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Volume 49, Issue 10
Displaying 1-14 of 14 articles from this issue
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S. Tsuchiya1996 Volume 49 Issue 10 Pages 1137-1145
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe Japan Society of Coloproctology was established by the proctologists in practice in 1940. The inaugural meeting was held on 21. March of the same year. Its purpose was the promotion of the study concerning the anorectal diseases and organization of a well qualified speciality. The name of the society changed to the Japan Society of Coloproctology in 1967.
The number of the registered members was about 500 during the initial years, increased steadily after about 1960 and finally reached more than 5, 000 in 1995. The 50th meeting was commemorated in 1995. Formerly the annual meetings were performed usually rather on a small scale with less than 30 papers. Afterwards it grew larger year after year and consequently there were more than 300 presentations at the last meeting.
The society has issued regularly its journals since 1940. At present time there are 10 issues with 1, 200 pages in a year. Also it has supported many domestic and international societies concerned and did many cooperatins with them.
Since 1988 the accreditation of the specialist is one of the important roles of the society.
In prospect, the society will have to contribute much more due to the rapid development of the disciplines concerned.View full abstractDownload PDF (1532K) -
Y. Matsuda, H. Tomochika, S. Satoh, K. Kimura, H. Kita, H. Aoyama, K. ...1996 Volume 49 Issue 10 Pages 1146-1158
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSPurpose
Operative cases for fistula-in-ano were reviewed during a ten-year period, and self-assessment was made from a point of view of recurrence rate, term of wound healing, morbidity rate, and postoperative sphincter function.
Method
Eighty-eight recurrence cases, out of 2388 total cases, were classified according to the type of fistula, and the operative method was divided into two groups, laying open method and sphincter preserving method. The latter is a coring out method which consists of whole ductectomy, including primary opening and total closure at the anal canal.
Results
The mean recurrence rate was 3.7% [1986-1989 3.8% (36 out of 953 cases) 1990-1995 3.6% (52 out of 1435 cases)]. Among the recurrence cases, intersphincteric type was 60 cases in which lay open method was 17 (1.5%) out of 1165, while sphincter preserving method was 43 (5.6%) out of 770 cases. Furthermore, as to the ischiorectal type, there were 10 (5.5%) out of 181 cases in lay open method, and 9 (8.6%) out of 105 cases in coring out method.
Conclusion
Sphincter preserving operation was considered to be an excellent procedure, however, the recurrence rate increased despite good sphincter function.View full abstractDownload PDF (1582K) -
Y. Hongo, A. Kurokawa, Y. Nishi1996 Volume 49 Issue 10 Pages 1159-1168
Published: 1996
Released on J-STAGE: May 07, 2010
JOURNAL FREE ACCESSFistula operations can be very destructive ; functional abnormalities occur easily (even with internal lateral sphincterotomy, minor incontinence occurs); hence function preserving operations are best.
Indication : Fistula is a low intersphincteric long string type, of which the primary tract (primary opening and primary focus) shows heavy inflammation and induration.
Open Coring-Out Procedure : We developed an “open coring-out” technique where the whole fistula is pulled out making the inside and outside clearly visible. The portion from the internal opening to the primary focus is easily opend (fistulotomy) and the primary focus is excised by coring out (fistulectomy).
Repair Procedure : The sphincter muscle edges are fixed to the underlying tissues with two kinds of sutures. The cored portion is provided with adequate drainage and a single suture that reinforces and prevents pocket formation.
Results : Since 1984, 279 patients were treated, 48 requierd postoperative treatment : delayed healing (45); recurrence (3). Of patients responding to our survey, 16 (7.4%) reported postoperative complaints.
Delayed healing has always been a major problem. Because the repair procedure inhibits pocket formation and allows adequate drainage of the cored portion, cases of delayed healing was decreased to by 7%. This technique, which is continually being improved and evaluated, is simple, has a low risk of infection, preserves functions, and prevents deformations.View full abstractDownload PDF (4327K) -
M. Kosugi1996 Volume 49 Issue 10 Pages 1169-1181
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSSphincter preserving operation and radicality are needed to treat anal fistulas. Different methods that were suitable for the site of internal opening and for four major types of fistula in ano, based on the idea of 'complete removal of primary focus' were selected.
Anterior and lateral originated low intersphincteric fistulas were treated by three different methods. Fistulectomy for posterior low intersphincteric fistulas and myoplasty after removal of primary focus were performed for complicated trans-and supra-sphincteric fistulas. In 174 anterior and lateral low intersphincteric fistulas during '81-94, closure of the internal opening by primary suture, sliding or rotating skin flap, and coring-out methods had been done, and the recurrence rates were 4.7%, 2.3%, and 11% respectively. The recurrent cases were treated by the rotating skin flap method or seton.
