Annals of Coloproctology

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Original Articles

The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year: Ri Na Yoo, Bong-Hyeon Kye, HyungJin Kim, Gun Kim, Hyeon-Min Cho; Ann Coloproctol. 2023;39(1):32-40. Published online March 11, 2022; DOI: https://doi.org/10.3393/ac.2021.00696.0099

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Purpose
Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up.
Methods
This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively.
Results
Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001).
Conclusion
The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.

Citations

Citations to this article as recorded by

Pelvic Floor Prehabilitation for Prevention of Low Anterior Resection Syndrome: Insights From a Randomized Trial (CARRET Study)
Cinara Sacomori, Luz Alejandra Lorca, Marta Pizarro, Gonzalo Rebolledo, Monica Martinez‐Mardones, Diego Dantas
ANZ Journal of Surgery.2026;[Epub] 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
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Benign proctology,Surgical technique

Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?: Keun-Hee Lee, Keehoon Hyun, Seo-Gue Yoon, Jong-Kyun Lee; Ann Coloproctol. 2021;37(5):275-280. Published online July 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00976.0139

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13 Citations

Abstract PDF

Purpose
Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method.
Methods
We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively.
Results
The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%).
Conclusion
Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

Citations

Citations to this article as recorded by

Outcome of lateral internal sphincterotomy for anal fissure in a retrospective cohort of patients
Sayali Valiyeva, Vincenza Cofini, Vinicio Rizza, Mario Muselli, Renato Pietroletti
Updates in Surgery.2026;[Epub] CrossRef
Assessment of Treatment Effectiveness in Acute and Chronic Anal Fissures
Onur İlkay Dinçer, Duygu Felek, Erol Cakmak, Vugar Ali Turksoy
Medicina.2026; 62(3): 490. CrossRef
Operative Therapie der Analfissur
Ricarda Diller
coloproctology.2025; 47(4): 254. CrossRef
Current evidence and new trends in anal fissure treatment
Marta DOMÍNGUEZ-MUÑOZ, Andrea BALLA, Juan Carlos GÓMEZ-ROSADO, Salvador MORALES-CONDE
Minerva Surgery.2025;[Epub] CrossRef
The Practices and Preferences of Turkish Surgeons in the Treatment of Anal Fissure
Ümit Özdemir, Necip Tolga Baran, Ahmet Seki
Journal of Coloproctology.2025; 45(03): 001. CrossRef
Management of Hemorrhoids and Anal Fissures
Oladapo Akinmoladun, William Oh
Surgical Clinics of North America.2024; 104(3): 473. CrossRef
Anal Fissure and Its Treatments: A Historical Review
Cristiana Riboni, Lucio Selvaggi, Francesco Cantarella, Mauro Podda, Salvatore Bracchitta, Vinicio Mosca, Angelo Cosenza, Vincenzo Cosenza, Francesco Selvaggi, Bruno Nardo, Francesco Pata
Journal of Clinical Medicine.2024; 13(13): 3930. CrossRef
Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser khakpour, Sina Seyedipour
Langenbeck's Archives of Surgery.2024;[Epub] 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
Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2023; 7(4): 250. CrossRef
The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure
Katie L. R. Cross, Steven R. Brown, Jos Kleijnen, James Bunce, Melanie Paul, Sophie Pilkington, Oliver Warren, Oliver Jones, Jon Lund, Henry J. Goss, Michael Stanton, Tatenda Marunda, Artaza Gilani, L. Wee Sing Ngu, Philip Tozer
Colorectal Disease.2023; 25(12): 2423. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology

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

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Abstract PDF

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

Citations

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

Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence: Lisa Ramage, Shengyang Qiu, Zhu Yeap, Constantinos Simillis, Christos Kontovounisios, Paris Tekkis, Emile Tan; Ann Coloproctol. 2019;35(6):319-326. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.16

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5 Web of Science
8 Citations

Abstract PDF

Purpose
This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).
Methods
Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.
Results
Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.
Conclusion
PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

Citations

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Capturing Patient Reported Outcomes Following Treatment of Benign Anorectal Disease Requires Significant Surgeon Commitment: Do Surgeons Really Want to Know?
Thomas Peponis, Marc S. Rubin, Ronald Bleday, Harrison T. Hubbell, Robert N. Goldstone, Joel E. Goldberg, Khawaja F. Ahmed, Liliana G. Bordeianou
World Journal of Colorectal Surgery.2025; 14(1): 1. CrossRef
Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20‐Year Retrospective Analysis
Nicola Adanna Okeahialam, Ranee Thakar, Abdul H. Sultan
BJOG: An International Journal of Obstetrics & Gynaecology.2025; 132(12): 1802. CrossRef
Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence
Alayne Markland, Mary Ackenbom, Uduak Andy, Ben Carper, Eric Jelovsek, Douglas Luchristt, Shawn Menefee, Rebecca Rogers, Vivian Sung, Donna Mazloomdoost, Maria Gantz
International Urogynecology Journal.2024; 35(12): 2367. CrossRef
Pelvic floor investigations for anal incontinence: Are they useful to predict outcomes from conservative treatment?
Karina Cuinas, Linda Ferrari, Carlene Igbedioh, Deepa Solanki, Andrew Williams, Alexis Schizas, Alison Hainsworth
Neurourology and Urodynamics.2023; 42(5): 1122. CrossRef
Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach
Martina Kovari, Jan Stovicek, Jakub Novak, Michaela Havlickova, Sarka Mala, Andrew Busch, Pavel Kolar, Alena Kobesova
NeuroRehabilitation.2022; 50(1): 89. CrossRef
Postpartum fecal incontinence. State of the problem
D.R. Markaryan, A.M. Lukyanov, T.N. Garmanova, M.A. Agapov, V.A. Kubyshkin
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (6): 127. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Usefulness of Patient-Reported Outcome Measures and Anorectal Physiologic Tests in Predicting Clinical Outcome for Fecal Incontinence
Chang-Nam Kim
Annals of Coloproctology.2019; 35(6): 289. CrossRef

Case Report

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome: Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul; Ann Coloproctol. 2017;33(4):146-149. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.146

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Abstract PDF

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

Citations

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The Japan Society of Coloproctology Practice Guidelines for Fecal Incontinence 2024 (Revised Second Edition)
Keiji Koda, Toshiki Mimura, Tetsuo Yamana, Mitsuru Ishizuka, Tomoko Takahashi, Shota Takano, Tatsuya Abe, Yuji Nishizawa, Hidetoshi Katsuno, Masami Sato, Kaoru Nishimura, Masahiro Yoshida, Kotaro Maeda
Journal of the Anus, Rectum and Colon.2026; 10(1): 64. CrossRef
Colorectal perforation following anorectal manometry in a patient with anal stenosis post rectal prolapse repair: a rare complication
Leanne Iorio, Monique Couto Matos, Benjamin Linkous, Marco Ferrara, Antonio Caycedo
Journal of Surgical Case Reports.2025;[Epub] CrossRef
Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study
Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2123. CrossRef
Functional anorectal studies in patients with low anterior resection syndrome
Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer
Bin Zhang, Ke Zhao, Yu‐Juan Zhao, Shu‐Hui Yin, Guang‐Zuan Zhuo, Yong Zhao, Jian‐Hua Ding
Colorectal Disease.2021; 23(2): 424. CrossRef
Broken beer bottle as a cause of sigmoid perforation
Christian German Ospina-Pérez, Ana Milena Álvarez-Acuña, Lina María López-Álvarez, Rosa María Ospina-Pérez, Ivan David Lozada-Martínez, Sabrina Rahman
International Journal of Surgery Case Reports.2021; 85(C): 106261. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef

Original Articles

Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection: Audrius Dulskas, Narimantas E. Samalavicius; Ann Coloproctol. 2016;32(3):101-104. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.101

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18 Web of Science
20 Citations

Abstract PDF

Purpose

For several decades, the low anterior resection (LAR) with total mesorectal excision (TME) has been the gold standard for treating patients with rectal cancer. Up to 90% of patients undergoing sphincter-preserving surgery will have changes in bowel habits, so-called 'anterior resection syndrome.' This study examined patients' continence after a LAR for the treatment of rectal cancer.

