Annals of Coloproctology

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Original Article

Anorectal benign disease

Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids: Isaac Seow-En, Lionel Raphael Hui Chen, Yun Zhao, Yvonne Ying-Ru Ng, Emile Kwong-Wei Tan; Ann Coloproctol. 2025;41(6):537-544. Published online December 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00549.0078

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Abstract PDF Supplementary Material: Purpose
We aimed to determine whether intra-anal cryotherapy reduces postoperative pain in patients undergoing hemorrhoidectomy.
Methods
This randomized controlled trial was conducted from January 2023 to August 2024. Patients with symptomatic grade III hemorrhoids were randomized 1:1 to receive either 1 minute of intra-anal cryotherapy or standard postoperative care. Because cryotherapy was applied before reversal of general anesthesia, patients were blinded to treatment allocation. The primary outcome was pain at rest on postoperative day (POD) 1. Secondary outcomes included pain after defecation, time to return to work or non-work activities, 30-day complications, and compliance with analgesia. Pain was measured using the visual analog scale.
Results
A total of 50 patients were randomized (25 per group). All 50 were included in the analysis. Baseline clinicodemographic characteristics were comparable between groups. The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046). On POD 2, median pain scores at rest and after defecation were both significantly lower in the cryotherapy cohort (at rest: 2.0 vs. 4.0, P=0.043; after defecation: 2.0 vs. 5.0, P=0.001).
Conclusion
Intra-anal cryotherapy significantly reduces pain after defecation in the early postoperative period following surgery for grade III hemorrhoids. Its therapeutic efficacy, ease of application, and safety support consideration for routine use. Trial registration ClinicalTrials.gov identifier: NCT06005727

Review

Inflammatory/benign bowel disease

Clinical outcomes and optimal indications for nonoperative management of acute appendicitis in adult patients: a comprehensive literature review: Hyun Gu Lee, In Ja Park; Ann Coloproctol. 2025;41(2):107-118. Published online April 16, 2025; DOI: https://doi.org/10.3393/ac.2023.00192.0027

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Graphical Abstract Abstract PDF

Appendectomy as the standard treatment for acute appendicitis has been challenged by accumulating evidence supporting nonoperative management with antibiotics as a potential primary treatment. This review aimed to summarize the clinical outcomes and the optimal indications for nonoperative management of acute appendicitis in adults. Current evidence suggests that uncomplicated and complicated appendicitis have different pathophysiologies and should be treated differently. Nonoperative management for uncomplicated appendicitis was not inferior to appendectomy in terms of complications and length of stay, with less than a 30% failure rate at 1 year. The risk of perforation and postoperative complications did not increase even if nonoperative management failed. Complicated appendicitis with localized abscess or phlegmon could also be treated conservatively, with a success rate of more than 80%. An interval appendectomy following successful nonoperative management is recommended only for patients over the age of 40 years to exclude appendiceal malignancy. The presence of appendicoliths increased the risk of treatment failure and complications; thus, it may be an indication for appendectomy. Nonoperative management is a safe and feasible option for both uncomplicated and complicated appendicitis. Patients should be informed that nonoperative management may be a safe alternative to surgery, with the possibility of treatment failure.

Citations

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Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions
Ju Tian
World Journal of Clinical Cases.2025;[Epub] CrossRef

Original Articles

ERAS

Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery: Hyeon Deok Choi, Sung Uk Bae; Ann Coloproctol. 2024;40(6):564-572. Published online November 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00143.0020

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1 Web of Science
1 Citations

