Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.277
Seok-Gyu Song, Soung-Ho Kim
Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used.
{"title":"Optimal treatment of symptomatic hemorrhoids.","authors":"Seok-Gyu Song, Soung-Ho Kim","doi":"10.3393/jksc.2011.27.6.277","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.277","url":null,"abstract":"<p><p>Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3393/jksc.2011.27.6.277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.322
Sun Hee Jee, Sun Mi Moon, Ui Sup Shin, Hoe Min Yang, Dae-Yong Hwang
Purpose: The aims of this study were to investigate the survival results and the prognostic factors of adjuvant chemotherapy in stage II colon cancer in the sparsity of Korean data.
Methods: From 1993 to 2006, 363 curatively resected pathologic stage II colon cancer patients were enrolled. Six cycles of adjuvant chemotherapy was performed: intravenous bolus 5-fluorouracil (5-FU) 500 mg/m(2) with leucovorin 20 mg/m2 for 2 hours daily for 5 days, followed by a 3-week resting period (n = 308). Fifty-five patients received only curative surgery. A high risk of recurrence was defined as the presence of one or more of the following factors: T4 tumor, lympho-vascular invasion, perineural invasion, perforation, obstruction, retrieved lymph node < 12, and poorly differention. The median follow-up period was 68 months (1 to 205 months).
Results: The five-year overall survival (OS) rate was 90.1%, and the five-year disease-free survival (DFS) rate was 84.7%. Among high-risk patients, the OS and the DFS rates of the treatment group were significantly higher than those of the non-treatment group (OS: 90.6% vs. 69.1%, P < 0.0001; DFS: 85.9% vs. 54.1%, P < 0.0001). Among low-risk patients, the survival results of the treatment group were also significantly superior (OS: 97.7% vs. 88.2%, P < 0.0001; DFS: 93.0% vs. 80.0%, P = 0.001). In the multivariate analysis, adjuvant chemotherapy was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.41; 95% confidence interval, 0.22 to 0.75; P = 0.004).
Conclusion: In our population, adjuvant chemotherapy showed superior survival to curative surgery alone and significantly reduced the risk of death. A nationwide multicenter randomized trial is needed.
目的:本研究的目的是在韩国数据稀少的情况下,探讨辅助化疗在II期结肠癌患者的生存结果和预后因素。方法:1993 ~ 2006年共纳入363例经手术切除的II期结肠癌患者。辅助化疗6个周期:5-氟尿嘧啶(5- fu) 500 mg/m(2)静脉滴注,亚叶酸素20 mg/m2,每天2小时,连续5天,然后静息3周(n = 308)。55名患者只接受了治疗性手术。复发的高风险定义为存在以下一个或多个因素:T4肿瘤,淋巴血管浸润,神经周围浸润,穿孔,阻塞,淋巴结回收< 12,差分化。中位随访时间为68个月(1 ~ 205个月)。结果:5年总生存率(OS)为90.1%,5年无病生存率(DFS)为84.7%。高危患者中,治疗组的OS和DFS率均显著高于非治疗组(OS: 90.6% vs. 69.1%, P < 0.0001;DFS: 85.9% vs. 54.1%, P < 0.0001)。在低危患者中,治疗组的生存结果也显著优于对照组(OS: 97.7% vs. 88.2%, P < 0.0001;DFS: 93.0% vs. 80.0%, P = 0.001)。在多变量分析中,辅助化疗是总体生存的显著有利预后因素(风险比,0.41;95%置信区间为0.22 ~ 0.75;P = 0.004)。结论:在我们的人群中,辅助化疗比单纯的治愈性手术生存率更高,并显著降低了死亡风险。需要一个全国性的多中心随机试验。
{"title":"Effectiveness of Adjuvant Chemotherapy with 5-FU/Leucovorin and Prognosis in Stage II Colon Cancer.","authors":"Sun Hee Jee, Sun Mi Moon, Ui Sup Shin, Hoe Min Yang, Dae-Yong Hwang","doi":"10.3393/jksc.2011.27.6.322","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.322","url":null,"abstract":"<p><strong>Purpose: </strong>The aims of this study were to investigate the survival results and the prognostic factors of adjuvant chemotherapy in stage II colon cancer in the sparsity of Korean data.</p><p><strong>Methods: </strong>From 1993 to 2006, 363 curatively resected pathologic stage II colon cancer patients were enrolled. Six cycles of adjuvant chemotherapy was performed: intravenous bolus 5-fluorouracil (5-FU) 500 mg/m(2) with leucovorin 20 mg/m2 for 2 hours daily for 5 days, followed by a 3-week resting period (n = 308). Fifty-five patients received only curative surgery. A high risk of recurrence was defined as the presence of one or more of the following factors: T4 tumor, lympho-vascular invasion, perineural invasion, perforation, obstruction, retrieved lymph node < 12, and poorly differention. The median follow-up period was 68 months (1 to 205 months).