Objective: To evaluate the results of Gant-Miwa- Thiersch (GMT) rectal prolapse repair using an artificial ligament in elderly patients.

Subjects and Methods: We investigated the perioperative and postoperative outcomes of 35 patients aged 85 years or older with rectal prolapse who underwent radical surgery at our hospital from January 2012 to December 2022.

Results: The median age of the patients was 88 years, and all were female. The median length of bowel evacuation was 7 cm, and the median operative time was 37 minutes. There was one perioperative complication including infection of the artificial ligament. There was two cases of recurrence, but neither recurrence occurred after additional transperineal surgery. Fecal incontinence was present preoperatively in 23 patients, but improved postoperatively in 11. Constipation was well controlled with oral medication, and there were no cases of long-term difficulty of defecation.

Conclusion: GMT using an artificial ligament may be the first choice for rectal prolapse repair in very elderly patients.

A 58-year-old man presented to our department with symptoms of bloody stools and anal pain. A well-defined erythematous brown spot and a moveable nodule were observed on the skin of the anorectal area. Biopsy confirmed the presence of anal canal carcinoma with pagetoid spread. Imaging studies showed no evidence of invasive cancer, lymph node metastasis, or distant metastasis. Colonoscopy revealed a tumor extending 1 cm on the oral side from the dentate line. Based on the above, we considered that radical resection of the tumor and preservation of anorectal function were feasible by local excision. The colorectal surgery, endoscopy, and dermatology departments collaborated to perform endoscopic submucosal dissection, perianal skin resection, and trans-anal local excision. The patient was discharged on the 7th day of hospitalization and has remained recurrence-free for 2 years. We report this relatively rare case, detailing our surgical approach and the progress of the patient.

Sigmoid colon cancer was detected in a 75-year-old woman during colonoscopy to investigate fecal occult blood. The patient had a history of systemic lupus erythematosus and was administered oral steroids and immunosuppressants. Laparoscopic sigmoidectomy was performed to address a cT1b cN0 cM0 cStage I sigmoid colon cancer. One day after the drain was removed on the 6th day in hospital, the patient vomited and paralytic ileus was suspected based on various tests. Intestinal decompression was thus initiated using an ileus tube. On the 10th day in hospital, she developed left lower abdominal pain, and computed tomography revealed findings suggestive of a Richter's intestinal hernia just below the 5-mm port site. Emergency surgery was performed. The small intestine was found to be incarcerated in the abdominal wall at the 5-mm port site in the left lower abdomen. After the incarceration was removed, the patient underwent partial small bowel resection. The patient's postoperative course was uneventful, and she was discharged from the hospital on the 39th day in hospital.

The patient was a 55-year-old male who presented with lower abdominal pain and pain during urination. An abdominal CT scan showed a low-density area extending from the umbilicus to the top of the bladder, which also continued into the sigmoid colon. Due to the presence of pneumaturia and fecaluria, a diagnosis of sigmoid colon-bladder fistula was made, and surgery was planned. Intraoperatively, continuity between the urachal remnant near the bladder and a diverticulum of the sigmoid colon was observed. A laparoscopic sigmoid colectomy, including fistulectomy, and urachal remnant excision was performed. Histopathological examination confirmed the diagnosis of a sigmoid colonic diverticulum-urachal diverticulum fistula. The presence of a urachal remnant forming a fistula with the colon is very rare. This report presents a case of a sigmoid colon-urachal diverticulum fistula that was successfully resected laparoscopically, accompanied by a literature review.

A total of 38 patients having PCCRC detected within 5 years after index colonoscopy and another total of 928 having sporadic colorectal cancer (SCRC) with no previous colonoscopies were clinicopathologically compared. The lesions in PCCRC patients were significantly located in the right colon (57.9% vs 34.5%) (p < 0.005), showed a significantly smaller size of < 20 mm (42.1% vs 13.1%) (p < 0.0001), had much more non-polypoid appearance (42.2% vs 7.2%) (p < 0.0001), and had shallower invasion depth of T1, T2 (50.0% vs 28.7%) (p < 0.005). The findings of index colonoscopy in 38 patients with PCCRC were as follows: 3 cases (7.9%) with no polyps, 11 (28.9%) with diminutive adenomas, 13 (34.3%) with adenomas > 5 mm and intramucosal cancers, and 11 (28.9%) with invasive cancers. Among 24 cases (63.2%) with adenomas and intramucosal cancers 16 cases (66.7%) had right-sided lesions, 20 cases (83.3%) had multiple lesions, and 16 cases (66.7%) had at least one lesion located in the same colonic segment with subsequent PCCRC. Among 12 cases with unresected lesions at index colonoscopy, 2 cases (16.7%) developed into PCCRC. In 11 cases with invasive cancers at index colonoscopy the cancers tended to be right-sided, smaller in size, and shallower depth of invasion similar to subsequent PCCRC.

We analyzed 122 cases of anal fistulas in two years based on a broad anatomical definition of perineum such as a fistula in a urogenital or anal triangle region.

Twelve anal fistulas in men proceeding into the scrotum, two anal fistulas in women of a superficial transverse perineal muscle route and an anal fistula in a woman of the bulbospongiosus muscle route were included in the urogenital triangle region. All these fistulas were low transsphincteric fistulas having anterior primary openings. All the other of anal fistulas were included in the anal triangle region. Of anal fistulas with anterior primary openings, one third were included in the urogenital triangle region, and two thirds were included in the anal triangle region.

Although an anal fistula in the urogenital triangle region is rare, it is important to be aware of the sex difference and the characteristic anatomy and to be careful during surgery.

Recently, some surgical techniques for anal fistula have described the importance of postoperative curability and functionality. We performed surgical operation using the two-step technique for patients with anal fistula except mucosal fistula. This technique involves ligation and division of the primary duct in the intersphincter and division of the crypt.

This method was performed on 59 patients with 38 intersphincteric fistulas and 21 ischiorectal fistulas. There was one patient with recurrence and no serious decrease in the post-operative defecatory function.

This new method is called the two-step technique, since it transects the primary duct in the intersphincter and crypt. This method might be effective for various anal fistulas.