Annals of Coloproctology

Original Articles

Colorectal cancer

Comparing the efficacy of combined versus single immune cell adaptive therapy targeting colorectal cancer: Denis Nchang Che, NaHye Lee, Hyo-Jung Lee, Yea-Won Kim, Solongo Battulga, Ha Na Lee, Won-Kook Ham, Hyunah Lee, Mi Young Lee, Dawoon Kim, Haengji Kang, Subin Yun, Jinju Park, Daeyoun David Won, Jong Kyun Lee; Ann Coloproctol. 2024;40(2):121-135. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00402.0057

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Abstract PDF Supplementary Material: Purpose
Colorectal cancer (CRC) is the most frequent cancer with limited therapeutic achievements. Recently, adoptive cellular immunotherapy has been developed as an antitumor therapy. However, its efficacy has not been tested in CRC. This study investigated the ability of an immune cell cocktail of dendritic cells (DCs), T cells, and natural killer (NK) cells to overcome immunological hurdles and improve the therapeutic efficacy of cell therapy for CRC.
Methods
CRC lysate-pulsed monocyte-derived DCs (Mo-DCs), CRC antigen-specifically expanded T cells (CTL), and in vitro-expanded NK cells were cultured from patient peripheral blood mononuclear cells (PBMC). The ability of the combined immune cells to kill autologous tumor cells was investigated by co-culturing the combined immune cells with patient-derived tumor cells.
Results
The Mo-DCs produced expressed T cell co-stimulating molecules like CD80, CD86, human leukocyte antigen (HLA)-DR and HLA-ABC, at high levels and were capable of activating naive T cells. The expanded T cells were predominantly CD8 T cells with high levels of CD8 effector memory cells and low levels of regulatory T cells. The NK cells expressed high levels of activating receptors and were capable of killing other cancer cell lines (K562 and HT29). The immune cell cocktail demonstrated a higher ability to kill autologous tumor cells than single types. An in vivo preclinical study confirmed the safety of the combined immune cell adaptive therapy showing no therapy-related death or general toxicity symptoms.
Conclusion
The results suggested that combined immune cell adaptive therapy could overcome the limited efficacy of cell immunotherapy.

Benign bowel disease

Anal canal coronal-sagittal ratio: a novel parameter for diagnosing pelvic floor injury in 2-dimensional transanal ultrasound: Hong Yoon Jeong, Keehoon Hyun, Jong Kyun Lee; Ann Coloproctol. 2024;40(5):459-466. Published online November 10, 2022; DOI: https://doi.org/10.3393/ac.2022.00129.0018

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Abstract PDF: Purpose
Pelvic floor injury diagnosis using 3-dimensional (3D) pelvic floor ultrasound or magnetic resonance imaging is unfeasible in many clinics. We assessed the efficacy of a novel diagnostic parameter, the anal canal coronal-sagittal (CS) ratio, for pelvic floor injury on 2D transanal ultrasound.
Methods
This retrospective study analyzed the data of 126 female patients who underwent 3D pelvic floor ultrasound (including 2D transanal ultrasound) at a pelvic floor center between August and December 2020. The anal canal CS ratio on 2D transanal ultrasound and pelvic floor avulsion injury measurements were recorded for all patients.
Results
A cutoff anal canal CS ratio of 1.15 was obtained using receiver operating characteristic analysis (sensitivity, 0.820; specificity, 0.763; and area under the curve, 0.838). Patients were categorized into the anal canal CS ratio ≥1.15 and the anal canal CS ratio <1.15 groups. Bilateral pelvic floor avulsion was more common in the anal canal CS ratio ≥1.15 group (n=35, 56.5%), and the incidence of pelvic floor avulsion was significantly different between the 2 groups (P=0.001). Existing parameters of pelvic floor injury, including minimal levator hiatus (P=0.001), levator plate descent angle (P=0.001), and levator ani deficiency score (P=0.001), were statistically different between the 2 groups.
Conclusion
The anal canal CS ratio was an efficient novel parameter that indirectly detected pelvic floor injury in 2D transanal ultrasound. It is a potential alternative indicator for pelvic floor injury on the widely popular 2D transanal ultrasound.

Benign proctology

Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score: Yongwoo Yune, Hong Yoon Jeong, Duk Hoon Park, Jong Kyun Lee; Ann Coloproctol. 2021;37(5):291-297. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.01095.0156

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Abstract PDF

Purpose
The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.
Methods
This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.
Results
There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm² vs. 14.95±2.60 cm², P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.
Conclusion
There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