Methods

This prospective study was performed between September 2014 and August 2015 at the National Cancer Institute and included 30 patients who underwent anorectal manometry preoperatively and at 3 and 4 months after a LAR, but 10 were excluded from further evaluation for various reasons. Wexner score was recorded preoperatively and 4 months after LAR (1 month after ileostomy repair).

Results

Postoperatively, 70% of patients complained of some degree of soiling (incontinence to liquid stool), and 30% experienced urgent defecation. Four months after surgery, these symptoms had somewhat abated. The anal resting pressure and the maximum squeezing pressure did not change significantly. Rectal capacity and compliance were reduced in all patients. The majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first 4 months after surgery. The Wexner scores and the manometric findings showed no correlation.

Conclusion

Many patients undergoing a LAR with TME for the treatment of rectal cancer experience some degree of incontinence postoperatively. Anorectal manometry may be used as an additional tool for evaluating problems with continence after a LAR. No correlation between the Wexner score and the manometric findings was observed.

Citations

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Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study
Ditte Reitz Petersen, Pia Møller Faaborg, Issam Al-Najami, Maja Mi Thygesen, Anna Pilegaard Bjarnesen Mølstrøm, Sören Möller, Mark Bremholm Ellebæk
Surgical Endoscopy.2026;[Epub] CrossRef
Long-term Survival and Functional Outcomes of Laparoscopic Surgery for Clinical Stage I Ultra-low Rectal Cancers Located Within 5 cm of the Anal Verge
Masaaki Ito, Yuichiro Tsukada, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma,
Annals of Surgery.2025; 281(2): 304. CrossRef
Low Anterior Resection Syndrome (LARS): A Contemporary Surgical Review of Incidence, Pathophysiology, Risk Stratification and Functional Outcomes
Supreet Kumar, Vivek Tandon, Deepak Govil
Apollo Medicine.2025;[Epub] CrossRef
Long term persistence and risk factors for anorectal symptoms following low anterior resection for rectal cancer
E. Koifman, M. Armoni, Y. Gorelik, A. Harbi, Y. Streltsin, S. D. Duek, R. Brun, Y. Mazor
BMC Gastroenterology.2024;[Epub] CrossRef
Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis
Pamela Milito, Guglielmo Niccolò Piozzi, Mohammad Iqbal Hussain, Tommaso A. Dragani, Luca Sorrentino, Maurizio Cosimelli, Marcello Guaglio, Luigi Battaglia
Tumori Journal.2024; 110(4): 284. CrossRef
Low anterior resection syndrome
Matthew C. Hernandez, Paul Wong, Kurt Melstrom
Journal of Surgical Oncology.2023; 127(8): 1271. CrossRef
Effects of neoadjuvant radiochemotherapy for anorectal function in locally advanced rectal cancer patients: a study protocol for a prospective, observational, controlled, multicentre study
Jie Shi, Yi-Kan Cheng, Fang He, Jian Zheng, Yun-Long Wang, Xiang-Bo Wan, Hong-Cheng Lin, Xin-Juan Fan
BMC Cancer.2023;[Epub] CrossRef
Should anorectal manometry be routine before stoma reversal in patients after an intersphincteric resection?
Mufaddal Kazi, Bhushan Jajoo, Jitender Rohila, Sayali Dohale, Chaitali Nashikkar, Rajesh Sainani, Prajesh Bhuta, Ashwin Desouza, Avanish Saklani
Colorectal Disease.2023; 25(8): 1638. CrossRef
Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations
Satish S.C. Rao, Nitin K. Ahuja, Adil E. Bharucha, Darren M. Brenner, William D. Chey, Jill K. Deutsch, David C. Kunkel, Baharak Moshiree, Leila Neshatian, Robert M. Reveille, Gregory S. Sayuk, Jordan M. Shapiro, Eric D. Shah, Kyle Staller, Steven D. Wexn
Clinical Gastroenterology and Hepatology.2023; 21(11): 2727. CrossRef
Clinical impact of the triple‐layered circular stapler for reducing the anastomotic leakage in rectal cancer surgery: Porcine model and multicenter retrospective cohort analysis
Ryota Nakanishi, Yoshiaki Fujimoto, Masahiko Sugiyama, Yuichi Hisamatsu, Tomonori Nakanoko, Koji Ando, Mitsuhiko Ota, Yasue Kimura, Eiji Oki, Tomoharu Yoshizumi
Annals of Gastroenterological Surgery.2022; 6(2): 256. CrossRef
Troubles de la motricité anorectale : troubles fonctionnels de la défécation et incontinence fécale
C. Desprez, V. Bridoux, A.-M. Leroi
Journal de Chirurgie Viscérale.2022; 159(1): S46. CrossRef
Disorders of anorectal motility: Functional defecation disorders and fecal incontinence
C. Desprez, V. Bridoux, A.-M. Leroi
Journal of Visceral Surgery.2022; 159(1): S40. CrossRef
Long-Term Anorectal Manometry Outcomes After Laparoscopic and Transanal Total Mesorectal Excision
Ana López-Sánchez, Antonio Morandeira-Rivas, Carlos Moreno-Sanz, Francisco Javier Cortina-Oliva, Marina Manzanera-Díaz, Jhonny David Gonzales-Aguilar
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(4): 395. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
European Journal of Oncology Nursing.2021; 55: 102059. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
S. Kim, M. H. Kim, J. H. Oh, S.‐Y. Jeong, K. J. Park, H.‐K. Oh, D.‐W. Kim, S.‐B. Kang
Colorectal Disease.2020; 22(4): 399. CrossRef
Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer
Masatoshi Kochi, Hiroyuki Egi, Tomohiro Adachi, Yuji Takakura, Shoichiro Mukai, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Minoru Hattori, Hideki Ohdan
Surgery Today.2020; 50(5): 516. CrossRef
Manometric assessment of anorectal function after transanal total mesorectal excision
M. X. Bjoern, S. K. Perdawood
Techniques in Coloproctology.2020; 24(3): 231. CrossRef
Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management
Chris George Cura Pales, Sanghyun An, Jan Paolo Cruz, Kwangmin Kim, Youngwan Kim
Annals of Coloproctology.2019; 35(4): 160. CrossRef
Effectiveness of Pelvic Floor Rehabilitation for Bowel Dysfunction After Intersphincteric Resection for Lower Rectal Cancer
Hideaki Nishigori, Masayuki Ishii, Yujiro Kokado, Kouji Fujimoto, Hiroshi Higashiyama
World Journal of Surgery.2018; 42(10): 3415. CrossRef

Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study: Jeong-Ki Kim, Byeong Geon Jeon, Yoon Suk Song, Mi Sun Seo, Yoon-Hye Kwon, JI Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2015;31(4):138-143. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.138

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Abstract PDF

Purpose

This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer.

Methods

Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores.

Results

Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups.

Conclusion

Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated.

