maeda kotaro

[Purpose]To elucidate the indications for sacral nerve stimulation (SNS) in patients with fecal incontinence (FI) as part of a study investigating their clinical characteristics and practical management in Japanese institutions.<BR>[Methods]In the patients with FI visiting one of nine institutions in 2009, their indications for SNS were retrospectively investigated.<BR>[Results]The subjects were 293 patients (mean age: 65, female: 214). Although a variety of therapies were performed in 266 patients (91%) with reasonable effectiveness and an improvement rate of 44-93%, 8 and 73 patients were considered "definitely suitable" and "probably suitable" for SNS, respectively, as a next-step therapy. The reasons for the positive indication included "Insufficient symptomatic improvement by currently available treatments" in 47% and "Expect SNS to be effective" in 38%.<BR>[Conclusion]Although most patients underwent some examinations and therapies, 81 patients (28%) were still indicated for SNS in expectation of further improvement. The introduction and judicious use of SNS in Japan would provide more options and opportunities for the better treatment of patients with FI.

[Purpose]To investigate the clinical characteristics of patients with fecal incontinence (FI) and their practical management in Japanese institutions.<BR>[Methods]In the patients with FI visiting one of nine institutions in 2009, their clinical characteristics, examinations performed, possible causes of FI and therapies as well as their effectiveness were retrospectively investigated.<BR>[Results]The subjects were 293 patients (mean age: 65, female: 214). The most frequently performed examination was anorectal manometry (87%), followed by endoanal ultrasonography (62%) and rectal balloon sensation test (41%). The possible causes of FI included internal anal sphincter dysfunction (35%), both internal and external anal sphincter dysfunction (21%), obstetric anal sphincter injury (8.5%) and so forth. Most patients were treated conservatively, whilst surgical therapies were performed in only 16 patients (5.5%). The proportion of patients who symptomatically improved with each treatment was 44% by modification of diet, life style and bowel habit, 74% by polycarbophil calcium, 88% by loperamide, 65% by pelvic floor muscle exercise, 80% by biofeedback and 93% by sphincteroplasty.<BR>[Conclusion]Most patients with FI underwent some examinations and therapies, which were reasonably but not completely effective.

Abdominal rectopexy for rectal prolapse is a more invasive and radical procedure than perineal procedures. Though patients with rectal prolapse are usually aged and poor risk patients, abdominal rectopexy is usually recommended if feasible because of the radicality. In recent years, laparoscopic rectopexy has become more popular and covered by insurance since April this year, therefore less invasive and more radical treatment can now be achieved.&lt;BR&gt;The key points of the procedures are to mobilize the rectum, to pull it up, and to fix it fully. The detailed procedures might differ slightly according to the institute where performed, to what extent the rectum is dissected, whether the lateral ligament is divided or not, whether the rectum is fixed by mesh or sutured directly, and whether bowel resection is accompanied or not. To determine the proper detailed procedures, a prospective comparative study should be planned and treatment guidelines established.

[Purpose]To investigate the clinical characteristics of patients with fecal incontinence (FI) and their practical management in Japanese institutions.&lt;BR&gt;[Methods]In the patients with FI visiting one of nine institutions in 2009, their clinical characteristics, examinations performed, possible causes of FI and therapies as well as their effectiveness were retrospectively investigated.&lt;BR&gt;[Results]The subjects were 293 patients (mean age: 65, female: 214). The most frequently performed examination was anorectal manometry (87%), followed by endoanal ultrasonography (62%) and rectal balloon sensation test (41%). The possible causes of FI included internal anal sphincter dysfunction (35%), both internal and external anal sphincter dysfunction (21%), obstetric anal sphincter injury (8.5%) and so forth. Most patients were treated conservatively, whilst surgical therapies were performed in only 16 patients (5.5%). The proportion of patients who symptomatically improved with each treatment was 44% by modification of diet, life style and bowel habit, 74% by polycarbophil calcium, 88% by loperamide, 65% by pelvic floor muscle exercise, 80% by biofeedback and 93% by sphincteroplasty.&lt;BR&gt;[Conclusion]Most patients with FI underwent some examinations and therapies, which were reasonably but not completely effective.

Since the introduction of robotic surgery for colorectal cancer in 2009, 20 patients have undergone the procedure so far. We herein report three cases of intersphincteric resection for lower rectal cancer with da Vinci Surgical System&lt;SUP&gt;®&lt;/SUP&gt;. At present, inclusion criteria are cT1 or pT1. We performed ISR with the totally robotic technique and one cart position, and retrieved the specimen from the anus. The median distance of the tumor from the anal verge was 5 cm. The mean operative time was 512 min (range, 473-571 min), and there was no conversion to open or conventional laparoscopic surgery. The estimated blood loss was 113 g (range, 35-209 g). The number of lymph nodes harvested was 17 (range, 14-22). The surgical margin was negative in all cases. The mean postoperative hospital stay was 9 days (range, 7-10 days). One patient had a pelvic abscess postoperatively that could be managed with conservative therapy. Despite the insufficient experience regarding robotic ISR, our short-term outcomes were comparable to those in the literature. In order to clarify the feasibility and safety of the procedure, and to move steadily up the learning curve, further operations need to be performed.

[Purpose]To elucidate the indications for sacral nerve stimulation (SNS) in patients with fecal incontinence (FI) as part of a study investigating their clinical characteristics and practical management in Japanese institutions.<BR>[Methods]In the patients with FI visiting one of nine institutions in 2009, their indications for SNS were retrospectively investigated.<BR>[Results]The subjects were 293 patients (mean age: 65, female: 214). Although a variety of therapies were performed in 266 patients (91%) with reasonable effectiveness and an improvement rate of 44-93%, 8 and 73 patients were considered "definitely suitable" and "probably suitable" for SNS, respectively, as a next-step therapy. The reasons for the positive indication included "Insufficient symptomatic improvement by currently available treatments" in 47% and "Expect SNS to be effective" in 38%.<BR>[Conclusion]Although most patients underwent some examinations and therapies, 81 patients (28%) were still indicated for SNS in expectation of further improvement. The introduction and judicious use of SNS in Japan would provide more options and opportunities for the better treatment of patients with FI.