Intersphincteric fistulas are the most prevalent fistulas encountered by a surgeon. In general, there are two surgical methods for treating intersphincteric fistulas: fistulotomy and fistulectomy. The advantage of a fistulotomy is less sphincter muscle destruction; the disadvantage is a higher recurrence rate. The advantage of a fistulectomy is a lower recurrence rate; the disadvantage is more sphincter muscle destruction and a higher flatus incontinence rate. Because of the disadvantages with both surgical methods, the authors have developed a new method for treating intersphincteric fistulas. The new method is a fistulectomy with seton. A fistulectomy with seton is a seton tightening of the remaining internal sphincter and subcutaneous external sphincter after coring out of the fistula tract. The advantages of this method are a lower recurrence rate due to complete removal of the fistula and a lower flatus incontinence rate due to the seton slowly cutting the remaining sphincter muscle. For that reason, the authors submit that fistulectomy with seton is the most effective operation method for treating intersphincteric fistulas, especially because fistulectomy with seton has many advantages such as a lower recurrence rate, a lower flatus incontinence rate, and less anal deformity.
Congenital Abnormalities ; Fistula* ; Flatulence ; Recurrence

At Hue Central Hospital, Transmitted disease department, 41 viral hepatitis with anorexia, flatulence and dyspepsia were divided into 2 groups: the control group using fortex, polyvitamin and the intervened group using pantyrase in addition. The study showed that acute hepatitis occurred more in male than in female patients, the most age at 16-45 years old (61%). The group using pantyrase got improvement on the symptoms of flatulence, dyspepsia, promoted the digestion and the appetition. The anorexia interrupted after 7.18  1.91 days in pantyrase group and 16.84  4.91 days in the control group
Anorexia ; Flatulence ; Hepatitis, Viral, Human

PURPOSE: Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery. METHODS: PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I2 = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I2 = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results. CONCLUSION: These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.
Adult ; Flatulence ; Herbal Medicine ; Humans ; Population Characteristics

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.
Anesthetics ; Bupivacaine* ; Flatulence ; Infusion Pumps ; Injections, Intramuscular ; Meperidine ; Morphine* ; Peritoneum

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a feasible and acceptable surgical technique for treating early gastric cancer. However, there are no reports about the role of the first assistant on LADG. The aim of this study is to compare between an experienced first assistant and an inexperienced first assistant surgeon for conducting LADG to treat early gastric cancer. METHODS: The data from 32 consecutive patients with early gastric cancer and who underwent LADG by one surgeon between May 2008 and December 2008 was reviewed. The operation times of 32 consecutive patients were reviewed. Other indicators such as the transfusion requirements, the time to first flatus, and the postoperative hospital stay were also evaluated between an experienced first assistant and an inexperienced first assistant surgeon. RESULTS: No significant differences between an experienced first assistant and an inexperienced first assistant surgeon in terms of the patients' clinicopathologic characteristics and surgical outcomes were found, but there was a statistically significant difference in the operation times between the two groups. CONCLUSION: After the operator has overcome the learning curve and standardization has been established, LADGs are minimally affected by the role of the first assistant.
Flatulence ; Gastrectomy ; Humans ; Learning Curve ; Length of Stay ; Stomach Neoplasms

PURPOSE: Robotic surgery (RS) overcomes the limitations of previous conventional laparoscopic surgery (CLS). Although meta-analyses have been published recently, our study evaluated the latest comparative surgical, urologic, and sexual results for rectal cancer and compares RS with CLS in patients with rectal cancer only. METHODS: We searched three foreign databases (Ovid-MEDLINE, Ovid-Embase, and Cochrane Library) and five Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi) during July 2013. The Cochrane Risk of Bias and the Methodological Index for Non-Randomized were utilized to evaluate quality of study. Dichotomous variables were pooled using the risk ratio (RR), and continuous variables were pooled using the mean difference (MD). All meta-analyses were conducted with Review Manager, V. 5.3. RESULTS: Seventeen studies involving 2,224 patients were included. RS was associated with a lower rate of intraoperative conversion than that of CLS (RR, 0.28; 95% confidence interval [CI], 0.15-0.54). Time to first flatus was short (MD, -0.13; 95% CI, -0.25 to -0.01). Operating time was longer for RS than that for CLS (MD, 49.97; 95% CI, 20.43-79.52, I2 = 97%). International Prostate Symptom Score scores at 3 months better RS than CLS (MD, -2.90; 95% CI, -5.31 to -0.48, I2 = 0%). International Index of Erectile Function scores showed better improvement at 3 months (MD, -2.82; 95% CI, -4.78 to -0.87, I2 = 37%) and 6 months (MD, -2.15; 95% CI, -4.08 to -0.22, I2 = 0%). CONCLUSION: RS appears to be an effective alternative to CLS with a lower conversion rate to open surgery, a shorter time to first flatus and better recovery in voiding and sexual function. RS could enhance postoperative recovery in patients with rectal cancer.
Bias (Epidemiology) ; Flatulence ; Humans ; Laparoscopy* ; Odds Ratio ; Prostate ; Rectal Neoplasms*

