Annals of Coloproctology

Review

Colorectal cancer

Total neoadjuvant therapy in rectal cancer: a network meta-analysis of randomized trials: Sergey Sychev, Aleksey Ponomarenko, Stanislav Chernyshov, Mikhail Alekseev, Zaman Mamedli, Dmitriy Kuzmichev, Andrey Polynovskiy, Evgeny Rybakov; Ann Coloproctol. 2023;39(4):289-300. Published online April 11, 2023; DOI: https://doi.org/10.3393/ac.2022.00920.0131

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Purpose
To assess the efficacy of total neoadjuvant therapy (TNT) for rectal carcinoma in comparison with conventional chemoradiotherapy (CRT).
Methods
A systematic review was performed according to the PRISMA guidelines. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. This study was registered in PROSPERO on March 3, 2022 (No. CRD-42022307867).
Results
Outcomes of 2,719 patients from 10 randomized trials between 2010 and 2022 were selected. Of these 1,191 (44%) had conventional long-course CRT (50–54 Gy) and capecitabine, 506 (18%) had induction chemotherapy followed by CRT (50–54 Gy) and capecitabine (iTNT), 230 (9%) had long-course CRT (50–54 Gy) followed by consolidation chemotherapy (cTNT), and 792 (29%) undergone modified short-course radiotherapy (25 Gy) with subsequent chemotherapy (mTNT). Total pathologic complete response (pCR) was 20% in the iTNT group, 21% in the mTNT group, 22% in the cTNT group, and 12% in the CRT group. Statistically significant difference in pCR rates was detected when comparing iTNT with CRT (odds ratio [OR], 1.76; 95% credible interval [CrI], 1.06–2.8), mTNT with CRT (OR, 1.90; 95% CrI, 1.25–2.74), and cTNT with CRT groups (OR, 2.54; 95% CrI, 1.26–5.08). No differences were found in R0 resection rates. No significant difference was found in long-term outcomes.
Conclusion
The early administration of systemic chemotherapy in the TNT regimen has improved short-term outcomes, though long-term results are underreported. Randomized trials with survival as the endpoint are necessary to evaluate the possible advantages of TNT modes.

Citations

Citations to this article as recorded by

Predictive Value of Tumor-Infiltrating Lymphocytes and Ki-67 for Pathological Response to Total Neoadjuvant Therapy in Rectal Cancer
Amrallah Mohammed, Adel Bakry, Shimaa Gharieb, Amira Hanna, Ahmed Obaya, Waleed Abdelhady, Abdelrahman Metwalli
Journal of Gastrointestinal Cancer.2024; 55(2): 869. CrossRef
Changes in clinical guidelines for the treatment of colorectal cancer in 2024
S. S. Gordeev, M. Yu. Fedyanin, M. V. Chernykh, Ye. G. Rubakov, A. M. Karachun, A. A. Nevolskikh, A. A. Tryakin, Z. Z. Mamedli
Surgery and Oncology.2024; 14(1): 21. CrossRef
Oncological Outcomes and Response Rate After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Network Meta-Analysis Comparing Induction vs. Consolidation Chemotherapy vs. Standard Chemoradiation
Sergei Bedrikovetski, Luke Traeger, Warren Seow, Nagendra N. Dudi-Venkata, Sudarsha Selva-Nayagam, Michael Penniment, Tarik Sammour
Clinical Colorectal Cancer.2024; 23(4): 326. CrossRef
Executive Summary of the American Radium Society on Appropriate Use Criteria for Nonoperative Management of Rectal Adenocarcinoma: Systematic Review and Guidelines
Christopher J. Anker, Leila T. Tchelebi, J. Eva Selfridge, Salma K. Jabbour, Dmitriy Akselrod, Peter Cataldo, Gerard Abood, Jordan Berlin, Christopher L. Hallemeier, Krishan R. Jethwa, Ed Kim, Timothy Kennedy, Percy Lee, Navesh Sharma, William Small, Vone
International Journal of Radiation Oncology*Biology*Physics.2024; 120(4): 946. 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
A randomized phase 3 trial of total neoadjuvant therapy (induction chemotherapy, neoadjuvant chemoradiation, neoadjuvant chemotherapy, and surgery) vs. standard long-term chemoradiation therapy (neoadjuvant chemoradiation, surgery, and adjuvant chemothera
Freshte Foroughi, Seyed Alireza Javadinia, Roham Salek
Frontiers in Oncology.2024;[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

