods

All consecutive patients older than 75 years of age who underwent colorectal cancer surgery between January 2009 and April 2013 were included in this study. The main outcome was mortality at 1 year after surgery. Logistic regression analyses were performed to determine risk factors for a poor outcome (mortality) after survival of the early postoperative course of surgery at 1-year follow-up. Patients who died within 30 days postoperatively were excluded from analysis.

Results

The early mortality rate was 6.3% (n = 15), and 2 patients died during follow-up as a result of complications after a second surgery. A total of 223 patients survived the perioperative period and were included in this study. Twenty-two patients (9.9%) died during the first year of follow-up. Stage IV disease (P = 0.002), complications of primary surgery (P = 0.016), and comorbidity (P = 0.050) were risk factors for 1-year mortality. Intensive care unit stay, reoperation and readmission were not associated with a worse 1-year outcome.

Conclusion

Elderly patients with stage IV disease at the time of surgery, comorbidity, and postoperative complications are at risk for mortality during the first year after surgery. A patient-tailored approach with special attention to perioperative care should be considered in the elderly.

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    Hans B. Rahr, Susanna Streym, Charlotte G. Kryh-Jensen, Helene T. Hougaard, Anne S. Knudsen, Steffen H. Kristensen, Ejler Ejlersen
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    Nicola de'Angelis, Solafah Abdalla, Giorgio Bianchi, Riccardo Memeo, Cecile Charpy, Niccolo Petrucciani, Iradj Sobhani, Francesco Brunetti
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    Eiji Hidaka, Chiyo Maeda, Kenta Nakahara, Kunihiko Wakamura, Yasuhiro Ishiyama, Shoji Shimada, Junichi Seki, Yojiro Takano, Sonoko Oae, Yuta Enami, Naruhiko Sawada, Fumio Ishida, Shin-ei Kudo
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Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation
Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo
Ann Coloproctol. 2016;32(6):221-227.   Published online December 31, 2016
DOI: https://doi.org/10.3393/ac.2016.32.6.221
  • 14,566 View
  • 102 Download
  • 39 Web of Science
  • 40 Citations
AbstractAbstract PDF
Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

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Use of a Comprehensive Geriatric Assessment to Predict Short-Term Postoperative Outcome in Elderly Patients With Colorectal Cancer
Yoon Hyun Lee, Heung-Kwon Oh, Duck-Woo Kim, Myong Hoon Ihn, Jee Hyun Kim, Il Tae Son, Sung Il Kang, Gwang Il Kim, Soyeon Ahn, Sung-Bum Kang
Ann Coloproctol. 2016;32(5):161-169.   Published online October 31, 2016
DOI: https://doi.org/10.3393/ac.2016.32.5.161
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AbstractAbstract PDF
Purpose

This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer.

Methods

Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA.

Results

A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168–3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346–4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications.

Conclusion

A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial.

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Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer
Hyeon Yu, Yong-Geul Joh, Gyung-Mo Son, Hyun-Sung Kim, Hong-Jae Jo, Hae-Young Kim
Ann Coloproctol. 2016;32(1):20-26.   Published online February 29, 2016
DOI: https://doi.org/10.3393/ac.2016.32.1.20
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AbstractAbstract PDF
Purpose

The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection.

Methods

The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80).

Results

No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 ± 1.0 vs. 13.5 ± 1.2, respectively, P = 0.001).

Conclusion

Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.

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Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study
Hee Seok Moon, Sun Wook Park, Dong Hwan Kim, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong
Ann Coloproctol. 2014;30(4):182-185.   Published online August 26, 2014
DOI: https://doi.org/10.3393/ac.2014.30.4.182
  • 5,939 View
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  • 23 Citations
AbstractAbstract PDF
Purpose

A colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy.

Methods

This was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis.

Results

The average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12-1.27; P = 0.03).

Conclusion

The size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.

