Annals of Coloproctology

Volume 14(2); June 1998

Original Articles

NAT2 Polymorphism and Individual Genetic Susceptibility to Colorectal Cancer Patients in Korea.: Park, Young Seok , Lee, Kwang Soo , Jun, Kyu Young , Lee, Heung Woo , Chun, Ho Kyung , Kim, Hyun Jun , Kong, Gu; J Korean Soc Coloproctol. 1998;14(2):155-164.

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Abstract PDF: To determine the frequencies of the genotypes of NAT2 gene in healthy Korean populations and to identify the high-risk genotypes of NAT2 gene in colorectal cancer patients, 115 healthy controls and 109 cancer patients were analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). The distribution of NAT2 polymorphism in healthy Korean was found to be 7.8% of S/S genotype, 48.7% of S/F genotype, and 43.5% of F/F genotype. And the frequency of phenotypes was 8% of slow acetylator and 92% of rapid acetylator. S/S genotype of colorectal cancer patients was slightly more frequent than that of healthy controls(11.9% vs 7.8%). The relative risk of S/S genotype to colorectal cancer was estimated to be 1.41, taking the risk of F/F genotype as a baseline(1.00). These results suggest that the distribution of frequencies of NAT2 genotypes is very unique in Korean characterized by extremely low frequency of slow acetylator geno type(S/S) in comparison to the other ethnic groups. And the slow acetylator genotype(S/S) in Korean was found to be more susceptible to colon cancer. Therefore, S/S genotype may have a certain role an colonic carcinogenesis in Korean.

Expression of p53, bcl-2 Protein in Colorectal Cancer and Its Relationship to Pathologic Factor.: Jun, Ho Jin , Park, Dong Kook , Lee, Chan Young , Kim, Jung Tak , Lee, Do Sun , Jung, Min , Park, Jong Kwon , Rhu, Jin Woo , Lee, Min Chol , Myeong, Na Hye; J Korean Soc Coloproctol. 1998;14(2):165-178.

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Abstract PDF: PURPOSE
This study was undertaken to evaluate the correlation between p53, bcl-2 expression and pathologic factors stage, anatomic location, histologic grade, gross pattern, lymph node metastasis of the colorectal cancer.
METHODS
Analysis were made on archival pathology tissue of 56 patients with colorectal cancer. The oncoproteins were localized using commerically available monoclonal antibodies : DO-7 for, p53 and clone 124 for bcl-2.
RESULTS
P53 protein was detected in 53 out of 56(94.6%) adenocarcinomas of the colorectal cancer and the most frequently expressed patterns of immunoreactivity of p53 were strong in intensity in 40 cases(71.4%) and were diffuse in pattern in 39 cases(69.6%). Bcl-2 protein was detected in 34 out of 56(60.7%) adenocarcinomas of the colorectal cancer and the most frequently expressed patterns of immunoreactivity of bcl-2 were weak in intensity in 17 cases(30.3%) and were diffuse in pattern in 16 cases(28.6%). There was no correlation between p53, bcl-2 expression and Dukes' stage, anatomic location ,histologic grade, gross pattern of tumor, lymph node metastasis of the colorectal cancer.
CONCLUSION
53 mutation and bcl-2 expression are frequent event in human colorectal carcinoma as shown in this study, but p53 and bcl-2 protein expression is not significant independent predicator of aggressiveness and progression of colorectal cancers.

One-Stage Resection and Anastomosis of Left Colon Cancer Obstruction.: Kim, Myung Hwan , Lee, Do Sang , Sung, Gi Young , Song, Moo Hyung , Kim, Wook , Park, Il Young , Won, Jong Man; J Korean Soc Coloproctol. 1998;14(2):179-188.

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Abstract PDF: Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.

Comparison of One Stage Operation with Staged Operation in Malignant Obstruction of the Left Colon and Rectum.: Kim, Hyun Ho , Kim, Byung Seok , Moon, Duk Jin , Park, Ju Sup; J Korean Soc Coloproctol. 1998;14(2):189-198.