Graphical Abstract Abstract PDF

Purpose
Continuous wound infiltration (CWI) has been introduced as a component of multimodal analgesia to counteract the adverse effects of the most frequently used opioids. Advantages of reduced-port laparoscopic surgery (RPLS) include cosmetic benefits and decreased postoperative pain. We aimed to investigate the effect of CWI in patients using intravenous (IV) patient-controlled analgesia (PCA) for pain management after RPLS for colorectal cancer.
Methods
This retrospective study included 25 patients who received both CWI (0.5% ropivacaine infused over 72 hours) and IV PCA (fentanyl citrate) and 52 patients who received IV PCA alone. The primary endpoint was pain scores on postoperative days (PODs) 0, 1, and 2. Univariate and multivariate analyses were conducted to determine the factors affecting the pain score on POD 0.
Results
On POD 0, the mean numeric rating scale score was significantly lower in the CWI group than in the control group (3.2±0.8 vs. 3.7±0.9, P=0.042). However, the scores were comparable between the groups during the rest of the period. Within 24 hours of surgery, the CWI group consumed fewer opioids (0.7±0.9 vs. 1.3±1.1, P=0.018) and more nonsteroidal anti-inflammatory drugs (2.0±1.4 vs. 1.3±1.4, P=0.046) than the control group. Time to removal of IV PCA was significantly longer in the CWI group than in the control group (4.4±1.6 days vs. 3.4±1.0 days, P=0.016).
Conclusion
CWI with ropivacaine and IV PCA was more effective than IV PCA alone in controlling postoperative pain within 24 hours of surgery, and opioid use could be reduced further.

Citations

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Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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4 Citations

Graphical Abstract Abstract PDF

Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Case Report

Anorectal benign disease

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature: Nalini Kanta Ghosh, Ashok Kumar; Ann Coloproctol. 2024;40(Suppl 1):S1-S5. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.00752.0107

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Abstract PDF

The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

Citations

Citations to this article as recorded by

A Long-standing Perianal Fistula Hiding an Adenocarcinoma: A Case Report
I-Wei Lin, Ying-Wen Su, Ching-Heng Ting, Ming-Jen Chen
Journal of Cancer Research and Practice.2026;[Epub] CrossRef

Review

Colorectal cancer

Survival outcomes of salvage surgery in the watch-and-wait approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis: Wenjie Lin, Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Emile Kwong-Wei Tan; Ann Coloproctol. 2023;39(6):447-456. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2022.01221.0174

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8 Web of Science
11 Citations

Abstract PDF Supplementary Material

Purpose
This systematic review and meta-analysis compared the outcomes of the watch-and-wait (WW) approach versus radical surgery (RS) in rectal cancers with clinical complete response (cCR) after neoadjuvant chemoradiotherapy.
Methods
This study followed the PRISMA guidelines. Major databases were searched to identify relevant articles. WW and RS were compared through meta-analyses of pooled proportions. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis rates. Pooled salvage surgery rates and outcomes were also collected. The Newcastle-Ottawa scale was employed to assess the risk of bias.
Results
Eleven studies including 1,112 rectal cancer patients showing cCR after neoadjuvant chemoradiation were included. Of these patients, 378 were treated nonoperatively with WW, 663 underwent RS, and 71 underwent local excision. The 2-year OS (risk ratio [RR], 0.95; P = 0.94), 5-year OS (RR, 2.59; P = 0.25), and distant metastasis rates (RR, 1.05; P = 0.80) showed no significant differences between WW and RS. Local recurrence was more frequent in the WW group (RR, 6.93; P < 0.001), and 78.4% of patients later underwent salvage surgery (R0 resection rate, 97.5%). The 2-year DFS (RR, 1.58; P = 0.05) and 5-year DFS (RR, 2.07; P = 0.02) were higher among RS cases. However, after adjustment for R0 salvage surgery, DFS showed no significant between-group difference (RR, 0.82; P = 0.41).
Conclusion
Local recurrence rates are higher for WW than RS, but complete salvage surgery is often possible with similar long-term outcomes. WW is a viable strategy for rectal cancer with cCR after neoadjuvant chemoradiation, but further research is required to improve patient selection.