Citations

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Effectiveness of pelvic floor muscle training in the recovery of patients after low anterior resection: A systematic review and meta-analysis
Min Jeong Kim, Seonmi Yeom, Young Man Kim
European Journal of Oncology Nursing.2025; 77: 102918. CrossRef
BENEFÍCIOS DA FISIOTERAPIA EM PACIENTES COLOSTOMIZADOS E ILEOSTOMIZADOS: UMA REVISÃO NARRATIVA
Ana Carolina Aboukalam da Cruz, Anderson Viana Pantoja, Leonardo Gomes de Souza, Maicon Maximiliano de Almeida, Marcus Vinicius Henriques Brito, George Alberto da Silva Dias
REVISTA FOCO.2025; 18(7): e9137. CrossRef
The effectiveness of physiotherapy interventions on fecal incontinence and quality of life following colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
Ming Yan Pun, Pak Ho Leung, Tsz Ching Chan, Chunn Pang, Kin Hei Chan, Priya Kannan
Supportive Care in Cancer.2024;[Epub] CrossRef
Application of pelvic floor rehabilitation in patients with colorectal cancer: a scoping review
Lu Zhou, Changkun Zhong, Yuanyuan Su, Zhengyang Zhang, Ling Wang
Techniques in Coloproctology.2024;[Epub] CrossRef
Effectiveness of Pelvic Floor Muscle Training for Patients Following Low Anterior Resection
Young Man Kim, Eui Geum Oh
Journal of Wound, Ostomy & Continence Nursing.2023; 50(2): 142. CrossRef
ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal
N. Blanco, I. Oliva, P. Tejedor, E. Pastor, A. Alvarellos, C. Pastor, J. Baixauli, J. Arredondo
Techniques in Coloproctology.2023; 27(12): 1251. CrossRef
Low anterior resection syndrome
Seung‐Bum Ryoo
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Yuki Nakashima, Kenichi Fudeyasu, Yuki Kataoka, Shunsuke Taito, Takashi Ariie, Yukio Mikami
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British Journal of Surgery.2021; 108(6): 644. CrossRef
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Mateusz Rubinkiewicz, Jan Witowski, Michał Wysocki, Magdalena Pisarska, Stanisław Kłęk, Andrzej Budzyński, Michał Pędziwiatr
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Mind–Body Interventions for Irritable Bowel Syndrome Patients in the Chinese Population: a Systematic Review and Meta-Analysis
Weidong Wang, Fang Wang, Feng Fan, Ana Cristina Sedas, Jian Wang
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Lentivirus‐mediated shRNA interference of ghrelin receptor blocks proliferation in the colorectal cancer cells
An Liu, Chenggang Huang, Jia Xu, Xuehong Cai
Cancer Medicine.2016; 5(9): 2417. CrossRef
Biofeedback Therapy After Sphincter-Preservation Surgery for the Treatment of Rectal Cancer
Ik Yong Kim
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Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy: Young Ki Hong, Yoon Jung Choi, Jung Gu Kang; Ann Coloproctol. 2013;29(5):198-204. Published online October 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.5.198

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Abstract PDF

Purpose

The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy.

Methods

Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated.

Results

Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence.

Conclusion

Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

Citations

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The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis
James Z. Jin, Velia Men, Praharsh Bahl, Harshitha Penneru, Robin Yang, Niket Shah, Andrew G. Hill
Surgery.2025; 180: 109139. CrossRef
Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model
Chia-Cheng Wen, Shih-Ming Huang, Yi-Wen Wang
International Journal of Molecular Sciences.2024; 25(6): 3543. 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
Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes
Chetty Y. V. Narayanaswamy, M. R. Sreevathsa, G. Akhil Chowdari, Koteshwara Rao
The Surgery Journal.2022; 08(03): e199. CrossRef
Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam
Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha, Tran Quang Hung, Do Van Loi, Tran Manh Hung, Nguyen Van Son, Vu Duy Kien
Advances in Therapy.2020; 37(3): 1136. CrossRef
Post-surgical fecal incontinence
Filippo Pucciani
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Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions
Franciszek Burdan, Iwona Sudol-Szopinska, Elzbieta Staroslawska, Malgorzata Kolodziejczak, Robert Klepacz, Agnieszka Mocarska, Marek Caban, Iwonna Zelazowska-Cieslinska, Justyna Szumilo
European Journal of Medical Research.2015;[Epub] CrossRef
Histopathology and Physiological Alterations After Procedure for Prolapsed Hemorrhoids
Do Sun Kim
Annals of Coloproctology.2013; 29(5): 179. CrossRef

An Analysis of Factors Associated with Increased Perineal Descent in Women: Jina Chang, Soon Sup Chung; J Korean Soc Coloproctol. 2012;28(4):195-200. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.195

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Abstract PDF

Purpose

Treatment of descending perineal syndrome is focused on personal etiology and on improving symptoms. However, the etiology of increased perineal descent (PD) is unclear. Therefore, the aim of the present study was to evaluate factors associated with increased resting and dynamic PD in women.

Methods

From January 2004 to August 2010, defecographic findings in 201 female patients were reviewed retrospectively. Patient's age, surgical history, manometric results and defecographic findings were compared with resting and dynamic PD.

Results

Age (P < 0.01), number of vaginal deliveries (P < 0.01) and resting anorectal angle (P < 0.01) were correlated with increased resting PD. Also, findings of rectoceles (P < 0.05) and intussusceptions (P < 0.05) were significantly correlated with increased resting PD. On the other hand, increased dynamic PD was correlated with age (P < 0.05), resting anal pressure (P < 0.01) and sigmoidoceles (P < 0.05). No significant correlation existed between non-relaxing puborectalis, history of pelvic surgery and increased PD. Also, no significant differences in PD according to the symptoms were observed.

Conclusion

Increased number of vaginal deliveries and increased resting rectoanal angle are associated with increased resting PD whereas increased resting anal pressure is correlated with increased dynamic PD. Older age correlates with both resting and dynamic PD. Defecographic findings, such as rectoceles and intussusceptions, are associated with resting PD, and sigmoidoceles correlated with dynamic PD. These results can serve as foundational research for understanding the pathophysiology and causes of increasing PD in women better and for finding a fundamental method of treatment.

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Isabelle M. A. van Gruting, Kirsten Kluivers, Aleksandra Stankiewicz, Joanna IntHout, Kim W. M. van Delft, Ranee Thakar, Abdul H. Sultan
Journal of Clinical Medicine.2025; 14(2): 548. CrossRef
Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders
Lian-Jun Zhu, Xing-Lin Zeng, Xiang-Dong Yang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Imaging and clinical assessment of functional defecatory disorders with emphasis on defecography
Neeraj Lalwani, Rania Farouk El Sayed, Amita Kamath, Sara Lewis, Hina Arif, Victoria Chernyak
Abdominal Radiology.2021; 46(4): 1323. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Diseases of the Colon & Rectum.2021; 64(1): 31. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdom
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Female Pelvic Medicine & Reconstructive Surgery.2021; 27(1): e1. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Techniques in Coloproctology.2021; 25(1): 3. CrossRef
Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results
Aude Nessi, Aminata Kane, Etienne Vincens, Delphine Salet-Lizée, Karine Lepigeon, Richard Villet
Frontiers in Surgery.2018;[Epub] CrossRef
Descending perineum syndrome: a review of the presentation, diagnosis, and management
Zaid Chaudhry, Christopher Tarnay
International Urogynecology Journal.2016; 27(8): 1149. CrossRef
Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms
Sthela M. Murad-Regadas, Francisco Sergio Pinheiro Regadas, Lusmar V. Rodrigues, Adjra da Silva Vilarinho, Guilherme Buchen, Livia Olinda Borges, Lara B. Veras, Mariana Murad da Cruz
Diseases of the Colon & Rectum.2016; 59(12): 1191. CrossRef
Descending perineum syndrome: new perspectives
F. Pucciani
Techniques in Coloproctology.2015; 19(8): 443. CrossRef
A theory of progression from obstructed defecation to fecal incontinence
F. Pucciani
Techniques in Coloproctology.2015; 19(12): 713. CrossRef