Citations

Citations to this article as recorded by  
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    Wei-Feng Li, Bing Lai, Li Lv, Xi-Qiu Yu, Jia-Le Fan, Zhi-Wei Zhou, Jing-Wen Xu, Ruo-Yu Gao, Ze-Ming Chen, Bi-Xia Xu
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Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods
Ji Hye Choi, Byeong Geon Jeon, Sang-Gi Choi, Eon Chul Han, Heon-Kyun Ha, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park
Ann Coloproctol. 2014;30(1):35-41.   Published online February 28, 2014
DOI: https://doi.org/10.3393/ac.2014.30.1.35
  • 10,609 View
  • 141 Download
  • 49 Web of Science
  • 49 Citations
AbstractAbstract PDF
Purpose

A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF.

Methods

The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed.

Results

The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion.

Conclusion

Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.

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Case Report
Acute Cholecystitis After a Colonoscopy
Tae Ik Park, Sang Yong Lee, Jun Hee Lee, Min Cheol Kim, Bong Gap Kim, Dong Hyuk Cha
Ann Coloproctol. 2013;29(5):213-215.   Published online October 31, 2013
DOI: https://doi.org/10.3393/ac.2013.29.5.213
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AbstractAbstract PDF

Acute cholecystitis after a colonoscopy is a rare event, and only eight documented cases are reported in the literature. A 35-year-old male underwent a screening colonoscopy. There was a 5-mm sessile polyp in the sigmoid colon, which was removed by using a hot snare polypectomy. Forty-eight hours after the colonoscopy, the patient visited our emergency department with epigastric pain and fever. Based on the clinical findings, laboratory data and radiologic imaging, our diagnosis was acute cholecystitis. Because no previous cases of this type have been reported to date in Korea, we publish the details of our patients who presented with a postcolonoscopy complication diagnosed as acute cholecystitis.

Citations

Citations to this article as recorded by  
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    Kimberley Maree Neubeck, Derek Mwagiru, Eric Frederick Boseto
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    Danial H Shaikh, Kishore Kumar, Harish Patel, Shehriyar Mehershanhi, Jasbir Makker
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    Cheol Yun Jeong, Sung Hoon Jung
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Original Articles
Incidence and Risk Factors of Parastomal Hernia
Yeun Ju Sohn, Sun Mi Moon, Ui Sup Shin, Sun Hee Jee
J Korean Soc Coloproctol. 2012;28(5):241-246.   Published online October 31, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.5.241
  • 7,973 View
  • 66 Download
  • 63 Citations
AbstractAbstract PDF
Purpose

Among the various stoma complications, the parastomal hernia (PSH) is the most common. Prevention of PSH is very important to improve the quality of life and to prevent further serious complications. The aim of this study was to analyze the incidence and the risk factors of PSH.

Methods

From January 2002 and October 2008, we retrospectively reviewed 165 patients who underwent an end colostomy. As a routine oncologic follow-up, abdomino-pelvic computed tomography was used to examine the occurrence of the PSH. The associations of age, sex, body mass index (BMI), history of steroid use and comorbidities to the development of the PSH were analyzed. The median duration of the follow-up was 36 months (0 to 99 months).

Results

During follow-up, 50 patients developed a PSH and the 5-year cumulative incidence rate of a PSH, obtained by using the Kaplan-Meier method, was 37.8%. In the multivariate COX analysis, female gender (hazard ratio [HR], 3.29; 95% confidence interval [CI], 1.77 to 6.11; P < 0.0001), age over 60 years (HR, 2.37; 95% CI, 1.26 to 4.46; P = 0.01), BMI more than 25 kg/m2 (HR, 1.8; 95% CI, 1.02 to 3.16; P = 0.04), and hypertension (HR, 2.08; 95% CI, 1.14 to 3.81; P = 0.02) were all independent risk factors for the development of a PSH.

Conclusion

The 5-year incidence rate of a PSH was 37.8%. The significant risk factors of a PSH were as follows: female gender, age over 60 years, BMI more than 25 kg/m2, and hypertension. Using a prophylactic mesh during colostomy formation might be advisable when the patients have these factors.