Citations

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Pelvic floor dysfunction in patients with gestational diabetes mellitus
Mustafa Arslan, Ramazan Kozan
World Journal of Diabetes.2025;[Epub] CrossRef
The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum
Bei Gan, Shan Zheng, Xiuyan Wu, Xuemei Li
Heliyon.2024; 10(4): e25636. CrossRef
Advancements in artificial intelligence for pelvic floor ultrasound analysis
Xinghua Huang
American Journal of Translational Research.2024; 16(4): 1037. CrossRef
Three‐dimensional endovaginal ultrasound assessment using the levator ani deficiency score in primiparas: A replication study
Emilia Rotstein, Vilhelmina Ullemar, Marianne Starck, Gunilla Tegerstedt
Acta Obstetricia et Gynecologica Scandinavica.2023; 102(9): 1236. CrossRef
Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse
Célia Maheut, Thibaud Vernet, Hugo Le Boité, Hervé Fernandez, Perrine Capmas
Journal of Gynecology Obstetrics and Human Reproduction.2023; 52(9): 102650. 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
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology,Postoperative outcome & ERAS,Complication

Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy: Hong Yoon Jeong, Seok Gyu Song, Jong Kyun Lee; Ann Coloproctol. 2022;38(1):53-59. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00304.0043

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Abstract PDF

Purpose
This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.
Methods
This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.
Results
Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57–2.68; P=0.001) than those who did not.
Conclusion
Male sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.

Citations

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Assessment of the efficacy and safety of pudendal nerve block in post-hemorrhoidectomy pain: A meta-analysis of randomized controlled trials
Jun Li, Hai-Qiong Wu, Jun-Tao Zhang, Shi-Jian Liu, Ke-Lin Peng
Asian Journal of Surgery.2025; 48(3): 1607. CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Diseases of the Colon & Rectum.2025; 68(7): 865. CrossRef
Comparison of the effect of hot and cold compresses on post‐operative urinary retention in older patients: A clinical trial study
Tayebeh Mirzaei, Farkhondeh Roudbari, Ali Ravari, Sakineh Mirzaei, Elham Hassanshahi
International Journal of Urological Nursing.2024;[Epub] CrossRef
General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy
Chun-Yu Lin, Yi-Chun Liu, Jun-Peng Chen, Pei-Hsuan Hsu, Szu-Ling Chang
Frontiers in Surgery.2024;[Epub] CrossRef
Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis
Chen Li, Ningyuan Liu, Zichen Huang, Zijian Wei, Keyi Li, Wenxiao Hou, Sangyu Ye, Lihua Zheng
BMC Gastroenterology.2024;[Epub] CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients
Lei-lei Wang, Meng Kang, Li-xin Duan, Xu-fei Chang, Xiao-xin Li, Xiang-yang Guo, Zhi-yu Kang, Yong-zheng Han
Frontiers in Surgery.2023;[Epub] CrossRef
Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia
Mina Olia, Aliakbar Jafarian, Masood Mohseni
Journal of PeriAnesthesia Nursing.2023; 38(5): 745. CrossRef
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report
Zhexuan Chen, Chuxi Lin
BMC Anesthesiology.2023;[Epub] CrossRef

Benign proctology,Surgical technique

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

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Abstract PDF

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

Citations

Citations to this article as recorded by

Operative Therapie der Analfissur
Ricarda Diller
coloproctology.2025;[Epub] CrossRef
Current evidence and new trends in anal fissure treatment
Marta DOMÍNGUEZ-MUÑOZ, Andrea BALLA, Juan Carlos GÓMEZ-ROSADO, Salvador MORALES-CONDE
Minerva Surgery.2025;[Epub] CrossRef
Management of Hemorrhoids and Anal Fissures
Oladapo Akinmoladun, William Oh
Surgical Clinics of North America.2024; 104(3): 473. CrossRef
Anal Fissure and Its Treatments: A Historical Review
Cristiana Riboni, Lucio Selvaggi, Francesco Cantarella, Mauro Podda, Salvatore Bracchitta, Vinicio Mosca, Angelo Cosenza, Vincenzo Cosenza, Francesco Selvaggi, Bruno Nardo, Francesco Pata
Journal of Clinical Medicine.2024; 13(13): 3930. CrossRef
Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser khakpour, Sina Seyedipour
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Modern trends and priority in treatment of chronic anal fissure
S. A. Aliev, E. S. Aliev
Grekov's Bulletin of Surgery.2024; 183(4): 77. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2023; 7(4): 250. CrossRef
The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure
Katie L. R. Cross, Steven R. Brown, Jos Kleijnen, James Bunce, Melanie Paul, Sophie Pilkington, Oliver Warren, Oliver Jones, Jon Lund, Henry J. Goss, Michael Stanton, Tatenda Marunda, Artaza Gilani, L. Wee Sing Ngu, Philip Tozer
Colorectal Disease.2023; 25(12): 2423. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment: Hong Yoon Jeong, Seok Gyu Song, Woo Jung Nam, Jong Kyun Lee; Ann Coloproctol. 2021;37(1):51-57. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.26.1

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5 Citations

Abstract PDF

Purpose
According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula.
Methods
All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital.
Results
A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence.
Conclusion
Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