Effects of Age and Sex on Anorectal Manometry.: Heo, Seung Chul , Kang, Sung Bum , Park, Kyu Joo , Park, Jae Gahb; J Korean Soc Coloproctol. 2009;25(5):285-293.; DOI: https://doi.org/10.3393/jksc.2009.25.5.285

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Abstract PDF

PURPOSE
This study was performed to evaluate the effects of age and sex on anorectal manometry.
METHODS
Seventy-four consecutive patients who underwent surgery for sigmoid colon cancer and who had neither anal disorders nor colonic obstruction were included in this study. There were 45 men and 29 women, and the mean age was 58.6. Pressure measurements used both the rapid and the station pull-through (RPT and SPT) methods, and volume measurements used a balloon-tipped catheter. Three pressure indices (vector volume, maximal pressure, and mean pressure), three sphincter length indices (sphincter length, high pressure zone [HPZ] length, and maximal pressure position), and three volume indices (minimal sensory volume, maximal tolerance volume, and rectoanal inhibitory reflex) were analyzed.
RESULTS
Squeezing pressures were higher in men than in women, especially in the RPT method, while resting pressures were not different. Sphincter length and HPZ length were not different between the sexes, but the maximal pressure position was farther from the anal verge in men. Rectal volume indices were not different between the sexes. The resting and squeezing pressures decreased linearly with aging in men, but not in women. The differences in squeezing pressures between men and women were evident in their forties and fifties, but decreased gradually with aging, with no differences being observed in their seventies. With aging, the minimal sensory volume increased in women, and the maximal tolerance volume increased in men.
CONCLUSION
Anal canal pressures and volume indices are influenced by sex, age, and measurement method. Therefore, sex, age, and measurement method must be considered in the evaluation and application of anorectal manometry.

Citations

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Comparison between a new electronic bidet and conventional sitz baths: a manometric evaluation of the anal resting pressure in normal healthy volunteers
S.-B. Ryoo, H.-K. Oh, E. C. Han, Y. S. Song, M. S. Seo, E. K. Choe, S. H. Moon, K. J. Park
Techniques in Coloproctology.2015; 19(9): 535. CrossRef
Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function
Hyang Ran Lee, Seok-Byung Lim, Jeong Yun Park
International Journal of Colorectal Disease.2014; 29(11): 1393. CrossRef

Evaluation of Anal Continence Function by Advanced Anal Manometric Parameters.: Seong, Moo Kyung , Kim, Keun Young , Yoo, Young Bum; J Korean Soc Coloproctol. 2009;25(1):20-25.; DOI: https://doi.org/10.3393/jksc.2009.25.1.20

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Abstract PDF

PURPOSE
Anal manometry is one of the most commonly used tests to evaluate fecal continence function. Advanced pressure parameters of the tests, such as fatigue rate index (FRI), resting rectoanal pressure gradient (RPG), cough index (CI), and radial asymmetry (RA) are recently devised to make up the inaccuracy of conventional parameters, but without solid verification. The object of this study is to investigate such parameters including conventional ones in incontinent patients compared with those in controls and to determine the significance of each parameter.
METHODS
Forty-four patients with anal incontinence and 42 controls were studied. We examined conventional pressure parameters (mean resting pressure [MRP], maximum squeeze pressure [MXSP]) and advanced parameters (RPG, FRI, CI, RA), and compare those parameters with normal controls. Multiple logistic regression analysis and receiver operating characteristic curve analyses were also performed.
RESULTS
No difference was detected in demographic factors between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 31.1+/-20.7 mmHg vs. 41.4+/-18.6 mmHg, P=0.0170; MXSP, 203.1+/-84.3 mmHg vs. 258.5+/-105.9 mmHg, P=0.0086). Among advanced parameters, RPG and FRI were significantly different (2.83+/-1.54 vs. 4.08+/-1.53, P=0.0003; 9+/-21.6 sec vs. 75.6+/-12.1 sec, P=0.0333), but CI and RA were not so different (0.74+/-0.45 vs. 0.61+/-0.33, P=0.1326; 22.7+/-7.0% vs. 21.1+/-7.6%, P=0.3244). Only RPG was significant in multiple logistic regression analysis (P=0.019). Areas under ROC curves were 0.65 for MRP, 0.65 for MXSP, 0.82 for RPG, and 0.73 for FRI.
CONCLUSION
Among anal manometric pressure parameters, RPG and FRI as advanced parameters are more accurate than any other parameters in detecting fecal incontinence.

Citations

Citations to this article as recorded by

Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function
Hyang Ran Lee, Seok-Byung Lim, Jeong Yun Park
International Journal of Colorectal Disease.2014; 29(11): 1393. CrossRef
Determinant of Anal Resting Pressure Gradient in Association With Continence Function
Moo-Kyung Seong, Ung-Chae Park, Sung-Il Jung
Journal of Neurogastroenterology and Motility.2011; 17(3): 300. CrossRef

Case Report

Rectal Perforation after Anorectal Manometry Following Preoperative Chemoradiotherapy and Low Anterior Resection: Report of a Cases.: Jeong, Woon Kyung , Chung, Tae Sung , Lim, Sang Woo , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(4):298-301.; DOI: https://doi.org/10.3393/jksc.2008.24.4.298

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Anorectal manometry is widely used to evaluate anorectal function. Few reports have described complications resulting from this procedure. A 47-year-old male underwent preoperative chemoradiotherapy and a low anterior resection for rectal cancer. The patient underwent anorectal manometry at postoperative 8 months. A rectal perforation was diagnosed shortly thereafter. The patient was initially managed conservatively using percutaneous drainage and parenteral antibiotics and then discharged on day 60 after the event. One month later, a colo-cutaneous fistula and expanding abdominal fasciitis developed. The patient underwent surgical exploration, drainage, resection of the rectum including the fistula, and redo-coloanal anastomosis with a diverting ileostomy. The patient discharged without complications on postoperative day 25. Anorectal manometry should be performed with particular care in patients who have undergone radiotherapy and anastomosis at the rectum.

Citations

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Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: study protocol for a randomised controlled trial
Christine Norton, Anton Emmanuel, Natasha Stevens, S. Mark Scott, Ugo Grossi, Sybil Bannister, Sandra Eldridge, James M. Mason, Charles H. Knowles
Trials.2017;[Epub] CrossRef
Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome
Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
Annals of Coloproctology.2017; 33(4): 146. CrossRef
Perforación rectal tras manometría anorrectal sin enfermedad rectal previa: una complicación excepcional resuelta con tratamiento médico
Jorge Antonio Núñez Otero, Mariano Gómez Rubio, Ángel R. Durán Aguado, José L. Martínez Albares
Gastroenterología y Hepatología.2013; 36(9): 577. CrossRef

Original Articles

Measurement of External Anal Sphincter Function by Fatigue Rate Index.: Seong, Moo Kyung , Yoo, Young Bum; J Korean Soc Coloproctol. 2002;18(3):184-189.

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Abstract PDF: PURPOSE
Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence.
METHODS
Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them.
RESULTS
All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis.
CONCLUSION
FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.

Reproducibility of Anal Manometric Measurement.: Sun, Kwan Woo , Seong, Moo Kyung; J Korean Soc Coloproctol. 1998;14(3):483-492.