Citations

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Watch‐and‐Wait Approach Following Neoadjuvant Chemo‐Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single‐Center Cohort Study
Georgi Kalev, Sylvia Buettner, Tianzuo Zhan, Ralf‐Dieter Hofheinz, Judit Boda‐Heggemann, Christoph Reissfelder, Steffen Seyfried, Georgi Vassilev, Julia Hardt
Journal of Surgical Oncology.2025; 131(4): 658. CrossRef
Phase 2, Multicenter, Open-label, Nonrandomized Study of Neoadjuvant Chemotherapy Liposomal Irinotecan With 5-Fluorouracil, Leucovorin, and Oxaliplatin, Followed by Chemoradiotherapy in Patients With Rectal Cancer in a Watch-and-Wait Program
César Muñoz, María-C. Riesco Martinez, Lisardo Ugidos, Pilar García-Alfonso, Rafael Alvarez-Gallego, Paloma Peinado, Carmen Toledano, Luka Mihic-Góngora, Justo Gabriel Ortega Anselmi, Enrique Sanz Garcia, Emilio Vicente, Yolanda Quijano, Hipólito J. Durán
American Journal of Clinical Oncology.2025; 48(3): 142. CrossRef
Therapeutic Management of Locally Advanced Rectal Cancer: Existing and Prospective Approaches
Horia-Dan Lișcu, Nicolae Verga, Dimitrie-Ionuț Atasiei, Andreea-Teodora Ilie, Maria Vrabie, Laura Roșu, Alexandra Poștaru, Stefania Glăvan, Adriana Lucaș, Maria Dinulescu, Andreea Delea, Andreea-Iuliana Ionescu
Journal of Clinical Medicine.2025; 14(3): 912. CrossRef
A management of patients achieving clinical complete response after neoadjuvant therapy and perspectives: on locally advanced rectal cancer
Yu-Xin Liu, Xin-Rong Yang, Lan-Qing Peng, Zhuo-Hong Li
Frontiers in Oncology.2025;[Epub] CrossRef
ACCORD study: a national multi‐centre study of the watch and wait approach in patients with rectal cancer in Aotearoa New Zealand

ANZ Journal of Surgery.2025; 95(3): 440. CrossRef
Watch and wait in early onset rectal cancer patients: A review of the literature
Melissa K Drezdzon, Carrie Y Peterson
Seminars in Colon and Rectal Surgery.2025; : 101117. CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions
Vincenzo Schiavone, Gabriella Teresa Capolupo, Gianluca Mascianà, Filippo Carannante, Gianluca Costa, Valentina Miacci, Marco Caricato
Encyclopedia.2025; 5(4): 165. CrossRef
Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer
Francesco Giulio Sullo, Alessandro Passardi, Chiara Gallio, Chiara Molinari, Giorgia Marisi, Eleonora Pozzi, Leonardo Solaini, Alessandro Bittoni
Journal of Clinical Medicine.2024; 13(9): 2562. CrossRef
Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Combined Transanal and Laparoscopic Approach for Full-Thickness Local Excision of Locally Advanced Rectal Cancer Following Near-Complete Response after Chemotherapy
Joshua S. H. Lim, Si-Lin Koo, Iain Beehuat Tan, Isaac Seow-En
World Journal of Colorectal Surgery.2024; 13(3): 95. CrossRef

Technical Note

Clinical outcomes with of the Contix Faecal Incontinence Management System: preliminary results: Moris Venturero, Reuma Yehuda-Margalit, Carla Maradey-Romero, Yael Corcos, Dan Carter, Marc Beer-Gabel; Ann Coloproctol. 2023;39(1):89-93. Published online December 6, 2022; DOI: https://doi.org/10.3393/ac.2022.00563.0080

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1 Web of Science
1 Citations

Abstract PDF

Fecal incontinence (FI) has a significant long-term impact on patient quality of life for which there is a range of medical and surgical management alternatives. We report the preliminary outcome using the ForConti Contix Faecal Incontinence Management System (FIMS) in FI patients who had failed conservative therapy and who were recruited at 2 tertiary institutions between September 2018 and September 2020. Comparative assessments were made before and after 2 week periods of treatment using bowel diaries and subjective Wexner and Faecal Incontinence Quality of Life scores. Of 17 patients enrolled, 11 completed an 8-week assessment with a significant fall in the average percentage of FI days reported from 84% before treatment to 16.8% at the first posttreatment assessment and down to 13.2% by the second assessment period. This finding correlated with a similar reduction in the total weekly number of episodes of frank FI, minor soiling, and fecal urgency reported by patients along with concomitant improvements in the Wexner scores. For those using the device, there was less concern about accidental bowel leakage, high rates of satisfaction, and minimal problems with the device. Initial results are encouraging warranting further study.

