Annals of Coloproctology

Volume 36(5); October 2020

Editorials

Malignant disease

Comprehensive Approach for Older Cancer Patients: New Challenge in an Aging Society: Do Young Lee, Jung-Myun Kwak; Ann Coloproctol. 2020;36(5):289-290. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.10.25

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Immune Checkpoint Inhibitors: The Unexplored Landscape of Geriatric Oncology
Khalil Choucair, Abdul Rafeh Naqash, Caroline A Nebhan, Ryan Nipp, Douglas B Johnson, Anwaar Saeed
The Oncologist.2022; 27(9): 778. CrossRef
Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison
Nicolás M. González-Senac, Jennifer Mayordomo-Cava, Angela Macías-Valle, Paula Aldama-Marín, Sara Majuelos González, María Luisa Cruz Arnés, Luis M. Jiménez-Gómez, María T. Vidán-Astiz, José Antonio Serra-Rexach
International Journal of Environmental Research and Public Health.2021; 18(11): 6072. CrossRef

Benign proctology

The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy: Hyeonseok Jeong; Ann Coloproctol. 2020;36(5):291-292. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.10.13

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A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Review

Malignant disease, Rectal cancer

Robotic Total Mesorectal Excision for Rectal Cancer: Current Evidences and Future Perspectives: Je-Ho Jang, Chang-Nam Kim; Ann Coloproctol. 2020;36(5):293-303. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.16

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Despite the technical limitations of minimally invasive surgery, laparoscopic total mesorectal excision (LTME) for rectal cancer has short-term advantages over open surgery, but the pathological outcomes reported in randomized clinical trials are still in controversy. Minimally invasive robotic total mesorectal excision (RTME) has recently been gaining popularity as robotic surgical systems potentially provide greater benefits than LTME. Compared to LTME, RTME is associated with lower conversion rates and similar or better genitourinary functions, but its long-term oncological outcomes have not been established. Although the operating time of RTME is longer than that of LTME, RTME has a shorter learning curve, is more convenient for surgeons, and is better for sphincter-preserving operations than LTME. The robotic surgical system is a good technical tool for minimally invasive surgery for rectal cancer, especially in male patients with narrow deep pelvises. Robotic systems and robotic surgical techniques are still improving, and the contribution of RTME to the treatment of rectal cancer will continue to increase in the future.

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Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
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Laparoscopic Low Anterior Resection for Rectal Cancer With a Wristed Articulated Instrument
Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Diseases of the Colon & Rectum.2023; 66(1): e1. CrossRef
Short-term outcomes of da Vinci SP versus Xi for colon cancer surgery: a propensity-score matching analysis of multicenter cohorts
Jin-Min Jung, Young Il Kim, Yong Sik Yoon, Songsoo Yang, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Journal of Robotic Surgery.2023; 17(6): 2911. CrossRef
Cirugía del cáncer de recto asistida por robot (X y Xi)
P. Rouanet, M. Lehiany, A. Mourregot, P.-E. Colombo, C. Taoum
EMC - Técnicas Quirúrgicas - Aparato Digestivo.2023; 39(4): 1. CrossRef
Chirurgia del cancro del retto mediante assistenza robotica (X e Xi)
P. Rouanet, M. Lehiany, A. Mourregot, P.-E. Colombo, C. Taoum
EMC - Tecniche Chirurgiche Addominale.2023; 29(4): 1. CrossRef
The clinical impact of robot‐assisted laparoscopic rectal cancer surgery associated with robot‐assisted radical prostatectomy
Anri Maeda, Hiroki Takahashi, Kaori Watanabe, Takeshi Yanagita, Takuya Suzuki, Nozomu Nakai, Yuzo Maeda, Kazuyoshi Shiga, Takahisa Hirokawa, Ryo Ogawa, Masayasu Hara, Yoichi Matsuo, Shuji Takiguchi
Asian Journal of Endoscopic Surgery.2022; 15(1): 36. CrossRef
Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Direction of diagnosis and treatment improvement in colorectal cancer
In Ja Park
Journal of the Korean Medical Association.2022; 65(9): 540. CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Robot-assisted laparoscopic rectal surgery: operative technique and initial experiences
Bianka Hummel, Anna Nagel, Benjamin Süsoy, Linda Tarantik, Linda Michlmayr, Friedrich Längle, Clemens Bittermann
European Surgery.2021; 53(4): 175. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef

Original Articles

Malignant disease, Rectal cancer

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery: Do Hoe Ku, Hyeon Seung Kim, Jin Yong Shin; Ann Coloproctol. 2020;36(5):304-310. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.10.22

