Outcome and Preoperative Predictive Factor after Complete Anatomical Repair in Perineal Obstetric Injury

PURPOSE: To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury. METHODS: Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9+/-10.1 years, mean duration of symptom was 18.9 (range: 1-33) years, mean delivery numbers were 2.8 +/-1.2 times, and mean follow up was 11.9 +/- 4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex), duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score. RESULTS: The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score < or =5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (p<0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (p<0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017). CONCLUSIONS: Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.

Difference between Genders in Patients with Obstructive Defecation: Analysis of 1,513 Defecograms

PURPOSE: The aims of this study were to find the difference in frequency between genders and to determine the correlation between age-related disease and other diseases in obstructive defecation. METHODS: A consecutive series of 1,513 patients (343 males, 1,170 females) with obstructive defecation who undertook defecography and/or cinedefecography during 1 year period was analyzed. RESULTS: The causes of obstructive defecation in males showed as spastic pelvic floor syndrome (SPFS) (48.3%), rectal prolapse (RP) (31.4%), descending perineum syndrome (DPS) (25.9%), enterocele or sigmoidocele (7.6%), and rectocele (7%). However, in females, the causes were rectocele (83.8%), DPS (49.2%), RP (37.6%), SPFS (32.5 %), and enterocele or sigmoidocele (11.2%). The SPFS was negatively correlated with enterocele or sigmoidocele, DPS, RP in both genders, but SPFS had no statistical correlation with rectocele. DPS was correlated with RP in both genders and with enterocele or sigmoidocele in females, but no statistical correlation was seen in males. The size of the rectocele showed a slight correlation with age in females (r=0.102, P=0.01). Age was correlated with rectal prolapse in females; however, it showed a negative correlation with SPFS in females. CONCLUSIONS: The frequency of diseases causing obstructive defecation is different between genders. Age may not play a role in aggrevating the diseases causing obstructive defecation. Further pathophysiologic study of gender differences in patients with obstructive defecation is needed.

Clinical Analysis of Deep Vein Thrombosis in Lower Extremity

PURPOSE: The natural history of deep vein thrombosis (DVT) has been of increasing interest since the mid-1960s. Prevention, diagnosis & management of DVT has been continously development. Howerver, Early diagnosis for prevention & effectivly choice of management method of DVT has been difficult problem. METHODS: We reviewed retrospectively 42 patients who were admitted and out patients department follow up to Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, for treatment of DVT from November, 1990 to August, 1998. RESULTS: There was a wide age distribution from teenage to 9th decade, and peak age distribution was 7th decade (23.8%). It occured more old age than younger age. Sex distribution, male to female, was about 1.2 : 1 and occured more male than female. Main chief complaint in pateints with DVT at initial our hospital visit was painful swelling (57.1%), and followed by swelling (33.3%) of lower extremity. Duration of sign and symptom in pateints with DVT at initial our hospital visit was more than 1 month (38.1%), and followed by less than 1 weeks (31.0%). The left side of lower extermities was more frequently involved than that of right side, left to right ratio was 2.1:1. Most location of involved vein of lower extremity was Popliteal vein (71.4%), and followed by Superficial femoral vein (55.4%), Calf vein (44.6%), and Common femoral vein (39.4%) in ration of 56 limbs. More frequent risk factor of DVT was major surgery (28.6%), and followed by immobility (16.7%). but most frequent risk factor was idiopathic (31.0%). Diagnosis of DVT was made with color doppler (90.5%) and venogram (57.1%). Treatment was done with intravenous or oral anticoagulants in most pateints (90.5%), Forgarty thrombectomy (7.1%), and Bypass and A.-V. fistula (2.4%) and followed by only or combined oral anticoagulants theraphy. Treatment of DVT was wide duration from less than 3 month to more than 1 years. It was done for less than 3 month (52.4%), and followed by 6 to 12 month (19.0%), 3 to 6 month (14.3%) and 14.3% were continued more than 1 years. During oral anticoagulant theraphy, GOT/GPT elevation was observed in 26.2%, and 23.8% was detected bleeding tendency (hematuria). Post-treatment response of DVT was divided three group, good (31.0%), moderated (42.9%), no response group (26.3%) in pateint complaint of before or after treatment. Most pateint were improved in 3 month. CONCLUSION: We have been thick that DVT in the lower extremity must done early diagnosis and choiced more massively intensively method of treatment and with only or combined oral anticoagulant therapy after operation was prevented for reccured and serious complication.