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Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital
Soo Jung Jung, Do Kyung Lee, Jun Hyun Kim, Pil Sung Kong, Kyung Ha Kim, Sung Woo Bae
J Korean Soc Coloproctol. 2012;28(3):152-159.   Published online June 30, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.3.152
  • 6,144 View
  • 45 Download
  • 22 Citations
AbstractAbstract PDF
Purpose

Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea.

Methods

We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals.

Results

The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion.

Conclusion

Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Citations

Citations to this article as recorded by  
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The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown
Min Sang Kim, Ho Kun Kim, Dong Yi Kim, Jae Kyun Ju
J Korean Soc Coloproctol. 2012;28(3):145-151.   Published online June 30, 2012
DOI: https://doi.org/10.3393/jksc.2012.28.3.145
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AbstractAbstract PDF
Purpose

Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition.

Methods

A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010.

Results

Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications.

Conclusion

A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.

Citations

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Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation
Guiyun Sohn, Chang Sik Yu, Chan Wook Kim, Jae Young Kwak, Tae Young Jang, Kyung Ho Kim, Song Soo Yang, Yong Sik Yoon, Seok-Byung Lim, Jin Cheon Kim
J Korean Soc Coloproctol. 2011;27(4):180-187.   Published online August 31, 2011
DOI: https://doi.org/10.3393/jksc.2011.27.4.180
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  • 33 Citations
AbstractAbstract PDF
Purpose

The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation.

Methods

A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale.

Results

The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%).

Conclusion

A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation.

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Surgical Treatment of a Parastomal Hernia
Seung Chul Heo, Heung-Kwon Oh, Yoon Suk Song, Mi Sun Seo, Eun Kyung Choe, Seungbum Ryoo, Kyu Joo Park
J Korean Soc Coloproctol. 2011;27(4):174-179.   Published online August 31, 2011
DOI: https://doi.org/10.3393/jksc.2011.27.4.174
  • 6,087 View
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  • 9 Citations
AbstractAbstract PDF
Purpose

Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias.

Methods

Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias.

Results

Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients.

Conclusion

In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained.

Citations

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  • Long-term outcomes after open parastomal hernia repair at a high-volume center
    Alexis M. Holland, William R. Lorenz, Brittany S. Mead, Gregory T. Scarola, Vedra A. Augenstein, B. Todd Heniford, Monica E. Polcz
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    Colorectal Disease.2018; 20(S2): 5.     CrossRef
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    In Ho Song, Heon-Kyun Ha, Sang-Gi Choi, Byeong Geon Jeon, Min Jung Kim, Kyu Joo Park
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Complication and Relevant Factors after an Ileostomy for Fecal Diversion in a Patient with Rectal Cancer.
Kim, Jeong Yeon , Kim, Jin Soo , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan
J Korean Soc Coloproctol. 2009;25(2):81-87.
DOI: https://doi.org/10.3393/jksc.2009.25.2.81
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  • 3 Citations
AbstractAbstract PDF
PURPOSE
The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. METHODS: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence.
RESULTS
Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. CONCLUSIONS: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down.

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The Complications of Stoma Take-down.
Kim, Dae Dong , Kim, Eun Jung , Lee, Hae Ok , Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon
J Korean Soc Coloproctol. 2008;24(2):83-90.
DOI: https://doi.org/10.3393/jksc.2008.24.2.83
  • 2,395 View
  • 39 Download
  • 3 Citations
AbstractAbstract PDF
PURPOSE
The study aimed to investigate the complications accompanying stoma take-down and to elucidate the significant factors associated with complications. METHODS: We recruited 341 patients who underwent stoma take-down in our hospital between January 2000 and December 2005. Data on various complications during this procedure, i.e., wound infection, prolonged ileus, and anastomotic leakage, were collected with respect to patient- and operation-associated parameters. RESULTS: Complications of stoma take-down developed in 72 (21.1%) patients: 53 (20.3%) patients in a loop ileosotmy, 10 (21.3%) patients in a loop colostomy, and 9 (27.3%) patients in a Hartmann colostomy, The overall complication rate was significantly associated with the urgency of the primary operation (elective vs. emergent, 17.8% vs. 29%, P=0.017), and with the operation time (< or =80 min vs. > 80 min, 16.5% vs. 29.3%, P=0.005). Among the complications, ileus developed in 46 (13.5%) patients, wound infection in 17 (5.0%) patients, and anastomotic leakage in 5 (1.5%) patients. Wound infection was related to the type of stoma between a loop ileostomy and a Hartmann colostomy (3.5% vs. 12.1%; P=0.014), but no other factors were associated with other complications. CONCLUSIONS: There were significant differences in overall complications in relation to urgency of the primary operation and the operation time, but there was no statistical difference in complications between a loop ileostomy and a loop colostomy take- down groups. The significance of these factors appears to be reduced with accurate surgical technique and patient care.