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Abstract PDF: BACKGROUND
The optimal management of malignant obstruction of the left colon and rectum is controversial.
METHODS
A retrospective study was performed of 33 patients who underwent one-stage operation(n=11), staged operation(n=20), and palliative colostomy(n=2) at Kwangju Christian Hospital between January 1992 and December 1996.
RESULTS
Eleven patients underwent one-stage operations(7 cases with anterior resection, 3 cases with left hemicolectomy, 1 case with Miles' operation). In this group, postoperative morbidity was 36.3% including 1 wound infection(9.0%), 1 anastomotic leakage (9.0%), 1 postoperative intestinal obstruction and 1 pulmonary complication, but there was no postoperative death. The average of hospital stay in this group was 18.1 days and the first day of normal diet was 6.0 days. Twenty patients underwent staged operations including 12 cases of Hartmann's procedure. In this group, postoperative morbidity was 35.0% including 3 wound infections(15.0%), 2 pulmonary complications(10.0%), 1 parastomal hernia and 1 fistula. There were two postoperative deaths as a result of sepsis. The average of hospital stay in this group was 34.9 days and the first day of normal diet was 6.8 days.
CONCLUSION
We believe that one-stage operation was of value in management of malignant obstruction of the left colon and rectum in selected patients.

A Clinical Analysis of Colorectal Cancer in Young and Elderly Patients.: Kim, Hyeong Rok , Kim, Young Jin , Lee, Jung Hun , Kim, Dong Yi , Kim, Shin Kon; J Korean Soc Coloproctol. 1998;14(2):199-208.

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Abstract PDF: Colorectal carcinoma in patients under 40 years and over 70 years of age is unusual but not rare. The prognosis of these two groups, compared with remainder of patients, is thought to be unfavorable. From Jan. 1981 to Dec. 1997, 541 patients with primary colorectal cancer who were treated by surgical resection were analyzed retrospectively. They were divided into three age groups according to the age at admission, i.e. under 40 years, over 70 years and between 40 and 69 years(control group). Among three age groups, sex ratio, tumor characteristics(size, location , depth of invasion, lymph node metastasis, liver metastasis, peritoneal metastasis, histopathologic classification, stage, DNA ploidy pattern), serum CEA level and survival were compared and analyzed. The results were as follows: 1) In the young patient group(52 cases), female predominence, large tumor size, high proportion of mucinous adenocarcinoma in histopathologic classification, more frequent metastasis to regional lymph node, frequent peritoneal metastasis and high incidence in tumor location at transverse colon were noted(p<0.05). 2) In the elderly group(69 cases), deep invasion of tumor(T4) was noted (p<0.05). In addition, among them, concomittent diseases were presented in 25 patients(36%). They were diabetes(8), cardiac arrhythmia(4), old myocardial infarction(2), liver cirrhosis(5), COPD(3), previous cancer(3). 3) The 5-year survival rates of the young patient group and that of elderly patient group were lower than that of the other(p<0.01). 4) There was no significant differences in liver metastasis, tumor stage, DNA ploidy pattern, serum CEA level among three age groups.

Management for Obstructed Carcinoma of the Left Colon.: Kim, Hyun Chul , Baek, Moo Jun , Park, Nae Kyung , Lee, Moon Soo , Jang, Yong Suk , Song, Ok Pyung; J Korean Soc Coloproctol. 1998;14(2):209-216.

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Abstract PDF: The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.

Anal Endosonographic Findings of Internal Anal Sphincter in Normal Adult Korean.: Kim, Kyung Jong , Kim, Cheong Yong , Jang, Jeong Hwan , Kim, Kweon Cheon , Min, Young Don; J Korean Soc Coloproctol. 1998;14(2):217-224.

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Abstract PDF: PURPOSE
To describe the appearance and average thickness of the internal anal sphincter with anal endosonography in healthy Korean adults. MATERIAL AND METHODS: 184 subjects(male: 96, female: 88) with no history of anorectal disease or surgery were studied with anal endosonography. The average thickness of internal sphincter was meas ured at the mid-anal canal. For the internal sphincter, which is often asymmetric, the thickness of each 4 part(12, 3, 6 and 9 o'clock direction) were measured in left lateral decubitus position.
RESULTS
The anal wall was well visualized in 5 layers(mucosa, submucosa, internal anal sphincter, intersphincteric plane, external anal sphincter) with anal endosonography. The anal endosonogram showed the internal anal sphincter as a homogenous, well-defined, hypoechoic, circular band, and slightly asymmetric. The average thickness of the internal anal sphincter in the area of mid-anal portion was 2.0 0.3 mm(range: 1~3 mm). There was no sexual difference; however, a significant positive correlation with age was found in average thickness of the internal anal sphincter. The correlation with lean body mass was not found.
CONCLUSION
The internal anal sphincter is well-visualized, best defined structure by anal endosonography. Average thickeness of the sphincter in Korean appeared to be the same as in the Western.

Pathogenesis and Surgical Treatment of Rectal Prolapse Syndrome.: Kim, Jin Cheon , Kim, Chang Nam , Park, Sang Kyu , Kim, Sook Young , Yu, Chang Sik; J Korean Soc Coloproctol. 1998;14(2):225-234.