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Purpose
Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.
Methods
From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.
Results
The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).
Conclusion
In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

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Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure
C. Stabilini, M.A. Garcia-Urena, F. Berrevoet, D. Cuccurullo, S. Capoccia Giovannini, M. Dajko, L. Rossi, K. Decaestecker, M. López Cano
Hernia.2022; 26(2): 411. CrossRef
Choice of specimen’s extraction site affects wound morbidity in laparoscopic colorectal cancer surgery
Mahmood Al Dhaheri, Mohanad Ibrahim, Omer Al-Yahri, Ibrahim Amer, Mahwish Khawar, Noof Al-Naimi, Ayman Abdelhafiz Ahmed, Mohamed Abu Nada, Amjad Parvaiz
Langenbeck's Archives of Surgery.2022; 407(8): 3561. CrossRef

Malignant disease

Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy: Jungtak Son, Yong Jun Park, Sung Ryol Lee, Hyung Ook Kim, Kyung Uk Jung; Ann Coloproctol. 2020;36(5):311-315. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.15.1

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Abstract PDF

Purpose
The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy.
Methods
This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed.
Results
All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). Conclusion: The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy. These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.

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Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?
Şevki Pedük
European Journal of Therapeutics.2024; 30(2): 145. CrossRef
Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy
Pietro Fransvea, Caterina Puccioni, Gaia Altieri, Luca D’Agostino, Gianluca Costa, Giuseppe Tropeano, Antonio La Greca, Giuseppe Brisinda, Gabriele Sganga
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Exploring the mysterious mucinous appendiceal neoplasm
Erika Hissong
Seminars in Diagnostic Pathology.2024; 41(5): 222. CrossRef
High Incidence of Appendiceal Neoplasms in the Elderly: A Critical Concern for Non-Surgical Treatment
Gizem Issin, Fatih Demir, Irem Guvendir Bakkaloglu, Diren Vuslat Cagatay, Hasan Aktug Simsek, Ismail Yilmaz, Ebru Zemheri
Medical Principles and Practice.2023; 32(6): 358. CrossRef
Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef
Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis
Roberto Peltrini, Valeria Cantoni, Roberta Green, Ruggero Lionetti, Michele D'Ambra, Carolina Bartolini, Marcello De Luca, Umberto Bracale, Alberto Cuocolo, Francesco Corcione
The Surgeon.2021; 19(6): e549. CrossRef
Interval appendicectomy for complicated appendicitis: do not let your guard down!
R Peltrini, M Podda, S Di Saverio, U Bracale, F Corcione
British Journal of Surgery.2021; 108(9): e288. CrossRef
Modern Management of the Appendix
CPT Samuel Grasso, LTC Avery Walker
Surgical Clinics of North America.2021; 101(6): 1023. CrossRef

Malignant disease,Prognosis and adjuvant therapy

Identification of Risk Factors Associated With Stage III Disease in Nonmetastatic Colon Cancer: Results From a Prospective National Cohort Study: Jakob Lykke, Ole Roikjaer, Per Jess, Jacob Rosenberg, On behalf of the Danish Colorectal Cancer Group; Ann Coloproctol. 2020;36(5):316-322. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.03.03

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Purpose
This study aimed to identify possible patient- and tumor-related factors associated with risk of TNM stage III disease in nonmetastatic colon cancer.
Methods
The associations between stage III disease and age, sex, lymph node yield, pathological tumor (pT) stage, tumor subsite, type of surgery, and priority of surgery were assessed in a nationwide cohort of 13,766 patients treated with curative resection of colon cancer. Each level of age, lymph node yield, and pT stage was compared to the preceding level.
Results
Age, lymph node yield, pT stage, tumor subsite, and priority of surgery were associated with stage III disease. Odds ratios (95% confidence interval [CI]) were as follows: age < 65/65–75 years: 1.28 (95% CI, 1.15–1.43) and 65–75/ > 75 years: 1.22 (95% CI, 1.13–1.32); lymph node yield 0–5/6–11: 0.60 (95% CI, 0.50–0.72), lymph node yield 6–11/12–17: 0.84 (95% CI, 0.76–0.93), and lymph node yield 12–17/ ≥ 18: 0.97 (95% CI, 0.89–1.05); pT1/pT2: 0.74 (95% CI, 0.57–0.95), pT2/pT3: 0.35 (95% CI, 0.30–0.40), and pT3/pT4: 0.49 (95% CI, 0.47–0.54). Only tumors of the transverse colon were independently associated with lower risk of stage III disease than tumors in the sigmoid colon (sigmoid colon: 1, transverse colon: 0.84 [95% CI, 0.73–0.96]; elective surgery: 1, acute surgery: 1.43 [95% CI, 1.29–1.60]).
Conclusion
In this study, stage III disease in colon cancer was significantly associated with age, lymph node yield, pT stage, tumor subsite, and priority of surgery but was not associated with right-sided location compared with stage I and II cancers.

