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Volume 52, Issue 10
Displaying 1-13 of 13 articles from this issue
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J. Iwadare1999 Volume 52 Issue 10 Pages 1027-1029
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSRecently, day surgery has attracted the attention of surgeons, as well as patients. The need for outpatient surgery has increased for social reasons such as taking a week off to have an operation in today's ailing economy, a problem for patients. Furthermore, recent medical finance policies require cost reduction. For these reasons, the number of day surgeries can be expected to increase in Japan. However, evaluating day surgery from an economic point of view alone is a source of great debate. The benefits to the patient should be considered. If day surgery is introduced, the indications might have to be reconsidered, based not only on medical concerns but also on social matters that affect patients. In addition, there are several questions that should be answered. What are the necessary preoperahve examinations? What is the ideal anesthesia? Are our existing procedures suitable for outpatient surgery? How should we manage postoperative care? Although the advantages of day surgery tend to be emphasized in the debate, the authors have been requested to write these arhcles based on the limitations and drawbalcks. It is hoped that this feature wil make a positive contribution to the current practice of colorectal day surgery.View full abstractDownload PDF (429K) -
Y. Tsuji, J. Kuromizu, T. Toyohara1999 Volume 52 Issue 10 Pages 1030-1037
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSIn a period of two years from April 1997, we performed day surgery for 218 cases and obtained the following results. (1) The percentage of the cases, for which surgery was determined at the clinic was : day surgery 59%, surgery in short-term hospitalization 36%. (2) Postoperative bleeding occurs in rare cases, but this was successfully reduced by careful treatment of wound, change of suture threads, and elaborate efforts on prevention of tension on anus after operation, reduction of sites for ligation & excision to less than 2 sites, and adoption of the secondary operation. (4) For suppository used as postoperative analgesic, patients often exhibit anxiety at the insertion, and oral administration seems to be more adequate. (5) When the cost was compared between day surgery and surgery in 2-week hospitalization in the cases of hemorrhoids, the cost for day surgery was about 25% of that of the operation in hospitalization.View full abstractDownload PDF (1241K) -
N Matsuda1999 Volume 52 Issue 10 Pages 1038-1044
Published: 1999
Released on J-STAGE: February 05, 2010
JOURNAL FREE ACCESSOutpatint therapies in proctology have always been popular. A majority of patients find that outpatient surgery is easy, convenient, efficient and psychologically acceptable.
Today the high costs of hospitalization, the frequency of lengthy waiting lists for operation at the most qualified centres, the obvious preference of patients themselves (avoiding admission to the hospital) and the tendency to avoid the psychological stress of hospitalization tend to stimulate the growth of the outpatient depatment. The evaluation of indications and contraindications has to be done knowing the limits and risk of the proctological operation.This does not oblige the patient to make daily outpatient visits. It is better to admit the patient to the hospital even for a minor operation if age or general health represent eisk factor.
If it is esential that outpatent proctology has wider diffusion, it is necessary that it not be over-rated and that the physician who wants to practice it should know the limits and the risks involved.View full abstractDownload PDF (7182K) -
Y. Matsuda, S. Satoh, K. Hirano, S. Nakamura, A. Oomori, S. Fujii, H. ...1999 Volume 52 Issue 10 Pages 1045-1050
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSAccording to the medical restruction, the necessity of day surgery has rapidly been drawing attention in our country. Our day surgery cases during the past thirteen years were investigated ated to assess the merits and demerits of day surgery. The total number of day surgery cases was 316, which was 2.0% of 15, 479 cases of the total proctological operations in the same period. Sex rate revealed that female cases were three times as much as male. The frequency of disease-related cases was large for hemorrhoid and anal skin tag 66.3% followed by, anal polyp 7.6%, postoperative disorder 6.9%, and others. As for operative method-related frequency, a half of the operation was skin tag excision. The healing time was 25.7 days (ordinal operation 30.0 days) for hemorrhoid, and 40.0 days (ordinal operation 50.2 days) for intersphincteric fistula-ani. Postoperaaive complication rate was 13.6%, two times higher than the ordinal operation (6.8%).
In conclusion, there were many merits in day surgery as far as making district operative indication and obtaining the informed consent of the patient was concerned.View full abstractDownload PDF (2055K) -
A. Kurokawa, K. Kitsuki, Y. Kurokawa, Y. Masuda, Y. Hata1999 Volume 52 Issue 10 Pages 1051-1056
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSIn this paper, our methods of day surgery and consideration there of are presented.Recently, consideration of day surgery has spread among the surgeous. Many proctologists do day surgery optimistically, whether or not they are an expert. Abuse of day surgery often results in patients making complaints about operators.
In our clinics, almost all patients have been treated with ambulatory surgery. Patients with severe degree of lesion have mainly undergone the classical ligation treatments. It is thought that these classical treatments enable to perform day surgery easier.
