Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence

PURPOSE: The most common risk factor for fecal incontinence (FI) is obstetric injury. FI affects 1.4%–18% of adults. Most patients are unaware when they are young, when symptoms appear suddenly and worsen with aging. Autologous fat graft is widely used in cosmetic surgical field and may substitute for injectable bulky agents in treating FI. Authors have done fat graft for past several years. This article reports the effectiveness of the fat graft in treating FI and discusses satisfaction with the procedure. METHODS: Fat was harvested from both lateral thighs using 10-mL Luer-loc syringe. Pure fat was extracted from harvests and mixed with fat, oil, and tumescent through refinement. Fats were injected into upper border of posterior ano-rectal ring, submucosa of anal canal and intersphincteric space. Thirty-five patients with FI were treated with this method from July 2016 to February 2017 in Busan Hangun Hospital. They were 13 male (mean age, 60.8 years) and 22 female patients (mean age, 63.3 years). The Wexner score was checked before procedure. We evaluated outcome in outpatients by asking the patients. For 19 patients we checked the Wexner score after procedure. RESULTS: Symptom improved in 29 (82.9%), and not improved in 6 (17.1%). In 2 of 6 patients, they felt better than before procedure, although not satisfied. No improvement in 4. Mean Wexner score was 9.7 before procedure. There were no serious complications such as inflammation or fat embolism. CONCLUSION: Autologous fat graft can be an effective alternative treatment for FI. It is safe and easy to perform, and cost effective.

Clinicopathologic characteristics and prognosis of remnant gastric cancer

PURPOSE: Remnant gastric cancer is defined as a malignant tumor developing on the remnant side of stomach after partial gastrectomy. The purpose of this study is to evaluate the clinical characteristics and prognosis of remnant gastric cancer according to the cause and the reconstruction method of previous surgery.METHODS: Between January 2007 and February 2016, we analyzed 39 patients with their medical records who were diagnosed as remnant gastric cancer and underwent gastrectomy at Inje University Busan Paik Hospital.RESULTS: In the comparison of malignant disease (MD) and benign diseases (BD) group, the Billroth I:Billroth II ratio was 52.2% and 12.5%. The time interval from the previous operation to the diagnosis of remnant gastric cancer (RGC) was shorter in the MD group than in the BD group (6.6±6.04 vs. 34.7±10.12 years). Comparing B1 and B2 group, the proportion of patients previously undergone surgery due to MD was 85.7% and 44%. The time interval was higher in the B1 group than in the B2 group (8.0±8.78 vs. 23.8±16.48 years). Analyzing prognostic factors of survival, age and the presence of symptoms at the time of RGC diagnosis, and curability of surgery had a significant effect on the survival of the patients (P=0.032, hazard ratio [HR]=5.241, 95% confidence interval [CI], 1.158–23.723; P=0.005, HR=5.086, 95% CI, 1.642–15.750; P=0.034, HR=3.165, 95% CI, 1.088–9.208).CONCLUSION: Patients who underwent partial gastrectomy for benign or MD require regular endoscopic follow-up and appropriate surgical approach is essential for the treatment of RGC.