Recurrence after myoplasty for 152 complicated fistulas was 6 cases (3.5%). Surgical treatment for fistulas of male infants by silk tight seton was excellent. On assessment of recurrent cases, recurrence was caused by inappropriate removal techniques of primary focus rather than the operation method.View full abstractDownload PDF (6334K) -
Y. Tsuji, M. Takano, J. Kuromizu, Y. Kamura, T. Toyohara, K. Ishibashi1996 Volume 49 Issue 10 Pages 1182-1190
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA comparative study on surgical techniques for lateral intermuscular fistula was performed on 33 cases, in which transanal ultrasongraphy and anal manometry were performed preoperatively and in the 1st and 3 sd months postoperativery. These cases included 7 cases of lay open, 7 cases of seton, and technique 19 cases of sphincter-preserving technique.
The results were as follows
1) When lay open is performed, contracture occurs rapidly on internal and external sphincter muscles with incised region in the border. Sphincter muscles aer opened and the resting and voluntary pressures decrease.
2) In the cases treated by the seton technique, when fistula is opened, wound healing occurs at the same time, however, decrease of resting pressure similar to that of lay open is found after opening because the internal sphincter muscle is cut. However, the external sphincter is incised to a lesser extent, and almost the same voluntary pressure as that of the sphincter preserving technique is obtained.
3) The sphincter preserving technique contributes to both radicality of the fistula and preservation of anal functions after the operation, and this seems to be the best technique for the treatment of lateral intermuscular fistula.View full abstractDownload PDF (4160K) -
J Iwadare1996 Volume 49 Issue 10 Pages 1191-1201
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSConventionally, low intersphincteral fistulas have been operated on by incising the internal sphincter muscle and eliminating the primary opening and primary lesion. Suturing is then performed, and the fistular canal is eliminated from the secondary opening to the subcutaneous external sphincter. With this technique, recurrence is seen in 2% or less of the cases, but there are some rare cases of failure of the suture of the muscle. For this reason, the author recently switched to a technique in which the internal sphincter muscle is incised and only the primary opening is eliminated. Suturing is then performed, and the primary lesion and fistular canal are eliminated by coring out from the secendary opening.
In the case of ischiorectal fistulas, the space formed after elimination of the primary opening and primary lesion is subjected to sphincter filling up. Recurrence is seen in 2% or less of these cases, but there are some cases of recurrence due to suture failure at the sphincter filling up site. In order to prevent this, steps should be taken to achieve good drainage.View full abstractDownload PDF (1212K) -
M. Takano1996 Volume 49 Issue 10 Pages 1202-1213
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSAnal fistula is one of the most difficult anal diseases to cure because of the tendencies for recurrence and insufficiency. To understand the postoperative long-term results, the 204 cases who underwent surgery in our hospital in 1991 were surveyed. The 204 cases were 12 cases of subcutaneous, 141 low intersphincteric, 20 high intersphincteric, 25 ischiorectal and 6 pelvirectal fistulas. The operative methods were open for subcutaneous and posterior low intersphincteric fistulas and sphincter-preserving methods for the other fistulas. As a result, the wounds healed completely after 23.6 days postoperatively in average. The postoperative complaints decreased to 73 from the preoperative 387 complaints. Most of the persisting postoperative complaints seemed to originate from 2 factors of accompanied lesions left behind after operation such as hemorrhoids and postoperative deformity and/or minor insufficiency. In order to prevent postoperative complaints, curative operation of the accompanied lesions and protection of normal anatomy are needed. Only 4 cases (2.0%) showed manifest symptoms of anal insufficiency postoperatively. Manometry revealed declined anal pressures in deeper types of fistulas, among which the deepest pelvirectal fistula did not recover after radical operation. Recurrence occurred in 6 cases (2.9%) consisting of a case of short-term recurrence and 5 cases of long-term recurrence, all of which healed well after the second reoperation.View full abstractDownload PDF (1258K) -
K. Takahashi, T. Mori, M. Yasuno, M. Asano1996 Volume 49 Issue 10 Pages 1214-1229
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSResected colonic cancer patients were divided into two groups by operative period : the first period (from 1977 to 1983) contained 267 patients and the latter period (from 1984 to 1990) 466 patients. The surgical effect for the patients of the latter period was compared with that of the first period. Cumlative 5-year survival rates of the first and the latter period were 65.2% and 74.7% respectively. There was statistically significant improvemant (p<0.05) in the cases of the latter period. In spite of this result, in CurA cases of any stage, there was no significant difference of prognosis between these two periods. This fact showed that surgical technique for colonic cancer had already been established in the first period. In Cur B cases of the latter period, the 5-year survival rate improved from 33.3% to 47.8%. This improvement may come from aggresive resection for metastatic lesions. Bacause of increased moderately differentiated adenocarcinoma and peritoneal dissemination in the latter period, there was no prognostic improvement in both stage IIIa and IIIb cases. Until now, our attention has been given to the therapy for hematogeneous metastases, but the time has come to treat seriously other types of cancer spreading (especially for peritoneal dissemination) in addition to hematogeneous cancer spreading.View full abstractDownload PDF (8283K) -
T. Hirai, T. Kato, K. Yasui1996 Volume 49 Issue 10 Pages 1230-1237