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Abstract PDF: PURPOSE
Anorectal manometry has become a routine investigation for the evaluation of patients with anorectal disorders. However, the interpretation of such studies is confounded by the fact that controversial data are reported with regard to the same events. The aim of this study was to measure the reproducibility of the pressure profiles of anorectal manometry in healthy controls for standardization of their measurements.
METHODS
Manometric study was performed on different days with 7 days interval in 22 male healthy subjects with the use of a pneumohydraulic capillary perfusion system.
RESULTS
For resting pressures with rapid pull-through (RPT) technique, maximum pressure revealed 43.58, 19.8% and mean pressure, 16.02, 14.6% in the order of reproducibility coefficient and coefficient of variation. For resting pressures with stationary pull-through (SPT) technique, maximum pressure; 17.22, 12.2% and mean pressure; 14.66, 26.4%, respectively. For squeezing pressures with RPT technique, maximum pressure; 53.37, 14.3% and mean pressure; 66.32, 23.6%. For squeezing pressures with SPT technique, maximum pressure; 72.80, 11.9%, mean pressure; 93.10, 30.5% and coughing pressure; 69.42, 15.8%, respectively, For anal canal length (ACL) with RPT technique, at resting state; 7.10, 7.9% and at squeezing state; 14.55, 13.7%, respectively. For high pressure zone (HPZ) with RPT technique, at resting state; 6.68, 16.3% and at squeezing state; 11.06, 23.5%. For HPZ with SPT technique, at resting state; 11.28, 25.4% and at squeezing state; 10.04, 17.5%, respectively. For radial asymmetry (RA) with RPT technique, at resting state; 13.76, 42.3% and at squeezing state; 7.86, 22.9%. For RA with SPT technique, at resting state; 24.6, 58.6% and at squeezing state; 14.28, 46.7%, respectively.
CONCLUSION
Measurements of resting and squeezing pressure are more reproducible by SPT technique, in which technique it seems that maximum value is more preferred as a representative value. ACL and HPZ are may well measured on resting pressure with SPT technique. Radial asymmetry shows the best reproducibility on squeezing pressure with RPT.

Fecal Soiling Manometric findings and treatment.: Lee, Kwang Real , Whang, Do Yun , Kim, Kun Wook , Park, Weon Kap , Yoo, Jung Jun , Lim, Seok Won , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(3):477-482.

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Abstract PDF: BACKGROUND
Fecal continence is maintained by complex coordination of the sphincter mechanism and the anorectal sensation. Although most patients with fecal incontinence have a dysfunction of anal sphincter, fecal soiling seems to be related with a change in the anorectal sensation. PURPOSE: This study was done to evaluate the manometric findings and the methods of treatment for patients with fecal soiling.
METHODS
The manometric findings from 25 patients with fecal soiling were compared with those from 22 normal controls. The patients were treated with biofeedback and with bulking agent.
RESULTS
All the patients affected by fecal soiling were male except for one. There were no differences in the mean maximal resting pressure (MRP), and the mean maximal squeezing pressure (MSP) between the patients and the controls. The mean sphincter length and the mean length of the high pressure zone (HPZ) of the patients were significantly longer (50.5 vs. 55.6 mm and 28.2 vs. 31.3 mm, respectively; p<0.05 student t-test) than those of the controls. The minimal sensory volume (MSV) was significantly larger in the patient group, with a mean of 24.2 ml vs. 17.8 ml, than in the control group (p<0.05). The mean volume necessary to induce the recto-anal inhibitory reflex (RR) was 47.1 ml for the control group and 32.6 ml for the patient group (p<0.05). In the longitudinal profile of the anal sphincter, the HPZ was shifted proximally and the pressure peak was broader in the fecal soiling group. Of the 14 patients treated with biofeedback, 11 responded well.
CONCLUSION
Almost all of the patients affected by fecal soiling were men. The MRP and the MSP of the patients with fecal soiling were not lower than those of the normal controls. The sphincter length was longer in the patients with soiling than in the controls(p<0.05). However, for the fecal soiling group the distribution of the pressure along the anal canal was different in the sense that the HPZ was shifted proximally and the pressure peak was broader. The changes in the MSV and the RR suggest that there may be a defect in the anorectal sensation. The patients responded well to the combined use of biofeedback and a bulking agent.

Anorectal Physiology in the Rectal Prolapse Patient.: Son, Kyung Soo , Joo, Jae Sik , Wexner, Steven D; J Korean Soc Coloproctol. 1998;14(3):467-476.

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Abstract PDF: PURPOSE
The aim of our study was to evaluate the physiological spectrum of anorectal dysfunction among patients with full thickness circunferential rectal prolapse. MATERIAL AND METHODS: Between January 1988 and March 1995, 88 patients who visited department colorectal surgery, Cleveland Clinic Florida with rectal prolapse were studied. There were 8 males and 80 females, with a mean age 69 (range 28~101) years. Patients underwent a detailed history and the following anorectal physiology tests were performed: anal canal manometry, pudendal nerve terminal motor latency (PNTML) assessment, anal electromyography and cinedefecography.4 standard continence scoring system, based on the frequency and type of incontinence (0=full continence, 20=complete incontinence) was used. Patients with rectal prolapse (n=88) were divided into two subgroups: Group I=continent patients (n=33) and Group II= incontinent patients (n=55).
RESULTS
There were statistically significant differences between each group when comparing mean resting pressures, anal pressures, anal canal length, rectal compliance, rectoanal inhibitory reflex, increased fiber density, the occurrence of premature evacuation (p<0.001), and rectal capacity (p<0.05). However, dynamic changes of anorectal angle, resting anorectal angle, puborectalis length, and rectal sensitivity were not significantly different (p>0.05) between groups.
CONCLUSION
Continence may be disturbed in patients with rectal prolapse; knowledge of impairment in continence may assist in surgical management.

Manometric Investigation of Anorectal Dysfunction in Patients with Progressive Systemic Sclerosis.: Choi, Hong Jo , Lim, Hyun Sung , Park, Ki Jae , Chung, Won Tae , Lee, Sung Won; J Korean Soc Coloproctol. 2002;18(2):83-88.

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Abstract PDF: PURPOSE
The aim of this study was to investigate the anorectal function in patients with progressive systemic sclerosis (PSS), thus to define the clinical role of anorectal manometry in the earlier diagnosis of anorectal involvement of PSS.
METHODS
Seventeen consecutive patients (all females) with PSS were evaluated with anorectal manometry by the stationary pullthrough technique using the 8-channel hydraulic capillary infusion system for anorectal function. Functional parameters of the manometry were compared between patients with PSS and 20 normal control subjects, matched for age and sex.
RESULTS
The mean resting pressure over the high pressure zone (HPZ) in patients with PSS was significantly lower than that in the control group (70.8 3.4 mmHg vs. 81.5 3.2 mmHg: P=0.046). The HPZ in patients with PSS was also significantly reduced compared with that in the control (1.5 0.1 cm vs. 2.5 0.1 cm: P=0002). The rectoanal inhibitory reflex (RAIR) was detected in only 10 patients (59%) in the PSS group, but was present in all except one (95%) in the control (P=0.022). More interestingly, RAIR in patients with PSS responded at a higher volume of the air insufflated than that in the control (74% vs. 30% at 20 cc, 21% vs. 30% at 30 cc, and 0% vs. 40% at 50 cc, respectively: P=0.031). Other functional parameters, including maximal squeeze pressure, minimal sensory and maximal tolerable volume of the rectum, and rectal compliance were not significantly different between two groups.
CONCLUSIONS
Anorectal involvement reflected by the anorectal manometric dysfunction may be rather an earlier event in patients with PSS. An awareness to perform an anorectal manometric study in every case of PSS may be necessary for earlier subclinical detection of anorectal involvement by the disease.