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Novel Nonablative Radiofrequency Approach for the Treatment of Anal Incontinence: A Phase 1 Clinical Trial
Patrícia Lordêlo, Juliana Barros, Claudia Liony, Cristiane Maria Carvalho C Dias, Janine Ferreira, Priscila G Januário, Luana N Matos, Camila O Muniz, Laizza S Silva, Cristina Brasil
Cureus.2023;[Epub] CrossRef

Original Article

Benign GI diease,Benign diesease & IBD,Postoperative outcome & ERAS,Minimally invasive surgery

Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis: Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee; Ann Coloproctol. 2021;37(4):232-238. Published online September 30, 2020; DOI: https://doi.org/10.3393/ac.2020.09.15

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15 Web of Science
23 Citations

Abstract PDF

Purpose
The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.
Methods
Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM).
Results
After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups.
Conclusion
SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

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Evolving Paradigms in Minimal Access Surgery: A Comprehensive Review of Single-Incision Laparoscopic Appendicectomy
Divyakant H Barot, Minesh Sindhal, Priyanka Aanandaka, Nidhi D Gheewala, Parmar Bhargav
Cureus.2026;[Epub] CrossRef
Meta-analysis of single-incision versus three-port laparoscopic appendectomy comparing operation time and postoperative pain
Kyung-Goo Lee, Min Ki Kim, Jong Seob Park, Areum Han, Seokyung Hahn
International Journal of Surgery.2026; 112(1): 1737. CrossRef
Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children
Martin Salö, Catarina Tiselius, Anders Rosemar, Elin Öst, Sara Sohlberg, Roland E Andersson
BJS Open.2025;[Epub] CrossRef
Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis
Ahmer Irfan, Ahsan Rao, Irfan Ahmed
Cochrane Database of Systematic Reviews.2025;[Epub] CrossRef
Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
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Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
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Yoshito Tsuji, Yujiro Nishizawa, Yuki Ozato, Akira Inoue, Yoshinori Kagawa
Nippon Daicho Komonbyo Gakkai Zasshi.2024; 77(3): 161. CrossRef
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Gwan Chul Lee, Dong Woo Kang, Choon Sik Chung, Chul Seung Lee
Asian Journal of Surgery.2024; 47(7): 3272. CrossRef
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Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
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Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
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A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
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Review

Benign proctology, Functional outcomes

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

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39 Citations

Abstract PDF

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

Citations

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Modified Ferguson hemorrhoidectomy for grade II–IV hemorrhoids offers low recurrence and complication rates: a retrospective cohort study
Run-Yi Geng, Lu Yin, Yong-Qing Cao, Xiao Shen, Ya-Qing Ding, Yi-Bo Yao, Chen Wang
Frontiers in Medicine.2026;[Epub] CrossRef
The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial
Suwan Sanmee, Witcha Vipudhamorn, Pawit Sutharat, Ekkarin Supatrakul
Asian Journal of Surgery.2025; 48(1): 193. CrossRef
Rectal Artery Embolization for the Treatment of Hemorrhoidal Disease
Seyed S. Zakavi, Mohammad Mirza-Aghazadeh-Attari, Arian Mansur, Peiman Habibollahi, Nariman Nezami, Juan C. Camacho
Seminars in Interventional Radiology.2025; 42(01): 093. CrossRef
Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment
Ismail Cem Eray, Ugur Topal, Serdar Gumus, Kubilay Isiker, Burak Yavuz, Ishak Aydin
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
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Tao Jiang, Lichao Fan, Xuesong Tang, Zhigang Xu, Wenjiang Wu
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EXPLORING THE ANTI-INFLAMMATORY PROPERTIES OF METFORMIN IN EXPERIMENTAL HEMORRHOID MODELS
DARMAWI DARMAWI, MUHAMMAD YULIS HAMIDY, SORAYA SORAYA, NURUL AZIZAH, LALU MUHAMMAD IRHAM, BAIQ LENY NOPITASARI, INA F. RANGKUTI, A. A. MUHAMMAD NUR KASMAN, WIRAWAN ADIKUSUMA
International Journal of Applied Pharmaceutics.2025; : 190. CrossRef
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Original Article

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.

