Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis

PURPOSE: While perianal disease (PAD) is a characteristic of patients with Crohn disease, it has been overlooked in patients with ulcerative colitis (UC). Thus, our study aimed to analyze the incidence and the clinical features of PAD in patients with UC. METHODS: We reviewed the data on 944 patients with an initial diagnosis of UC from October 2003 to October 2015. PAD was categorized as hemorrhoids, anal fissures, abscesses, and fistulae after anoscopic examination by experienced proctologists. Data on patients’ demographics, incidence and types of PAD, medications, surgical therapies, and clinical course were analyzed. RESULTS: The median follow-up period was 58 months (range, 12–142 months). Of the 944 UC patients, the cumulative incidence rates of PAD were 8.1% and 16.0% at 5 and 10 years, respectively. The incidence rates of bleeding hemorrhoids, anal fissures, abscesses, and fistulae at 10 years were 6.7%, 5.3%, 2.6%, and 3.4%, respectively. The cumulative incidence rates of perianal sepsis (abscess or fistula) were 2.2% and 4.5% at 5 and 10 years, respectively. In the multivariate analyses, male sex (risk ratio [RR], 4.6; 95% confidence interval [CI], 1.7–12.5) and extensive disease (RR, 4.2; 95% CI, 1.6–10.9) were significantly associated with the development of perianal sepsis. CONCLUSION: Although the clinical course of PAD in patients with UC is not serious, in clinical practice, PAD is not rare in such patients. Therefore, careful examination and appropriate management for PAD is needed if the quality of life for patients with UC is to be improved.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Persistent Bleeding Following a Stapled Hemorrhoidopexy

A stapled hemorrhoidopexy (SH) is widely used for treatment of patients with grades III and IV hemorrhoids. The SH is easy to perform, is associated with less pain and allows early return to normal activities. However, complications, whether severe or not, have been reported. Here, we present the case of a female patient with persistent bleeding after a SH. The bleeding was caused by the formation of granulation tissue at the stapler line, diagnosed with sigmoidoscopy, and successfully treated via transanal excision (TAE) under spinal anesthesia. The biopsy showed inflammatory granulation tissue. After the TAE, her symptom was completely gone.

Morphometrical Data of Size and Shape of the Late-Stage Human Fetal Liver, Including Those of Intrahepatic Vessels: Some Prenatal and Postnatal Developmental Consideration / 한국간담췌외과학회지

BACKGROUND/AIMS: The fetus liver was characterized by its relatively larger left lobe than right lobe. So far there are no available morphometrical data and shape of the late-stage of human fetal liver, including identification of the intrahepatic vessels, which is little bit different from adult liver. METHODS: Among usual anatomic cadavers in department of anatomy of Sapporo medical university we choose normal- looking 12 late-stage human and 10 adult livers. At first, we measured the thickness and height and width of the livers at each designated sites and than underwent dissection for measurement of major intrahepatic vessels. In fetus, the upward protrusion of S8 was not evident, while S4 provided the greatest thickness of the liver. The fetus revealed an ellipsoid or oval shaped visceral surface and large S3, while the adult liver was triangular. The Arantius duct was almost always narrower than each of the 3 major hepatic veins, and it was often narrower than the umbilical vein. CONCLUSION: Both S2 and S6 seemed to enlarge during the postnatal growth, although there seemed to be great individual variations in the process of the growth. In the late stage fetus, three major hepatic veins seemed to play a great role for the venous return to the heart from the liver, rather then the Arantius duct.

The Characteristics of Patients and Recurrence Patterns in Patients with Hepatocellular Carcinoma Treated with Radio-frequency Ablation / 한국간담췌외과학회지

BACKGROUND/AIMS: The purpose of our study was to describe the characteristics of patients and recurrence patterns in patients with hepatocellular carcinoma (HCC) treated with radio-frequency ablation (RFA). Those were expected little different in some aspects from that in patients treated with surgical ablation (SA). METHODS: One hundred and twenty-five patients with HCC underwent RFA (Thermal Ablation, TA) between March 1, 1998 and May 31, 2001. Out of these, fifty-seven patients who were amenable to TA as a primary treatment, because of various reasons, were enrolled. Forty-eight patients were underwent SA due to HCC during the same period of time. RESULTS: The patients in the TA group exhibited more frequent ascites (p15 ng/ml) in the patients of TA was significantly higher than that of SA.