</p><p><strong>Results: </strong>The five-year overall survival (OS) rate was 90.1%, and the five-year disease-free survival (DFS) rate was 84.7%. Among high-risk patients, the OS and the DFS rates of the treatment group were significantly higher than those of the non-treatment group (OS: 90.6% vs. 69.1%, P < 0.0001; DFS: 85.9% vs. 54.1%, P < 0.0001). Among low-risk patients, the survival results of the treatment group were also significantly superior (OS: 97.7% vs. 88.2%, P < 0.0001; DFS: 93.0% vs. 80.0%, P = 0.001). In the multivariate analysis, adjuvant chemotherapy was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.41; 95% confidence interval, 0.22 to 0.75; P = 0.004).</p><p><strong>Conclusion: </strong>In our population, adjuvant chemotherapy showed superior survival to curative surgery alone and significantly reduced the risk of death. A nationwide multicenter randomized trial is needed.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/42/jksc-27-322.PMC3259429.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.275
Kwang Ho Kim
See Article on Page 282-286 Ischemic colitis (IC) occurs as a result of an inadequate blood supply to the colon. The segmental nature of IC can be explained by the vascular anatomy and the blood flow to the colon and the rectum. Colonic blood flow is supplied by three vessels: the superior mesentetic artery, the inferior mesenteric artery, and the superior hemorrhoidal artery. The vascular anatomy, however, is variable and often individually unique. Watershed zones are areas that are frequently susceptible to ischemic insult as a result of their location between two different vascular supplies. These areas include the splenic flexure (Griffiths' point) and the sigmoid colon (Sudeck's point), both of which may have potentially limited collateral blood flow. The significance of these anatomic points in an individual case cannot be determined without angiographic confirmation of vascular anatomy. Overall, the left part of the colon seems to be affected by IC in 75% of the cases. The right part of the colon, including the ileocecal area, can be affected as well, but the incidence is reported to be low. However, Brandt et al. [1] reported an affection of the left colon in only 32.6% of 313 patients and more right-sided and pancolon involvement and less hepatic and splenic flexure involvement than have previous studies. Confirmed again in their study was the predominant association of certain comorbidities, i.e., hypertension, diabetes mellitus, and coronary artery disease, in patients with IC. Chronic kidney disease requiring dialysis was again a more common comorbidity in cases of right colon IC than it was for IC in general. Sepsis was a major cause of IC in patients with pancolon involvement. Chronic obstructive pulmonary disease (COPD), previous stroke, and hyperthyroidism were shown to be the only three statistically significant independent predictors of mortality. Finally, with right colon involvement, surgery was more commonly required, and death was more frequently observed compared with the aggregate of all other patterns of IC. Carlson and Madoff [2] also suggested that the watershed zone was not especially vulnerable. Glauser et al. [3] also suggested that every segment of the colon could be affected by IC. The region of Griffith' point did not show a significant higher incidence of IC than the right colon. The right colon was significantly more often affected than the left colon in patients with non-steroidal anti-inflammatory drug (NSAID) intake. In this study, the author suggests that IC of the right colon is significantly associated with renal failure, requires more surgical treatment and shows higher mortality than IC of the left colon.