PURPOSE: The aim of this study was to compare end-to-side with side-to-side esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer in terms of complications. METHODS: One hundred and fourteen patients who underwent laparoscopy-assisted total gastrectomy for gastric cancer with curative intent from June 2003 to February 2010 at Seoul National University Bundang Hospital were retrospectively reviewed. Comparative analysis of short term outcomes including complications was performed to compare the end-to-side esophagojejunostomy (EJ) and side-to-side EJ groups. RESULTS: Overall morbidity and mortality rates after LATG were 17.5% (20 patients) and 0%, respectively. Comparing the end-to-side EJ group (93 patients) with the side-to-side EJ group (21 patients), there was no significant difference in operating time (242.3 versus 250.7 minutes), estimated blood loss (176.6 versus 133.3 ml), time to first flatus (3.8 versus 4.0 days), time to first soft diet (5.3 versus 5.7 days), postoperative morbidity (15.1% versus 28.6%), and mortality. However, there was a difference in postoperative hospital stay (9.0 versus 12.9 days, p=0.045). Also, the EJ leakage rate of the side-to side EJ group was higher than that of end-to-side EJ group (14.3%, 3 patients, versus 2.2%, 2 patients; p=0.043). CONCLUSION: End-to-side EJ can be recommended after LATG because the EJ leakage rate after end-to-side EJ was lower than that after side-to-side EJ.
Diet ; Flatulence ; Gastrectomy ; Humans ; Length of Stay ; Retrospective Studies ; Stomach Neoplasms

Acute colonic pseudo-obstruction is a functional disorder that closely mimics a mechanical large-bowel obstruction. Two such patients were treated by pharmacological manipulation of the parasympathetic innervation to the colon with intravenous neostigmine infusion. The two responded to treatment with passage with flatus and stool within several minutes with complete resolution of the symptoms, although the first patient required two additional infusions and the second patient required one additional infusion for subsequent recurrence. Dizziness occurred in one patient, and no other serious side effects were apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery when conservative management has failed.
Colon* ; Colonic Pseudo-Obstruction* ; Decompression ; Dizziness ; Flatulence ; Humans ; Neostigmine* ; Recurrence

PURPOSE: The purpose of this study was to examine the effects of a gum-chewing on the recovery of bowel motility and days of hospitalization after surgery for colorectal cancer. METHODS: This study used a non-equivalent control group and non-synchronized design. Thirty-four patients undergoing abdominal surgery for colorectal cancer were assigned to either gum-chewing group (n=17) or control group (n=17). The patients in the gum-chewing group chewed gum for 10 min three times daily from the first postoperative morning until the day they began oral intake. Outcome variables were time of first flatus, time of first bowel movement, and length of hospital stay. RESULTS: Gum-chewing was effective in enhancing the first passage of flatus, but was not effective in enhancing time of bowel movement and length of hospital stay. CONCLUSION: Gum-chewing can be utilized as a useful nursing intervention to shorten the time of the first flatus of postoperative colectomy.
Colectomy ; Colorectal Neoplasms ; Flatulence ; Gingiva ; Hospitalization ; Humans ; Length of Stay ; Mastication

PURPOSE: Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. METHODS: The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. RESULTS: Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. CONCLUSION: Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.
Deglutition Disorders ; Diagnosis ; Eructation ; Flatulence ; Fundoplication* ; Gastroesophageal Reflux ; Humans ; Korea*