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The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grade III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

Conventionally, the Thiersch operation has typically involved blind positioning of the sling, and sling tension is subjectively based on a rule-of-thumb estimate. The aim of this study was to describe standardized methods for performing the Thiersch operation. Seventeen patients with fecal incontinence underwent the calibrated method of the Thiersch procedure. As an encircling sling, a 6-mm-wide silastic tube was used. Through 4 minimal perianal skin incisions, the sling was placed proximal to the anal skin 3 cm from the anal verge and 4 cm in depth. The circumference of the sling was 10 cm in length. Results were assessed by clinical responses and by comparing pre- and postoperative Wexner scores. The data were collected retrospectively. The median follow-up period was 9 months (range 6–19). In 16 out of 17 fecal incontinence patients (94.1%), the median Wexner incontinence score was 0 (range 0–3) postoperatively. Localized sepsis developed in three cases (17.7%, 3/17), which were controlled with drainage and antibiotics. Fecal impaction occurred in one case (5.9%, 1/17). There was no removal or breakage of the inserted sling. The elasticity of the silastic tube reduced the incidence of sling breakage. According to the standardized method, the sling was placed external to the external anal sphincter muscle and at the junction of the external anal sphincter muscle and puborectalis muscle. Fecal incontinence was controlled effectively, and the incidence of fecal impaction was negligible. High reproducibility was observed with this method.

Background Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving operation for anal fistulas. Although it has advantages in preserving continence after surgery, it is difficult to perform owing to the narrow field of view. We performed a modified surgical procedure based on the LIFT to overcome these drawbacks. Materials and methods Twenty-eight patients who were scheduled to undergo high ligation of the anal fistula tract by the lateral approach for the treatment of transsphincteric anal fistulas were prospectively studied. Instead of making a new stab incision on the intersphincteric groove, we dissected along the fistula tract from the external opening until the intersphincteric space appeared. The fistula tract was then ligated close to the internal anal sphincter with absorbable sutures, and the distal part of the ligation was cut off. A cored-out wound was left open for drainage. Results The median follow-up was 16 months (range, 8–27 months). Of the 28 patients, 19 (68%) had simple transsphincteric fistulas and 9 (32%) had complex transsphincteric fistulas. Successful fistula closure was achieved in 21 patients (75%), with a median healing time of 4 weeks (range, 3–7 weeks). None of the patients complained of any incontinence symptoms after the procedure. Of the seven patients (25%) who failed to heal successfully, two (7%) did not heal up to 2 months after surgery and five (18%) experienced recurrence after complete healing. Conclusion High ligation of the anal fistula tract by lateral approach may be a useful sphincter-sparing procedure for transsphincteric anal fistulas.

Purpose: The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection. Methods: Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage. Results: The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage. Conclusion: The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.

Purpose: The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid, ) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids. Methods: From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV) were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared. Results: The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P

Purpose: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. Methods: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient’s pain were compared. Results: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation, diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3 ±4.0 min vs. 7.6±4.3 min, P

Purpose: The aim of this study is to compare and analyze the histological differences between vascular and mucosal hemorrhoids, two structurally different types of hemorrhoids. Methods: Internal hemorrhoidal tissue samples were fixed in 10% Formalin solution, and coronal sections included 10-mm proximal and 5-mm distal of the dentate line. Routine Masson-Trichrome and H&E were performed to evaluate the thickness of the mucosa and changes in the structure and the densities of submucosal vessels, connective tissue, and muscle. Results: Compared with the corresponding tissues of mucosal hemorrhoids, the submucosal connective tissue and perivascular connective tissue of vascular hemorrhoids showed a loosened density, severe fragmentation, and an irregular arrangement. The submucosal vascular dilatation was more frequent and more severe in vascular hemorrhoids, but the number of vessels between both types of hemorrhoids did not show much difference. Hypertrophy and regular arrangement of the submucosal muscles were observed more frequently in the mucosal than in the vascular hemorrhoids. Conclusion: Compared to mucosal hemorrhoids, vascular hemorrhoids showed augmented damage in submucosal connective tissue and intense dilatation of vessels with a thinner mucosa. On the other hand, compared to vascular hemorrhoids, mucosal hemorrhoids showed hypertrophy of submucosal muscle and relatively minor alterations in vessels with a thicker mucosa. These histological differences may provide the basis for different etiologies between vascular and mucosal hemorrhoids.

Introduction: Lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment, commonly used in patients with chronic anal fissures (CAFs). Although LIS is a simple surgical technique, it may cause several complications. Open LIS is usually performed through an incision made in the intersphincteric groove; radial or circumferential incisions, used according to the surgeon's preference. However, differences in clinical outcomes and wound healing, based on type of skin incision, are unclear. We investigated incision site wound healing and other clinical outcomes, after open LIS, according to the type of skin incision employed. Methods: We retrospectively reviewed the data of the electronic medical records of 602 patients who underwent open LIS for CAFs between March 2005 and February 2010 at Yang Hospital, Seoul, Korea. Results: Of the 602 patients, 298 patients received radial incisions and 304 received circumferential incisions. Circumferential incisions of the anus reduced the wound healing time compared to radial incisions (19.1 vs. 24.0 days, p