{"title":"Clinical characteristics of ischemic colitis according to the localization.","authors":"Kwang Ho Kim","doi":"10.3393/jksc.2011.27.6.275","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.275","url":null,"abstract":"See Article on Page 282-286 \u0000 \u0000Ischemic colitis (IC) occurs as a result of an inadequate blood supply to the colon. The segmental nature of IC can be explained by the vascular anatomy and the blood flow to the colon and the rectum. Colonic blood flow is supplied by three vessels: the superior mesentetic artery, the inferior mesenteric artery, and the superior hemorrhoidal artery. The vascular anatomy, however, is variable and often individually unique. Watershed zones are areas that are frequently susceptible to ischemic insult as a result of their location between two different vascular supplies. These areas include the splenic flexure (Griffiths' point) and the sigmoid colon (Sudeck's point), both of which may have potentially limited collateral blood flow. The significance of these anatomic points in an individual case cannot be determined without angiographic confirmation of vascular anatomy. Overall, the left part of the colon seems to be affected by IC in 75% of the cases. The right part of the colon, including the ileocecal area, can be affected as well, but the incidence is reported to be low. However, Brandt et al. [1] reported an affection of the left colon in only 32.6% of 313 patients and more right-sided and pancolon involvement and less hepatic and splenic flexure involvement than have previous studies. Confirmed again in their study was the predominant association of certain comorbidities, i.e., hypertension, diabetes mellitus, and coronary artery disease, in patients with IC. Chronic kidney disease requiring dialysis was again a more common comorbidity in cases of right colon IC than it was for IC in general. Sepsis was a major cause of IC in patients with pancolon involvement. Chronic obstructive pulmonary disease (COPD), previous stroke, and hyperthyroidism were shown to be the only three statistically significant independent predictors of mortality. Finally, with right colon involvement, surgery was more commonly required, and death was more frequently observed compared with the aggregate of all other patterns of IC. Carlson and Madoff [2] also suggested that the watershed zone was not especially vulnerable. Glauser et al. [3] also suggested that every segment of the colon could be affected by IC. The region of Griffith' point did not show a significant higher incidence of IC than the right colon. The right colon was significantly more often affected than the left colon in patients with non-steroidal anti-inflammatory drug (NSAID) intake. In this study, the author suggests that IC of the right colon is significantly associated with renal failure, requires more surgical treatment and shows higher mortality than IC of the left colon.","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/66/jksc-27-275.PMC3259420.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.287
Ki Bum Park, Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeun Park, Jong Pil Ryuk, Won Ho Choi, You Seok Jang
Purpose The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele. Methods A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed. Results The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients. Conclusion A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.
{"title":"Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases.","authors":"Ki Bum Park, Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeun Park, Jong Pil Ryuk, Won Ho Choi, You Seok Jang","doi":"10.3393/jksc.2011.27.6.287","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.287","url":null,"abstract":"Purpose The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele. Methods A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed. Results The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients. Conclusion A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/dd/jksc-27-287.PMC3259424.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.298
Wan Jo Jeong, Sung Wook Cho, Kyung Tae Noh, Soon Sup Chung
Purpose: Doppler-guided hemorrhoidal artery ligation and recto-anal repair (DG-HAL & RAR) is known for low recurrence, high patient satisfaction, and less postoperative pain. The purpose of this study is to analyze the 1-year follow-up results in patients who underwent a DG-HAL & RAR and to establish the benefits of the procedure.
Methods: Among the hemorrhoid patients who were admitted to our hospital from March 2008 to May 2010 and who underwent a DG-HAL & RAR, 97 patients who were followed up for a year were investigated. Recurrence, complications, admission period, difference in preoperative and postoperative pain, operation time, and time to return to daily activities were investigated.
Results: The average admission period was 1.6 ± 1.1 days. Pain at postoperative day 7 showed no significant difference from preoperative pain (P > 0.05). The operation time was 34.0 ± 7.3 minutes on average, and return to daily activities was timed at 2.3 ± 2.0 days postoperatively. At the one year follow-up, no serious complications were noted, and preoperative symptoms recurred only in 14 patients (14.4%).
Conclusion: In most patients with hemorrhoids, excluding those with severe prolapsed hemorrhoids, less pain, no serious complications, and good long-term outcome can be expected from a DG-HAL & RAR.