Original Article

Anorectal benign disease

Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome: Mahdi Alemrajabi, Abolfazl Akbari, Sara Sohrabi, Mohammad Rezazadehkermani, Mohammad Moradi, Shahram Agah, Mohsen Masoodi; Ann Coloproctol. 2023;39(4):351-356. Published online May 16, 2022; DOI: https://doi.org/10.3393/ac.2022.00017.0002

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Abstract PDF

Purpose
Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide.
Methods
This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods.
Results
There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups.
Conclusion
Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

Citations

Citations to this article as recorded by

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef
Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
Juliana Jee, Lauren Vourneen O’Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
Digestive Surgery.2024; 41(4): 204. CrossRef
Haemorrhoid artery ligation – recto anal repair (HAL‐RAR) blind versus Doppler: a systematic review and meta‐analysis
Amos Nepacina Liew, Jason Wang, Michelle Zhiyun Chen, Yeng Kwang Tay, Joseph C.H. Kong
ANZ Journal of Surgery.2024; 94(11): 2053. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study
Sara Z. Kuiper, Kayleigh A. M. Van Dam, Merel L. Kimman, Litza Mitalas, Paula G. M. Koot, Jarno Melenhorst, Sander M. J. Van Kuijk, Carmen D. Dirksen, Stephanie O. Breukink
Journal of Clinical Medicine.2023; 12(1): 391. CrossRef

Review

Benign proctology, Functional outcomes

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020: Kheng-Seong Ng, Melanie Holzgang, Christopher Young; Ann Coloproctol. 2020;36(3):133-147. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2020.05.04