Citations

Citations to this article as recorded by  
  • Comparing Surgical Site Infection Rate Between Primary Closure and Rhomboid Flap After Stoma Reversal
    Che-Ming Chu, Chih-Cheng Chen, Yu-Yao Chang, Kai-Jyun Syu, Shih-Lung Lin
    Annals of Plastic Surgery.2024; 92(1S): S33.     CrossRef
  • Influences of Symptom Experience and Depression on Quality of Life in Colorectal Cancer Patients with Stoma Reversal
    Jung Ha Kim, Hyunjung Kim
    Journal of Korean Biological Nursing Science.2015; 17(4): 306.     CrossRef
  • The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown
    Min Sang Kim, Ho Kun Kim, Dong Yi Kim, Jae Kyun Ju
    Journal of the Korean Society of Coloproctology.2012; 28(3): 145.     CrossRef
Postoperative Complications and Recurrence in Patients with Crohn's Disease.
Hong, Dong Hyun , Yu, Chang Sik , Kim, Dae Dong , Jung, Sang Hun , Choi, Pyong Hwa , Park, In Ja , Kim, Hee Cheol , Kim, Jin Cheon
J Korean Soc Coloproctol. 2008;24(1):13-19.
DOI: https://doi.org/10.3393/jksc.2008.24.1.13
  • 2,519 View
  • 19 Download
  • 4 Citations
AbstractAbstract PDF
PURPOSE
This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD.
RESULTS
There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age: 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.

Citations

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  • Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection
    Yoo Min Han, Ji Won Kim, Seong‐Joon Koh, Byeong Gwan Kim, Kook Lae Lee, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung
    Journal of Gastroenterology and Hepatology.2016; 31(8): 1436.     CrossRef
  • Clinical and Endoscopic Recurrence after Surgical Resection in Patients with Crohn's Disease
    Yang Woon Lee, Kang-Moon Lee, Woo Chul Chung, Chang Nyol Paik, Hea Jung Sung, You Suk Oh
    Intestinal Research.2014; 12(2): 117.     CrossRef
  • The epidemiology and cost of surgical site infections in Korea: a systematic review
    Kil Yeon Lee, Kristina Coleman, Dan Paech, Sarah Norris, Jonathan T Tan
    Journal of the Korean Surgical Society.2011; 81(5): 295.     CrossRef
  • Long-term Result of Surgical Treatment for Crohn's Enteritis
    Sang-Ji Choi, Eun-Kyung Choe, Sung-Chan Park, Kyu-Joo Park
    Journal of the Korean Society of Coloproctology.2008; 24(6): 409.     CrossRef
Complications, Mortality and Functional Outcome following a Total Colectomy and Ileo-rectal Anastomosis.
Kim, Do Yoon , Oh, Seung Yeop , Lee, Jae Man , Suh, Kwang Wook
J Korean Soc Coloproctol. 2007;23(6):448-453.
DOI: https://doi.org/10.3393/jksc.2007.23.6.448
  • 2,525 View
  • 18 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
This study reviews the feasibility of a total colectomy with ileo-rectal anastomosis (TCIRA) and the functional outcome following the operation.
METHODS
The cases of a total of 50 patients (31 men and 19 women) with a median age of 61 who underwent a TCIRA were reviewed retrospectively. The median follow-up time was 28 months (4~72). The clinical records were reviewed to analyze the postoperative complications and bowel function. The clinical outcomes were examined directly from patients' scoring.
RESULTS
The indications of TCIRA were metachronous or synchronous colorectal cancer (34 percent), multiple polypoid lesions (22 percent), malignant colon obstruction (24 percent), ischemic colitis (2 percent), Crohn's disease (6 percent), and tuberculosis colitis (2 percent). The overall mortality and morbidity rates were 0 and 31 percent, respectively. The morbidity included postoperative bleeding, obstruction, intra-abdominal abscess formation, pneumonia, and wound complications. We used the CCIS index to evaluate postoperative functional bowel habit change. The CCIS index evaluation revealed perfect continence in 57 percent of the patients with short-term follow up (<6 months) and in 83 percent of the patients who had undergone a TCIRA more than 2 years ago.
CONCLUSIONS
Most patients were satisfied with their bowel function on long-term follow up, and we think the TCIRA is a safe operation, and the clinical outcomes are relatively satisfactory.