{"title":"One Year Follow-up Result of Doppler-guided Hemorrhoidal Artery Ligation and Recto-Anal Repair in 97 Consecutive Patients.","authors":"Wan Jo Jeong, Sung Wook Cho, Kyung Tae Noh, Soon Sup Chung","doi":"10.3393/jksc.2011.27.6.298","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.298","url":null,"abstract":"<p><strong>Purpose: </strong>Doppler-guided hemorrhoidal artery ligation and recto-anal repair (DG-HAL & RAR) is known for low recurrence, high patient satisfaction, and less postoperative pain. The purpose of this study is to analyze the 1-year follow-up results in patients who underwent a DG-HAL & RAR and to establish the benefits of the procedure.</p><p><strong>Methods: </strong>Among the hemorrhoid patients who were admitted to our hospital from March 2008 to May 2010 and who underwent a DG-HAL & RAR, 97 patients who were followed up for a year were investigated. Recurrence, complications, admission period, difference in preoperative and postoperative pain, operation time, and time to return to daily activities were investigated.</p><p><strong>Results: </strong>The average admission period was 1.6 ± 1.1 days. Pain at postoperative day 7 showed no significant difference from preoperative pain (P > 0.05). The operation time was 34.0 ± 7.3 minutes on average, and return to daily activities was timed at 2.3 ± 2.0 days postoperatively. At the one year follow-up, no serious complications were noted, and preoperative symptoms recurred only in 14 patients (14.4%).</p><p><strong>Conclusion: </strong>In most patients with hemorrhoids, excluding those with severe prolapsed hemorrhoids, less pain, no serious complications, and good long-term outcome can be expected from a DG-HAL & RAR.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/a4/jksc-27-298.PMC3259426.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.315
Jin Yong Shin
Purpose: Postoperative small bowel obstruction is a common and serious complication following a proctectomy, and early postoperative small bowel obstruction (EPSBO) leads to longer hospital stays, delays chemotherapy in advanced cases, and may be a contributor to mortality. The goal of this study is to identify the risk factors of EPSBO after a proctectomy for rectal cancer, thereby seeking to reduce the incidence of EPSBO.
Methods: Patients (735) who underwent a proctectomy for rectal cancer between March 2005 and February 2010 were entered into this study, and data were collected prospectively. Patients were judged to have EPSBO if, within the first 30 days, they presented symptoms such as nausea, vomiting and abdominal distention lasting for 2 days, and radiologic finding of small bowel obstruction after evidence of return of small bowel motility. The association between EPSBO and patients and surgery-related variables were studied by using univariate and multivariate analyses.
Results: EPSBO developed in 47 cases (6.4%) and was the most frequently occurring complication in the early perioperative period following a proctectomy. The frequency of EPSBO according to operative variables shows that EPSBO developed in 3.0% of the patients who underwent laparoscopic surgery (LS) compared with 8.4% of the patients who underwent open surgery (OS) (P = 0.004). OS (odds ratio [OR], 2.5) and a previous laparotomy (OR, 2.3) were independent risk factors for the development of EPSBO after a proctectomy for rectal cancer.
Conclusion: EPSBO is more likely to occur in patients who undergo OS or who have had a previous laparotomy. LS may be considered as a surgical procedure that can reduce the risk of EPSBO in patients undergoing a proctectomy for rectal cancer.
{"title":"Risk factors of early postoperative small bowel obstruction following a proctectomy for rectal cancer.","authors":"Jin Yong Shin","doi":"10.3393/jksc.2011.27.6.315","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.315","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative small bowel obstruction is a common and serious complication following a proctectomy, and early postoperative small bowel obstruction (EPSBO) leads to longer hospital stays, delays chemotherapy in advanced cases, and may be a contributor to mortality. The goal of this study is to identify the risk factors of EPSBO after a proctectomy for rectal cancer, thereby seeking to reduce the incidence of EPSBO.</p><p><strong>Methods: </strong>Patients (735) who underwent a proctectomy for rectal cancer between March 2005 and February 2010 were entered into this study, and data were collected prospectively. Patients were judged to have EPSBO if, within the first 30 days, they presented symptoms such as nausea, vomiting and abdominal distention lasting for 2 days, and radiologic finding of small bowel obstruction after evidence of return of small bowel motility. The association between EPSBO and patients and surgery-related variables were studied by using univariate and multivariate analyses.</p><p><strong>Results: </strong>EPSBO developed in 47 cases (6.4%) and was the most frequently occurring complication in the early perioperative period following a proctectomy. The frequency of EPSBO according to operative variables shows that EPSBO developed in 3.0% of the patients who underwent laparoscopic surgery (LS) compared with 8.4% of the patients who underwent open surgery (OS) (P = 0.004). OS (odds ratio [OR], 2.5) and a previous laparotomy (OR, 2.3) were independent risk factors for the development of EPSBO after a proctectomy for rectal cancer.</p><p><strong>Conclusion: </strong>EPSBO is more likely to occur in patients who undergo OS or who have had a previous laparotomy. LS may be considered as a surgical procedure that can reduce the risk of EPSBO in patients undergoing a proctectomy for rectal cancer.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/e9/jksc-27-315.PMC3259428.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.293
Sun Gu Lim, Eun Jung Ahn, Seong Yup Kim, Il Yong Chung, Jong-Min Park, Sei Hyeog Park, Kyoung Woo Choi
Purpose: Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA.
