Risk Factors for Hypothyroidism after Thyroid Lobectomy with Papillary Thyroid Crcinoma according to Existence of Thyroiditis / 대한내분비외과학회지

PURPOSE: This study evaluated the risk factors for hypothyroidism after lobectomy for low risk papillary thyroid carcinoma according to existence of thyroiditis, especially on preoperative thyroid stimulating hormone (TSH) level and remnant thyroid volume. METHODS: The clinical records of 169 patients who underwent thyroid lobectomy due to papillary thyroid carcinoma were reviewed. We maintain the TSH level between 0.10~0.50 mU/L with thyroid hormone until 6 to 12 months after lobectomy. Then we stopped medication and check TSH level at intervals of 2~6 months. The patients were divided into 2 groups; hypothyroid (n=63) and euthyroid (n=106) state after lobectomy. Euthyroid state was defined as an TSH level between 0.50~5.0 mU/L, hypothyroid state as an elevated TSH level above 10 mU/L and need thyroid hormone. RESULTS: Factor for age, sex, type of operation, result of biopsy were not significant to postoperative hypothyroidism. Presence of thyroid autoantibody was significantly different (P0.05). When patient didn't have thyroiditis, there was high possibility of postoperative hypothyroidism when preoperative TSH is in high normal level and remnant thyroid volume ratio is below 50% (P<0.01). CONCLUSION: One can check the presence of thyroiditis with thyroid autoantibody and can predict the possibility of postoperative hypothyroidism after lobectomy in patients with low risk papillary thyroid carcinoma with preoperative TSH level and remnant thyroid volume.

Analysis of Relationship between Prognostic Factors and Number of Fine-Needle Aspiration Cytology (FNAC) Prior to Surgery for Papillary Thyroid Microcarcinoma According to Size / 대한내분비외과학회지

PURPOSE: Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma 10 mm. Indication of FNAC based only on tumor size is still in debate. Some favor the criteria of a size 5 mm, n=156) and the prognostic factors and number of pre-surgical FNAC procedures were compared. RESULTS: There were no significant differences in gender, age, site, accompanying benign disease, multifocality and bilaterality. Group 2 patients displayed more advanced features than group 1 patients concerning capsular invasion, lymph node metastasis and tumor stage. The number of FNAC procedures prior to the decision of surgery was not different in the two groups. CONCLUSION: PTMC exceeding 5 mm in size showed advanced features than smaller tumors. Further study about the use of FNAC according only to the size of thyroid nodules is warranted.

Diagnostic Value of C-reactive Protein in Complicated Appendicitis

PURPOSE: Early detection of appendicitis has increased due to development of computed tomography and ultrasonography, yet we are frequently meeting complicated appendicitis, including perforation, abscess and a gangrenous appendicitis due to delayed diagnosis. For that reason, we want to evaluate predictive factors for the complicated appendicitis. METHODS: A total of 128 patients with appendicitis, after 13 patients with a duration of under 12 hours and 15 patients with pathological non-appendicitis were excluded from 156 patients, who visited Kwangju Christian Hospital from November 2008 to November 2010 were retrospectively reviewed. RESULTS: There were 62 patients (48.3%) with simple appendicitis and 66 patients (51.7%) with complicated appendicitis. In univariate analysis, age (P < 0.001), C-reactive protein (P < 0.001) and the diameter of the appendix (P = 0.006), were found to be significant. Multivariate analysis demonstrated that C-reactive protein was an independent predictor for complicated appendicitis (odds ratio, 1.371; 95% confidence interval, 1.155 to 1.628; P < 0.001). The cut-off value of C-reactive protein was set at 7.05 mg/dL by using receiver operating characteristic curve (0.805; sensitivity, 57.6%; specificity, 98.3%). CONCLUSION: This study suggests that if C-reactive protein is above 7.05 mg/dL, immediate and proper management should be performed due to a high probability of complicated appendicitis, especially in young children or elderly patients who frequently present with vague symptoms.