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Abstract PDF: The rectal prolapse syndome is a disease entity includes rectocele and rectal prolapse, presenting prolapse(procidentia) of rectum. In rectocele, rectum is prolapsed anteriorly into the vagina, whereas in procidentia, inferiorly out of the anus. This study was aimed at analyzing pathogenesis and adequacy of surgical treatment in rectocele and rectal prolapse. Twenty-one patients with rectocele and 18 patients with rectal prolapse were assessed pre- and post-operatively in respect to symptoms and signs, pathogenesis, defecography, and manometry. In analysis of symptoms and sings, constipation was the commonest in both diseases(86% of rectocele and 67% of rectal prolapse) and incontinence was not infrequently found in both diseases as well(14% of rectocele and 33% of rectal prolapse). In analysis of the underlying causes, two patients with rectal prolapse had prolapse from childhood. Defecography showed anorectal angle of rectal prolapse in rest and push period. They were significantly wider than those of rectocele(p<0.05). The perineal descent of rectal prolapse was longer than that of rectocele. In analysis of the associated factors, average number of delivery was more than three times in both diseases(3.5 of rectocele and 5.1 of rectal prolapse). We could easily find previous operation history in both diseases. Among them, hysterectomy was the most frequent, especially in patients with rectocele. The hemorrhoids was associated more common in rectocele than in rectal prolapse(p<0.05). Preoperative maximal resting pressure of rectal prolapse was more significantly decreased than that of rectocele(p<0.05). The sensation of fullness was significantly decreased in patients with rectal prolapse postoperatively(p<0.05). Patients with rectocele underwent levator plication by transrectal or vaginal approach. Patients with rectal prolapse underwent posterior rectopexy in 11 patients, resection and rectopexy in 3 patients, Delorme's operation and Thiersch operation in 2 patients each. Constipation was significantly improved in patients with rectocele postoperatively(p<0.05). Incontinence was markedly improved in patients with rectal prolapse postoperatively(p<0.05). At the interview about subjective improvement of symptom, 95% of patients with rectocele and 89% of patients with rectal prolapse were satisfied with surgery. In conclusion, rectocele and rectal prolapse can be categorized as rectal prolapse syndrome because both diseases have anatomical derangements caused by similar pathogenesis such as altered bowel habits, anatomical factor, delivery, past history of hysterectomy, and hemorrhoids. Levator plication and posterior rectopexy seem to be useful surgical methods of anatomical repair for the respective disease.

Clinical Significance of Colon Transit Time Study in Patients with Chronic Constipation.: Seong, Moo Kyung , Joo, Jae Sik; J Korean Soc Coloproctol. 1998;14(2):235-240.

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Abstract PDF: PURPOSE
Measurement of colon transit time is well-known physiologic study for patients with chronic constipation. But information we get from it is frequently inconsistent with patient's complaint. This study was designed to ascertain the actual significance of that measurement.
METHODS
The subjects included two groups of patients with chronic constipation. One group consists of 32 patients(group A), The other group 36 patients(group B). Colon transit time study and defecographic examinations were done using previously described methods. But the former study was a little modified in group A, in which sodium phosphate enema was given at the previous day of oral intake of radio-opaque markers. Findings of colon transit time study and their relations to the defecographic results were compared with each other.
RESULTS
As for the 5th day-findings of colon transit time, 6 cases(18.7%) were abnormal in group A and 3 cases(8.4%) in group B(statistically not different). As for the 3rd day-findings, 15 cases(46.9%) were abnormal in group A and 7 cases(19.5%) in group B( statistically different, p=0.0163). Defecographic findings showed 7 cases(21.9%) of outlet obstruction pattern in group A and 9 cases(25%) in group B. Correlations between these findings and those of colonic transit time studies were not proven statistically.
CONCLUSION
Colon transit time study with single marker bolus and the 5th day photography technique was considered not to reflect the actual conditions of patients with chronic constipation. But sodium phophate enema, given to patients before starting the study, seemed to enhance the accuracy of study.

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.

Clinical Analysis of Ulcerative Colitis.: Lim, Seok Won , Kim, Kuhn Uk , Park, Weon Kap , Lee, Kwang Real , Yoo, Jung Jun , Kim, Hyun Shin , Chun, John Youl , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(2):247-258.