Citations

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A Perilous Plunge: A Unique Case of Rectal Foreign Body
Shehzadi Rimsha, Danish Aslam, Subas Ali, Shehanshah Muhammed Arqam, Ayesha Kausar
Cureus.2025;[Epub] CrossRef
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
Rectal foreign body of a cosmetic bottle treated successfully by transanal retrieval: A case report
Congcong Liu, Yuantao Li
Medicine.2024; 103(47): e40651. 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

Case Report

Abdominosacral Resection in the Management of Large-Size Retrorectal Tumors: A Report of 2 Rare Cases: Yuda Handaya, Sutamto Wibowo; Ann Coloproctol. 2018;34(5):271-276. Published online October 10, 2018; DOI: https://doi.org/10.3393/ac.2017.12.01

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Abstract PDF: Management of large-size retrorectal gastrointestinal stromal tumors (GISTs) is complex and challenging from diagnosis to treatment. This may create technical difficulties in surgical access and complete resection of the tumor. The abdominosacral resection has the benefit of improved visualization via the anterior incision, with enhanced exposure of the midrectal area, which makes resecting the tumor completely via the posterior approach easier. We report 2 cases of patients with a retrorectal GIST and neurofibromatosis type 1, one in a 27-year-old woman with a defecation complaint and the other in a 58-year-old woman with a defecation and urination complaint. Based on the anatomical pathology, both patients were diagnosed with a GIST. The tumors were excised via an abdominosacral resection. Retrorectal GISTs are rare, and abdominosacral resection allows complete resection of a large-size retrorectal GIST with low morbidity and an absence of functional impairment. The abdominosacral resection should be considered in certain situations.

Original Articles

The Outcomes of Management for Colonoscopic Perforation: A 12-Year Experience at a Single Institute: Jung Yun Park, Pyong Wha Choi, Sung Min Jung, Nam-Hoon Kim; Ann Coloproctol. 2016;32(5):175-183. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.175

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Abstract PDF

Purpose

Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP.

Methods

Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups.

Results

The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001).

Conclusion

The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.

Citations

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Risk Factors for Perforation in Endoscopic Treatment for Early Colorectal Cancer: A Nationwide ENTER-K Study
Ik Hyun Jo, Hyun Gun Kim, Young-Seok Cho, Hyun Jung Lee, Eun Ran Kim, Yoo Jin Lee, Sung Wook Hwang, Kyeong-Ok Kim, Jun Lee, Hyuk Soon Choi, Yunho Jung, Chang Mo Moon
Gut and Liver.2025; 19(1): 95. CrossRef
Cold Versus Hot Endoscopic Mucosal Resection for ≥15 mm Large Nonpedunculated Colorectal Polyps
Sneh Sonaiya, Dushyant S. Dahiya, Raj Patel, Shahryar Khan, Charmy Parikh, Karan Yagnik, Chun-Han Lo, Kyaw Min Tun, Pranav D. Patel, Bradley Confer, Harshit S. Khara, Sumant Inamdar, Babu P. Mohan
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Luminal electrophysiological neuroprofiling system for gastrointestinal neuromuscular diseases
Shriya S. Srinivasan, Sabrina Liu, Ryo Hotta, Sukhada Bhave, Amro Alshareef, Binbin Ying, George Selsing, Johannes Kuosmanen, Keiko Ishida, Joshua Jenkins, Wiam Abdalla Mohammed Madani, Alison Hayward, Niora Fabian, Allan M. Goldstein, Giovanni Traverso
Device.2024; 2(7): 100400. CrossRef
Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Wu Zhong, Chuanyuan Liu, Chuanfa Fang, Lei Zhang, Xianping He, Weiquan Zhu, Xueyun Guan
Medicine.2023; 102(24): e34057. CrossRef
Analysis of the Characteristics of Colonoscopy Perforation and Risk Factors for Failure of Endoscopic Treatment
Zhi Jiehua, Ali Kashif , Che YaoSheng , Sun YunYun , Liang Lanyu
Cureus.2022;[Epub] CrossRef
Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
Nihat Gülaydın, Raim İliaz, Atakan Özkan, A Hande Gökçe, Hanifi Önalan, Berrin Önalan, Aziz Arı
Turkish Journal of Surgery.2022; 38(3): 221. CrossRef
The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution
Dae Ro Lim, Jung Kul Kuk, Taehyung Kim, Eung Jin Shin
Asian Journal of Surgery.2020; 43(5): 577. CrossRef
Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef
Clinical Characteristics of Colonoscopic Perforation and Risk Factors for Complications After Surgical Treatment
Liang Li, Bing Xue, Chunxia Yang, Zhongbo Han, Hongqiang Xie, Meng Wang
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(11): 1153. CrossRef
ESTUDO RETROSPECTIVO DA PREVALÊNCIA DE PERFURAÇÕES GASTROINTESTINAIS EM PACIENTES SUBMETIDOS A COLONOSCOPIAS NO HOSPITAL REGIONAL HANS DIETER SCHMIDT
Viviane Helena Raimundo, Paula Fernanda Partika, Haroldo Luiz Jordelino da Luz, Eduardo Manoel Pereira
Arquivos Catarinenses de Medicina.2020; 49(2): 14. CrossRef
Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
World Journal of Gastroenterology.2019; 25(2): 190. CrossRef
Iatrogenic Colonic Perforations: Changing the Paradigm
Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): 173. CrossRef
Diagnosis and Management of Colonoscopy-related Perforation
Nam Seok Ham, Jung Ho Bae, Dong-Hoon Yang
The Korean Journal of Gastroenterology.2019; 73(6): 327. CrossRef
Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
World Journal of Emergency Surgery.2018;[Epub] CrossRef