Clinical Analysis of Stercoral Perforation of the Colon / 대한소화기학회지

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.

Predictive Factor for Surgical Indication in Postoperative Adhesive Small Bowel Obstruction

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).

Clinical Analysis of Endovenous Laser Treatment Combined with High Ligation for Treatment of Varicose Vein

PURPOSE: Endovenous laser treatment (EVLT) for varicose vein has been shown to be an effective method of treatment. But, after EVLT, recurrence due to recanalization of the great saphenous vein has been identified as a complication. This study was performed to evaluate the effectiveness of EVLT combined with high ligation and to assess the recurrence rate. METHODS: Between April 2004 and April 2009, medical records of 163 patients treated with EVLT combined with high ligation and stab phlebectomy were reviewed retrospectively. Duplex ultrasonography was performed before surgery. All patients were followed up with clinical evaluation at 1 week and 1, 3, and 6 months after operation. The mean follow up period was 5.9 months. RESULTS: In total, 178 limbs of 163 patients were reviewed. In our study, almost all (98.8%) patients had symptomatic and cosmetic improvement. We observed complications such as ecchymosis (22.1%), edema (12.9%), pain (5.5%), and in one case, hematoma. Ecchymosis, edema, and pain were controlled by conservative treatment. The patient with hematoma was hospitalized and improved with conservative therapy. There were no cases of recanalization during the follow up period. CONCLUSION: Compared to previous studies, EVLT combined with high ligation showed satisfactory results, with no recurrence. However, the longer operation time and higher cost were issues and further studies are necessary for objective comparison.

Application of Alvarado Score in Patients with Suspected Appendicitis / 대한소화기학회지

BACKGROUND/AIMS: Though acute appendicitis is one of the most common surgical conditions, the diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We designed this study to investigate whether the Alvarado score can be used as an admission criterion. METHODS: This is a prospective study comprising consecutive patients who attended the emergency room with right lower abdominal pain from January 2007 to March 2007. Patients were scored with the Alvarado score and if they were admitted, had a second scoring in the ward. Patients who were not admitted were told to attend the clinic the next day and patients who did not attend the clinic were interviewed by telephone. RESULTS: Total of 132 patients (M=83, F=49) were included and 105 patients were admitted for observation. Eighty-seven patients had surgery with the intention to treat appendicitis and 10 patients did not have appendicitis. The diagnosis of acute appendicitis was highly accurate for an Alvarado score above 6 (90.9%). Patients with a score 4 or less in the ward as well as in the emergency room did not have appendicitis. Of the patients with appendicitis, 49% (38/77) had higher scores in the ward than initial score at the emergency room. CONCLUSIONS: None of the patients with a score of 4 or less had appendicitis. They did not need admission. The Alvarado score can be used as an admission criterion in patients with suspected appendicitis.

Papillary Thyroid Cancer: Clinicopathologic Characteristics and Factors of Contralateral Jugular Lymph Node Metastasis after Lymph Node Dissection / 대한내분비외과학회지

PURPOSE: Contralateral jugular lymph node metastasis (CJLNM) of papillary thyroid cancer (PTC) is rarely found during operative procedures. HoweverPTC is being diagnosed with increasing frequency and lymph node metastasis is now recognized as a factor of prognosis and recurrence. Therefore, this study was conducted to evaluate the clinical and histological characteristics of papillary thyroid cancer and to determine the factors that lead to CJLNM. METHODS: Two-hundred patients with PTC were treated in our hospital between March 2005 and October 2006. A retrospective analysis of the patient's clinical and histological features and lymph node metastasis was conducted. RESULTS: The total ratio of CJLNM to PTC was approximately 7.5%, the male to female ratio was 1:6.5, and the mean tumor size was 14.93 mm. In addition, the multiplicity was 53.3% and the bilatrality was 53.3%. Further, there were 4 cases involving benign thyroid disease combined with goiter. In addition, the capsule invasion was 100%. Age under 40 years, bilaterality and capsule invasion were found to be significant clinicopathologic factors of CJLNM induced by PTC. CONCLUSION: A contralateral jugular lymph node biopsy of PTC may be considered in cases involving patients under 40 years of age with, bilaterality and capsular invasion.

