Intersphincteric resection (ISR) is the ultimate sphincter-preserving surgical technique for low rectal cancer. To promote the standardized implementation of ISR, this review discusses the important issues regarding the clinical application of ISR with reference to the latest Chinese expert consensus on ISR. In terms of ISR-related pelvic anatomy of the rectum/anal canal, hiatal ligament is not identical with the anococcygeal ligament. At the level where the rectourethralis muscle continuously extends to the posteroinferior area of the membranous urethra from the rectum, the neurovascular bundle is identified between the posterior edge of rectourethralis muscle and the anterior edge of the longitudinal muscle of the rectum. This knowledge is crucial to detect the anterior dissection plane during ISR at the levator hiatus level. The indication criteria for ISR included: (1) stage I early low rectal cancer; (2) stage II-III low rectal cancer undergoing neoadjuvant treatment, and supra-anal tumors and juxta-anal tumors of stage ycT3NxM0, or intra-anal tumors of stage ycT2NxM0. However, signet ring cell carcinoma, mucinous adenocarcinoma and undifferentiated carcinoma should be contraindicated to ISR. For locally advanced low rectal cancer (especially anteriorly located tumor), neoadjuvant treatment should be carried out in a standardized manner. However, it should be recognized that neoadjuvant chemoradiotherapy was a risk factor for poor anal function after ISR. For surgical approaches for ISR, including transanal, transabdominal, and transanal transabdominal approaches, the choice should be based on oncological safety and functional consequences. While ensuring the negative margin, maximal preservation of rectal walls and anal canal contributs to better postoperative anorectal function. Careful attention must be paid to complications regarding ISR, with special focus on the anastomotic complications. The incidence of low anterior resection syndrome (LARS) was higher than 40%. However, this issue is often neglected by clinicians. Thus, management and rehabilitation strategies for LARS with longer follow-ups were required.
Humans ; Rectal Neoplasms/pathology* ; Postoperative Complications ; Laparoscopy/methods* ; Anal Canal/pathology* ; Anus Neoplasms/pathology* ; Anus Diseases/surgery* ; Low Anterior Resection Syndrome ; Carcinoma, Signet Ring Cell/pathology* ; Treatment Outcome

Acupuncture Therapy ; Adult ; Anal Canal ; surgery ; Anus Diseases ; surgery ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Postoperative Complications ; therapy

OBJECTIVE: To observe the effect of Dong's extraordinary point needling technique on postoperative complications of anal fistula. METHODS: A total of 241 patients undergoing anal fistula surgery were randomly divided into an observation group (121 cases, 3 cases dropped off) and a control group (120 cases, 2 cases dropped off). The patients in the control group were treated with intramuscular injection of compound diclofenac sodium injection and oral administration of tamsulosin hydrochloride sustained release capsules. In addition to the treatment in the control group, the patients in the observation group were treated with Daoma needling technique at the "Sanqi points" (Qimen point, Qijiao point, and Qizheng point) combined with Dongqi needling technique at "Sanhuang points" (sub-Tianhuang point, Dihuang point, Renhuang point), with each session lasting 30 min. The treatment in the two groups both started on the first day after surgery, and was given once daily for 14 consecutive days. Visual analog scale (VAS) score was compared between the two groups on postoperative day 1, 7, and 14; bladder residual urine volume, spontaneous voiding volume, and urinary catheterization frequency were assessed after treatment on postoperative day 1; and anorectal dynamic indexes (anal canal resting pressure, rectal resting pressure, maximum squeeze pressure of the anal canal, and minimum rectal sensory threshold) were evaluated before surgery and on postoperative day 4. Clinical efficacy was assessed in both groups one month after surgery. RESULTS: On postoperative day 7 and 14, the VAS scores of both groups were lower than those on postoperative day 1 (P<0.05), and the VAS scores in the observation group were lower than those in the control group (P<0.05). The bladder residual urine volume and urinary catheterization frequency in the observation group were lower than those in the control group (P<0.05), while the spontaneous voiding volume was higher than that in the control group (P<0.05). On postoperative day 4, the anal canal resting pressure, maximum squeeze pressure of the anal canal, and the minimum rectal sensory threshold were lower than preoperative values (P<0.05), while the rectal resting pressure was higher than preoperative value (P<0.05) in both groups. The anal canal resting pressure, maximum squeeze pressure of the anal canal, and minimum rectal sensory threshold were lower than those in the control group, and the rectal resting pressure was higher than that in the control group (P<0.05). The effective rate was 93.2% (110/118) in the observation group, which was higher than 84.7% (100/118) in the control group (P<0.05). CONCLUSION Dong's extraordinary point needling technique could reduce postoperative pain, alleviate urinary retention, and improve defecation in patients undergoing anal fistula surgery.
Humans ; Rectum ; Rectal Fistula/surgery* ; Anal Canal/surgery* ; Treatment Outcome ; Anus Diseases ; Postoperative Complications/etiology* ; Acupuncture Points

OBJECTIVETo investigate the factors associated with postoperative fecal incontinence after anorectal procedures.

METHODSA total of 1074 patients underwent anorectal procedures in the Department of Colorectal Surgery at the Coloproctology Hospital of Shenyang. Factors associated with postoperative fecal incontinence were analyzed retrospectively.

RESULTSFollow-up was available in all the patients. One hundred and forty-four(13.4%) patients developed mild incontinence, and 57(5.3%) moderate incontinence. There was no complete incontinence. The overall incontinence rate was 18.7%. The incontinence rate was 41.8%(107/256) after fistula procedures, higher than that after hemorrhoid procedures(12.4%,73/591) and fissure procedures(9.2%,21/227), and the differences were statistically significant (P<0.01). Among 490 patients who received injection therapy for internal hemorrhoids, patients who received 10 ml of Xiaozhiling or more had a mild incontinence rate of 10.4%(27/259) and a moderate incontinence rate of 2.3%(6/259), and in those who received less than 10 ml of Xiaozhiling, the mild incontinence rate was 9.5%(22/231) and moderate incontinence rate was 4.3%(10/231). The differences were not statistically significant (all P>0.05). In 354 patients who underwent hemorrhoidectomy, the mild incontinence rate and moderate incontinence rate were both 14.1% in those who had excision of 3 or more hemorrhoids, and were 3.9%(11/283) and 2.1% (6/283) in those who had excision of less than 3 hemorrhoids, and the differences were statistically significant (P<0.01). There was no difference in Incontinence rate was not associate with fistula or fissure procedure (P>0.05).

CONCLUSIONSThe incidence of incontinence is high after fistula procedures. Excision of hemorrhoids should not exceed 3 hemorrhoids. Wider adoption of injection therapy is encouraged.

Adult ; Anus Diseases ; surgery ; Fecal Incontinence ; etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/microL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.
Adult ; Aged ; Anus Diseases/complications/*surgery ; Asian Continental Ancestry Group ; CD4-Positive T-Lymphocytes/cytology ; Condylomata Acuminata/surgery ; Female ; HIV Infections/*complications ; Hemorrhoids/surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Rectal Fistula/surgery ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Wound Healing ; Young Adult