However the most important thing for performing day surgery perfectly is that the outpatient can always get in touch with doctors by phone ; therefore, postoperative management at home becomes safer.
In order to do day surgery safely and completely, the operator must be trusted by the outpatients till they are cured.
Day surgery must be done very carefully.View full abstractDownload PDF (782K) -
[in Japanese]1999 Volume 52 Issue 10 Pages 1057-1058
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSDownload PDF (308K) -
K. Kobayashi, K. Katsumata, M. Igarashi, K. Yokoyama, M. Sada, K. Saig ...1999 Volume 52 Issue 10 Pages 1059-1064
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe effectiveness of endoscopic hemostasis for hemorrhagic lesion of the large intestine is explained herein. The methods of endoscopic hemostasis are divided into four groups, mechanical hemostasis, heater coagulation, endoscopic injection or spraying of hemostatic drugs. Among these methods, endoscopic clipping for hemorrhagic lesion of the large intestine is mainly used because it is both effective and safe.
The most suitable indication of endoscopic clipping is local colorectal hemorrhage post-polypectomy, because of its harmless effect on the intestinal wall. Endoscopic clipping is also useful for hemostasis of diverticular hemorrhage.
It is most important to choose appropriate method of endoscopic heomostasis for the basic disease of hemorrhage and the characteristics of bleeding evaluated by endoscopic findings.View full abstractDownload PDF (3338K) -
K. Isshi, M. Yamamoto, K. Suzuki1999 Volume 52 Issue 10 Pages 1065-1069
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSSymptomatic internal hemorrhoids are one of the most common anorectal diseases. A new technique, flexiblescopic hemorrhoidal sclerotherapy (FHS) using Aethoxysclerol (AS) and flexiblescopic hemorrhoidal ligation and sclerotherapy (FHL/S) was developed, and a total of 658 patients (158 : FHS, 500 : FHL/S) were treated. The purpose of this study was to introduce these techniques and investigate its usefulness.
An upper GI flexible endoscope was employed and the scope was retroflexed in the rectum. For FHS, 2-3 ml of AS was injected between each hemorrhoids submucosally followed by intrahemorrhoidal injection. For FHL /5, each hemorrhoids were ligated using endoscopic variceral ligator and AS was injected submucosally between ligated hemorrhoids. Two treatments were performed with a one-week interval on an out-patient basis. Excellent results (sympton free) were obtaind in more than 75% of the patients, however, for grade III hemorrhoids, only 56.3% excellent results were obtained by FHS while 78.8% by FHLS. Due to the results, it was recommended to perform FHS for grade I or II and FHL/S for grade II or III. Overall indications of these treatments were limited to grades I to III symptomatic hemorrhoids without prolapse of the fibrotic hemorrhoids.View full abstractDownload PDF (868K) -
H. Oka, Y. Ishida, H. Machida, H. Izuno, A. Nakayoshi1999 Volume 52 Issue 10 Pages 1070-1076
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSSurgery is the primary therapeutic option in cases of obstructive carcinoma of the left colon, since peroral enteral decompression utilizing an ileus tube cannot be carried out.
The safety of the surgical procedures for acute Colonic obstruction and the radical curability of the cancer must both be assessed when surgery is to be performed. Due to bowel distention, surgical operations are difficult if enteral decompression has not been carried out, and for this reason the radical curability of the cancer is reduced. Endoscopic decompression as a treatment for obstructive carcinoma of the left colon was first carried out by Lelucuk et al in 1986. In this procedure, a guide wire from an endoscope inserted via the anus is introduced beyond the constricted area of the tumor, and after dilation of the constricted area by means of a dilator, the ileus tube is secured per anum. Enteral matter retained in the opening in the tumor is expelled from the decompresion tube, the symptoms of obstruction are relieved, and palliative surgery is made possible. Complications, such as necrosis of enteral mucous membrane brought about by Colonic perforation at the time of guide wire insertion and by the pressure of the balloon inserted thereafter, may arise as problems encountered in implementation. However, at present, a kit for implementing this procedure is commercially available, and consideration is being given to complications.