Diagnostic Effects of Fine Needle Aspiration Cytology and Frozen Section for Follicular Neoplasm of the Thyroid

PURPOSE: To determine diagnostic effects of fine needle aspiration cytology (FNA) and frozen section of thyroid follicular neoplasm and its role in the therapeutic approach. METHOD: We performed a retrospective analysis of the data of patients who underwent thyroid surgery at the Gwangju Christian Hospital, between March 2000 and December 2004, and had a report of preoperative fine needle aspiration (FNA) biopsy of thyroid follicular lesions, which comprises cellular lesion, suspicious for follicular neoplasm or follicular carcinoma. RESULTS: Out of 45 patients with preoperative FNA biopsy diagnosis of follicular neoplasm, reveals true follicular carcinoma in 20 (44.4%), a follicular adenoma in 11 (24.5%), a papillary carcinoma in 7 (15.5%), a papillary carcinoma with follicular variant in 4 (8.9%), an adenomatous goiter in 3 (6.7%). Among the 45 patients having an intraoperative frozen sections, only 7 patients (15.5%) were true follicular carcinoma, suspicious for malignant follicular neoplasm in 14 patients (31.1%) and suspicious for benign follicular neoplasm in 8 patients (17.8%). final diagnosis were changed from suspicious for benign follicular neoplasm at intraoperative frozen section to malignant in 3 patients, from suspicious for malignant follicular neoplasm to benign in 1 patient. Three patients underwent a lobectomy and 1 patients a subtotal thyroidectomy followed by a completion thyroidectomy. CONCLUSION: Fine needle aspiration cytology and frozen section results are not good indicators in making the decision of operative extent. the best way to establish a diagnosis and to predict prognosis is to surgically remove the tumor for a proper histopathologic examination.

A Clinical Analysis of Endoscopic Thyroid Lobectomy and Comparison with Conventional Thyroid Lobectomy

PURPOSE: A conventional thyroidectomy requires a wide transverse incision on the anterior neck, which can cause significant scaring. We developed an endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure in order to produce better cosmetic results. We reports the clinical analysis of endoscopic thyroid lobectomy and compare the result with those from a conventional thyroid lobectomy. METHOD: From July 2003 and December 2004, 55 consecutive patients with benign thyroid nodules, who underwent endoscopic thyroid lobectomy, and 51 consecutive patients with benign thyroid nodules, who underwent a conventional thyroid lobectomy, were retrospectively reviewed. The preoperative diagnosis of the thyroid nodules was performed using high-resolution ultrasonography and fine- needle aspiration cytology. The clinical results of endoscopic thyroid lobectomy were analyzed and compared with those from a conventional thyroid lobectomy. RESULTS: There were no significant differences between the two groups in terms of the patients' gender, size of tumor, preoperative diagnosis (follicular tumor/adenomatous nodule), postoperative diagnosis (cancer/benign), level of postoperative discomfort, length of hospital stay. The patients who underwent endoscopic thyroidectomy were significantly younger than those underwent conventional thryoidectomy (37.4+/-10.3 years vs. 48.8+/-13.0 years; P<0.001). The operation time for the endoscopic group was significantly longer than that for the conventional group (171.9+/-35.6 min vs. 92.5+/-26.5 min; P<0.001). The length of closed drainage in the endoscopic group was longer than that in the conventional group (2.8+/-0.8 days vs. 1.4+/-1.3 days; P<0.001). However, these factors did not affect the length of the hospital stay, and the number of intraoperative complications. CONCLUSION: Endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure has cosmetic benefits and is a feasible and safe procedure.