Methods: We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed.
Results: There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028).
Conclusion: The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.
目的:虽然腹腔镜阑尾切除术(LAs)是一种普遍的手术方式,但对于复杂性阑尾炎(CA)是否适合腹腔镜阑尾切除术仍存在争议。我们回顾性评估了腹腔镜阑尾切除术与开放式阑尾切除术治疗CA的结果。方法:我们回顾性分析了从2009年7月到2011年1月连续诊断为CA的60例患者。分析手术时间、软性饮食时间、住院时间、术后并发症等结果。结果:LA组与开放式阑尾切除术(OA)组的手术时间差异无统计学意义。LA组恢复软性饮食更快(2.1±1.2 vs. 3.5±1.5天);P = 0.001)。LA组住院时间较短(4.4±2.3天vs. 5.8±2.9天);P = 0.045)。两组总并发症发生率无统计学差异。在阑尾周围脓肿的病例中,LA的腹腔内脓肿(IAA)和术后肠梗阻(PI;P = 0.028)。结论:LA在软性饮食时间、住院时间和手术部位感染(SSI)方面均取得了良好的效果,而两组的总并发症发生率相似。然而,对于阑尾周围脓肿,LA与IAA和PI的发生率显著升高相关。因此,当使用LA时,如果存在阑尾周围脓肿,外科医生必须非常小心,以尽量减少IAA和PI的发生率。
{"title":"A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis.","authors":"Sun Gu Lim, Eun Jung Ahn, Seong Yup Kim, Il Yong Chung, Jong-Min Park, Sei Hyeog Park, Kyoung Woo Choi","doi":"10.3393/jksc.2011.27.6.293","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.293","url":null,"abstract":"<p><strong>Purpose: </strong>Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA.</p><p><strong>Methods: </strong>We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed.</p><p><strong>Results: </strong>There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028).</p><p><strong>Conclusion: </strong>The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e5/db/jksc-27-293.PMC3259425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.303
Sung Wook Baek, Haeng Ji Kang, Ji Yong Yoon, Do Youn Whang, Duk Hoon Park, Seo Gue Yoon, Hyun Sik Kim, Jong Kyun Lee, Jung Dal Lee, Kwang Yun Kim
Purpose: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease.
Methods: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009.
Results: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months).
Conclusion: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
{"title":"Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults.","authors":"Sung Wook Baek, Haeng Ji Kang, Ji Yong Yoon, Do Youn Whang, Duk Hoon Park, Seo Gue Yoon, Hyun Sik Kim, Jong Kyun Lee, Jung Dal Lee, Kwang Yun Kim","doi":"10.3393/jksc.2011.27.6.303","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.303","url":null,"abstract":"<p><strong>Purpose: </strong>A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease.</p><p><strong>Methods: </strong>We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009.</p><p><strong>Results: </strong>All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months).</p><p><strong>Conclusion: </strong>In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/89/jksc-27-303.PMC3259427.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.282
Ho Jin Chang, Chul Woon Chung, Kwang Hyun Ko, Jong Woo Kim
Purpose: The aim of this study was to analyze various clinical characteristics of ischemic colitis according to its location.
Methods: The medical records of 92 cases of gastrointestinal ischemic colitis (IC) diagnosed at Bundang CHA Hospital from 1995 to 2008 were reviewed and analyzed retrospectively. The patients were diagnosed by using colonoscopic biopsies or laparotomy findings. The patients were divided into two groups, right and left, according to the main involvement area of the IC at the embryologic boundary line of the distal transverse colon, and the two groups were compared as to clinical characteristics and co-morbid diseases.