Citations

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  • Treatment of Multiple Colorectal Cancers
    Ok Joo Paek, Seung Yeop Oh, Kwang Wook Suh
    Journal of the Korean Society of Coloproctology.2009; 25(1): 34.     CrossRef
Clinical Outcomes of Lateral Internal Sphincterotomy for Patients with Chronic Anal Fissure.
Park, Jung Soo , Lee, Jae Bum , Kim, Tae Sun , Cho, Hang Jun , Kim, Do Sun , Lee, Doo Han
J Korean Soc Coloproctol. 2007;23(5):292-296.
DOI: https://doi.org/10.3393/jksc.2007.23.5.292
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AbstractAbstract PDF
PURPOSE
A lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment that is the most commonly used one for patients with chronic anal fissure. However, reports on the recurrence rate and complications after LIS published in Korea are rare. The purpose of our study is to identify the types and rates of recurrence, the complications after LIS, and the differences in clinical outcomes between open and closed LIS.
RESULTS
We used hospital records and telephone interviews to study retrospectively the rates of recurrence and complications of 898 patients who underwent a LIS for chronic anal fissure from July, 2003, to June 30, 2004.
RESULTS
There were 292 male (mean age: 36.8 years, range: 16~84) and 606 female (mean age: 32.4 years, range: 1~68) patients. The preoperative mean maximum resting pressure in anal manommetry was 99.2 cmH2O in male patients and 97.7 cmH2O in female patients. Recurrence of fissure after LIS was present in five cases (0.6%). All underwent a LIS, on the same side of a previous LIS in four cases and on the opposite side in one case. Delayed healing of the fissure was present in six cases (0.7%). All of these patients were improved by conservative management. Complications of the LIS were thrombus formation, perianal abscess, fistula, and incontinence. Thrombus formation was present in eight cases (0.9%). Five patients underwent a thrombectomy and three patients were cured by conservative management. Perianal abscess or fistula was present in three patients (0.3%), who underwent incision and drainage or a simple fistulotomy. Incontinence was present in two cases (0.2%). One patient was lost to follow up, and the other patient was improved by conservative management.
CONCLUSIONS
LIS is a safe and effective treatment for patients with chronic anal fissure, and recurrence and complications of LIS are rare.
Case Report
Laparoscopy-assisted Surgical Removal of a Retained Wireless Capsule Endoscopy: A case report.
Lee, Sang Hoon , Han, Sang Ah , Park, Chi Min , Yun, Seong Hyeon , Lee, Woo Yong , Chun, HoKyung
J Korean Soc Coloproctol. 2006;22(3):192-196.
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AbstractAbstract PDF
Occult bleeding of the gastrointestinal tract is a major cause of iron deficiency anemia. Even with endoscopic evaluation of the upper and the lower gastrointestinal tract in these patients, in 30~50% of the cases, the cause of bleeding still remains undiscovered. Wireless capsule endoscopy (WCE) is a novel method of evaluating the small bowel mucosa by using a small capsule equipped with a camera and transmission device. Complications of WCE include impaction within the gastrointestinal tract, sometimes requiring surgical removal. The authors report a case of capsule impaction in the small bowel in a patient evaluated for anemia due to occult gastrointestinal tract bleeding. The patient is a 19 year-old female with a history of anemia since age 4. The stool guaiac test was positive, but upper and lower gastrointestinal tract endoscopy showed no abnormalities, so WCE was done. A short segment of circular ulcers with lumen narrowing were seen in the distal jejunum. Seven days after ingestion of the capsule, the patient denied passage of the capsule. Small bowel enteroclysis was performed, and the capsule was seen along with a segment of lumen narrowing distal to the site of retention. Surgery was done, and upon laparoscopic examination, the entire bowel appeared normal. Retrieval of the capsule was done along with a resection of an 8 cm segment of the small bowel. Three linear ulcers were seen in the resected bowel specimen. Pathology revealed no evidence of Crohn's disease or tuberculosis. The patient is still on iron supplements, but her hemoglobin level remains stable at 11~12 g/dl.