Changes in Anal Pressure According to Age and Gender in Hemorrhoids and Anal Fissures.: Kim, Kwang Ho , Shim, Kang Sup , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(2):283-290.

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Abstract PDF: Hemorrhoid and anal fissure are common diseases in Korea. It has been demonstrated that patients with hemorrhoidal disease have increased activity of the internal anal sphincter. The fissure causes increased contraction in the internal anal sphincter, thereby increasing pressure in the anal canal. Many studies have reported differences in the anal canal pressures between males and females. Moreover, some papers have shown that sphincter pressures decrease with age. But the majority of these studies were not specific for the hemorrhoid and anal fissure. Therefore, we studied the effect of age and gender on anal pressure in hemorrhoid and anal fissure. Two hundred ninety six patients with hemorrhoid and sixty eight patients with anal fissure were retrospectively assessed. Anorectal manometry using a radial eight-port catheter was performed during resting and squeezing maneuvers of the anal sphincter. In hemorrhoid reduction in maximal average resting(MARP) and squeezing pressure(MASP) were found from the sixth decade, however in anal fissure reduction in MARP and MASP were found in the third decade. In hemorrhoid significant decrease of MARP and MASP were noted in entire ages of female, however in anal fissure increase of MARP and MASP were noted in fifth and sixth decade of female. In conclusion, in hemorrhoid both resting and squeezing pressure decrease with age in female. In anal fissure both resting and squeezing pressure decrease in third decade and in male with fifth and sixth decade.

Risk Factors of Recurrent Hemorrhoid after Primary Management.: Yong, Sung Sang , Joo, Jae Sik , Son, Kyung Soo , Lee, Ho Suk , Choi, Byung Soo , Lee, Sung Kyu; J Korean Soc Coloproctol. 1998;14(2):275-282.

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Abstract PDF: Before surgery for hemorrhoid, patients always have a worry of postoperative recurrence. The exact incidence and risk factors of recurrent hemorrhoid have not yet been delineated up to now. Therefore, the aim of this study was to assess the etiology of the recurrence after surgery. MATERIAL AND METHODS: Between March, 1997 and Feburary 1998, all patients who visited the Dept. of Surgery, Korea Veteran Hosipital, due to the recurrent hemorroid after surgical managememt including sclerotherapy(Group II: GII, n=60) were compared to the age and sex mathed(1:2) with primary hemorroid patients(group I: GI, n=120). The risk factors which might be related with the recurrence such as 1) hemorroidal factor(duration of symtom, symtom, associated perinial disease) 2) patient factor (constipation, incontience, cardiovascular disease, pulmonary and hepatic disease) 3) anorectal physiologic factors 4) surgical factors were evaluated. Stastical analysis were performed by a chi-square-test or Mann-Whitney U test and set the significance at p<0.05.
RESULTS
There were no differences between the two groups in terms of age(GI 58.1+/-8.5, GII 60.9+/-3.3 years), gender(M:F, GI; 97:23, GII; 56:4 ). The ratio of having a contipation before surgery was 41% in GI, 55% in GII. It was not statistically significant. However, the other factors related with constipation such as duration of constipation(GI; 9.85+/-7.73 years, GII; 14.62+/-7.38 years: p<0.05), duration of straining during defecation(GI; 5.82+/-2.34, GII; 7.32+/-5.6 minutes, p<0.05) number of laxative use(GI; 29, GII; 28) were significantly different between the two groups. The fecal incontince are 5% in group Iand 13% in group II. There were no differences in patient's subject symtoms related with hemorrhoid, and comorbid perianal disease between the two groups. In anorectal manometric findings, rectal complince was significantly lower in GII than that of GI(25.1+/-50.04 cc/cmH20 vs 16.0+/-25.2 cc/cmH20 p<0.05). GII has a significant number of preopertive hypertension than GI(6.7% vs. 21.6%, p<0.05). CONCLUSION: When a patient with hemorrhoid has a constipation or hypertension, and lower compliance in manometric findings, it would be related with the postoperative recurrence after treatment. Therefore, we surgeons should correct these comorbid conditions before surgery, otherwise give an information to the patient of high chance of postoperative recurrence after management.

Clinical Significance of Amplitude in Pudendal Nerve Conduction Study in Patients with Defecation Disorders.: Joo, Jae Sik , Kim, Jae Do; J Korean Soc Coloproctol. 1998;14(2):241-246.

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Abstract PDF: Many different kinds of anorectal physiologic studies were performed for the evaluation of defecation disorders. Some of these studies are anorectal manometry and pudendal nerve conduction study. In pudendal nerve conduction study, pudendal nerve terminal motor latency (PNTML) was considered to be very useful for the evaluation and management of these patients. However, evaluation of amplitude in pudendal nerve conduction study has been clinically seldom used. Therefore, the aim of this study was to evaluate the clinical significane of amplitude in pudendal nerve conduction study in patients with defecation disorders by comparing to manometric profiles. MATERIAL AND METHODS: Between February, 1997 and February, 1998 all patients who underwent pudendal nerve conduction study and anorectal manometry for the evaluation of defecation disorders (constipation and fecalincontinence) were analyzed. Latency as well as amplitude in pudendal nerve conduction study were compared in both groups to the pressure profiles in manometric study according to the subgroups of these patients. Statistical analysis were performed by a Chi-square or Student's t-test and significance was assumed when p<0.05.
RESULTS
A total of 80 patients, forty constipation with a mean age of 55.3+/-14.5 (GI: range; 24~86) years and forty fecal incontinence with a mean age of 61.1+/-10.3 (GII: range; 37~74) years and a male to female ratio of 25:15 (GI), 28:12 (GII), were studied. PNTML in both sides in GI were significantly decreased in comparision to those of GII (GI: Rt, 2.17+/-0.7 ms Lt, 2.03+/-0.5 ms, GII: Rt, 2.50+/-0.7 ms, Lt 2.64+/-0.8 ms, p<0.05), However, there were no differences between the two groups in terms of amplitudes (GI: Rt 399.0+/-348 uV, Lt 426.8+/-403 uV, GII: Rt, 406.9+/-273 uV Lt, 392.9+/-291 uV, NS) in pudendal nerve conduction study. In manometric findings, even though maximal resting, mean, minimum and maximal pushing pressures were no differences in both groups, mean resting and maximal squeezing pressure were significantly increased in GI than those of GII (GI: 82.4+/-31 cmH20, GII: 60.5+/-25 cmH20 in mean resting pressure, GI: 213.1+/-108 cmH20, GII: 178.7+/-66 cmH20 in maximal squeezing pressure, p<0.05) When we analyzed the overall values of amplitudes according to the diagnosis, age, gender, and the value of PNTML, there were no statistically significant differences between the two groups. But, when the one side of PNTML shorter than the other side, it tended to have a high amplitude in that side than that of the other side in the same patient (the probability for trend was 74%).
CONCLUSION
Constipation patient has a shorter PNTML, higher mean resting, and maximal squeezing pressure than fecal incontinene patient. The amplitude in pudendal nerve conduction study had a trend of inverse correlation to the latency in the same patient. Therefore, amplitude in pudendal nerve conduction study might be useful to monitor or predict the outcome after treatment in patients with defecation disorders.