Enhancing the Enhanced Recovery Program in Colorectal Surgery - Use of Extended-Release Epidural Morphine (DepoDur®): Rajeev Peravali, Rachael Brock, Elizabeth Bright, Patricia Mills, Dawn Petty, Justin Alberts; Ann Coloproctol. 2014;30(4):186-191. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.186

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Abstract PDF

Purpose

DepoDur® is a single-dose extended-release morphine injection into the epidural space. It is not commonly used, but has many advantages over traditional analgesic regimens. We analyzed a number of these advantages in our case series in the context of the colorectal enhanced recovery program (ERP) and aimed to show that the ERP could be further enhanced by using DepoDur®.

Methods

We conducted a prospective audit of all patients undergoing open and laparoscopic colorectal procedures where DepoDur® was used between July 2010 and April 2012. Validated pain scores were used, and primary outcome measures were resting and dynamic pain, mobilization, and need for additional analgesia.

Results

Two hundred eighty patients were included in the case series. Good pain control was seen at 24 and 48 hours. Eighty-one percent of the patients required simple analgesia alone at 24 hours, and 62% required simple analgesia (paracetamol +/- nonsteroidal anti-inflammatory drugs) alone at 48 hours. Only a minority required additional oramorph and patient-controlled analgesia at 24 and 48 hours (19% at 24 hours and 38% at 48 hours). Seventy-nine percent of the patients were mobilized at 24 hours, and 88% of the patients were mobilized at 48 hours.

Conclusion

DepoDur® is an effective alternative to conventional pain management techniques and may have a role in further enhancing the ERP.

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Is Conservative Treatment with Antibiotics the Correct Strategy for Management of Right Colonic Diverticulitis?: A Prospective Study: Tae Jung Kim, In Kyu Lee, Jong Kyung Park, Yoon Suk Lee, Youn Si, Hun Jung, Hyung Jin Kim, Sang Chul Lee, Dae Young Cheung, Lee D. Gorden, Seung Taek Oh; J Korean Soc Coloproctol. 2011;27(4):188-193. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.188

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Abstract PDF

Purpose

The goals of this study were to identify whether conservative treatment with antibiotics in right colonic diverticulitis (RCD) patients, our empirical method used until now, is adequate and to determine how the natural history of RCD is affected by conservative treatment.

Methods

This study was designed as a case-control study. Group I was comprised of 12 patients who were managed conservatively, and clinical data were retrospectively collected. In group II, a total of 49 patients, diagnosed by using diagnostic criteria for RCD and managed conservatively, were prospectively included.