Original Articles
Early Postoperative Complications following a Resection for Colorectal Cancer.
Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon
J Korean Soc Coloproctol. 2005;21(4):213-219.
  • 1,316 View
  • 17 Download
AbstractAbstract PDF
PURPOSE
Understanding of early postoperative course is very important for planning of operation and postoperative management. However, reports regarding early postoperative complications following colorectal cancer surgery are rare. The aim of this study was to report the incidence of immediate postoperative complications associated with colorectal cancer surgery.
METHODS
This prospective study examined clinicopathological data on 869 patients who underwent a resection for colorectal cancer between November 2002 and October 2003. Patients who underwent a palliative stoma, bypass, or emergent operation were excluded. Early postoperative complications were defined as complications occurring within 30 days of surgery. The male-to-female ratio was 518:351, and the mean age was 59 (range, 18~90) years.
RESULTS
The tumor was located at right colon in 176, at left colon in 169, and at rectum in 510 patients. In 158 patients (18.2%), at least one postoperative complication occurred. The most common complication was ileus (5.5%), followed by wound complication (4.1%), the voiding disturbance (3.3%), anastomotic bleeding (1.4%), anastomotic leakage (1.1%), and bleeding (0.6%). The complication rate was 21.6% in patients with right colon cancer, 16% in those with left colon cancer, and 17.3% in those with rectal cancer. Ileus occurred on mean postoperative day 8 and required a mean of 12 days for resolution. The wound complications occurred on mean postoperative day 9 and were resolved after a mean of 10 days. Of the 8 anastomotic leakage patients, proximal stoma construction was required in 5 patients. Intra-luminal bleeding occurred most common in patients with right colon cancer. Higher frequency of postoperative complications occurred in male patients (P=0.008), patients older than 70 years (P=0.02), and patients with co-morbid medical conditions (P=0.01).
CONCLUSIONS
The overall early postoperative complication rate following colorectal cancer surgery was 18.2%. The postoperative complication rate was higher in male, elderly, and patients with co-morbid medical conditions. Our results have allowed us to identify major complications and to better understand the postoperative course in patients undergoing colorectal cancer resections.
Laparoscopic Treatment of Colonic Injury Caused by Colonoscopy.
Lee, Sang Ho , Choi, Gyu Seog , Lee, Jong Ho
J Korean Soc Coloproctol. 2004;20(5):257-262.
  • 1,316 View
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AbstractAbstract PDF
PURPOSE
Colonoscopy is a reliable and useful tool for diagnosis, surveillance and treatment of colorectal disease. In spite of its safety, in a large number of procedures, serious complications such as perforation or bleeding of the colon are rare, but inevitable. Laparoscopically, we treated patients with complications after diagnostic or therapeutic colonoscopy and evaluated the safety and the usefulness of laparoscopic treatment.
METHODS