Analysis of the Possibility of Operative Treatment in Pediatric Intussusception and its Scoring

PURPOSE: Owing to the trend of a nuclear family the concern and protection are still more increasing than before. The patients admitted to hospital for intussusception, as well as their parents, seem to be under great stress when non- operative treatments fail. In order to identify those patients likely to fail an attempted non-operative treatment, and to administer prompt treatment, the patients that came to our hospital for pediatric intussusception were analyzed. METHODS: 285 cases, between 2000 and 2003 were reviewed. They were divided into two groups from their medical records, and retrospectively compared. Group I included 243 pneumoreduction cases and group II 42 operation cases. To find the probability of non-operative treatment failure, an attempt was made to analyze and score the risk factors that increase the possibility of operative treatment. RESULTS: The factors contributing to an increased possibility of operative treatment were fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms. CONCLUSION: This study revealed that fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms contributed to an increased possibility of operative treatment. An increase in the sum of the scores of each factor increased the possibility of operative treatment. This simple scoring system could eliminate excessive and repeated pneumoreduction, thus indicating its potential value as a useful aid in surgical decision making for high failure rate cases of pneumoreduction in intussusception.

The Role of Surgical Excision in the Management of Non-suppurative BCG Lymphadenitis

PURPOSE: Regional lymphadenitis is the most common complication of BCG vaccination and has various clinical course and prognosis, but there are no accurate guidelines for the management BCG lymphadenitis. This study was performed to reveal the clinical course of BCG lymphadenitis and provide guidelines for its management by comparison of observation and medication groups. METHODS: Between January, 2002 and April, 2003, 45 patients with non-suppurative lymphadenitis were reviewed. They were divided into two groups, and retrospectively compared. Group I consisted of 25 observation cases and group II of 20 antituberculous medication cases. RESULTS: The most prevalent age group of the 45 cases was three months old, and the most prevalent site of lesion was the ipsilateral axilla. A palpable single lesion was the most common finding. According to treatment (observation vs. antituberculous medication), the medication did not affect the prevention of suppuration. CONCLUSION: For the management of BCG lymphadenitis, systemic antituberculous medication and observation are not recommended, with active surgical resection being the treatment of choice.

A Clinical Comparison of the Mesh Method with the Conventional Herniorrhaphy in Adult Inguinal Hernia

PURPOSE: A tension-free hernioplasty, using mesh prosthetics, has revealed encouraging results in adult inguinal hernia repairs, and is increasingly being performed in Korea. However, there are few reports in Korea analyzing the clinical results of the mesh method. Therefore, this article compares the results of our mesh method with those of the non-mesh method in adult inguinal hernia repairs. METHODS: Between January 2000 and October 2002, 252 herniorrhaphies were performed. With these cases, a retrospective clinical analysis was performed on 52 tension-free herniorrhaphy cases and 48 conventional herniorrhaphy cases. The clinical features analyzed included: age, sex, location, type of operation, operating times, use of postoperative analgesics, length of hospital stays, recurrence rates and complications. RESULTS: The average number of analgesics used was significantly smaller in the mesh than the non-mesh group (P0.05, 4.1 days vs. 4.7 days, respectively). The recurrence rate in the non-mesh method was 6.3% (3/48), but there were no recurrences in the mesh group. Postoperative complications occurred in the non-mesh method group (1 case of a hematoma, and 2 of wound infection), but there were no complications in the mesh group. CONCLUSION: A tension-free herniorrhaphy, with mesh, is a useful technique because it is a pain-relieving operation, with a tendency for lower recurrences and complications than the non-mesh method. Therefore, it is suggest that a tension- free herniorrhaphy, with mesh, may also be a cost effective technique under the Diagnosis Related Group (DRG) system for patients and hospitals.

Risk Factors of Bowel Resection on Intussusception

PURPOSE: Intussusception is one of the most common causes of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. In this study, authors have tried to analyze the risk factors associated with intussusception in infants and children to establish an early diagnosis to prevent unwanted outcomes. METHODS: We reviewed 44 cases involving operations for childhood intussusception from 1997 to 2001. These were divided into two groups and compared retrospectively using medical records. Group I included 34 cases of manual reduction (77.3%), and group II consisted of 10 cases of bowel resection (22.7%). RESULTS: There were no significant differences in age, sex, and clinical symptoms between the 2 groups. The anatomic location of the intussusceptum, and fever seemed to vary, but this was of no statistical significance. Factors significantly contributing to increase in the rate of bowel resection were the duration of the symptoms (more than 48 hours), and the leukocyte count (more than 15,000/mm3). CONCLUSION: This study revealed that only the duration of symptom and the leukocyte count contributed to an increase in the rate of bowel resection. Further prospective studies would be needed to reveal more risk factors to accurately predict the prognosis of the disease.

