Background To date, there have been no studies on the normal anatomic values of the anal sphincter in healthy Koreans. Therefore, this study aimed to determine the normal anatomic values of transanal ultrasonography (TAUS).
Methods The thickness of the external anal sphincter (EAS) and internal anal sphincter (IAS) was measured by TAUS from healthy Korean volunteers between September 2019 and August 2021.
Results Thirty-six volunteers with a median age of 37 years (range, 20–77 years) and a median body mass index (BMI) of 23.5 kg/m2 (range, 17.2–31.2 kg/m2) were examined. The median thickness of the EAS at 4 cm and 2 cm from the anal verge was 7.4 mm (range, 5.8–8.8 mm) and 6.5 mm (range, 5.6–8.0 mm), respectively. The median thickness of the IAS at 2 cm from the anal verge was 1.8 mm (range, 0.8-4.3 mm). There were no differences in sphincter muscle thickness between the sexes. However, the EAS tended to thicken as the BMI increased (EAS at 2 cm and 4 cm from the anal verge, Spearman rho=0.433, 0.363; p=0.008 and p=0.029, respectively).
Conclusion In healthy Korean, the median thickness of the IAS at 2 cm from the anal verge was 1.8 mm and the median thickness of the EAS at 2 cm and 4 cm from the anal verge was 6.5 mm and 7.4 mm respectively. There were no differences in anal sphincter thickness between sexes, but BMI was related to EAS thickness.
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Anal Sphincter Defect and Fecal Incontinence Sherief Mansi, Karla Vaz, Neha R. Santucci, Khalil El-Chammas, Kahleb Graham, Nelson G. Rosen, Ajay Kaul JPGN Reports.2022; 3(4): e254. CrossRef
Background Omental transposition has been used to facilitate perineal wound healing in patients undergoing abdominoperineal resection (APR). However, there is no high-level evidence supporting the effectiveness of omental transposition in this regard. This study aimed to investigate the clinical efficacy of omental transposition in facilitating perineal wound healing after APR.
Methods In this systematic review, we systematically searched the PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science databases for literature regarding the topic of our study. Studies published since the inception of each database were considered for review. The outcomes of interest were the perineal wound healing rate at 1 and 3 months postoperatively, perineal wound infection rate, and perineal wound healing period.
Results Of the 1,923 studies identified, four articles representing 819 patients (omental transposition patients, n=295) were included in the final analysis. The wound healing rates at 1 and 3 months postoperatively in the omental transposition group (68.5% and 79.7%, respectively) did not significantly differ from those in the control group (57.4% and 78.7%, respectively) (p=0.759 and p=0.731, respectively). Perineal wound infection and chronic wound complication rates, including sinus, dehiscence, and fistula rates, also did not significantly differ between the omental transposition (8% and 7%, respectively) and control (11% and 7%, respectively) groups (p=0.221 and p=0.790, respectively).
Conclusion Our results suggest that omental transposition does not affect perineal wound healing in patients who undergo APR.
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Perineal Wound Healing Following Abdominoperineal Resection of the Rectum Muhammad Ali Khattak, Awais Nawaz Khan, Salman Jafferi, Yasir Iqbal, Habeeb Abdulrasheed, David McArthur Cureus.2024;[Epub] CrossRef
BACKGROUND This study was conducted to investigate preoperative carcinoembryonic antigen (CEA) as a prognostic factor in colorectal cancer. METHODS: Between January 2000 and July 2011, 1298 patients with primary adenocarcinoma colorectal cancer without metastasis, who underwent curative resection were retrospectively identified. The patients were divided into two groups according to serum CEA level at primary diagnosis: a high CEA (HCEA) group (serum CEA ≥6 ng/mL) and a normal CEA (NCEA) group (serum CEA <6 ng/mL). A 1:1 propensity score matching analysis was applied to reduce bias. Finally, 364 patients were enrolled in this study. Matched variables were age, gender, preoperative chemoradiotherapy, tumor site, cell differentiation and pathologic stage. RESULTS: The clinicopathological characteristics of the two groups did not differ significantly difference. The systemic metastasis rate was 16.5% (30/182) and 25.3% (46/182) in the NCEA and HCEA groups, respectively (p=0.039). There were no significant differences in local recurrence or metastatic sites between groups. The 5-year disease-free survival (DFS) rate of the HCEA group was worse than that of the NCEA group; however, there was no significant difference in overall survival between the two groups. CONCLUSION: Elevated preoperative CEA was related to frequent systemic recurrence and low DFS. Therefore, elevated preoperative CEA could be considered a prognostic factor for worse clinical outcomes in patients with colorectal cancer.
Perianal Crohn's disease is a major problem that impair quality of life. This article reviews the current surgical treatment of Crohn's perianal fistula. Fistulotomy and loose seton are commonly used surgical methods for treatment of perianal Crohn's disease. Mucosal advancement flap and fibrin glue are used in this treatment, despite a lake of controlled trials. Fecal diversion is disturbingly high in complicated complex perianal fistula in Crohn's disease. Ligation of intersphincteric fistula and autologous or allogenic stem cells are new surgical procedures for treatment of Crohn's disease that need further studies. Treatment success might be improved by multimodal treatment and new surgical and medical treatment options.