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Abstract PDF

The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

Citations

Citations to this article as recorded by

The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial
Suwan Sanmee, Witcha Vipudhamorn, Pawit Sutharat, Ekkarin Supatrakul
Asian Journal of Surgery.2025; 48(1): 193. CrossRef
Rectal Artery Embolization for the Treatment of Hemorrhoidal Disease
Seyed S. Zakavi, Mohammad Mirza-Aghazadeh-Attari, Arian Mansur, Peiman Habibollahi, Nariman Nezami, Juan C. Camacho
Seminars in Interventional Radiology.2025;[Epub] CrossRef
Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment
Ismail Cem Eray, Ugur Topal, Serdar Gumus, Kubilay Isiker, Burak Yavuz, Ishak Aydin
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Superselective superior rectal artery embolization in the treatment of hemorrhoidal disease
Tao Jiang, Lichao Fan, Xuesong Tang, Zhigang Xu, Wenjiang Wu
Frontiers in Medicine.2025;[Epub] CrossRef
Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV Hemorrhoids: A non-randomized prospective trial
Mohammad Ashour Khadr, Walid Galal El Shazly, Mohamed Mazloum Zakria, Ahmed Mohamed Moaz
Surgery Open Digestive Advance.2024; 13: 100129. CrossRef
A Retrospective Study of Milligan-Morgan Versus LigaSure Hemorrhoidectomy in the Treatment of Symptomatic Hemorrhoids at an Institute in North India
Anant Kaur Virk, Rohin Kansal, Carol Singh, Madhav Mehta, Baninder Arora, Anmol Singh, Kashish Malhotra, Jasneet Grewal, Himel Mondal, Ashvind Bawa
Cureus.2024;[Epub] CrossRef
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef
Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
Juliana Jee, Lauren Vourneen O’Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
Digestive Surgery.2024; 41(4): 204. CrossRef
Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review
Sofia Bizarro Ponte, Joana Oliveira, Andreia Rei, Paulo Salgueiro
GE - Portuguese Journal of Gastroenterology.2024; : 1. CrossRef
Systemic and local therapy of chronic hemorrhoids: Results of the prospective comparative study “VITA”
I. V. Kostarev, G. V. Rodoman, A. K. Batishev, I. S. Bogormistrov, N. V. Tuktagulov
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2024; 21(2): 153. CrossRef
Utility of botulinum toxin injection for post-operative pain management after conventional hemorrhoidectomy: a systematic review and meta-analysis of clinical trials
Hendry Lie, Patrick Putra Lukito, Taufik Sudirman, Antonius Agung Purnama, Rudy Sutedja, Andre Setiawan, Wifanto Saditya Jeo, Andry Irawan, Willi Satriya, Heru Sutanto Koerniawan, Timotius Ivan Hariyanto
Scandinavian Journal of Gastroenterology.2023; 58(2): 116. CrossRef
Hemorrhoid laser dearterialization: systematic review and meta-analysis
Paola De Nardi, Giulia Maggi, Michele Pagnanelli, Iliyan Vlasakov, Davide Corbetta
Lasers in Medical Science.2023;[Epub] CrossRef
Altered Gut Microbic Flora and Haemorrhoids: Could They Have a Possible Relationship?
Vincenzo Davide Palumbo, Roberta Tutino, Marianna Messina, Mauro Santarelli, Casimiro Nigro, Giacomo Lo Secco, Chiara Piceni, Elena Montanari, Gabriele Barletta, Paolina Venturelli, Girolamo Geraci, Sebastiano Bonventre, Attilio Ignazio Lo Monte
Journal of Clinical Medicine.2023; 12(6): 2198. CrossRef
Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids
Kangwei Xiong, Qian Zhao, Wanli Li, Tingting Yao, Yuan Su, Jiajia Wang, Haiming Fang
Irish Journal of Medical Science (1971 -).2023; 192(6): 2747. CrossRef
Therapeutic effect of Achillea millefolium on the hemorrhoids; A randomized double-blind placebo-controlled clinical trial
Aynaz Mahmoudi, Mirsalim Seyedsadeghi, Mansour Miran, Saeid Sadeghieh Ahari, Hojat Layegh, Sara Mostafalou
Journal of Herbal Medicine.2023; 39: 100657. CrossRef
Combined operations in outpatient laser treatment of chronic hemorrhoids of stage 2–3
I. A. Matveev, N. A. Borodin, V. T. Dgebuadze, L. A. Morozova, N. N. Povarnin
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Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience
Pierluigi Lobascio, Rita Laforgia, Angela Pezzolla
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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
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A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease
Tolga Onder, Merih Altiok
Asian Journal of Surgery.2023; 46(10): 4385. CrossRef
Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of randomized controlled trials
Konstantinos Perivoliotis, Charito Chatzinikolaou, Dimitrios Symeonidis, Konstantinos Tepetes, Ioannis Baloyiannis, George Tzovaras
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Comparison of the Efficacy of Rubber Band Ligation and Injection Sclerotherapy for 2nd Degree Hemorrhoids
Uzma Khan, Yasir Naseem Khan
Indian Journal of Colo-Rectal Surgery.2023; 6(2): 26. CrossRef
A Case of Long-Term Complication of Faecal Impaction after PPH
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Advances in Clinical Medicine.2022; 12(01): 399. CrossRef
Therapeutics in Radiation-induced Proctopathy: A Systematic Review
Nathália Nascentes Coelho dos Santos Omer, Ivana Duval de Araujo, Geraldo Magela Gomes da Cruz, Fábio Gontijo Rodrigues
Journal of Coloproctology.2022; 42(01): 085. CrossRef
Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial
Shu Yu Lim, Retnagowri Rajandram, April Camilla Roslani
BMC Surgery.2022;[Epub] CrossRef
Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids
Liu Tao, Jun Wei, Xu-Feng Ding, Li-Jiang Ji
World Journal of Clinical Cases.2022; 10(18): 6060. CrossRef
Haemorrhoids
Ian Peate
British Journal of Healthcare Assistants.2022; 16(10): 464. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
SURGICAL TREATMENT OF CHRONIC HEMORRHOIDS (LITERATURE REVIEW)
S. M. Vasyliuk, A. I. Gutculiak, V. I. Gudyvok, O. M. Dmytruk, V. S. Osadetc, I. R. Labyak
Kharkiv Surgical School.2022; (4-5): 134. CrossRef
Rubber band ligation of symptomatic hemorrhoids: an old solution to an everyday problem
Vasileios Komporozos, Vasiliki Ziozia, Aikaterini Komporozou, George Stravodimos, Ageliki Kolinioti, Antonia Papazoglou
International Journal of Colorectal Disease.2021; 36(8): 1723. CrossRef
Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis
Francesco Mongelli, Giorgio Treglia, Davide La Regina, Matteo Di Giuseppe, Jacopo Galafassi, Pietro E. Majno-Hurst, Dimitrios Christoforidis
Diseases of the Colon & Rectum.2021; 64(5): 617. CrossRef
Superior Rectal Artery Embolization with Tris-Acryl Gelatin Microspheres: A Randomized Comparison of Particle Size
Murat Bülent Küçükay, Fahrettin Küçükay
Journal of Vascular and Interventional Radiology.2021; 32(6): 819. CrossRef
Lifestyle and Risk Factors in Hemorrhoidal Disease
Stefania De Marco, Domenico Tiso
Frontiers in Surgery.2021;[Epub] CrossRef
The Laser Therapy for Hemorrhoidal Disease: A Prospective Study
Rafique Umer Harvitkar, Giri Babu Gattupalli, Seshu Kumar Bylapudi
Cureus.2021;[Epub] CrossRef
Emergency treatment of bleeding hemorrhoids in a patient taking aspirin and clopidogrel using a 1470 nm diode laser and the ELITE minimal invasive technique
Chris Bachtsetzis, Antigoni Papaioannou, Spyridon Bekas, Athina Lazaridou, George Bachtsetzis
Journal of Surgical Case Reports.2020;[Epub] CrossRef