From December 2002 to November 2003, thirteen patients were referred to us from regional colonoscopic clinics for laparoscopic surgery due to complications of colonoscopy. All patients presented radiologic intra- or retro-peritoneal free air and various degrees of clinical symptoms or signs comparable to colonic injury, such as abdominal pain and tenderness, distension, and/or fever. One patient with mild symptoms and an other colonoscopically treated were excluded for this study. Patients were followed up at least for two months after the operation.
RESULTS
Laparoscopic procedures ranged from exploration only or closure of a perforated colon to a standard operation for colorectal cancer according to the degree of injury or associated disease. The mean operative time was 102 min. Patients resumed meals at the 2nd to 4th post-operative day and were discharged 5 to 8 days after the operation. No operative complications occurred.
CONCLUSIONS
Laparoscopic surgery for complications of colonoscopy is feasible and safe and can allow an unnecessary laparotomy to be avoided. Even in patients with colonic injury due to the colonoscope and colorectal cancer together, laparoscopic surgery can be an alternative method for treatment of the disease.
Efficacy of Preoperative Radio-chemotherapy in Patients with Advanced Low Rectal Cancr.
Yu, Chang Sik , Kim, Jong Hoon , Lee, Je Hwan , Kim, Tae Won , Chang, Heung Moon , Namgung, Hwan , Kim, Hee Cheol , Kim, Jin Cheon
J Korean Soc Coloproctol. 2004;20(1):46-51.
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AbstractAbstract PDF
PURPOSE
This study was performed to evaluate the surgical and the oncological outcomes of preoperative radio-chemotherapy (PRCT) in patients with low rectal cancer.
METHODS
We reviewed 26 (M:F=17:9) patients who underwent PRCT between September 1999 and December 2001. Inclusion criteria were lower rectal cancer (4~5 cm from AV), more than T3 or N1 in preoperative staging using CT scan and transrectal ultrasound, and no distant metastasis. Patients received a mean of 47.3 (45.0 ~56.0) Gy of radiation therapy for 5 weeks and concomitant intravenous or oral chemotherapy using 5 FU and leucovorin. Surgery was performed in about 5~6 weeks after completion of radiotherapy. Total mesorectal excision and autonomic nerve preservation was the routine procedure. Adverse events during PRCT were assessed according to the NCI Common Toxicity Criteria (version 2.0, 1997).
RESULTS
The mean age was 49 (28~65) years old. The median follow-up period was 31 (20~44) months. The most frequent adverse event was diarrhea (8, 30.8%), followed by nausea and vomiting (5, 19.2%), dermatitis (5, 19.2%), anemia (4, 15.4%), leucopenia (2, 7.7%), and mucositis (1, 3.8%). The mean location of the tumor was elevated from 4.5 cm to 5.5 cm after PRCT. Downstaging of the tumor was identified in 69.2% of the T-level and 63.2% of the N-level. The serum CEA level was decreased from 14.5+/-5.0 ng/ml to 3.5+/-0.5 ng/ml after PRCT (P=0.034). A sphincter-saving resection (SSR) was possible in 16 cases (61.5%). The mean distal resection margin was 2.2+/-0.7 cm in SSRs. Small bowel obstruction was the most frequent complication (6 cases, 23.1%), followed by hydronephrosis 2 (7.7%), a recto-vaginal fistula (1, 3.8%), and a recto-vesical fistula (1, 3.8%). There were no mortalities. Five (19.2%) recurrences developed in distant area, one (3.8%) in a local area, and one in both a local and a distant area. The patients with N-level downstaging revealed a significantly low recurrence rate (8.3% vs. 57.1%; P=0.03).
CONCLUSIONS
PRCT can be performed with an acceptable toxicity and complication rate. It is effective in downstaging of the tumor and in increasing the sphincter-saving rate. However, a prospective, randomized, controlled trial should be performed to prove the oncological benefit.
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