Citations

Citations to this article as recorded by

Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: A meta‑analysis
Chunqiang Wang, Tianye Huang, Xuebing Wang
Experimental and Therapeutic Medicine.2024;[Epub] CrossRef
Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef
Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas
Pankaj Garg, Vipul D Yagnik, Sushil Dawka, Baljit Kaur, Geetha R Menon
World Journal of Gastroenterology.2022; 28(16): 1608. CrossRef
What Does Puborectalis Muscle Involvement on Magnetic Resonance Imaging Indicate in Patients With Complex Anal Fistula?
Sung Uk Bae
Annals of Coloproctology.2021; 37(1): 3. CrossRef
Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI
Pankaj Garg, Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon
Abdominal Radiology.2021; 46(12): 5550. CrossRef

Benign proctology

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders: Hong Yoon Jeong, Shi-Jun Yang, Dong Ho Cho, Duk Hoon Park, Jong Kyun Lee; Ann Coloproctol. 2020;36(4):256-263. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2020.02.09

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6 Web of Science
7 Citations

Abstract PDF

Purpose
The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders.
Methods
Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms.
Results
There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement.
Conclusion
This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.

Citations

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Can we use integrated total pelvic floor ultrasound as a screening tool in defaecatory pelvic floor dysfunction? A prospective evaluation of the accuracy of integrated total pelvic floor ultrasound compared with defaecation proctography
Charlotte Ralston, Max Reena, Deepa Solanki, Samantha Morris, Alexis M. P. Schizas, Andrew B. Williams, Alison J. Hainsworth
Colorectal Disease.2025;[Epub] CrossRef
Clinical value of transperineal ultrasound in evaluating the diagnostic grade of rectocele in Chinese women with obstructed defecation syndrome: An observational study
Yunlin Jiang, Zhimin Fan, Ling Gao, Guangshu Shen, Jingjing Yue, Xiaofeng Wang, Xueping Zheng, Yahong Xue
Medicine.2024; 103(36): e39259. CrossRef
Rectal prolapse and surgery for faecal incontinence
Judith Johnston, Athur Harikrishnan
Surgery (Oxford).2023; 41(7): 449. CrossRef
Role of contrast-enhanced ultrasonography in MR-guided focused ultrasound ablation on uterus fibroids: lesion selection and assessment of ablative effects
Wen Luo, Pei-di Zhang, Xiao Yang, Jian-min Zheng, Ying Liu, Xing Tang, Hai-jing Liu, Lei Ding, Li-na Pang, Xiao-dong Zhou, Li-wen Liu, Min-wen Zheng
European Radiology.2022; 32(3): 2110. 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
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score
Yongwoo Yune, Hong Yoon Jeong, Duk Hoon Park, Jong Kyun Lee
Annals of Coloproctology.2021; 37(5): 291. CrossRef

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes: Keehoon Hyun, Shi-Jun Yang, Ki-Yun Lim, Jong-Kyun Lee, Seo-Gue Yoon; Ann Coloproctol. 2018;34(3):119-124. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.31

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Abstract PDF

Purpose
Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
Methods
Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation.
Results
No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
Conclusion
LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

Citations

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Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy
Adel Zeinalpour, Alimohammad Bananzadeh, Mohammad Mostafa Safarpour, Sara Shojaei‐Zarghani, Seyede Saeideh Shahidinia, Seyed Vahid Hosseini, Ali Reza Safarpour
Surgical Practice.2025; 29(1): 26. CrossRef
Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study
Kwang Dae Hong, Keehoon Hyun, Jun Won Um, Seo-Gue Yoon, Do Yeon Hwang, Jaewon Shin, Dooseok Lee, Se-Jin Baek, Sanghee Kang, Byung Wook Min, Kyu Joo Park, Seung-Bum Ryoo, Heung-Kwon Oh, Min Hyun Kim, Choon Sik Chung, Yong Geul Joh
Annals of Surgical Treatment and Research.2022; 102(4): 234. CrossRef
Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children
Sherif M. Shehata, Ahmed A. Elhaddad, Wael M. Abo Senna, Mohamed A. Shehat
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(10): 1292. CrossRef
Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery
Suk-Hwan Lee
The Journal of Minimally Invasive Surgery.2019; 22(4): 135. CrossRef

Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse: Shi-Jun Yang, Seo-Gue Yoon, Ki-Yun Lim, Jong-Kyun Lee; Ann Coloproctol. 2017;33(2):64-69. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.64

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Abstract PDF

Purpose

Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy.

Methods

Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery.

Results

No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004).

Conclusion

Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.

Citations

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Surgical and Functional Outcome of Laparoscopic Vaginal Suspension Combined with Suture Rectopexy for Management of Pelvic Organ Prolapse
Mohamed I. Abuelnasr, Ahmed M. F. Salama, Ahmed M. Nawar
Journal of Coloproctology.2024; 44(01): e1. CrossRef
Mesh-associated complications in minimally invasive ventral mesh rectopexy: a systematic review
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Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults: 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; J Korean Soc Coloproctol. 2011;27(6):303-314. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.303

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Abstract PDF

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.

Citations

Citations to this article as recorded by

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