Clinical Evaluation of Gastrointestinal Stromal Tumor of the Stomach

PURPOSE: Despite modern pathologic techniques, GISTs pose a dilemma in nomenclature, cellular origin, diagnosis, classification, and prognostication. The authors attempted to elucidate the clinical applications of known prognostic factors at our hospital on the basis of CD34 or CD117 positivity. METHODS: Immunostaining was done on 24 cases of GI tract tumor including leiomyoma, leiomyosarcoma, and GISTs treated in our hospital between 1991 and 2000. 20 cases that showed positive reactivity to either CD34 or CD117 were chosen, and a retrograde evaluation of the clinical characteristics and pathological characteristics was done. RESULTS: 16 of 24 cases (66.7%) showed a positive reactivity to CD34, 18 cases (75%) to CD117, and 20 cases (83.3%) to both CD34 and CD117. Complete resection was performed on all, with exception of one in which intraperitoneal metastasis was detected. The mean age of the patients was 58.9 (19~74) years, the mean tumor size was 8.1 cm (3~20) and there was no significant difference between the sexes. The overall survival rate was 80%. The difference of cumulative survival rate was significant when tumor size was 10 cm or greater (p=0.0021), mitotic count was 5/50 HPF or over (p<0.0001), or severe cellularity (p=0.0001), invasion (p<0.0001), necrosis (p=0.0185) or atypism (p<0.0001) were accompanied. CONCLUSION: Authors defined GIST as those case that were immunohistochemically positive to either CD34 or CD117. The prognostic factors those affected 5-year survival rate were tumor size, mitotic count, intratumoral necrosis, severecellularity, atypism and invasion. Additionally, the surgical treatment for this condition should be a complete resection of macroscopically identified tumor with adequate margin secured. Finally, a long term follow-up for the recurrence should be carried out.

Preventive Effects for Wound Infection of Intra-incisional Metronidazole Infiltration Preoperatively in Appendectomy

PURPOSE: The aim of this prospective study was to evaluate the effect of metronidazole for wound infection by using intra-incisional infiltration before appendectomy. METHODS: From January to May 2000, 176 patients with acute appendicitis received appendectomy. All patients were randomly divided into two groups. Group I (n=50) was the treatment group and group II (n=126) was the control group. After anesthesizing the patients of group I, 7.5 mg/kg of metronidazole was injected into subcutaneous tissue and muscle. All patients of group I and II were given intravenous injection of cephalosporin and intravenous or intramuscular injection of aminoglycoside. RESULTS: In the 50 cases of group I, the rate of wound infection was 2% and the rate of wound infection in the 126 cases of group II was 4.8%. The rate of anaerobic bacteria of organisms cultured from wound of patients with infection was 0% in group I and 33% in group II. The statistical analysis using chi-square test was not significant (p=0.676) but the rate of wound infection was reduced, especially in infection caused by anaerobic bacteria. CONCLUSIONS: The rate of wound infection was not significant statistically but it was reduced after intra-incisional infiltration of metronidazole. Therefore we suggest that this method can be one of methods that reduce the rate of wound infection after appendectomy.