Is the Level of Anastomosis within the Anal Canal Pertinent to Physiologic and Functional Outcome in the Double-stapled Ileoanal Reservoir?.: Choi, Hong Jo , Choi, Jeong Seok , Saigusa, Naoto , Shin, Eung Jin , Weiss, Eric G , Nogueras, Juan J , Wexner, Steven D; J Korean Soc Coloproctol. 2001;17(6):295-303.

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Abstract PDF: PURPOSE
The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this diversity in epithelial types.
METHODS
According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group I), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group II), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome.
RESULTS
None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8 16.9 mmHg and 67.1 21.3 mmHg in group I, and 61.1 22.7 mmHg and 90.0 38.6 mmHg in group II, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group I and from 86.5% to 53.9% in group II, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2 26.1 ml and 2.8 3.3 to 163.3 115.7 ml and 14.7 15.3 in group I (P=0.0001, and <.0001, respectively), and from 77.0 59.5 ml and 4.4 6.8 to 167.3 87.9 ml and 28.7 44.0 in group II (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011).
CONCLUSIONS
Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.

The Ultraslow Wave in Patients with Hemorrhoids and Chronic Anal Fissure.: Kim, Jin Cheon , Kim, Sook Yeong , Kim, Hee Cheol , Yu, Chang Sik , Park, Sang Kyu; J Korean Soc Coloproctol. 2001;17(5):227-231.

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Abstract PDF: PURPOSE
We assessed the nature of the ultraslow wave in patients with hemorrhoids and chronic anal fissure according to clinical findings and manometry in this study.
METHODS
Three hundred and thirty-three patients with hemorrhoids and 88 patients with chronic anal fissure were included. Anorectal manometry was performed according to a modified protocol based on the Coller's study. The ultraslow wave was determined as an undulating wave equal or less than two waves/min.
RESULTS
The ultraslow wave was found in 142 of the 333 patients (42.6%) with hemorrhoids and 44 of the 88 patients (50%) with chronic anal fissure. The pressure variables (maximal resting and squeeze pressure, rectal pressure at the beginning of rectoanal inhibitory reflex, rectal pressure on sense or fullness of balloon) were significantly higher in patients with ultraslow wave than in those without (P<0.001-0.05). The ultraslow wave frequency was inversely proportional to aging and to its amplitude (P=0.006 and <0.001, respectively). Maximal squeeze pressure was closely correlated with maximal resting pressure in a multiple regression analysis (P=0.002). The defecation difficulty and anorectal bleeding were more frequent in patients with ultraslow wave than those without in the hemorrhoids (P=0.008 and 0.021, respectively).
CONCLUSIONS
The ultraslow wave closely correlates with an anorectal pressure and frequently occurs in patients with hemorrhoids and chronic anal fissure. It appears to be associated with the internal anal sphincter as well as with the external anal sphincter and levator ani muscles.

Manometric Assessment after Ileal Pouch- Anal Anastomosis.: Yu, Chang Sik , Kim, Hee Chul , Park, Sang Gyu , Kim, Sook Young , Cho, Young Gyu , Hong, Hyun Ki , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(4):187-192.

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Abstract PDF: PURPOSE
Functional derangement in bowel movement after ileal pouch-anal anastomosis (IPAA) is not infrequent. It results from several mechanisms mainly decreased rectal reservoir capacity and rectal sensation. Anal sphincter or pelvic nerve damage during surgery contributes physiological changes, also. This study was performed to evaluate manometric changes after IPAA and compare them with functional outcomes regarding anastomotic technique.
METHODS
Forty seven (M:F=23:24) patients who underwent IPAA and manometric assessment were enrolled. Pathological diagnoses of them were 32 ulcerative colitis, 12 familial adenomatous polyposis, and 3 hereditary non-polyposis colorectal cancer. Every pouch was constructed in J shape, 15cm length. Pouch-anal anastomosis was performed by 27 hand-sewn and 20 double stapling technique. Diverting ileostomy was performed in 30 cases (64%) and closed 2-3 months after IPAA. Manometry was performed preoperatively and 3 to 6 months interval, postoperatively. Twenty two patients underwent full manometic assessment pre- and post-operatively. The others did it either pre or postsoperatively. Functional outcome was investigated at the median follow-up period 25 (2-54) months. Statistical analysis was performed by using Chi- square and Fisher's exact test. Significance was assigned to a P value of <0.05.
RESULTS
Maximum resting pressure (MRP) was significantly decreased postoperatively (85.2 vs. 60.6 mmHg; P=0.002). This phenomenon could be observed throughout the follow-up period. However, the difference was getting smaller as times went by. Rectoanal inhibitory reflex (RAIR) was identified 96% preoperatively, and only 22% postoperatively (P=0.000). Rectal compliance was decreased at the time of ileostomy closure, and improved remarkably since 6 months after closure. In comparison of manometric findings according to anastomotic technique, MRP in hand- sewn group was significantly decreased (52.3 vs. 77.0 mmHg; P=0.003). RAIR could be identified more frequently in double stapled group (31.6 vs. 15.4%; P>0.05). Postoperative stool frequency and incontinence rate were not different between two groups. Thirty one percent of patients revealed night time seepage. MRP of this seepage group was significantly lower than the other group (67.9 vs. 48.4 mmHg; P=0.038).
CONCLUSIONS
Characteristic changes of manometric findings after IPAA were summarized as decrease of MRP and disappearance of RAIR. Rectal compliance was significantly improved since 6 months after IPAA or ileostomy closure. Decrease of MRP was more remarkable in hand-sewn group. However, we could not find any difference in functional outcomes between two anastomotic techniques. MRP was a crutial factor for postoperative seepage.

Factors Influencing Fecal Incontinence in Complete Rectal Prolapse: A Prospective Analysis.: Yoon, Seo Gue , Lee, Kwang Real , Kim, Khun Uk , Song, Seok Kyu , Kim, Chil Seok , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(1):7-14.

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Abstract PDF: PURPOSE
This study was undertaken to identify factors influencing fecal incontinence in rectal prolapse.
METHODS
The clinical and anorectal physiologic data (anal manometry, rectal sensitivity test, pudendal nerve terminal motor latency (PNTML)) of 42 complete rectal prolapse patients were collected in a prospective database and were analyzed according to Wexner's incontinence score (0-20).
RESULTS
The mean Wexner's incontinence score was 10.6. Females (n=24) were more prone to be incontinent than males (n=18)(incontinence score 14.8 vs 5.1, p<0.001). A linear regression analysis showed that increased age (r= 0.497, p=0.001), decreased maximum resting pressure (MRP) (r= 0.686, p<0.001), decreased maximum squeezing pressure (MSP)(r= 0.789, p<0.001), decreased maximal rectal tolerable volume (MTV) (r= 0.386, p=0.012) influenced the incontinence score. An absent rectoanal inhibitory reflex (RAIR) was not related to incontinence, but was related to significantly low resting anal pressure. Delayed PNTML did not influence incontinence or the MSP. In a multiple regression analysis, decreased MRP (beta= 0.383; p=0.002), decreased MSP (beta= 0.345; p =0.007) and female gender (beta=0.343; p=0.006) influenced incontinence significantly.
CONCLUSIONS
Major factors influencing fecal incontinence in complete rectal prolapse were decreased MRP and MSP. Female patients were more prone to fecal incontinence than males. RAIR and MTV were not significant factors. PNTML did not show any relation to incontinence score or the anal pressure.

Usefulness of Manometry in Anorectal Diseases.: Kim, Chang Nam , Park, Sang Kyu , Kim, Sook Young , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2000;16(6):376-382.