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Association of the pathomics-collagen signature with lymph node metastasis in colorectal cancer: a retrospective multicenter study
Wei Jiang, Huaiming Wang, Xiaoyu Dong, Yandong Zhao, Chenyan Long, Dexin Chen, Botao Yan, Jiaxin Cheng, Zexi Lin, Shuangmu Zhuo, Hui Wang, Jun Yan
Journal of Translational Medicine.2024;[Epub] CrossRef
Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Deep learning-based pathology signature could reveal lymph node status and act as a novel prognostic marker across multiple cancer types
Siteng Chen, Jinxi Xiang, Xiyue Wang, Jun Zhang, Sen Yang, Wei Yang, Junhua Zheng, Xiao Han
British Journal of Cancer.2023; 129(1): 46. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Deep learning can predict lymph node status directly from histology in colorectal cancer
Lennard Kiehl, Sara Kuntz, Julia Höhn, Tanja Jutzi, Eva Krieghoff-Henning, Jakob N. Kather, Tim Holland-Letz, Annette Kopp-Schneider, Jenny Chang-Claude, Alexander Brobeil, Christof von Kalle, Stefan Fröhling, Elizabeth Alwers, Hermann Brenner, Michael Ho
European Journal of Cancer.2021; 157: 464. CrossRef

Malignant disease

Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals: Soo Min Lee, Jun Sang Shin; Ann Coloproctol. 2020;36(5):323-329. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.19.2

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Abstract PDF

Purpose
Elderly population will comprise a substantial proportion of colorectal cancer (CRC) patients. We examined patients older than 80 years according to their clinical and pathological characteristics to fully understand the elderly patients.
Methods
CRC patients, 60 years or older at diagnosis, admitted between 2009 and 2014 at our hospital were enrolled. The patients were divided into 2 groups: elderly (aged > 80 years, n = 133), and controls (aged 60 to 79 years, n = 596). Patient’s demographics, risk factors for prognosis of CRC, Clinicopathological parameters, treatment, and survival rates were compared.
Results
The mean ages were 83.9 and 64.8 years, respectively. Male-to-female ratio and tumor sidedness were comparable in both groups. Prognostic factors found in univariate analysis; differentiation, stage, lymphovascular invasion, and carcinoembryonic antigen showed no statistical difference. The microsatellite instability status and number of retrieved lymph nodes were also similar (17.2 vs 21.6, P = 0.505). A significant difference was found in the treatment approach for chemotherapy as the elderly patients with stage III and IV tend to have omitted adjuvant (43.6% vs. 92.8%, P < 0.001) or palliative (35.8% vs. 89.4%, P = 0.016) chemotherapy. Except in stage I, elderly patients showed significantly lower overall survival rates.
Conclusion
Current study shows far-elderly patients with CRC were less likely to receive standard treatments, which might have resulted in an inferior outcome. As the number of elderly patients with CRC increase, our results provide a basis for further clinical and molecular investigations of elderly CRC patients.

Citations

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Mortality and morbidity after colorectal cancer resection surgery in elderly patients: a retrospective population-based study in Sweden
Maria Normann, Niklas Ekerstad, Eva Angenete, Mattias Prytz
World Journal of Surgical Oncology.2024;[Epub] CrossRef
Robot-assisted vs. laparoscopic right hemicolectomy in octogenarians and nonagenarians: an analysis of the US nationwide inpatient sample 2005–2018
Chien-Chang Lu, Chi-Tung Lu, Kai-Yen Chang, Wang Chun-Li, Chien-Ying Wu
Aging Clinical and Experimental Research.2024;[Epub] CrossRef
Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old
Ioannis A. Voutsadakis
Medicina.2023; 59(9): 1574. CrossRef
Octogenarian patients with colon cancer – postoperative morbidity and mortality are the major challenges
Øystein Høydahl, Tom-Harald Edna, Athanasios Xanthoulis, Stian Lydersen, Birger Henning Endreseth
BMC Cancer.2022;[Epub] CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Oncological liver resection in elderly – A retrospective comparative study
Carina E. Riediger, Steffen Löck, Laura Frohneberg, Raphael Hoffmann, Christoph Kahlert, Jürgen Weitz
International Journal of Surgery.2022; 104: 106729. CrossRef
Direction of diagnosis and treatment improvement in colorectal cancer
In Ja Park
Journal of the Korean Medical Association.2022; 65(9): 540. CrossRef
Epidemiology, risk factors, and prevention of colorectal cancer
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Korean Medical Association.2022; 65(9): 549. CrossRef
Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 231. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Comprehensive Approach for Older Cancer Patients: New Challenge in an Aging Society
Do Young Lee, Jung-Myun Kwak
Annals of Coloproctology.2020; 36(5): 289. CrossRef