Results

The period of fasting was 2.7 days, and the hospital stay was 4.6 days in all patients. The intravenous and the oral antibiotic periods were 3.8 days and 9.8 days, respectively. There were no statistically significant differences in treatment results between the two groups except the duration of fasting and the hospitalization, and there were no complications under conservative treatment. Eight patients (13.1%) had recurrent diverticulitis during the follow-up period. The recurrence risk showed no significant difference between the groups. The RCD-free period after management was 60.1 months, and patients with recurrent RCD were treated by conservative treatment or laparoscopic surgery.

Conclusion

Conservative treatment with antibiotics is the optimal treatment of choice for RCD and shows no increase in complications.

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B. Schiltz, C. Dumont, N. C. Buchs, Ph. Morel, F. Ris
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Hyoung-Chul Park, Byung Seup Kim, Kwanseop Lee, Min Jeong Kim, Bong Hwa Lee
International Journal of Colorectal Disease.2014; 29(10): 1217. CrossRef
Solitary Cecal Diverticulitis: An Unusual Cause of Acute Right Iliac Fossa Pain—A Case Report and Review of the Literature
Nikolaos Mudatsakis, Marinos Nikolaou, Konstantinos Krithinakis, Michail Matalliotakis, Nikolaos Politis, Emmanouil Andreadakis
Case Reports in Surgery.2014; 2014: 1. CrossRef
Prediction and management of recurrent right colon diverticulitis
Sun Min Park, Taek Soo Kwon, Dong Jin Kim, Yoon Suk Lee, Dae Young Cheung, Seong Taek Oh, Jun-Gi Kim, In Kyu Lee
International Journal of Colorectal Disease.2014; 29(11): 1355. CrossRef
Mesalamine Did Not Prevent Recurrent Diverticulitis in Phase 3 Controlled Trials
Jeffrey B. Raskin, Michael A. Kamm, M. Mazen Jamal, Juan Márquez, Ehud Melzer, Robert E. Schoen, Tibor Szalóki, Karen Barrett, Paul Streck
Gastroenterology.2014; 147(4): 793. CrossRef

Predictive Factor for Surgical Indication in Postoperative Adhesive Small Bowel Obstruction.: Kang, Ji Woong , Nam, Jung Kwang , Kim, Byung Seok , Moon, Duk Jin; J Korean Soc Coloproctol. 2010;26(3):186-189.; DOI: https://doi.org/10.3393/jksc.2010.26.3.186

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Abstract PDF: PURPOSE
There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO.
METHODS
Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed.
RESULTS
A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P=0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery.
CONCLUSION
Surgical management should be considered among adhesive SBO patients with elevated amylase (> or =90 IU/L) and ESR (> or =11 mm/hr) and with large drainage amount through the Levin tube (> or =500 mL/day).

Application of BMS(TM) Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene.: Shon, Dae Ho , Jung, Sang Hun , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2008;24(2):137-143.; DOI: https://doi.org/10.3393/jksc.2008.24.2.137

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Abstract PDF: PURPOSE
Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

Etiology and Management for Adult Intussusception.: Park, Sung Won , Kim, Hee Cheol , Cho, Young Kyu , Hong, Hyoun Ki , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(6):304-308.

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Abstract PDF: PURPOSE
Intussusceptions occurring in adults are relatively rare, however, surgery is usually recommended since they frequently accompany organic lesions as predisposing factor. The purpose of this study is to analyze clinical manifestations and investigate optimal treatment principles for adult intussusception.
METHODS
Clinicopathogic manifestations of 28 adult intussusception patient were analyzied, retrospectively. The types of adult intussusception were classified as enteric and colonic types. Sex ratio was 15:13 and mean age was 52 (17-80) years.
RESULTS
CT scan was the most accurate tool for diagnosis of adult intussusception and detection of underlying causes. The types of adult intussusception were 4 jejuno-jejunal, 7 ileo-ileal, 15 ileo-cecal, and 2 colo-colic types. The pathologic lesions were identified in 23 out of 28 cases (82%). Malignancy was the cause of adult intussusception in 5 cases (45%) of enteric type and in 6 cases (35%) of colonic type intussusception. Operations were performed in 26 cases (93%) and resection without reduction was performed in 23 cases.
CONCLUSIONS
Surgical exploration without reduction may be the treatment of choice since the majority of cases have organic lesions as the etiology, with relatively frequent association of malignancies.

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