Characteristics of Fecal Incontinence in Male Patients in Japan.

Objectives: Although community studies have shown no difference between the sexes in the prevalence of fecal incontinence (FI), few direct comparisons of disease characteristics between male and female patients have been reported. The aim of this study was to determine whether characteristics of FI differ between male and female patients in Japan. Methods: Included in the study were 408 (149 men, 259 women) patients with FI who visited the Matsushima Hospital Coloproctology Center between October 2016 and September 2017. We retrospectively evaluated data on age, number of bowel movements, Bristol stool form scale, number of FI, incontinence scores, anorectal manometry, comorbidities, and history of anal surgery. Results: Maximum resting pressure and maximum squeeze pressure were found to be within normal range in significantly more male than female patients (34.9% vs. 12.4%, respectively; p < 0.0001). Irritable bowel syndrome (IBS, 20.1% vs. 9.3%; p = 0.003) and a history of anal surgery (29.5% vs. 17.5%; p = 0.02) were more prevalent among male patients than among female patients. Use of mepenzolate as treatment was significantly more common among male patients than among female patients (16.8% vs. 6.6%, respectively; p = 0.005). Responses to the various treatments were good, regardless of sex. Conclusions: FI appears to be more commonly accompanied by normal anal sphincter pressures in male patients than in female patients, and IBS and previous anal surgery appear to be more common among male patients than among female patients. FI appears to be controllable in most patients, regardless of sex.

A Novel Surgical Technique for Anal Fistula Surgery Designed to Preserve the Anal Sphincter Function and Anoderm.

OBJECTIVES: We reviewed surgical outcomes after introducing a novel surgical technique for anal fistula surgery designed to preserve anal sphincter function and the anoderm. METHODS: We studied 200 male patients who underwent a functional preservative operative technique (FPOT group) for anal fistulas and 200 patients who underwent resection of trans-sphincteric anal fistulas (fistulectomy group) between February 2014 and September 2015. We compared complications, such as those affecting anal sphincter function, recurrence, and incontinence. RESULTS: Fistulas recurred in three (1.5%) patients in the FPOT group and two (1%) patients in the fistulectomy group. This difference was not significant. Other complications included gas leakage and other forms of incontinence in 1 (0.5%) and 14 (7%) patients in the FPOT and fistulectomy groups, respectively. Anal function assessment demonstrated that the FPOT was significantly better at preserving function than fistulectomy in all patients. CONCLUSIONS: There were no significant differences between the FPOT and fistulectomy in terms of recurrence or complication rates. Also, because there was no decrease in postoperative anal function, we concluded that the FPOT is an effective preservative surgical technique for treating trans-sphincteric anal fistulas.

Evaluation of Mucopexy-Recto Anal Lifting (MuRAL): A New Method for Treating Hemorrhoids.

OBJECTIVES: Ligation and excision remain the commonly recognized standard surgical modality for treating hemorrhoids. Further, impediments to surgical treatment owing to social factors and the need for minimally invasive procedures and other confounders have resulted in the adoption of the mucopexy-recto anal lifting (MuRAL) method which is associated with favorable outcomes. The objective of this study was to describe the procedure and report the outcomes in patients who underwent MuRAL. METHODS: Between March 2016 and February 2018, 55 patients (26 males and 29 females) underwent MuRAL for hemorrhoids and rectal mucosal prolapse. The duration of the surgical procedure and hospitalization, postoperative complications, and satisfaction were evaluated. RESULTS: The mean age of the male patients (n = 26) was 61.5 ± 4.9 years and that of the female patients (n = 29) was 61.5 ± 3.2 years. The mean duration of surgery was 46 ± 23 minutes for males and 53 ± 28 minutes for females, and the mean observation duration was 317 ± 186 days. Intraoperative hemorrhage was low for males and females. The mean hospitalization period was 3.2 ± 1.5 days for males and 4.3 ± 2.1 days for females. Differences in several postoperative complications were observed between male and female patients. Postoperative satisfaction was rated high by the patients. CONCLUSIONS: Risks of hemorrhage and pain associated with the MuRAL method were low because the procedure does not involve incision or excision. Other than ligation and excision, recurrence is favorable compared with that of other surgical modalities for the treatment of hemorrhoids.

Contamination levels of PCDDs, PCDFs and Co-PCBs in commercial baby foods in Japan.

To examine dioxin contamination in commercial baby foods in Japan, congener analyses of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and coplanar polychlorinated biphenyls (Co-PCBs) were performed on 102 varieties of baby foods obtained from supermarkets in 2001-2002. The toxic equivalent quantity (TEQ) levels for dioxins in samples ranged from < 0.001 to 0.135 pg-TEQ/g wet weight when undetected or trace levels of congeners were taken as zero. Among 102 samples tested, 26 samples exceeded 0.010 pg-TEQ/g. The highest TEQ value was for "sardine, vegetables" (0.135 pg-TEQ/g), followed by "Japanese radish (daikon), sardine" (0.080 pg-TEQ/g). Thus, dioxins were detected at low levels in baby foods containing animal products such as fishes and/or dairy products.

Recent survey and effects of cooking processes on levels of PCDDs, PCDFs and Co-PCBs in leafy vegetables in Japan.

We report here the latest levels of polychlorinated dibenzo-p-dioxins/polychlorinated dibenzofurans (PCDD/Fs) and coplanar polychlorinated biphenyls (Co-PCBs) in leafy vegetables in Japan as well as the effect of cooking processes on the reduction of these contaminants. Three kinds of leafy vegetables ("komatsuna", lettuce and spinach) from seven districts in Japan in 1998 were analyzed for the 2,3,7,8-chlorine substituted PCDD/Fs and three non-ortho-PCBs (#77, 126 and 169). The mean total TEQ levels (using the WHO-TEFs) in the komatsuna, lettuce and spinach were 0.094, 0.025 and 0.196 pg/g fresh weight, respectively. The TEQ levels are dominated by 2.3,7,8-TCDD, 1,2,3,7,8-PeCDD, 2,3,4,7,8-PeCDF and 3,3',4,4',5-PeCB in many of the samples. For one of these isomers, the 2,4,7,8-PeCDF TEQ levels showed good correlation with the total TEQ levels in the samples (r = 0.957). This suggests that 2,3,4,7,8-PeCDF may be an indicator for dioxin contamination in the analysis of the leafy vegetables. Also, the effects of two cooking processes (washing and washing followed by boiling) on the dioxin levels in two types of spinach samples were investigated. On average, in both samples, the total concentrations of the PCDDs, PCDFs and Co-PCB were reduced to about 38%, 73% and 88% of the initial concentrations by washing. and to 21%, 35%, and 61% of the initial concentrations by washing followed by boiling. The total TEQ levels were reduced to about 30% of the initial TEQ levels by washing followed by boiling. Significant reductions in the TEQ levels were observed in the cooked samples. Thus, the cooking processes may reduce the risk of dioxin intake from the leafy vegetables.