Benign proctology

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

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Abstract PDF

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

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

Benign GI diease

The Management of Retained Rectal Foreign Body: Ju Hun Kim, Eunhae Um, Sung Min Jung, Yong Chan Shin, Sung-Won Jung, Jae Il Kim, Tae Gil Heo, Myung Soo Lee, Heungman Jun, Pyong Wha Choi; Ann Coloproctol. 2020;36(5):335-343. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.03.1

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Abstract PDF

Purpose
Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.
Methods
We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.
Results
All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.
Conclusion
Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

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Combined laparoscopic and endoscopic method for foreign body removal from descending colon: A case report
Khairunnisa Che Ghazali, Huzairi Yaacob, Ahmad Shanwani Mohamed Sidek
World Journal of Surgical Procedures.2024; 14(1): 1. CrossRef
Minimally invasive techniques as adjuncts in low- versus high-lying retained rectal foreign bodies of autoerotic nature in young men: a tailored management algorithm with two contrasting case reports from India
Shubham Kumar Gupta, Vivek Kumar Katiyar, Sumit Sharma, Shashi Prakash Mishra, Satyanam Kumar Bhartiya
Journal of Trauma and Injury.2024; 37(3): 238. CrossRef
Caring for a patient with a rectal foreign body
Sophia Parsh, Hyun Ah “Esther” Oh, Bridget Parsh
Nursing.2023; 53(9): 11. CrossRef
Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature
Stefan Fritz, Hansjörg Killguss, André Schaudt, Christof M. Sommer, Götz M. Richter, Sebastian Belle, Christoph Reissfelder, Steffan Loff, Jörg Köninger
Langenbeck's Archives of Surgery.2022; 407(6): 2499. CrossRef
Deodorant aerosol spray can in the rectum: a potential fire hazard during surgery
Sivaraman Kumarasamy, Lileswar Kaman, Azhar Ansari, Amarjyoti Hazarika
BMJ Case Reports.2021; 14(5): e241538. CrossRef

Benign proctology

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial: Kyung Jin Cho, Do Yeon Hwang, Hyun Joo Lee, Ki Hoon Hyun, Tae Jung Kim, Duk Hoon Park; Ann Coloproctol. 2020;36(5):344-348. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2020.02.12

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Abstract PDF

Purpose
This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.
Methods
One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).
Results
Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).
Conclusion
Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

Citations

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PROSPECT guideline for haemorrhoid surgery
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Case Reports

Malignant disease

Early Postoperative Anastomotic Obstruction Due to an Intraluminal Blood Clot After Laparoscopic Anterior Resection: A Case Report: Soon Keun Kwon, Jin Soo Han, Jihyun Seo, Yong Sik Yoon; Ann Coloproctol. 2020;36(5):349-352. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.11.2

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Abstract PDF: Early postoperative anastomotic obstruction after colorectal surgery rarely develops. Herein, we present a case of a 50-year-old healthy woman who had an early postoperative anastomotic obstruction which was revealed caused by a blood clot and successfully managed by endoscopic approach. The patient was discharged after laparoscopic anterior resection and visited the emergency department one day after because of abdominal pain. Computed tomography showed that the anastomosis site was obstructed with low-density material. Intraoperative endoscopy was performed under general anesthesia and blood clot filling the lumen were identified. As the scope was advanced to the blood clot with air inflation, the blood clot was evacuated. The anastomosis site could be obstructed by blot clot with mucous debris albeit it is a rare condition. An endoscopic approach seems to be the first option in the diagnosis and treatment of postoperative obstruction at the anastomosis site and it could prevent unnecessary laparotomy.

Malignant disease

Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation: Jae Young Kwak, Kwan Mo Yang, Hyun Il Seo; Ann Coloproctol. 2020;36(5):353-356. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.02.27

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Abstract PDF: An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

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