Case Report

Benign proctology,Rare disease & stoma

Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review: Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios; Ann Coloproctol. 2021;37(Suppl 1):S11-S14. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.20

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Abstract PDF

Supralevator abscess is a rare form of anorectal disease responsible for very rare but morbid manifestations, one of which is superior spread through fascial planes. We present a rare case of a spreading anorectal abscess in a patient who presented with only diffuse abdominal pain, and we review similar cases in the literature according to anatomical considerations, presentation, diagnostic procedures, and treatment options. We identified 7 previously reported cases of spreading anorectal abscesses. Most abscesses had a horseshoe morphology, and all patients presented or developed abdominal pain. All patients had perianal swelling and pain. Five out of 7 patients were previously mistreated. Only 2 abscesses spread through both the pre- and retroperitoneal planes. Abdominal pain is a dominant feature of extraperitoneal inflammation originating from anorectal abscesses. The absence of perianal signs is rare, and proper inspection of the patient along with the medical history can lead to quicker diagnosis and decisive treatment.

Citations

Citations to this article as recorded by

Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
Hsiang Teng, Po-Hsien Wu
Medicina.2024; 60(2): 293. CrossRef
A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series
Giridhar Ashwath, Eshwar Kathiresan Manasijan, Logeshbalaji Seelampatti Palanisamy, Anthony P Rozario, Nachiket Shankar
Cureus.2024;[Epub] CrossRef
Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
Cureus.2024;[Epub] CrossRef

Original Articles

Clinical Significance of Colonoscopy in Patients with Benign Anorectal Disease.: Kim, Kyung Bo , Park, Hyun Chul , Oh, Jae Hwan; J Korean Soc Coloproctol. 2001;17(4):181-186.