Closure of the Colostomy

PURPOSE: To investigate the timing of colostomy closure and the associated risk factors that affect the development of complication after colostomy closure. METHODS: We have reviewed and analyzed the results of 28 patients with colostomy closure at the Kwangju Christian Hospital from January 1993 to December 1997. We investigated to associated literatures on this subject for timing of colostomy closure, preparing a patient for colostomy closure, suture technique, wound management, underlying disease process related to the incidence of complication and experience of surgeons. RESULT: Wound infection developed in 4 patients (14.4%). Anastomotic leakage occurred in one patient (3.6%). Small bowel obstruction developed in two patients (7.2%). Overall incidence of complication was 25%. The incidence of complications in patients with trauma who underwent colostomy was 44.4% and patients without trauma, 15.8%. Complication rate was 16.6% for loop colostomies and 40% for end colostomies. The morbidity was 40% for colostomies on the left side, 18.7% for transverse colostomies, and 0% for colostomies (2 ileostomies) on the right side. The morbidity rate for closures within 6 weeks for the initial operation was 50%; for those within 6 to 12 weeks, 8.3%; and for those after 12 weeks, 16.6%. CONCLUSION: The optimal timing of closure varies from patient to patient, but closure within 6 weeks of the initial operation significantly increased the morbidity. Colostomies on the left side are associated with a higher morbidity rate than transverse colostomies or colostomies on the right side.

Clinical Analysis of Surgical Treatment for Mid and Lower Rectal Cancers

PURPOSE: The aim of this retrospective study was to evaluate the risk of local recurrence such as patients who were treated for Dukes stage B and C low rectal cancer by abdominoperineal resection (APR) or low anterior resection (LAR). METHODS: From 1985 to 1995, 81 patients with low rectal cancers which were within 3~8 cm from the anal verge were treated by curative resection, 38 by APR and 43 by LAR. The present study examined clinical and tumor characteristics, type of intervention as potential predictors of local recurrence. Retrospective data were analysed by univariate Chi-square tests. RESULTS: Local recurrence was diagnosed in 17 of 81 patients with a median follow-up period of 24 months. The local recurrence rate was 23.6% (9 of 38) after APR and 18.6% (8 of 43) after LAR. There was no difference in local recurrence between patients who had APR and LAR (P=0.58). Also we could not find any significant differences among age (65 years, P=0.53), sex (M vs F, P=0.57), sized of tumors (5 cm, P=0.32), distance from anal verge (5 cm, P=0.57), Dukes stage (B vs C, P=0.22), histological grade (well and moderate vs poorly, P=0.17), distance from distal resection margin (2 cm, P=0.35). CONCLUSIONS: The tumor factors such as Dukes' stage were more critical for pelvic recurrences than other patient factors.

Thiersch Operation for the Treatment of Old Patients with Rectal Prolapse

Although many kinds of operation for rectal prolapse exist, generally they could be divided into the transabdominal and transperineal approach. The former has low recurrence rate as compared with the latter, but needs laparotomy. Unfortunately, many patients with rectal prolapse are old and debilitated. So they are not suitable candidates for a major abdominal operation. For those patient, a transperineal method may be proper, but the recurrence rate may be high and continence is not always achieved. We reviewed 12 patients who were older than 70 years of age and treated by the Thiersch operation among the 52 cases of rectal prolapse from Feb. 1992 to Mar. 1997 at Kwangju Christian Hospital. The results were summarized as follows; 1) The male to female ratio was 1 : 1.4. 2) Durations of rectal prolapse were distributed from 6 months to 30 years. Seven cases had duration of longer than 10 years. 3) The preoperative incidence of incontience was 8 (67%) of 12 cases. Among the 8 patients with incontinence, the male was 3 (37.5%) and female was 5 (62.5%). 4) Postoperative review of incontinence revealed complete disappearance in 4 cases (50%), improvement in 3 cases (37.5%), and no improvement in 1 case (12.5%). 5) After the Thiersch operation, rectal prolapse recurred in only 1 of the 12 cases (8.3%), a wound infection developed in 1 case (8.3%), defecation difficulty due to the small Thiersch ring was present in 3 cases (25%). The results of this study show that the Thiersch operation may be an effective method in treating rectal prolapse, especially in patient who are old or have poor general condition and manifested incontinence.

Clinical Review of the Double Stapling Technique for Lower Rectal Cancer

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.