This way of utilizing therapeutic endoscopy may be extended to other inductive operations besides decompression treatment; it may, for example, be used in stenting, balloon dilation in cases of postoperative anastomotic stenosis, and so on.View full abstractDownload PDF (9441K) -
Y. Saida, Y. Sumiyama, J. Nagao, M. Takase1999 Volume 52 Issue 10 Pages 1077-1082
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSDevelopment of expandable metallic stent endoprosthesis for colorectal obstruction relatively delayed compared to other digestive tract causes of the anatomical peculiarity of the large bowel. However, in the late 1990s, several clinical cases of the application of the metallic stent for rectal malignant stenosis have been reported. Further, insertion of self-expanding stainless steel stent under colonoscopic observation for the stenosis of large bowel cancer was started in November 1993 as preoperative preparation in our hospital. In this review, the history of the clinical literatures of metallic stent endoprosthesis for colorectal obstruction is presented. The method and results of Stent Endoprosthesis for Colorectal Cancer (SECC) that we developed are also presented. SECC was performed for 33 patients and the rate of insertion was 82% (27 cases). SECC is a new method for the operative preparation of patients with obstructing colorectal cancers, which may reduce the morbidity and mortality associated with this difficult problem. This method was noteworthy. The exclusive stent and kit are being developed for public sale. Development of the exclusive stent for colon and rectum would provoke the metallic stent endoprosthesis for colorectal obstruction being popularized as a part of therapeutic endoscopic treatment.View full abstractDownload PDF (4539K) -
K. Togashi, F. Konishi, Y. Furukawa, H. Nagai1999 Volume 52 Issue 10 Pages 1083-1088
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSIndications and limitations of endoscopic mucosal resection (EMR) for colorectal neoplasms were presented. Colonic neoplasms, which can be endoscopically removed at one cutting by injecting saline into the submucosal layer, are good indicaitions for EMR, as well as colonic neoplasms which require enough margin due to unfavorable histology. For example, flat tumors with central depression and multinodular tumors are good indications for EMR, and small flat tumors without central depression do not always need to be treated by EMR. Limitation of en block EMR is approximately 30 mm in size, but piecemeal EMR has no limitation in tumor size. However, maximum size of tumor which can be removed by piecemeal EMR is about 40 mm-50 mm because of high incidence of local recurrence and complications after EMR. Adenoma, carcinoma in situ and carcinoma with minute invasion are good indications for EMR, but carcinoma with massive invasion is not a good indication because of possibility of lymph node metastasis. When tumors are in unfavorable positions such as a sharply bent area and behind a tall fold, such tumors may not be removed by EMR even if they meet all of the above conditions. In addition, the procedure of injecting saline to perform en block EMR more easily, methods to prevent local recurrence after EMR and methods to prevent complications after EMR were presented based on our experience.View full abstractDownload PDF (2766K) -
S. Tanaka, K. Haruma, S. Nagata, K. Ooe, M. Yoshihara, K. Sumii, G. Ka ...1999 Volume 52 Issue 10 Pages 1089-1094
Published: 1999
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSTo determine the indication and the limit of endoscopic mucosal resection (EMR), a large number of colorectal carcinomas with submucosal invasion were analyzed regarding the risk factors of lymphnode metastasis. The front of the submucosal invasion was histologically analyzed, and were classifed into well (W), moderately (M) and poorly (Por) differentiation. And the moderately differentiated histological type was further subclassifed into two categories, i. e ; moderately well differentiation (Mw) and moderately poor differentiated (Mp). When the front of submucosal invasion showed W or Mw and the submucosal invasion was within 1, 500 μm below the muscularis mucosa without lymphatic channel invasion, EMR alone was considered to be a sufficient treatment. On the other hand, when the histology of the invasion front showed Mp or Por, our data showed that EMR was not a sufficient treatment regardless of level of submucosal invasion. Based upon these results, it was considered that with the histological analysis of the invasion front in the submucosa, it was possible to select cases with so-called sm2 invasion that could be cured by EMR. In the process of determining the indication of EMR for colorectal carcinomas with submucosal invasion, the direct measurement of the submucosal invasion below the muscularis propria was considered to be necessary.View full abstractDownload PDF (2877K) -
T. Sakuyama, S. Takamura, N. Takahashi1999 Volume 52 Issue 10 Pages 1095-1102
Published: 1999
Released on J-STAGE: February 05, 2010
JOURNAL FREE ACCESSIt is not easy to resect the rectal lesions through rectoscopy with only a 40mm diameter under rigid-scopic control. Thus the techniques of TEM are mainly described in detail using the practical skill of a one-day training course of TEM, and the knack and pitfalls are presented.
In six years, 57 patients were treated by TEM for rectal lesions at our hospital. The operative time ranged from 30 to 270min. (average : 110min.). Most resected lesions (96%) were located at the sites of Rb and Ra. For 67% of resections by this technique, mucosectomies were performed and for the others (33%) full-thickness resections were done. Postoperative bleeding (1) and stricture of suture line (3), perineal abscess (1), fecal incontinent (4) including intraoperative perforation of rectal wall (2) were main intra- and postoperative complications ; the rate was 20% (11/57).
In the treatment of rectal lesions such as creeping tumors or flat type early cancers which are beyond the indication of endoscopic mucosal resections at the same time, TEM is suggested to be an effective, accurate and minimally invasive therapeutic procedure.View full abstractDownload PDF (7913K)
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