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Abstract PDF: PURPOSE
Benign anorectal disease will often cause great concern to the patient and the practitioner about a more proximal colon pathology. The aim of this study is to evaluate the significance of routine colonoscopy for patients with benign anorectal disease.
METHODS
A retrospective analysis of 108 patients with benign anorectal disease who had undergone colonoscopic examination from April 1997 to August 1998 at Gil Medical Center was done.
RESULTS
The mean age of all patients was 43 years; the male-to-female ratio was 1:1.1. The diagnoses of anorectal disease were hemorrhoids in 84 cases, anal fissures in 13 cases, chronic anal pain syndrome in 6 cases, anorectal fistulas in 5 cases, and other in 9 cases. There were 37 patients (34.3%) with 53 abnormal findings:14 tubular adenomas, 11 inflammatory polyps, 4 hyperplastic polyps, 1 tuberculous colitis, 1 angiodysplasia, 6 diverticula, 6 nonspecific ileitis or colitis, 2 melanosis coli, 2 rectal ulcers, 2 ileal ulcers, and 3 other diseases. Among them, clinically significant lesions, such as neoplastic lesion, tuberculous colitis and angiodysplasia, were detected in 12 patients (11.1%). Because the lesions in 7 patients of the 12 patients were within the reach of sigmoidoscopy, only 5 patients (4.6%) needed a colonoscopic examination. In regard to neoplasms, patients presenting with anal bleeding and old age were not found to have a higher frequency of neoplasia. Also, the specific type of anorectal disease was not associated with an increased risk for colorectal neoplasia (P>0.05).
CONCLUSIONS
Sigmoidoscopy is a more acceptable primary diagnostic tool in patients with benign anorectal disease, but in patients with gastrointestinal symptoms, a high risk for colorectal cancer, suspicious inflammatory bowel disease, or fear of cancer, selective colonoscopy will be needed.

Laparoscopic-assisted Colorectal Resection in Malignant Polyps and Benign Disease.: Kang, Jung Gu , Kim, Nam Kyu , Yun, Seong Hyeon , Park, Jea Kun , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2001;17(2):84-90.

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Abstract PDF: PURPOSE
Laparoscopic colorectal procedures are widely used for benign disease but controversial for malignant disease. In early colorectal cancer, laparoscopic colectomy can be performed safely on the basis of oncologic principles. The purpose of this study is to evaluate the safety and effectiveness of laparoscopic-assisted colorectal resection for malignant polyps and benign disease.
METHODS
Twenty five patients submitted to surgical treatment between Oct. 1996 to June 2000 were reviewed retrospectively.
RESULTS
Malignant polyps comprized 7 cases whose resection margins were all positive for cancer cells after endoscopic polypectomy and benign diseases in 18 cases (benign polyp: 7, diverticular disease: 4, submucosal tumor: 4 etc.). The common sugical procedures were anterior or low anterior resection (7 cases) and segmental resection (6 cases). There was no conversion to an open surgery. In malignant polyps, pathologic results revealed early cancer with no lymph node metastasis. There was no operative mortality. Postoperative recovery was uneventful except 2 cases (9.0%) of complications, which were, prolonged ileus in one patient and subcutaneous emphysema in another patient.
CONCLUSIONS
Laparoscopic-assisted resection can be recommended as a safe and effective procedure for treatment of colonic malignant polyps and benign disease.

Randomized Controlled Trial

A Prospective Study on the Relationship between Postoperative Urinary Retention and Amount of Infused Fluid during Surgery of Benign Anal Diseases under Spinal Anesthesia.: Lee, Chai Young , Kim, Hee Cheol , Lee, Dong Hee; J Korean Soc Coloproctol. 1999;15(5):357-361.

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3 Download

Abstract PDF: PURPOSE
Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid.
METHODS
Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups.
RESULTS
There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group.
CONCLUSIONS
A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.

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