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Abstract PDF: Ulcerative colitis is increasing now in Korea, and the diagnosis has become relatively easy because sigmoidoscopy and colonoscopy are frequently used. However, the result of treatment is not satisfactory because the relapse rate is very high. Hence, the aim of treatment is to put this disease into remission as soon as possible and to keep it in remission. The authors reviewed 80 confirmed ulcerative colitis cases which were treated from Feb. 1997 to Sep. 1997 at Song Do Colorectal Hospital. The results are as follows: 1) The male to female ratio for these 80 cases was 41:39, and the most prevalent age group was the 4th decade. 2) The most common clinical symptoms were anal bleeding in 77 cases(96%), diarrhea in 68 cases(85%), and abdominal pain in 21 cases(26%). 3) The extension of the disease were the proctitis in 47 cases(59%), the left - side colitis in 28 cases(35%), the total colitis in 4 cases(5%), and the atypical colitis in 1 case(1.3%). 4) The duration of the disease was below 6 month in 30 cases, 6 months to 1 year in 35 cases, and 1~5 years in 11 cases, and over 5 years in 4 cases. 5) Clinical types were the one-attack-only type(18 cases), the relapsing-remitting type(60 cases), the chronic continuous type(1 case), and the acute fulminating type(1 case). 6) In the 28 cases of left side colitis, the average time to remission depended on the medication was 18 days for a 5-ASA 5-ASA suppository, 14.5 days for a 5-ASA oral steroid, and 8.3 days for a 5-ASA budesonide enema. Thus, a budesonide enema is the most effective medication for obtaining remission. 7) The most commonly suspected predisposing factors for relapse were cessation of medication(58 cases), mental stress(18 cases), physical stress(15 cases), and inadequate diet(8 cases). As indicated above, ulcerative colitis is increasing now in Korea, and the rectum is the most commonly involved site for this disease. Relapsing-remitting ulcerative colitis is the most frequently occurring type. Almost all cases were easily put into remission within 4 weeks, but relapse frequently occurred. Suspected predisposing factors, such as mental stress, physical stress, and inadequate diet, should be avoided in order to prevent relapse, and medication, such as 5-aminosalicylic acid, should be continued to maintain remission.

A Clinical Study of Hemorrhoids.: Lee, Sang Ho , Han, Joon Kil , Lee, Kwang Chan; J Korean Soc Coloproctol. 1998;14(2):259-268.

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Abstract PDF: BACKGROUND
Various surgical techniques are used for the cure of hemorrhoid according to the extent of disease and severity of symptom. Purpose : We compared the postoperative clinical course after submucosal hemorrhoidectomy and ligation and excision of hemorrhoids. MATERIAL AND METHODS: Between February 1995 and May 1997, 221 patients underwent submucosal hemorrhoidectomy and 111 patients underwent ligation and excision of hemorrhoids at the Department of Surgery, Eulji General Hospital. We compared the hospital course and postoperative complications in two group.
RESULTS
For submucosal hemorrhoidectomy group, mean operation time was 38 minutes, the improvement of postoperative pain, is based on no needs of analgesics after 48 hours of postoperation, was seen in 115 patients(52.0%), wound healing took 19.5 days in average, and mean hospital stay was 6.4 days. For ligation and excision group, these findings were mean operation time 21 minutes, the improvement of postoperative pain in 47 patients(42.3%), wound healing 25.4 days, and hospital stay 7.2 days. Postoperative complications such as skin tag, edema, and were more common in submucosal hemorrhoidectomy group. But anal fissure, stenosis were more frequent in ligation and excision group, although they did not occur later.
CONCLUSION
We think that submucosal hemorrhoidectomy is a better method than ligation and excision in respect of postoperative course and complications.

Intraoperative Muscular Injection of Tarasyn(R) for Postoperative Hemorrhoidectomy Pain Management.: Kim, Kuhn Uk , Park, Weon Kap , Lee, Kwang Real , Yoo, Jung Jun , Lim, Seok Won , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(2):269-274.

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Abstract PDF: The pain after a hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control their pain postoperatively. In an effort to decrease posthemorrhoidectomy pain by applying newer methods of analgesia, a prospective trial was conducted to investigate the postoperative analgesic effect of Tarasyn(R) (ketorolac tromethamine) injected into the internal sphincter muscle at the time of the hemorrhoidectomy. Tarasyn(R) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. It's action is peripheral. Therefore, it seems appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total loading dose of 60 mg(2 cc, 30 mg/ml) of ketorolac was used intraoperatively. It was injected intramuscularly locally after completion of hemorrhoidectomy. Postoperative pain after a hemorrhoidectomy can be safely controlled in a patient by using newer methods of pain control, including supplemental use of the nonsteroidal analgesic ketorolac, which allows early release of the patient, the day of surgery by diminishing the postoperative pain in our study group. Another important advantage of a local injection of ketorolac was the elimination of urinary retention.

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.

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.

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