Results: Left IC was present in 59 patients (64.1%) and right IC in 33 patients (35.9%). No differences between the two groups in terms of clinical characteristics, cardiovascular disease and diabetes mellitus were observed. However, in 16 cases with renal failure, 10 patient had right IC and 6 patients had left IC, and this difference had statistical significance (P = 0.014). Among the 16, the 11 patients requiring hemodialysis included 8 with right IC (24.2%) and 3 with left IC (5.1%; P = 0.009). Among the 19 cases of severe IC requiring surgical treatment or involving mortality, irrespective of surgery, 11 patients showed right IC and 8 patients showed left IC (P = 0.024).
Conclusion: Right-side ischemic colitis was significantly associated with renal failure and disease severity, so patients with right-side colon ischemia should be more carefully observed and managed.
{"title":"Clinical characteristics of ischemic colitis according to location.","authors":"Ho Jin Chang, Chul Woon Chung, Kwang Hyun Ko, Jong Woo Kim","doi":"10.3393/jksc.2011.27.6.282","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.282","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to analyze various clinical characteristics of ischemic colitis according to its location.</p><p><strong>Methods: </strong>The medical records of 92 cases of gastrointestinal ischemic colitis (IC) diagnosed at Bundang CHA Hospital from 1995 to 2008 were reviewed and analyzed retrospectively. The patients were diagnosed by using colonoscopic biopsies or laparotomy findings. The patients were divided into two groups, right and left, according to the main involvement area of the IC at the embryologic boundary line of the distal transverse colon, and the two groups were compared as to clinical characteristics and co-morbid diseases.</p><p><strong>Results: </strong>Left IC was present in 59 patients (64.1%) and right IC in 33 patients (35.9%). No differences between the two groups in terms of clinical characteristics, cardiovascular disease and diabetes mellitus were observed. However, in 16 cases with renal failure, 10 patient had right IC and 6 patients had left IC, and this difference had statistical significance (P = 0.014). Among the 16, the 11 patients requiring hemodialysis included 8 with right IC (24.2%) and 3 with left IC (5.1%; P = 0.009). Among the 19 cases of severe IC requiring surgical treatment or involving mortality, irrespective of surgery, 11 patients showed right IC and 8 patients showed left IC (P = 0.024).</p><p><strong>Conclusion: </strong>Right-side ischemic colitis was significantly associated with renal failure and disease severity, so patients with right-side colon ischemia should be more carefully observed and managed.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/b6/jksc-27-282.PMC3259423.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-12-31DOI: 10.3393/jksc.2011.27.6.329
Il Hyung Chung, Kwang Hyun Kim
Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasm, inflammatory bowel disease, hemorrhoid, and ischemic colitis. However, bleeding from the appendix has been reported very rarely in patients with lower gastrointestinal tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, a laparoscopic or surgical appendectomy would be recommended. We report a case of successful colonoscopic treatment of appendiceal bleeding without complications by endoclips. This report suggests that colonoscopic clipping is a safe and effective means to treat bleeding from appendiceal lesions. Further study is needed to evaluate procedure-related complications and to confirm the procedure's safety and efficacy.
{"title":"A case of successful colonoscopic treatment of acute appendiceal bleeding by endoclips.","authors":"Il Hyung Chung, Kwang Hyun Kim","doi":"10.3393/jksc.2011.27.6.329","DOIUrl":"https://doi.org/10.3393/jksc.2011.27.6.329","url":null,"abstract":"<p><p>Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasm, inflammatory bowel disease, hemorrhoid, and ischemic colitis. However, bleeding from the appendix has been reported very rarely in patients with lower gastrointestinal tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, a laparoscopic or surgical appendectomy would be recommended. We report a case of successful colonoscopic treatment of appendiceal bleeding without complications by endoclips. This report suggests that colonoscopic clipping is a safe and effective means to treat bleeding from appendiceal lesions. Further study is needed to evaluate procedure-related complications and to confirm the procedure's safety and efficacy.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/02/jksc-27-329.PMC3259430.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30398840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}