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Abstract PDF: PURPOSE
Anorectal manometry is an objective means of assessing the anorectal function through the anorectal sphincter muscles. The purpose of this study was to assess the usefulness of anorectal manometry.
METHODS
Manometric findings of 1145 patients with anorectal diseases were analyzed.
RESULTS
In hemorrhoids, the maximum resting pressure (MRP) was significantly decreased postoperatively (P<0.05), and the maximum squeezing pressure (MSP) was decreased postoperatively. The MRP was increased in hemorrhoids, internal sphincter hypertonia, and chronic anal fissure (CAF). The MRP and MSP were significantly decreased in CAF, anal fistula, and anal stricture postoperatively (P<0.05). In anal fistula, the high pressure zone length and sphincter length were significantly decreased postoperatively (P<0.05), and the vector symmetric index was decreased to 0.79 postoperatively. Fourteen of the 57 patients with fecal incontinence did not show rectoanal inhibitory reflex (RAIR). In 22 of the 25 patients were clinically suspected of congenital megacolon (CMC), unnecessary surgery was avoided with RAIR. Twelve of the 15 patients with CMC, who had undergone surgery, showed the RAIR. In patients treated by total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP), the MRP and MSP were decreased postoperatively, and the sensation of fullness (SOF) was significantly decreased postoperatively (P<0.05). In patients with rectal cancer treated by low anterior resection, the MRP, MSP, SOF, and compliance were significantly decreased until 12 months postoperatively (P<0.05).
CONCLUSIONS
Manometry appears to be an important tool to evaluate anorectal function that enables adequate surgery or treatment for the most of anorectal diseases. Furthermore, it is a valuable tool in assessing functional recovery after surgeries associated with a sphincter injury.

A Study of Anal Manometric Finding after Low Anterior Resection of Rectal Cancer.: Min, Byung Wook , Ryu, Keun Won , Kim, Seon Han , Choi, Sang Yong , Goo, Bum Hwan , Park, Young Tae , Moon, Hong Young; J Korean Soc Coloproctol. 2000;16(5):328-333.

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Abstract PDF: PURPOSE
Low anterior resection, irrespective of anastomotic technique, may be associated with frequent bowel movement and other bowel management difficulties. The aim of this study was to access the anorectal function after low anterior resection of the rectal cancer.
METHODS
We studied 28 patients who had mid and low rectal cancer (average 8.3 cm above the anal verge) had undergone low anterior resection using stapling suture devices (average level of anastomosis was 3.8 cm above anal verge) and anal manometry was undertaken 95 times preoperatively (N=28) and 3 month (N=26), 6 months (N=22) and 12 months (N=19) postoperatively from 1992 to 1995 in Korea University Guro Hospital.
RESULTS
Maximum resting pressure was reduced after resection (from 64.7 mmHg to 42.7 mmHg, change ?22 mmHg) but gradually increased and returned to preoperative level at 12 months postoperatively. Minimum perceived volume was decreased after operation (from 40.3 ml to 25 ml change of ?15.3 ml) and this change persist at 12 months postoperatively. Rectoanal inhibitory reflex was present in all patient before surgery but disappeared in most of the patient after operation. Reflex returned to normal in 4 of 22 patients at 6 months later and in 7 of 19 patients at 12 months after operation. Maximum squeezing pressure and maximum tolerable volume were not decreased after operation.
CONCLUSIONS
Anorectal function (maximum resting pressure, minimum perceived volume and rectoanal inhibitory reflex) was reduced immediately after low anterior resection of rectal cancer. But this functional changes returning to normal at 6 months and most of the patients had good function at 12 months after operation.

Clinical and Physiologic Study of Encopresis.: Chung, Soon Sup , Kwon, Jae Bong; J Korean Soc Coloproctol. 2000;16(3):171-176.

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Abstract PDF: The pathophysiology of pediatric encopresis has been incomprehensible. The current study was designed to assess its clinical and physiologic findings. Moreover, outcome of treatment was evaluated.
METHODS
The clinical and functional findings of 18 patients (13 boys, 5 girls) were analyzed, retrospectively. Physiologic studies for cooperative child included anal manometry (n=12), cinedefecography (n=3), and PNTML (pudendal nerve terminal motor latency, n=1). For exclusion of the organic cause, barium contrast study was carried out in all case. Patients were categorized by leading symptom as constipation or incontinence. Physiologic findings and outcome of treatment were analyzed based on the categorized groups. Biofeedback therapy by using newly-developed anal sphincter control system (KONTINENCE CLINICAL(TM)) in my institute, was underwent a mean 4.1 (range, 2~12) sessions. The outcome was analyzed in the period of 5.4 (range, 1~33) months follow-up.
RESULTS
Patients were categorized as having constipation (group I, n=12) or incontinence (group II, n=6) group. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction between group I and II. In the cinedefecography, 3 of group I patients revealed as having the pelvic floor dyssynergia. The findings of PNTML were not specific in group II (n=1). Regarding to the therapeutic outcome, 8 of 10 patients were cured or improved.
CONCLUSIONS
There were no differences in the resting and squeeze profiles of manometric parameters between two groups. However, pelvic floor dyssynergia was identified in the cinedefecography of constipated group. Conventional and biofeedback treatment for encopretic children provides acceptable outcome.

Role of Anorectal Physiologic Studies for the Diagnosis and Treatment of Non- relaxing Puborectalis Syndrome.: Kim, Nam Hyuk , Hwang, Yong Hee , Choi, Kun Phil; J Korean Soc Coloproctol. 2003;19(4):221-228.

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Abstract PDF: PURPOSE
To assess the effectiveness of cinedefecography (CD), anal electromyography (EMG), and anal manometry (ARM) for the diagnosis of non-relaxing puborectalis syndrome (NRPR) and to compare the outcomes for patients after biofeedback therapy (BF).
METHODS
The clinical criteria used in this study for NRPR included straining, incomplete evacuation, tenesmus, and the need for enemas, suppositories, or digitation. Patients who satisfied the clinical criteria were evaluated by use of anorectal physiology tests: CD, EMG, and ARM. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis (PR) during attempted evacuation. The ARM criteria included failure to achieve a significant decrease in intra-anal pressure during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the PR to relax together with incomplete evacuation. Other possible etiologies for incomplete evacuation, such as rectal intussusception or rectocele, were excluded in all cases. Fifty-eight constipated patients diagnosed as having NRPR by at least one of anorectal physiolosic tests had more than one BF session. The outcomes for fifty-one patients (mean age, 44.8 years; male-to-female ratio, 22:29) were reported as either improved or unimproved at a mean follow-up of 12.7 (range, 2~30) months. The sensitivities, the specificities, and the positive and negative predictive values for the CD, EMG, and ARM diagnoses of NRPR were calculated to assess the diagnostic accuracy of each test and to identify predictors associated with the outcome of BF.
RESULTS
The sensitivities of EMG, CD, and ARM were 96%, 89%, and 85%, respectively (P>0.05). The positive predictive values of the three tests were 63% for EMG, 52% for ARM, and 51% for CD (P>0.05). The negative predictive values of the three tests were 90% for EMG, 43% for ARM, and 25% for CD (P<0.05). The specificities of the three tests were 38% for EMG, 13% for ARM, and 2% for CD (P<0.05). The positive predictive values the two-study-positive groups and the three-study-positive group were 63% for the EMG- and ARM-positive group, 61% for the CD- and EMG-positive group, 51% for the CD- and ARM-positive group, and 61% for the three-study- positive group (P>0.05).
CONCLUSIONS
A combination of the CD and the EMG tests is suggested for the diagnosis of NRPR.

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

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

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