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSEight hundred seventy-one patients with colonic cancer underwent surgery between 1965 and 1990. To evaluate the surgical advance, they were divided into three groups (early, middle, late terms) and the outcome was compared. Overall survival gradually improved due to the following reasons : 1. The ratio of stage I patient increased. 2. The ratio of curability B patients increased. Surgical technique could not improve overall survival. However, survival of patients with colonic cancer of 4 or more positive lymph nodes in the late term increased significantly by advancement of surgical techniques which mainly consist of wide lymph node dissection.View full abstractDownload PDF (1096K) -
T. Morita, T. Itoh, F. Nakamura, J. Suzuki, T. Baba, K. Nanmoku, T. Yo ...1996 Volume 49 Issue 10 Pages 1238-1246
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSRecent progress of preoperative diagnostic techniques in rectal cancer has led to accurate information on spread of cancer and application of smallest necessary resection of the organ and/or the autonomic nerve and extended lymph node dissection. Widespread health screening in our country also provides more chances to treat lower-staged rectal cancer, in which organ sparing and radical lymph node dissection can be balanced. Since 1984, radical paraaortic lymph node dissection, lateral lymph node dissection though the extraperitoneal approach, and pelvic nerve and/or anus preserving operation for rectal canter have been applied. Surgical results of both subjects before and after 1984 were compared. A five-year survival rate of 83.3% of the latter cases was significantly better than that of 71.2% of former cases. Improvement was more apparent in stage IIIa cancer, and there were some long survivors with n3 or n4 degree lymph node metastases in the latter cases. Organ and/or nerve preserving operation can be consistent with radical lymph node dissection for rectal cancer, which provides both patient survival and better postoperative quality of life.View full abstractDownload PDF (1150K) -
M. Watanabe, T. Teramoto, S. Yamamoto, Y. Chiba, S. Narai, M. Ishihara ...1996 Volume 49 Issue 10 Pages 1247-1255
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSPatients with rectal cancer were divided into those treated in the early stage from 1975 to 1983 and the late stage from 1984 to 1990, and were compared with regard to the type of surgery and prognosis. Recently, the purpose of surgery has been radically extended resection with functional preservation of organs such as the sphincter. When rectal cancer (curability A and B) were treated surgically, the survival rate was greater in the late stage than the early stage, and significant improvement was observed for stage III a (curability A). These results were predominantly attributed to progress in operative procedures such as lymph node disection and radical resection of metastatic lesion. Since extended resection has revealed the mode of lymph node metastasis for rectal cancer, lateral Bisection has become important and has been done more frequently. Sphincter preserving operations have become widespread and are now performed in about half of the patients with cancer of the lower rectum. These procedures are not associated with worse prognosis than abdominoperineal resection. A major future task in the treatment of rectal carcinoma is to establish multidisciplinary therapy for stage 1ff b, for which prognosis has not improved, especially lateral lymph node metastasis positive cases. In addition, it may be necessary to consider the compatibility of resection and autonomic nerve preservation.View full abstractDownload PDF (1097K) -
S. Fujita, K. Sugihara, Y. Moriya, T. Akasu1996 Volume 49 Issue 10 Pages 1256-1265
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSTo clarify recent results of hepatic resection for metastatic colorectal cancer treated by National Cancer Center Hospital from 1984 to 1991, the relationship between clinicopathological background and survival, pattern of recurrence after hepatic resection, and the effectiveness of hepatic arterial infusion for adjuvant therapy were examined. Patients : One hundred thirty-four patients with hepatic metastases due to colorectal cancer treated by curative resection were analyzed. Results : In univariate analysis, lymph node status (p<0.0001), disease-free intervals (p=0.049), extent of liver involvement (p=0.018), and microscopic positive margin (p=0.004) were significant prognostic factors. Cox's proportional hazards model revealed that only lymph node status was an independent predictor of suvival (p=0.0002). After curative hepatic resection, recurrence was observed in 96 patients (72%) and recurrence in the liver was most frequent (54%). Thirty patients were treated by repeat hepatectomy, and 10 patients survived longer than 5 years. The effectiveness of hepatic arterial infusion for adjuvant therapy were unclear. Conclusion : Prevention of liver metastases, detection of novel risk factors, and establishment of new treatment modality are essential for improving the prognosis after hepatic resection for metastatic colorectal cancer.View full abstractDownload PDF (962K) -
M. Kameyama, K. Kodama, S. Imaoka, S. Nakamori, Y. Sasaki, T. Kabuto, ...1996 Volume 49 Issue 10 Pages 1266-1275
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSSixty-one patients underwent pulmonary resection for metastatic colorectal cancer. Overall 5-and 10-year survival rates were 50% and 43% respectively. However, median survival of palliative resected or non-resected cases was 15 and 12 months, respectively. Prethoracotomy serum carcinoembryonic antigen level, number of lung metastases, intrathoracic lavage cytology, and mediastinal lymphnode metastases were found to be prognostic factors. Furthermore, survival of the 25 patients treated with Nd : YAG-Laser was longer than those treated with other tools. It was suggested that Nd : YAG-Laser was effective for preserving pulmonary function and enabled repeat thoracotomy and extrapulmonary resections.View full abstractDownload PDF (4596K) -
[in Japanese]1996 Volume 49 Issue 10 Pages 1276-1281
Published: 1996
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSDownload PDF (678K)
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